Thursday, 7 June 1984
Dáil Eireann Debate
Minister of State at the Department of Health and Social Welfare (Mr. Donnellan): I move: “That the Bill be now read a Second Time”. I should like to apologise for the absence of the Minister who is taking the Committee Stage of the Dentists Bill in the Seanad. That is the reason he is not here.
Mr. Donnellan: I presume he is. The need for this Bill arises out of the necessity to update the existing legislative provisions governing the regulation and control of the nursing profession in order to take account of developments that have  occurred since the existing provisions were enacted. In addition, it is necessary to make legislative provision for intended changes in the composition, powers and functions of An Bord Altranais. In view of the extensive amending legislation that would be required to give effect to the desired changes I propose to repeal all the existing legislation and to enact new, consolidated legislation.
The Bill now before the House provides for the implementation of much of the recommendations made by the Working Party on General Nursing as require legislative support. Before going into the provisions of the Bill itself, I would like to take this opportunity to describe for Deputies the general background to the working party's report which paved the way for the preparation of this Bill. I shall also outline the nature of the working party's other recommendations and indicate my own proposals in relation to them.
The working party was established by the Minister for Health, Brendan Corish, in 1975 and was widely representative of the various nursing interests, An Bord Altranais, the Irish Matrons' Association, the Irish Nurses' Organisation, health boards, voluntary hospitals, trade unions, medical organisations and the Department of Health. The establishment of the working party was greeted with enthusiasm by nurses who, through the Irish Nurses' Organisation, An Bord Altranais and the Irish Matrons' Association had been actively seeking the setting up of such a body to review the nursing services in this country.
The working party was given every broad terms of reference. It was asked to examine and make recommendations on the role of nurses, other than psychiatric nurses, and on the education, training and grading structures appropriate for that role. It was also asked to examine the question of a common basic training course for all nurses to be followed by specialisation in particular areas of nursing.
The working party reported to the Minister for Health in 1980. Its recommendations reflect a fundamental — indeed radical — reappraisal of nursing and are almost exclusively concerned with the improvement of the organisation and delivery of nursing services through better training arrangements, career structures and development programmes. Through this report, nurses have set the scene for their own development and that of the nursing service for the remainder of this century.
The report was widely circulated for examination and comment by relevant interests. I have taken into account the responses received in deciding how I should proceed in relation to the recommendations. The consultative process undertaken after the publication of the report was extensive and necessarily lengthy.
The working party recommended changes in the composition of An Bord Altranais and in its powers and functions along the lines as provided for in this Bill. The remainder of the recommendations range across the whole spectrum of nursing and do not require legislative backing.
Many of the recommendations are concerned with practical, procedural and commonsense issues which are fully acceptable and I do not propose to take up the time of the House in going into them. The remaining recommendations will, I believe, have far reaching implications for the organisation, operation and administration of nursing services in the future.
One group of the recommendations I would propose to refer to Bord Altranais for further examination and feasibility studies before I take a final decision. I consider this a very necessary step to take in view of the four years that have elapsed since the report was published. The major issues in this group of recommendations are (i) common basic training for student nurses and (ii) restructuring of the existing 62 training schools into a maximum of 15 with at least one in each health board area. These two issues are closely related to each other and are absolutely fundamental to the future of nurse training here. I intend to ask the new Bord Altranais to be established under the provision of this Bill to commence  the necessary feasibility studies at the earliest possible opportunity, Consideration of these issues will inevitably involve a view being taken on nursing requirements over the next five to ten years.
I will also be asking Bord Altranais to examine and pursue the working party's recommendations on the organisation and assessment of basic education programmes which would involve a completely new approach to training and examinations based on a modular system with continuous assessment throughout the training period.
In the area of continuing education, the working party made a number of recommendations all designed to ensure that qualified nurses have every opportunity to keep themselves abreast of developments in their own disciplines and to encourage their potential for personal and professional development through various courses of study. Bord Altranais will have the major role in bringing these recommendations to fruition and I intend to ask the board to undertake an examination of them.
There is one recommendation in particular in relation to continuing education which I personally welcome. It is for a university degree course in nursing for qualified nurses. The working party felt that nurses need a broader approach to nursing and a deeper knowledge of the concepts of the health of their own profession's role in society. The working party envisaged an annual competition to select candidates for the degree course among registered nurses. It did not rule out a degree course leading to registration but recommended that priority should be given to the development of such a course for registered nurses. Clearly, the working party foresaw the nursing profession selecting its future clinicians, managers, teachers and leaders from its existing ranks. This seems to me to be a very desirable goal to aim for and I would, in general, be favourably disposed to it. But there are, of course, both policy and cost implications to be considered and different ways and means of providing degree level courses for  selected nurses to be explored. Clearly, the solution will have to be found within the parameters of benefit and cost. To set the ball rolling, my Department will be engaging in some exploratory discussions with the Department of Education.
This brings me to the last group of recommendations that I want to mention to Deputies. These amount to about one-quarter of all the recommendations of the working party and cover just about every area touched on in the report except those provided for in the Bill. Basically, these recommendations are acceptable in principle to me but they will require the agreement and co-operation of staff, employer and union interests to implement and may give rise to some extra expenditure. In the current climate implementation will not only depend on agreement but on there being no extra net cost involved now or in the future.
The major recommendations in this group propose a revised hospital grading structure at the basic, middle and higher management levels together with changes of titles for nursing posts above the staff nurse grade. These recommendations are very important as they deal with the whole area of management of nursing resources in hospitals. When one considers that 50 per cent of total pay roll costs in the health services are accounted for by nursing and ancillary nursing services, it is clear that decisions cannot be lightly made on such fundamental issues. I intend, therefore, to make sure that full consultations and discussions take place involving staff, employer and union representatives before I make any decision on developments in this area of staff structures.
In the last 20 years or so, there has been an unprecedented acceleration in developments in nursing. The sixties heralded an era of evolution in nursing which has definitely marked out nurses as professional people in their own right. Our nurses today are light years away from — although still one in spirit with — their counterparts of earlier times. In the past nurses embarked on a life of dedication to the care of the sick without much thought for their own personal enrichment as nurses or for the development  of their way of life as a career. Those days are gone. The caring motivation that leads a young person to choose a career in nursing is still very much alive but nowadays nurses have expectations of what nursing can offer them as well as what they can offer to society as nurses.
During the sixties public health nurse training was introduced following a reorganisation of the public health nursing service. In 1960 a diploma course for nurse tutors was established in University College, Dublin. This marked the first involvement of universities with the profession. October 1974 saw the inauguration of a Faculty of Nursing in the Royal College of Surgeons. The faculty's primary objective is the self-development of nurses who take the diploma courses. This is positive action aimed at improving the quality of nursing.
These advances, together with the improvements in pay and conditions of employment of nurses secured in the late seventies and the recommendations for further developments made by the Working Party on General Nursing, show clearly that the nursing profession is still evolving. Nurses are still growing in professionalism and, as the working party's report demonstrates, they are actively seeking due recognition for their current role and status and the ways and means to structure and guide the future development of the profession. It is in the context of this growth process in nursing that I see this Bill as one vital component. It also has an EEC dimension, however.
Since the present Minister came to tives have been adopted by the Council of Ministers to facilitate freedom of movement for nurses within the member states. The directives require mutual recognition of professional qualifications issued in the different member states and they prescribe minimum standards of training and education for such qualifications. By ministerial regulations made under the European Communities Act, 1972, giving effect to the directives, An Bord Altranais was designated as the competent authority and assigned specific functions for the purpose of the  directives. The Joint Committee on Secondary Legislation, however, have been critical of some of the powers taken under these regulations and considered that these matters should more appropriately be dealt with in legislation enacted by the Oireachtas. I have accordingly made appropriate provision in the Bill for the registration and recognition of persons holding relevant nursing qualifications awarded in an EEC member state.
