Fergus O'Dowd (Louth, Fine Gael)
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To clarify, I submitted this Topical Issue matter yesterday before last night's debate. It was not selected for last night's Topical Issue debate, but I wanted to make my views known clearly and emphatically. I know I represent the whole country, including every Deputy, regardless of political party, when I say that we greatly appreciate the almost 40,000 committed and dedicated nurses and midwives working in our hospitals, nursing homes and other healthcare facilities. Along with all other healthcare staff, they have done fantastic work in this most dreadful battle with the coronavirus, particularly in our hospitals.

Included among the 40,000 are student nurses who went into the bearna bhaoil and worked nights and all sorts of hours to ensure that our hospitals stayed open. During the crisis, thousands of health staff were sick with Covid or had to cocoon because they had underlying health issues or for family reasons. There was a large demand for nurses, including students, to work with might and main to protect the lives of our most vulnerable and ill.

This Topical Issue matter addresses an issue on which I received a number of requests from nurses in my constituency. They felt that a waiver or credit should be given to the nursing profession in respect of the Nursing and Midwifery Board of Ireland, NMBI's, registration fees. It might not seem like much money, but it would make a significant difference in principle and would recognise in a small way the work they have done. The credit would be provided to the NMBI by the State to pay for at least this year. Public opinion is strongly of the view that we should do much more. Many Deputies feel the same. We must find a way of doing this that is acceptable to the Government and the nursing unions.

Peadar Tóibín (Meath West, Aontú)
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Deputy O'Dowd voted against paying student nurses last night.

Fergus O'Dowd (Louth, Fine Gael)
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Am I being interrupted?

Peadar Tóibín (Meath West, Aontú)
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The Deputy who is speaking voted against paying student nurses last night.

Fergus O'Dowd (Louth, Fine Gael)
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No. I-----

Bernard Durkan (Kildare North, Fine Gael)
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That is not-----

Bernard Durkan (Kildare North, Fine Gael)
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I am sorry, but everyone has the right to raise a Topical Issue-----

Bernard Durkan (Kildare North, Fine Gael)
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-----without interruption.

Mattie McGrath (Tipperary, Independent)
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He is riding two horses.

Bernard Durkan (Kildare North, Fine Gael)
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Deputy O'Dowd to continue, please.

Fergus O'Dowd (Louth, Fine Gael)
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Deputy Tóibín is right, in that I voted last night. He knows from his time as a party member that, when we are whipped to vote in a particular way, we have to do so or we can start up-----

Fergus O'Dowd (Louth, Fine Gael)
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I am speaking as a backbencher. I tabled this matter before last night's vote. I want to put on the record what I believe.

Peadar Tóibín (Meath West, Aontú)
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I stood up for what I believed in.

Fergus O'Dowd (Louth, Fine Gael)
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The majority of Deputies, including most members of the Government to whom I have spoken, believe that this should be the case.

Peadar Tóibín (Meath West, Aontú)
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That is meaningless.

Fergus O'Dowd (Louth, Fine Gael)
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All healthcare staff, including student nurses, have given their all during this period.

Mattie McGrath (Tipperary, Independent)
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Pay them, then.

Fergus O'Dowd (Louth, Fine Gael)
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I am glad we live in a democracy where the moans and groans I hear from the left are-----

Mattie McGrath (Tipperary, Independent)
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The double talk is amazing.

Thomas Gould (Cork North Central, Sinn Fein)
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You voted against it.

Peadar Tóibín (Meath West, Aontú)
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You voted against it.

Bernard Durkan (Kildare North, Fine Gael)
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Deputies, please observe the usual courtesy when someone else is in possession. Allow Deputy O'Dowd to continue. Time is running out rapidly.

Fergus O'Dowd (Louth, Fine Gael)
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There were some undemocratic interruptions. The point I wanted to make-----

Mattie McGrath (Tipperary, Independent)
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Is called "hypocrisy".

Fergus O'Dowd (Louth, Fine Gael)
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I am entitled to free speech as an elected Member, just like every other Deputy. As a Government backbencher, every effort must be made to find the extra funding that is needed to reward these workers in a special way for the sacrifices they have made.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Deputy for raising this important issue. The NMBI is the regulatory body for the nursing and midwifery professions. Its role in setting standards and providing guidance for approximately 79,000 registered nurses and midwives focuses on public safety. The board is an independent body answerable to the Oireachtas with responsibility for ensuring that it has the financial capacity to fulfil all of its legal obligations.

The NMBI has a number of statutory obligations: to protect the integrity of the practice of the professions of nursing and midwifery, to protect the public, and to ensure public safety. It performs important functions in setting education standards, approving training programmes, and investigating complaints against registrants.

My Department is responsible for the oversight and governance of the NMBI, but it has no role in setting or approving fees. The board has a statutory responsibility to ensure it discharges its legal obligations within the financial resources available to it while maximising efficiencies and income generation in keeping with best financial governance practice.

