Tim O'Malley (Limerick East, Progressive Democrats)

I will attempt to answer some of the questions. On the issue of accountability and clinical indemnity, it is important that these issues are addressed during consultation, and a great deal of consultation with professionals will take place to allay doctors' fears and ensure they are dealt with if unforeseen issues arise during implementation .

Senator Ryan asked whether doctors will be held accountable for the prescribing decisions of nurses and midwives. The answer is "No". Nurses and midwives are accountable for their own professional practice and competence. The authority to prescribe medication will require the individual practitioner to be responsible for the prescribing decision, which is the nurse in this case. An individual not involved in determining the medication treatment plan cannot be held accountable. Communication and collaboration among the health care team is essential in sharing the plan of care of patients and clients, particularly as it relates to medication management. On that point, Senator Ryan also asked about errors made in prescription by a nurse. It is the professional responsibility of the pharmacist to pick up errors made in prescriptions, regardless of who prescribed.

On the question of clinical indemnity, nurses working in hospitals or other agencies covered by the clinical indemnity scheme are insured to undertake any practice which is in accordance with the law and any stipulations by An Bord Altranais regarded as falling within its area of responsibility. The clinical indemnity scheme is based on the principle of enterprise liability. The employer is covered and assumes vicarious liability for the acts and omissions of employees. The clinical indemnity scheme covers public hospitals and other agencies funded by the Exchequer. It does not cover GP practices.

Senator Ryan also asked a question on identifying prescriptions. When the GMS started, numbered medical pads with the name of the doctor were introduced, and only prescriptions on those pads are accepted by pharmacists. Only doctors who are registered can prescribe. The same system will apply for nurses. I agree with Senator Ryan that it will be a technical matter to sort out the classes of nurses who will be allowed to prescribe. It will be done by regulation following consultation with An Bord Altranais and the nursing profession. It has been done in other countries. It will take a great deal of agreement and consultation but it can and will be done.

Compounding is a term used. Senator Ryan is correct to state that pharmacists do little compounding, but it was done up to a few years ago and pharmacists are still competent to do it. EU regulations have changed it and a problem now exists with pharmacists using broken packs. It is extremely difficult for pharmacists to compound extemporaneously. It is still done in hospitals and in the community but not as much as before.