The registration and control of nurses here is at present governed by the Nurses Act, 1950, as amended by the Nurses Act, 1961. An Bord Altranais, as it now exists, was established under the 1950 Act to replace the former General Nursing Council. Some provisions of the Midwives Act, 1944, are still extant although most of the provisions of that Act ceased to have effect when the Central Midwives Board was also dissolved under the 1950 Act. Its functions were handed over to An Bord Altranais and the Midwives Committee which was established under the aegis of An Bord Altranais by the Nurses Act, 1950.
I will now turn to the provisions of the Bill. In drawing up this Bill I have taken the opportunity to include certain provisions which I believe to be in the best interests of the board itself, of the nursing profession and of the nursing service. I would like to refer briefly to some of these now. First of all, I am providing for an increase of four on the current membership of 23. This is to meet the undoubted need to adjust the composition of the board to reflect more accurately the interests of the profession as it has developed in recent years. I am proposing therefore to increase the elected membership from the present ten to 15. This means that the majority of the 27 members will be elected by nurses. Furthermore, I am making specific provision for the representation of the clinical, teaching and administrative areas of nursing and also for the various disciplines of nursing. These provisions, I feel, are a substantial improvement on the existing rather general requirements for elected members.
Among the 12 members to be appointed by the Minister, I am including  a new requirement for one to be a representative of third level education bodies involved in nurse training. I am also providing for two members to represent the interests of the general public.
There is one other point I would like to bring to the House's attention in relation to membership. With an eye to the future and to the probability of further developments in nursing, I considered it desirable to include a provision to enable the Minister to vary the composition of the board by regulations and with the board's consent. I believe this provision to be in keeping with the general intent of the Bill, which is to ensure that the controlling body for the profession will reflect, through its membership, the level of development of the profession at any time.
I have included in Part IV of the Bill an enabling provision for the board to establish a central applications system to process applications from persons who wish to undertake nurse training. This is a new provision which stems directly from a recommendation by the Working Party on General Nursing.
The working party made their recommendation on the basis of the findings of a national survey of applicants for nurse training which they commissioned. The survey sought to determine the actual number of applicants for general nurse training over a one-year period and the extent to which applications were made to more than one of the 29 training schools. The results were predictable. The overall national ratio of applications to training places was 29 applications for every place, while over 48 per cent of applicants applied to more than one training school. Indeed, over 3 per cent of applicants, that is 366 people, applied to more than ten schools. These figures are staggering especially when one takes into account that not all of the training schools advertised for students during the survey period and that the response rate to the survey was just 60 per cent.
It is clear that the present recruitment procedure is expensive, inconvenient and wasteful of time and energy for both applicants and training schools. Added to the problems engendered by the multiple  applications syndrome is the problem for young people of the lack of uniformity in recruitment procedures, entry requirements and methods of selection adopted by the various schools.
The working party devoted a great deal of consideration to the form and organisation of a central applications bureau. Indeed, one whole chapter of its report is given over to the subject of the methodology and criteria for selection for nurse training. I do not propose here to go into details about the organisation of the system here or to anticipate what may emerge from the feasibility study which is being conducted by An Bord Altranais. I do, however, want to give a firm assurance that any system adopted will meet with the following critical criteria:
(ii) It will provide for the involvement of the nurse training schools in the selection process through their representation on the bureau which would act as an agency on behalf of all training schools.
The training schools are only too well aware of the need for rationalisation in the applications system and I would hope that, perhaps even in advance of the enabling legislation, a central applications system could be introduced on a voluntary basis with the co-operation of the schools.
In relation to matters of discipline and fitness to practise, I am providing in the Bill for considerable improvements on the existing rather inadequate controls. At present the board is empowered under the 1950 Act only to remove a nurse's name from the register. Under their own rules the board have prescribed the causes for removal as:
I believe that it is incumbent on me, in the interests of guarding the health and safety of the public and, indeed, the professional integrity of nurses, to provide comprehensive statutory controls in the areas of discipline and fitness to practise. Accordinly, I have made a mandatory provision in the Bill for the board to establish a fitness to practise committee. This committee will have functions of investigation and of recommending sanctions similar to those that already obtain for the medical profession and to those that I am proposing for dentists.
With public safety and professional integrity in mind, I consider it most important to provide for erasure or suspension from the register for unfitness to practise because of physical or mental disability as well as for professional misconduct and I have included an appropriate provision.
The nursing profession is the major care-giving profession involved in the health services. Much has been said and written in praise of nursing as a profession and the personal qualities of the dedicated nurse have been described in glowing terms. I am quite sure that nurses do not think of themselves as being in any way wonderful or extraordinary. We are very fortunate in this country in that our nurses are as highly motivated and as skilled as any in the world, but we cannot afford to be complacent on that account. We must work to keep our standards high. We need to attract the most suitable people into the profession; we must give them the optimum levels of training; and we must give our nurses the means to constantly develop and improve skills in  their areas of expertise so that they, in turn, can give back the best possible return to the profession and the nursing service, all in the interests of patient care.
Firstly, we have to strengthen the legislative framework within which nursing will flourish. This means we must build up Bord Altranais into a body with the powers and the authority it needs to guide the profession successfully into the 21st century. I submit that the enactment of this Bill will clearly demonstrate our unanimous desire to achieve that aim.
Dr. O'Hanlon: I join with the Minister of State in paying tribute to Irish nurses not alone for their technical skill but for the concern, care and compassion which they bring to their work. These excellent qualities are recognised in our country but are appreciated also worldwide anywhere Irish nurses work. Be it in hospitals, in community or in the mission fields, we can be very proud of this. I would also like to pay tribute to the existing Bord Altranais for the work they have carried out over the years, as they will be no longer in existence after this Bill comes into operation. When paying tributes. I should pay one to the Working Party on General Nursing for a most comprehensive and useful report on the whole field of nursing in Ireland.
The Bill itself is very limited and vague. If one takes the example of the central applications bureau, there is no great detail of how that will work. The Minister said he hopes that the central applications bureau will come into operation before this legislation is enacted. I should like to know why the Minister foresees a delay. In the proposed legislation there is no set date for the first meeting of the board. The Minister's reference is vague because it does not say if it will be a month, six months, a year or two years following the enactment of this Bill.
We welcome a Nurses Bill because we believe it to be necessary to bring nursing legislation into line with practices in the eighties. It was time to repeal the 1950 Act. However, there are many sections  in this Bill which are unacceptable to us, and for that reason we are opposing it.
First, the Minister is taking most extraordinary powers to himself, many of which are unnecessary and show a total lack of confidence in the board he is about to set up. If one reads the legislation fully one will see that the Minister will have almost total control of everything. Section 31 provides that the board will be obliged to register persons whom the Minister requests them to register. Section 54 is highly dangerous because it will give the Minister power to assign additional functions to the board. I cannot understand why the Minister would want that power. Surely, if it becomes necessary to assign such new functions, the correct procedure would be to come here with amending legislation rather than have the Minister imposing functions on the board to which the board and the majority in this House might be opposed to. I am not saying the present Minister would do that.