Under the Nurses and Midwives Act 2011, the NMBI is required to be self-financing. This is primarily achieved through the annual retention fee paid by each registrant, which was set at €100 in 2014 and has not been increased since. The income from this fee and other sources provides the funding required by the board to carry out its statutory obligations to protect the integrity of the practice of the professions of nursing and midwifery and to protect the public. Like every other healthcare regulator, the board continues to face considerable costs arising from the way the laws regulating the professions operate and from handling fitness-to-practise complaints. The annual retention fee was set by the board.

Among the NMBI's core functions are maintaining the register of nurses and midwives and a candidate register for student nurses and midwives; setting the standards for the education and training of nurses and midwives; approving the programmes of education necessary for registration and monitoring these programmes on an ongoing basis; supporting registrants by providing appropriate guidance on professional conduct and ethics for registered nurses and midwives; and holding inquiries into complaints about registrants.

The NMBI makes decisions relating to the imposition of sanctions on registered nurses and midwives who have findings made against them, and advises the Minister and the public on all matters of relevance relating to NMBI functions.

It is vital that the NMBI remains independent to allow it to regulate the professions of nursing and midwifery, as defined by the 2011 Act. The work of the NMBI over the next two months will concentrate on collecting the registration data of all nurses and midwives, and that is important for our entire health service. The registration process is open until 31 January 2021.

As the Deputy said, during the current Covid-19 pandemic, it has been important that we carry out our duties in a well-regulated and timely manner. Staff in the NMBI have worked throughout the pandemic to ensure we satisfy our statutory requirements to ensure nurses and midwives can be registered throughout this time.

Again, I pay tribute and thank the nurses and, indeed, student nurses for the work they have done through this pandemic. The Minister, Deputy Stephen Donnelly, has confirmed to me that he is looking into the request that nursing home registration fees paid to the NMBI by nurses can be repaid in another way. We are looking into it and seeing what can be done. We are looking for €7 million per year to get this resolved. We need to find it somewhere but we are looking at that fund so those payments can be reimbursed or repaid by Government in some other way. We hope to have a decision in the coming weeks.

Fergus O'Dowd (Louth, Fine Gael)
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The Minister of State has iterated the importance of the registration process and the importance of the independence of the board. I acknowledge that and everybody acknowledges that. On the request made to me to put this before the Houses, which I did yesterday and which has been taken today, I am fulfilling my commitment to speak in support of this motion.

I welcome the fact that progress is being made and, in particular, the comments today by the Tánaiste, Deputy Varadkar, when he said that, in fact, negotiations are ongoing with the nurses' unions and at the Department of Health with a view to improving pay and to regulate the income student nurses get in a way that is more attractive to them. That is an important point.

Part of the problem and what really happened here is that when we entered the pandemic, nobody knew what was ahead. All those people on the front line, and I am talking about people in the National Ambulance Service, all the healthcare assistants, cleaners, people who work in nursing homes and all those, took huge risks with their health to stay the course and help us through this pandemic, which is not over yet.

It is important that we go ahead and provide significant increased support at this time, particularly to nurses, and acknowledge the work they have done in a special way. I believe that is the will of the people. From the debate last night and the views we are getting today, the fact is that student nurses were not acting as student nurses when they went in but were acting in their full capacity to protect, help and support people who had Covid-19. I believe that is what we should do.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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It has long been the practice, both in this country and internationally, that registered health professions pay an annual registration fee to their respective regulator allowing it to perform its functions independently of State support. The regulation of the healthcare sector and its professionals has become increasingly important over recent decades to ensure the compliance of set standards of healthcare and administration.

As I said, the NMBI has a number of statutory obligations to fulfil to protect the integrity of the practice of the professions of nursing and midwifery, to protect the public and to ensure patient safety. The NMBI performs important functions in setting education standards, approving training programmes and investigating complaints against registrants. The annual retention fee is the single most important item of income for the NMBI in order for the board to progress these statutory duties.

My Department, as part of its oversight and monitoring role regarding regulators within the health sector, including the NMBI, will continue to engage with it as appropriate. This engagement will include guidance and support but will fully respect its independence, as required by the legislation.

Regarding the professions of nursing and midwifery, there are many recent positive developments for these careers in recent years. For example, the creation of the enhanced nurse-midwife role allows today's graduate nursing and midwifery students to apply, after one year and 16 weeks' suitable experience, for these enhanced nurse-midwife roles, with a starting salary of €37,161. That does not include those allowances or premium pay that are also available.

Additional promotion opportunities are available under advanced and specialist practice where the policy of the development of the graduate to advance nursing and midwifery practice provides a framework for graduate nurses to draw upon their undergraduate programme and translate their broad-based experience and knowledge into action.

Again, the Minister has confirmed that he is trying to resolve this issue and I hope we will have some positive outcome in the coming weeks.