Brendan Ryan (Labour)

This House has never held up legislation and it is extremely efficient at processing it. We do not cause delays. We wait and we ask. Most of the time in this House we are either waiting for the Dáil to finish legislation or for the Government to be ready to move with it. We do not hold up legislation either by inertia or deliberate intent and none of us is an innocent in politics. This is a good legislative House.

I do not have a script from the Minister of State and I can only remember so much of what he said. This is a profound change, one to which I do not have any principled objection. The Minister of State referred to subsection (i) of new paragraph (3) of an amendment. This is entirely wrong. If I had any sense I would just leave but I am not going to.

I have a number of questions. I am not even in a position to state to which amendments they refer because I do not know. The fundamental change to the legislation is both necessary and correct but it must be clear where the professional liability will lie if a nurse prescribes erroneously. Some people suggest to me, including people very close to me, whose existence I do not have to advert to every time I speak here, that the professional liability will still lie with the medical practitioner and that in the event of a prescribing error it is not clear that a nurse would be professionally liable but that it may well be the doctor under whose supervision the nurse is working.

That question must be answered with absolute clarity, otherwise the Minister is heading for another big row with the medical organisations, one in which the medical organisations will have right on their side. The legislation must contain clarity on where professional liability begins and ends in terms of culpability for negligence. It appears that professionals are to be liable for the errors of others. We cannot leave this matter unclear and I have seen nothing in the amendments to provide clearly for it. The matter may be addressed but the more I have read of the amendments, the more my mind boggled.

Assuming we are only talking about nurses, I question why we have to introduce into our legislation terminology that is hopelessly dated. The Minister of State said that giving people the power to prescribe somehow involves giving them the power to compound and manufacture. I do not know if it does because I am totally confused. The Minister of State mentioned words like "compound" and "manufacture". I put it to him in his professional capacity that a reference to pharmacists compounding prescriptions is little more than a leftover from the way they used to do business. Pharmacists have a hugely important role as the interface in this transaction and as a second safety check but I am not sure they do much compounding any more, if at all. They do an extremely important professional job in terms of making sure that what the public gets is what has been prescribed and deal with ambiguities, uncertainties or even mistakes by those prescribing.

It is not clear how pharmacists will know what different grades of nurse are allowed to prescribe. The Minister of State said that certain nurses will be allowed to write prescriptions for certain substances but how will an individual pharmacist know whether Nurse Ryan is a psychiatric nurse or a palliative care nurse? We must know where that information will show up in a way that is clear. My spouse is a psychiatrist and when she writes prescriptions she regularly gets telephone calls from pharmacies to confirm the prescription because she is not a GP. This situation will now be multiplied.

I would like to know if the Department of Health and Children has thought out the process by which we can ensure a failsafe proof that prescriptions for palliative medicine in particular, which can have appeals to people other than those who need it, are valid. Increasingly, we have a corporatist pharmacy industry in which there is not an individual local pharmacy but a number of pharmacists employed by what is, effectively, in some cases nearly a multinational at this stage. Substances should be available to people that can help them palliatively, including some of the more controversial substances. If there is medical evidence that either heroin or cannabis is helpful to people who are sick I cannot accept there is any reason not to provide it for them. We must ensure that the chain of authorisation is clear. It may be my fuzzy head or advanced years but I choose to say it is the Minister of State's fault for producing amendments like this without back-up documentation. I do not know that these matters are dealt with in the proposed amendments. That is my first round.