The Minister has taken power to direct the CEO, and the board themselves, in relation to appointments of staff and officers. If the board decide that a school should not be recognised for training, any such school will have the right to appeal. This is an extraordinary provision in the field of nursing. I am sure people of the highest integrity will be serving on the board and if they decide that a training school will not be recognised it should not be in the power of the Minister to direct them. That would be completely unacceptable. The Minister told us he will keep to himself the right to vary the structure of the board. Having set up the board, the Minister can change the structure by regulation. We are very much opposed to that. If the Minister decides to change the structure of the board the correct procedure would be to come here with amending legislation.
Since the present Minister came to office there has been a trend to undermine the independence of the hospitals, particularly the voluntary hospitals. We appreciate that the voluntary hospitals receive most of their finances from the  taxpayers, but the State is getting good value for money. We all agree with that. Many of the voluntary hospitals were set up more than two centuries ago, some a century ago, to cater for the needs of the sick poor and this has developed to the stage where they are offering a very high level of medical and nursing care. It appears that for some reason, possibly doctrinaire socialism, of which we have seen much since this Minister came to office, the Minister seems to be opposed to the voluntary hospitals and does not seem to realise the work they are doing. During his contribution to the budget debate on 26 January last, the Minister said:
In reality, therefore, at present there is little statutory control over the establishment and operation of hospitals or nursing homes here other than those hospitals owned and administered by health boards and statutory bodies. If unchecked this could lead to chaos in the organisation of hospital services generally. I am therefore at the moment preparing a submission to Government in which I propose to suggest measures to remedy a gap in the controls available to my Department to secure the most efficient use of resources.
That shows that he intends that the Department will have some measure of control in the running of the voluntary hospitals. We all accept that the Minister has responsibility to see that proper use will be made of the money allocated, but the voluntary hospitals prepare their own accounts which are there for the Department to examine and the Minister to see. The Minister should realise they are giving excellent value for money and he should not feel it necessary to move into the voluntary hospitals.
He went further because he appointed an officer of the Department to the board of St. James's Hospital in Dublin, and in reply to a question by me on 22 May 1984, the question No. 372, in which I asked him about the appointment, he said:
I believe that such a proposal is most  appropriate given the State's commitment to the funding of the hospital and the central role played by my Department in the determination and implementation of policy relating to the provision of general hospital services.
Therefore, the Minister and the Department are getting into the day-to-day administration of the voluntary hospitals. It is fair to ask if this is the first of many such appointments and if we are going to see them on all the voluntary hospital boards.
The reason I dealt with the Minister's attitude to the voluntary hospitals particularly is that the manner in which he has presented the proposed legislation for a central applications bureau represents a further instruction not only on the voluntary hospitals but on the health board hospitals also. The Minister proposes to give the board power to establish a central application bureau for the processing of applications for training in nursing but he is not including conditions as to the rights of the hospitals who will be employing these people. There is provision for the board to set out minimum educational requirements that would be necessary for entry for training. We would all accept that but in the same section it is proposed that any hospital or institution approved by the board pursuant to section 35 may not, without the consent of the board, accept for training any person who is not approved of and recommended by the board. Surely if the board are to lay down minimum educational standards that should be sufficient, but it is unsatisfactory that they would have control as to whom a hospital should or should not employ. In that section there should be recognition of the right of hospitals as employers to have some say in whom they would employ as trainee nurses.
Will hospitals be obliged to take trainees who have been selected by a computer for instance? The Minister has said that the bureau would incorporate assessment of candidates' personal suitability for nursing and that educational qualifications  on their own will not be the basis of selection.
Regarding the criteria to be laid down for the selection of people for training as nurses, the Minister tells us that there will be provision for the involvement of the nurse-training schools in the selection process through their representation on the bureau who would act as an agency on behalf of the training schools. Are we to understand from that that the bureau will select the people who will go to the various training schools? If so, that is unsatisfactory.
It is important to recognise that training for nursing is not the same as going to university. There is an employer-employee relationship in nurse-training schools because these training nurses are employed by the hospitals. It would undermine the hospitals especially since the various hospitals have various disciplines. Some of them are involved in major heart work, others in major brain work and so on. It is mainly the voluntary hospitals who have developed what one might call the super specialty. There is the factor, also, that voluntary hospitals have their own ethos. These are considerations to be respected because there can hardly be another area in which the question of ethics is more important than in the delivery of medical care.
There is no indication in the Bill that the Minister intends to have the character of hospitals preserved. We are not opposed in principle to a central applications bureau to which interested persons would apply for admission to training. We are all very unhappy with the situation in which, on leaving school, boys and girls who are interested in training as nurses apply to perhaps 40 hospitals only to receive the reply in many instances that there is no place for them. That is demoralising. Therefore, while welcoming the idea of an applications bureau we consider it the right of the training schools to select their trainees provided they have the educational qualifications as laid down by the board.
The training school must have an input in the selection of the people they will train. The Minister has told us that the bureau acting as an agency would take  some account, in their selection of persons for training, of the situation of invividual training schools but that is not sufficient when one considers the phenomenal powers the Minister is taking on himself to direct the board in various ways. Indeed, I question the constitutionality of section 36, particularly its third paragraph.
There are a number of sections in which it is proposed to give the Minister powers that are much too far-reaching. He is taking power to direct the CEO of the board as to the number of staff he may employ. I do not know why he should consider it necessary to assume that power. The CEO will have the right to employ persons to work for the board but surely if there is to be provision for giving him directions, those directions should come from the new nursing board.
The Minister is also taking to himself the right to approve a training school even if the board should decide that that school should not be accepted. That is most extraordinary legislation particularly in respect of a board set up under Statute of this House.
We accept the structure of the new board which increases the membership to 27. The nurses believe there should be more nurses on the board. Fifteen nurses will be elected by the nurses themselves and there will be 12 people nominated by the Minister. The Minister has the right to nominate two people from his own Department. The working party recommended that there should be one person from his Department and two nurses. The Minister reversed that to two people from his own Department and one nurse. Perhaps he might look again at the working party's recommendation.
In section 9(d) the Minister has power to appoint a person from a third level institution for training nurses. The legislation states that the Minister for Education should be consulted. I can understand why the Minister for Education would be consulted if a person was to be nominated from a third level educational institution but I do not see why she should be consulted about a person in a third level institution for training nurses.
 Nurses will have to pay a retention fee similar to that which the medical profession pay at present. Hopefully the amount will not be similar. Nurses have expressed the legitimate anxiety that when they registered they believed they were registered for life. They are unhappy that the Minister should now ask them to pay an annual retention fee. It is understandable that the amount of the fee is not specified in the legislation but there is concern that it may increase at an astronomical rate. Perhaps it might be possible to ensure that the fee will be kept within reasonable limits and be linked to the CPI so that nurses would not find themselves unable to meet the fee. The nursing profession is different to the medical profession and the dental profession in that there are many nurses who do part-time work. Some might do only one week's work in a year or a few hours per week. They do not want to be confronted with a big bill in order to be retained on the register. It is important that the fee element would not act as a deterrent to any nurse who wanted to remain on the live register. It is important that a live register is kept.
Section 31 gives power to the board to register persons engaged in ancillary nursing. It gives power to the Minister to direct them to register persons engaged in ancillary nursing. This is a nurses register and only nurses should be registered on it. On the continent and in the UK there are State enrolled nurses. I understand this grade is being phased out. It was a short training course which was introduced when there was an insufficient number of applicants for nursing. We have never been in the position of having insufficient applicants.
When the Minister addressed us this morning he told us about all the recommendations he was accepting from the working party. It is interesting that he did not accept the recommendation in relation to the registration of ancillary nurses. They believe we do not need to introduce another grade of nursing. That was their recommendation in 1980 and it still holds true today because of the numbers of nurses who are unemployed. I refer again to the danger in the power the Minister is taking on himself in being able to direct  the board to register anyone he likes. No Minister should have that power. We welcome the section on education and training and fully support the idea of a common basic grade training. A three-year course for all nurses can have nothing but merit in it. Following on the three-year basic course they can do further studies in whatever discipline they are interested in, be it psychiatric, mental-handicap, paediatric or general nursing.
We welcome the recommendation for a change in the training of nurses and also the opportunity afforded to nurses who wish to go to university. The Minister said he was looking at the recommendation to reduce the number of training schools from 62 to 15 and ensure there would be one in each health board area. The Minister should tread carefully. If a school is too small to sustain itself one must look at it but reducing the number to 15 might be going too far. The Minister should look carefully at that. Training schools make a valuable input into the character of the hospital in which they are placed.
We welcome the section on fitness to practise because the situation has been most unsatisfactory since 1950. The Nursing Board only had power to erase a name from the register. This was for very serious offences. They did not have power to impose a lighter penalty. We welcome the extension of the disciplinary powers where the Fitness to Practise Committee will have power not only to erase a name but suspend or censure a person whose name is on the register. We also welcome the severe penalties for misrepresentation in cases where people misrepresent themselves as being nurses.
We are fortunate with the standard and quality of nurses we have, their technical skills and the care they bring to their profession. As a result of the rapid advance in technology, nurses are assuming more and more responsibility not only in hospitals but also in the community. They are making a very valuable contribution to maintaining people in the community instead of them having to go to hospital. This must be one of the basic elements in the philosophy of any  Government who are trying to deliver a health service. In human terms we must always strive to keep as many people as possible in the community. It is also helpful in terms of economics that as many people as possible be kept out of hospital or long-stay residential units. I ask the Minister to look at the manpower levels in hospitals, and also what studies he is doing on the question of patient-nurse ratios in hospitals. It appears that some hospitals are working under severe pressure because of insufficient nursing staff.
While we welcome many sections of this Bill, we are unhappy about the Minister's intrusion into the rights of hospitals in selecting trainees, and we are especially perturbed by the number of areas where the Minister has taken what we consider to be unwarranted powers to himself.
Mr. Begley: I join with the Minister and Deputy O'Hanlon in paying a tribute to the Irish nurses. I do that possibly with tongue in cheek because I am married to a nurse and I have a sister who is a nurse.
There is widespread concern among the nurses about this proposed legislation. This Bill was published only last week, and since President Reagan's visit and the Forum report monopolised the media during the past weeks, the nurses' concern about some sections of this Bill has not been given the coverage it deserves.
I hope the Minister will be amenable to take positive amendments from nursing organisations on Committee Stage. It is very dogmatic and highanded of the Minister to introduce a section in a Bill which would provide that if a nurse was not registered she would be struck off the role. That is dictatorial in the extreme. There are many unemployed nurses who may not be able to pay this fee. Deputy O'Hanlon was right when he said that the fee might start small but eventually it could be very high. There might be nurses who for domestic or financial reasons would not be able to pay this fee and the new board would have the power to delete their names from the list. If there is to be registration, let it be from a current date. It should not be retrospective.  I urge the Minister to take particular note of this point.
I would not go all the way along the road with Deputy O'Hanlon when he spoke about the nurse training schemes. anyone who looks around him will have to admit that these training schemes are a disgrace. It is crazy that 600 girls from all over the country go for an interview for ten vacancies. Look what that costs the parents — at least £100. They have to pay road or rail fares, buy clothes and so on. Some streamlining must be brought into that area.
I am unhappy with the present situation in voluntary hospitals. I know girls who were not able to get into the public hospitals but had no trouble getting into the voluntary hospitals. Hospitals refused to take girls who had higher educational standards than those they undertook to train — I admit educational standards should not be the only criterion. The same is true in the Royal College of Surgeons. Boys and girls with 18, 19 and 20 points are getting into that college while others with 24 points are being refused admission. Is it not about time the State played a part in this type of selection? In my view we must have a quota scheme. There is no point in having 600 girls applying for ten positions. This is crazy. The Minister said 366 people applied to more than ten hospitals. This shows that the situation will have to be streamlined.
The working party report was presented to the Minister in 1980, but this is 1984. I know from the nursing profession that many boys and girls have left the Irish Nursing Organisation and joined other unions. Have the other unions made a positive input into the working party in the last few years? That is a very pertinent point. Why are young nurses so disillusioned with the Irish Nursing Organisation? There must be a reason. I hope the Minister will not look for all stages of this Bill today, because even after this morning's discussion I am sure he will be showered with representations from nurses all over the country. I am glad this Bill is before the House, because we have been fiddling with it since 1975.  Now at last it has seen the light of day.
I would like to join with the Minister and the previous speakers in paying a very well deserved tribute to the Irish  nursing profession. Worldwide our nurses are renowned for their dedication and the care and compassion they have shown in this very old profession.
There has been a very long delay in implementing the various recommendations of the working committee set up in 1975. This indicates the great difficulties that developed during the preparation of this Bill and shows the disagreements and dissatisfaction felt by many sections and representatives of the nursing profession because of this long delay. I agree that it is only right that we update regulations and control the nursing profession, but the Bill goes very far, indeed too far.
The nursing profession has been operating very smoothly and very satisfactorily for a good number of years under the present Act. There would in some areas be a need for updating of the regulations, but some of this updating is contained in the Bill before the House. We must understand and accept the present great difficulties under which hospitals and consequently the nursing profession, are operating because of present financial restraints. These have been brought about by severe cutbacks in the Department of Health, which have caused many of our nurses to work long hours — on a voluntary basis in many cases, I might add. This proves once more the total dedication of this very excellent profession.
I note that the existing number, 62, of the training schools referred to in the Bill is to be reduced to a maximum of 15. That could eventually be 14, 10 or down to five. It is not a very good proposal to cut back so drastically from 62 to this maximum of 15. I have no doubt that there are good grounds for argument on the closing down of a number of training schools in some parts of the country, but suggest that the Minister be extremely cautious and careful in his approach here.
As we all know from experience in our own constituencies, many girls are anxious to nurse and would make fine nurses but unfortunately, for one reason or another, they are not offered that opportunity. While there is a need for academic qualifications in nursing, other aspects  must be taken into account. Nursing has always been regarded as a vocation and many of our nurses must endure tasks and duties which most of us would not care even to think about. That a girl or a man has many academic qualifications does not necessarily mean that she or he will make a good nurse. We have all had evidence of that over the years.
I welcome the Minister's proposal regarding the central application system, but think that it should stop there. I do not agree that the central system should be extended so far as to select applicants for hospitals and hospital training centres or schools. The system has worked well in the past and should not be disturbed.
The Minister is seeking far too much control in this Bill. Dotted throughout the length of the Bill are various clauses in which the Minister reserves the right to do this or that, or not to do this or that, as the case may be. He reserves the right of approval for entrance to a training school, for example. If the board appointed by the Minister decide, for some reason or other, that a particular application for a training school should not be granted, it is not right that the Minister should then consider that case, review an appeal on his own and decide to overthrow the decision of the board which he himself set up. That says very little for the content of the board which the Minister is proposing to set up. In other proposed ministerial rights, the Minister is going too far in trying to dictate to the medical profession, hospitals, nursing profession and so forth. I hope that he will decide to cut back on the powers which he proposes to give himself.
This brings us to the question of the voluntary hospitals. No Member in this House will disagree that these have done tremendous work for this country over the years. In Dublin city alone, many of our leading hospitals are operated on a voluntary basis and were set up with the funds of various orders and so forth. Here again, I see the Minister's proposals as an attack on these hospitals. All these voluntary hospitals have put a huge financial input into their buildings and their maintenance programmes and whilst the  Department of Health and the various health boards contribute a major share of the operational costs, nevertheless the various orders running these hospitals are still to a large extent funding maintenance today. They are doing that by selling off other areas of interest, perhaps ground for which they have no more use. They are still putting in much finance into the maintenance of voluntary hospitals.
There is also the question of the ethos of these hospitals, for which we must all have respect and regard. If these hospitals are not to have any say in the type of people they accept for training, that will upset, disturb and destroy overnight the principles for which those hospitals have been famous and when I talk about principles, I am not talking about religious principles. These principles have done this country proud over the years. I cannot see why, at this point in time, the Minister should see fit to try to disturb the situation. One can only interpret it as a further attack on a system which he considers, perhaps, not to be socialist enough, whether in character or otherwise.
The Minister appears determined to dictate policy as far as these hospitals are concerned. Certainly from discussions which I have had with various managements of these hospitals, I can say that if he tries to push his proposals to an extreme, he will regret very much that he decided to take that course. Before we reach that position, the Minister must think very carefully and decide not to be dictatorial in deciding what type of ethos, for example, voluntary hospitals pursue, or dictate to those hospitals the type of staff, nurses, professional people to be employed by them.
We on this side of the House have decided to oppose the Bill on that basis alone. That is for us the most important criterion of this Bill. The previous Government speaker, Deputy Begley, also expressed serious reservations in that respect. Deputy Oliver Flanagan is present in the House and obviously intends making a speech which I have no doubt will follow the same course as  mine. This should be sufficient for the Minister to understand that irrespective of what his Department or his officials may think this party certainly feel that the voluntary hospital system should not be disturbed to the extent proposed in the Bill.
With regard to the composition of the board I feel the Minister is taking too much power in relation to appointments. He is reserving the right to disband the board if he sees fit. If one sets up a board to do a job one must give them sufficient time, power and authority to do their job. It is not good enough for a board to have to look over their shoulders all the time wondering if the Minister will approve of the actions they are taking. I feel the chairman of the board should be a qualified nurse who has experience of the profession and who understands and appreciates the difficulties of that profession. I hope the Minister will keep that in mind.
There is no specific information in the Bill about the retention fee. I hope it is in line with inflation. If the Minister insists on an application fee I hope it will be purely a nominal one which will not be detrimental in any way to people from the poorer sections of the community who are seeking to register.
I would like to refer to the sections dealing with registration of unskilled people. This is potentially dangerous. I know from representations I have received that the profession are scared of this particular aspect. The Minister is taking the power to register unskilled people. I believe this is wrong and should not be accepted by the House. I welcome the section regarding the fitness to practise. It will enable the board to take appropriate action in the case of malpractise. The Fitness to Practise Committee should be comprised mainly of nurses who are widely experienced and would readily understand any difficulties which might arise for a person who comes before the committee. There are too many unqualified nurses in private practise. I would like the Minister to have a look at this problem to see what action can be taken to eliminate it.
My objection to the Bill is based mainly  on the sections I have referred to regarding the training centre and taking power away from the voluntary hospitals in relation to who should be accepted for training. Our voluntary hospitals and our religious have played a major role in hospitalisation and nursing. We should be very appreciative and show our gratitude to those hospitals. The sections in the Bill I have referred to are not the way to do that. I trust the House will at least reject those sections.
Mr. O.J. Flanagan: I came in here especially this morning to comment on this Bill which I have read very carefully. I see in it some very serious, important and dangerous clauses and that is why I was anxious to make a contribution. Our nurses have got so little over the years from any Government that there is a certain degree of rejoicement that even a Bill under the title of the Nurses Bill is being acclaimed widely. They are now expressing appreciation for the very stale and humble crumbs that fall from the tables of the Legislature.
The nurses in all our hospitals and everybody connected with the nursing profession have for far too long been neglected. I do not believe there is any professional body the people owe more to than the nursing profession. At some time in most people's lives they realise the value of the nursing profession. They work in line with the medical profession. It takes the nursing profession to restore people to health. This cannot be undertaken by people if they are not highly skilled and highly trained. We see in other fields the advancement of science and technology and we also see the advancement in medicine, drugs and treatment. Our nurses are always in line in considering new and modern methods and the application of modern drugs to restore people to normal good health. When surgeons perform operations and when physicians carry out tests they leave their patients with very great confidence under the care of nurses because they know their patients will be well looked after.
I am not happy about this Bill, but I  will be obliged under party rules to vote for it. I suppose it is not a problem of conscience and I must fall into line with the majority of my party, but it will not be without saying that I see very grave and dangerous sections in the Bill. I am surprised that the way is being opened for unskilled people to be registered. This is coming from a Labour Minister who has already described another law as an ass. I have read the Bill carefully and it contains some dangerous sections which I would not have expected from a Labour Party Minister. I am definitely suspicious of legislation of this kind, particularly coming from a man who has the views on family planning that have been expressed by the Minister for Health. That is for another day and another time.
The attitude towards private and voluntary hospitals is dangerous. I am a believer in such hospitals and I join with other Deputies in paying tribute to the great contribution which has been made by the nursing staff of all our private and voluntary hospitals. I salute the Sisters of Mercy for their great contribution. I pay tribute to the nursing Sisters of Charity who are known for their skill, care and attention in dealing with the sick. I commend also the nursing Order of Saint Camillus and the outstanding order who look after the sick, the poor and the aged, the nursing Sisters of St. Vincent de Paul. The mentally afflicted have received the greatest possible care and attention from these sisters. I pay tribute to the Order of St. John of God for their wonderful contribution to nursing and their successful attempts to bring people back to good health.
There are between 2,500 and 3,000 unemployed nurses. Some qualified nurses are working as waitresses and doing hotel work. Great numbers of fully qualified nurses have applied for jobs abroad, in the United Kingdom and elsewhere. At the same time there is not a hospital in the country which is not understaffed. The health boards have been making pleas for increases in staff and private hospitals have been endeavouring to overcome the difficulties caused by the serious cutbacks. They find it impossible to increase the number of  their nursing staff. Inadequate numbers of nurses are being employed on night duty. Whilst every member of the nursing profession is fully qualified for night duty, matrons and administrative staffs are aware that some nurses are more suited to undertaking the responsibility of nursing patients at night. The result of these cutbacks is that ordinary citizens are not getting the hospital services to which they are entitled. They are not getting the care and attention which the hospital staff would wish because the financial structures render it impossible to provide adequate numbers of nurses. Hospital managements talk of the difficulties in providing the best possible nursing care for their patients and it is despicable that at the same time fully qualified nurses are working as waitresses, receptionists and secretaries, while some are without any work and are dependent on social welfare benefits.
How sad it is that these highly qualified girls are leaving the country in order to earn their living as nurses. They should be provided with the facilities whereby they can serve the sick, the disabled and the aged in their own country. I register the strongest possible protest at the unemployment of almost 3,000 nurses while every hospital is calling out for additional staff. In many instances only one nurse is employed instead of three or four, especially on night duty. Emergencies can arise where patients need urgent attention and one or two nurses cannot look after several wards. The health boards and hospital managements greatly disapprove of this understaffing.
In a general hospital in my constituency there is a highly qualified head nurse who is in receipt of a salary of £15,065 per annum. He is a married man and his wife applied for and obtained a job as assistant matron in another hospital at a salary of £11,982 per annum, which means that a combined income of £27,047 is going into one household. Some other nurses cannot get even an hour's work in a hospital. This has been approved and sanctioned by a Labour Minister. Is there any sense in having 3,000 young, highly qualified nurses, eligible for promotion,  idle? I want to raise also the establishment of interview boards for considering promotions. I contend there should be a central board comprised of fully qualified persons. I am not saying that those who sit on those boards at present are not qualified. But it should be comprised of both medical and nursing personnel so that appropriate recommendations can be made. But to reiterate — within the nursing profession to have £27,047 being earned in one year between husband and wife while 2,500 nurses cannot get as much as £10 per week is not in line with my thinking or belief. Seemingly it is within the belief and thinking of a Labour Party, trade union, Minister for Health.
Mr. O.J. Flanagan: How can we deal with these problems if we do not raise them in Parliament? That is what Parliament is for. There are nurses talking and complaining about these things. Where can they go? What must they do? Who is listening to them, who is giving them work? Because of the cutbacks they are told by every hospital to which they apply for work: sorry, we cannot employ you. It should be remembered also that the parents of many of those girls have spent vast sums of money paying for their accommodation while in training in, say, Dublin, perhaps in a training hospital in Mullingar, Ballinasloe, Cork or wherever. Yet what do they get at the end of all their studies, training and expenditure? As far as I can ascertain at present because of the strictness of the board and of hospital managements there is little difference between the training our nurses must undergo and that of doctors. Their examinations are extremely severe. It is almost impossible for the ordinary person to understand the amount of study and training that must be undertaken by these young girls. Indeed in many cases their parents may have had to borrow in order to assist them in the course of their training. At the end of it all what is there for them — no work, the emigrant ship.
I have noted recently that whenever any nuns in the nursing profession have applied for promotion — no matter what  their qualifications — they appears to be rejected. Is there a sinister move afoot here? Is it not very strange, bearing in mind the wonderful contribution made by religious institutions over the years, that in recent times there appears to be — I am not saying there is — an amount of preferential treatment in appointments being given to people other than those highly qualified in religious orders. I have seen that happen in my constituency and in connection with other appointments. Although they cannot do so now is it the policy of the Department of Health to lay a solid foundation for State hospitalisation, eventually squeezing out the private and voluntary hospitals, rendering it impossible for them to continue, thereby ensuring that nursing sisters from such religious orders who apply for promotion to health boards, no matter what their qualifications, experience or study of modern medicine, will not feature at the top of the list? I am not saying that those who interview at present are not qualified to do so. Neither am I contending that any of our interview boards established with regard to nursing appointments have not operated fully in accordance with the law as it stands. As Deputy Glenn has said, the Minister for Health has already referred to the law as an ass without there being any disapproval expressed on the part of the Government in the wake of that remark.
There are many sections of the Bill in need of alteration and many questions in regard to the filling of nursing appointments which should be challenged. Indeed it might be no harm if the Minister for Health involved himself by visiting our hospitals ascertaining what is the position in relation to understaffing. I do not know what is the total amount of money paid weekly to the 2,500 nurses unemployed, but would it not be better to expend that amount, subsidised by the Department of Health, in order to maintain those girls working in our hospitals,  so that they might be kept in touch with modern developments and medicine in such hospitals? Above all it would provide the sick and aged the nursing services to which they are entitled. I do not know who said this but I shall repeat: a country that cannot look after the interests of its sick will not be able to protect those who are well for too long. Our first concern should be to look after the sick in our hospitals, to co-operate with those hospitals in rendering the best possible service. I venture to say that there has been no greater contribution than that of our young girls who gave their lives to the nursing profession with great honour and distinction.
It must be said that not everybody can be a nurse; like most other professions it is a natural calling. It is indeed a great calling to devote one's life to helping those in ill health and, above all, those people in the course of their final illness. Such considerations should be given when dealing with legislation of this type. We should consider the quality of the person who is charged because of the devotion and skilful training with easing the pain of patients, for example, those in cancer hospitals. The world owes a deep debt of gratitude to nurses. We are all aware of the extraordinary work being undertaken by Irish nurses in Third World countries. Where leprosy prevails nurses have the courage and determination to give relief to those who do not have any hope of recovery.
Those involved in the nursing profession in the future will be subject to the provisions of the Bill under discussion. I first became aware of the Bill when I received a notice from the Whips' office about two weeks ago. I should like to know if consultations have been held with the trade unions, the nurses' organisations or those involved in the administration of hospitals. I am sure all Members in their daily post received correspondence from well educated young girls seeking a training post. The Bill proposes to deal with such applications centrally instead of applicants applying to all hospitals listed in the telephone directory.
The position in regard to applicants for nursing training has been totally unsatisfactory.  Many young girls, and their parents, contact Members and communicate with all hospitals in the hope that at least one hospital will see fit to grant them an interview. To some degree the Bill will remedy that problem. On the composition of the board section 9 states:
There is no obligation on the Minister to consult any particular organisation. I do not like the compostion of the board. I have an objection to it because at least two-thirds of the membership of the board should be fully qualified nurses. The section proposes the appointment of 15 nurses out of a total board membership of 27. I support those who have suggested that no less than 18 nurses should be appointed to the board. What would the reaction be if it was suggested that our Committee on Procedures and Privileges should have a number of people who are not Members of the House? I have no doubt that there would be strong objection from Members to that suggestion. In any business concern employing only trade union labour what would be the reaction if non-union workers were taken on? The Bill is providing for the appointment of unskilled people to the new board. If that happened in any business concern work would be brought to a standstill within hours. What objection can there be to having nurses in the majority on a board that concerns their profession? It will take a lot of explaining from the Minister to convince me that there is not some extraordinary reason behind the decision not to give nurses a majority on the  board. Any such board that does not have a majority of nurses on it will not have the confidence of nurses. Their trust in such a board would be shaken from the start. I hope all parties will ensure that commonsense prevails in regard to appointments to the board and that not less than 18 nurses will be appointed.
Under this section also the powers of the board are too severely curtailed. It will be necessary to have consultations with the nursing profession and the management of hospitals to ensure that the activities of the board meet with the approval of the nursing profession.
register in a register maintained for that purpose, the names or persons who are engaged in a profession or calling which is ancillary to nursing, and the provisions of this Act, subject to such modifications as may be specified in rules made by the Board, with the approval of the Minister, shall apply to any such registration.
The Minister's brief this morning does not explain that clearly. I cannot possibly understand or follow that. We are dealing with a highly professional calling on which depends life or death. What am I to understand, because of my limited experience of modern phraseology of legislation, by “whenever the Minister so requests,”— I see great danger there — and “the names of persons who are engaged in a profession or calling” who are, as we may say in plain language, associated with nursing but may not be nurses? The person may not be fully qualified and may not have the professional skill to deal with the problems of life and death. It is vital that persons dealing with patients coming into the world or going out of it be fully qualified.
I do not like section 31. I am too long  a Member of this House watching Ministers taking something, adding, multiplying and subtracting whenever political will or pressure makes them do so. No matter how well intentioned a Minister may be on taking office, if he finds a way to drive a coach and four through legislation, human nature being what it is he will do so, but that temptation will not be there for any Minister unless the means is passed and approved by this House. I do not know whether Deputy O'Hanlon or any other speaker has made reference to it. I might not put as much importance or emphasis on this section if it dealt with, say, mechanics in the motor trade, carpenters, plumbers, tradesmen, painters and if the Minister could instruct that persons associated with those professions would be registered to do the work. But when this applies in the case of the nursing profession, dealing with life and death, I must express a strong view on it. I must express suspicion. I do not like it. The Minister may tell us that he is not going to add to any register the name of any person who is not qualified. If he is not going to do so, why put it into the Bill? Will this not open the floodgates to allow the names of numerous unqualified persons to be added because they are associated with nurses? Are we to include persons providing meals for nurses? Does that mean that whoever carries and injection tray or a stetoscope for a nurse and is not qualified but is therefore associated with nurses will be registered? If that is so — nothing in the Minister's speech convinces me that it is not — that is a dangerous provision regarding nurses into whose hands full responsibility professionally for life and death lies. If this section is accepted what is to stop the Minister — not necessarily the present Minister, any Minister for Health — in the future from adding to that register the name of whomsoever he wishes after that person has been associated with nursing for two or three months?
I am not happy about section 31. It may give power to the board and also directly to the Minister for Health to request the board to register persons engaged in a profession or calling associated with nursing. Can the Minister  indicate any other Bill that has been passed in this House providing for such a power to be vested in any board? I do not believe he can. I am saddened that with between 2,500 and 3,000 nurses unemployed we see a provision of this kind in a Bill.
Students taking their final examinations this very year have little hope of finding employment at home. It is very sad that young qualified nurses who came out of the May examinations cannot get jobs in their own country, yet under section 31 any other person, unqualified, can be put on the register of nurses. There is no decrease in the number of suitable applicants seeking entry to our training schools. Why should candidates have to train if by knowing the Minister or somebody who knows the Minister they can become registered if they have performed work associated with nursing or in the line of nursing?
I will watch this Bill on Committee Stage as closely as I am watching the Criminal Justice Bill. I do not think the nurses know what is in the Bill and I do not think the nursing organisations are treating their members right if they do not tell them what is in this Bill. I will do it in my constituency: there will not be a nurse in Laois-Offaly who will not know what is in the Bill and I suggest there is a duty on every Member of the Oireachtas to go to hospitals and have meetings with nurses to tell them what is in this Bill and what is likely to come from it. This is a Bill that should not be rushed.
I wish to refer particularly to section 25. I know hospitals too well — I have been too long a patient in hospitals not to know the importance of the nursing profession. I have been a member of a health board for many years, a member of hospital visiting committees involving various hospitals. I have seen people restored to health in hospitals, and sadly I have seen people leaving us forever in hospitals.
This House could not be dealing with more important legislation. Section 25 to me is unacceptable. Nothing has been said in favour of it. I support the concept of a register but it should be completely a function of the board. Sufficient money  should be made available, to maintain the register without charging a substantial annual fee to nurses to be retained on the register. Many nurses have got documents from the board stating they are included in the existing register, without a time limit. Registration fees should cover the cost of the certificate and the registration and I am requesting that this be provided for in section 25.
Many nurses who are not so young are finding it extremely difficult to live because of PAYE, which imposes heavy tax on them. In many cases in the city they have to pay for flats or they have to keep their own homes. In many cases nurses would like to undertake additional duties but they are debarred from doing so by the cold hand of the taxman who takes back from them most of what they earn.
Now nurses will be asked to pay an annual fee for the retention of their names in the register. That is another tax on them, a reduction of their pay by the amount of the retention fee this is wrong. Where did this idea come from? It is one of the evil aspects of the Bill which I do not like. They are entitled to be on the register because they were educated in their profession. If they comply with a proper code of conduct they cannot be removed from the register, but they have to pay a fee to be retained on it. Is there any other profession whose members must pay an annual fee? Perhaps trade union members have an annual membership fee imposed on them. That is in order, but it is wrong to impose a condition on nurses that they must pay a fee to have their names left on the register. Already they are being taxed. Every fortnight or month large amounts are deducted from their pay. Their conditions are not the best due to cutbacks in hospital allocations.
The conditions are so bad in some hospitals that nurses now have to bring in their own soap to be able to wash their hands. It is unbelievable. There is not any other profession whose members must wash their hands as often as nurses because of the danger of infection being passed from one patient to another,  because they have to handle delicate surgical instruments. However, there are many hospitals in which soap is not made available due to cutbacks. How can there be an efficient, proper complete health service if our nurses, the mainstay of doctors, surgeons and physicians, are subjected to such conditions? How can we have a proper health service in conditions of that kind?
Section 25 is totally unacceptable, but I expect that since it does not involve a matter of conscience the Whips will insist on all of us voting for it. However, I wish it to be known that if I must vote for that section I shall be doing so solely on the basis of being a member of the Coalition. I do not like the section. It is wrong and it is dangerous. Therefore, I wish all nurses to know that if I have to vote for it, I will do so on the basis I have outlined and on the basis of its being introduced by a Labour Minister in this Coalition.
Mr. O.J. Flanagan: I shall refer briefly to section 36. I support fully the concept of a central applications bureau which will help applicants for nurse training instead of continuing the present situation in which applicants incur the expense of applying to various training schools. I am disappointed that the general hospital in Portlaoise has not been designated as a training hospital despite such a move being mooted some time ago. I hope we will receive from the Minister at a later stage of the Bill details of the training hospitals, of the numbers who have applied to them for training and also the number that has been accepted. Such information is necessary. The views of the INO on this matter have been documented fully and that documentation is with the Department and with the board.
Subsections (2) and (3) of section 36 need to be clarified further in regard to the role of the employing authority in the selection of students. What is to be the main criterion to be used in the selection of these students? Should the important consideration, following an interview by a board consisting of doctors and management  of a hospital, not be the consideration of the ability of an applicant?
The Bill is long overdue. There are many who will welcome it. I welcome those sections that will prove helpful, but there is a slant in the Bill that is anti-voluntary private hospitals. I hope there will be discussion in the House regarding promotions and appointments in hospitals to which fully qualified nurses, whether married or single, may make application. Discussions I have had with nurses in various hospitals leave me to believe that there should be some completely independent central authority which would ensure that promotions in a hospital are confined to that hospital and also that the people concerned be interviewed independently of the hospital. In that way the best and most highly qualified people would be appointed.
This Bill should be for the benefit of nurses only. The important factors should be the training, education, conditions of employment and improvement of conditions for nurses. That is why I have spent so much time this morning on this stage of the debate. I do not believe that all the provisions of this Bill are in the interests of nurses. I am seeking a Bill to cater for nurses and nurses only in consultation with their organisation and with those concerned in that great and noble profession, the services of which are always available to us. Their services are available when we are coming into the world and when we are leaving it. We as Members of Parliament must show the greatest concern for that profession. I hope that by the time the Bill reaches its Final Stage, those objectionable provisions will have been deleted from it and that it will lead to improved standards for nurses.
Mr. Mac Giolla: I commend Deputy Flanagan for his spirited endorsement of the nursing profession. I agree totally that this Nurses Bill should be a Bill for nurses only. I agree also with a number of points made by Deputy O'Hanlon. However, without wishing to upset Deputy Flanagan, I welcome the introduction  of the Bill on the basis that it is the start of a process of legislating for the working party report that was begun in 1975.
The Bill merely deals with the board and its functions. In his speech the Minister said the board would be asked to carry out an examination and feasibility study of basic training of nurses and the restructuring of the existing training schools. Training does not really arise under this Bill. Deputy Begley referred to the chaos in that whole area. I do not know if the working party's proposal to reduce the number of training schools from 62 to 15 is the best way to restructure it.
The working party consisted of representatives of various nursing interests, An Board Altranais, the Irish Matrons' Association, the Irish Nurses' Organisation, health boards, voluntary hospitals, trade unions, medical organisations and the Department of Health. All these interests will be represented on the new board except for one, and that is the trade unions. There is no reference good, bad or indifferent to them in the Bill. The contribution they made to the working party is not recognised in the Bill.
Deputy Flanagan asked if the various interests had been consulted before the Bill was drafted. I do not know the answer to that. However, I have a copy of a circular which was issued by the Irish Transport and General Workers' Union. They circulated the Bill to all their nursing branches and asked them to ensure that their branch discussed the Bill and let the union know their comments at the earliest possible opportunity. They did not say if they were consulted about it but that would seem to indicate that they were not. Presumably the other interests were not consulted either. I hope the Minister will keep his mind open to alterations which may be suggested on Committee Stage.
The majority of the board will be elected by nurses but when we look into this we see that there are to be five representatives from the teaching side, five from the management side and only five from the general nursing and psychiatric  nursing area. I do not think that represents nurses at all. There are to be five people resident in the State engaged in training nurses of whom one is to be in general nursing, one in psychiatric nursing, one in mental-handicap nursing and one in midwifery. There are to be five others engaged in administration, there is administration in general nursing, public health nursing, psychiatric nursing, midwifery and mental handicap nursing. They would represent a small number of nurses. The total number of nurses involved in psychiatric nursing is 6,000. I am sure there are a greater number involved in general nursing. They are to be represented by five people. There is to be one nurse representing those engaged in clinical practice in general nursing. That is the area where the vast majority of nurses are concentrated and where they have made their careers. Deputy Flanagan referred to this. They are only allowed to have one representative on the board. One is to represent clinical practice in psychiatric nursing. There are two people representing psychiatric nurses on the board. One will represent those in clinical practice in midwifery, one will represent those involved in public health nursing and one will represent those involved in nursing the mentally handicapped. That is a total of five representing the whole general body of nurses. That does not represent a balanced structure.
The general body of nurses can only elect five people to represent their interests on the board. It is not balanced in the sense that there is only one for each area of nursing. This is one of the biggest defects in the Bill and will cause a great deal of upset to the general nursing profession. They will feel they cannot elect their own board and the people they would like to have on it. They are dictated to from the beginning as to how the board will be constituted and who they must elect onto the board. They do not have a free choice. They must select five from the teaching nurses, five from the management area and one for each of the general nursing areas. Either they do that or they do not bother to vote. It is not  democratic. Can one imagine the Minister telling the medical profession they must give greater representation and powers to those engaged in the teaching areas, in the universities and the College of Surgeons, that they must have one-third of the representation on their professional body, that those engaged in the administrative areas of hospitals must have one-third of the representatives on their professional body, and that doctors in general practice, physicians and surgeons, would have only one-third representation on their professional bodies. It is a joke, it is a laugh.
Everyone gives tremendous praise to the nursing profession for the great skills, dedication, hard work and discipline required. They must have discipline not just living and working in an institution, but they must have personal discipline. They must not reflect their inner feelings to their patients whether it be illness, pain, suffering or emotional upset. They must exercise control. Everybody agrees that this is a marvellous profession and say how well nurses do their job, but they are not recognised as a profession in their own right, with their own rights. They are treated in a paternalistic way. We say these are marvellous girls and we must do what we can for them. This paternalistic attitude goes right through the Bill.
The Minister's first three appointments are doctors; one is a registered medical practitioner engaged in the practice of medicine in a hospital approved of by the board for the training of general nurses; the second is a registered medical practitioner engaged in the practice of medicine in a hospital approved of for the training of psychiatric nurses, and the third is a registered medical practitioner engaged in the practice of obstetrics in a hospital approved of by the board for the training of midwives. The next appointment is a person representative of the management of health boards; the next is a person representative of the management of hospitals, two are from the Department of Health, and two are representative of the interests of the general public. I presume they will be political appointees, if the doctors are not already political appointees. These 12 people are  appointed, and the nurses are told who they must elect to the board. This is supposed to be An Bord Altranais, the Nursing Board. This board will have the responsibility of developing the nursing profession and bringing it to the stage it should be, but it will not be run by the nurses and the majority of the nursing profession — 90 per cent — will not have majority representation on that board.
On Committee Stage The Workers' Party will be putting down amendments in this area. I agree with Deputy Flanagan that 16 nurses on the board is not sufficient representation. In my view that figure should be increased to 18. The election by the nurses should not be five-five-five but rather eight-four-three. The 90 per cent of the nurses should elect the majority of the 15, that is eight as against seven. The people representing the nurses will present their case to the board. I am sure they will have regular meetings with the nurses before board meetings and they will then put forward the nurses' views. As I said, they should have the majority of seats on the board. This is the type of amendment we will be proposing on Committee Stage.
It is important that we get a feedback from the nurses. What is their view on these issues? The views of the Irish Nurses' Organisation — which is not a trade union — and the unions which represent nurses should be put forward. If we believe all the high sounding phrases we use to describe the nursing profession, we should give them the status and power they deserve. We believe they are dedicated, trained, capable people. Are they not then capable of running their own organisation? The Minister does not think so. He thinks he is better qualified to tell them what they are supposed to have and what they should have.
There are a number of other sections which need to be looked at. Registration is a good idea and Deputy Flanagan mentioned an annual fee and a fee for about ten other services. It may be that the nurses would like to have their independence and not to be dependent on the Department of Health for funding. They might wish to develop their own fee system, but that is something we should find  out from the nurses. Under this Bill the board may charge fees for registration, retention of the name of the person on the register every year and restoration to the register of the name which has been removed. They must pay for giving to any person a certificate of registration. They can be charged for the registration of any candidate for nurse training in any register maintained by the board. They can be charged for entering any examination conducted by the board. They can be charged for applications to undergo nurse training and any other service which the board may from time to time provide. That seems highly dangerous to me, particularly at a time when there is so much unemployment in the nursing profession. How are these people to keep up to date, maintain their training and keep their certificates and registration when they are unemployed?
Section 31 was adverted to by Deputy Flanagan. In my view he may have misinterpreted it, although he may be right. As I see it, this is a separate item. Section 31 says, not that the Minister can put people on the nurses' register but that he and the board can set up a separate register for people in a profession or calling which is ancillary to nursing. The wording reads:
Could the Minister tell us what precisely this section means? What is a profession or calling ancillary to nursing? Have these been listed out? Is the Minister leaving that as a general phrase or could he not tell us what the phrase means? I cannot think offhand, apart from doctors, of any profession or calling ancillary to the nursing profession.
On the question of fitness to practice, I am not sure that that phrase is better than the phrase “professional conduct” which is normally used with professional  bodies when referring to professional conduct, or of misconduct for which members can be erased from the register. A person could be fit this week and not fit next week. This is a very broad phrase and we need on Committee Stage to go into what exactly it means. The Bill refers to allowing the board to inquire into alleged unfitness to practice by reason of physical or mental disability. There is nothing wrong in inquiring into that in the normal course, but in the course of a person's work if the physical or mental disability is such that he or she is unable to work we then enter into the normal area of early retirement or retirement on grounds of ill health, not into the area of being struck off a register or being told that one is unfit to practice the profession. This is a very dangerous concept, especially in the area of physical disability.
In the nursing profession as in any other, a person can do certain jobs despite physical disability. I am sure that there are many variations of physical disability and many areas in which members of the nursing profession suffering from physical disability could still discharge their duties in particular areas, whether in a laboratory, administration and so on. They could carry out these tasks just as well as the physically fit person. There is a danger of discrimination in the area of physical disability in the nursing profession, as is present in many other professions and trades. The question of unfitness to practice referred to in the Bill should be looked at very closely.
I have reservations, first about the structure and composition of the board, the main and most important part of the Bill, to which I hope most time will be devoted on Committee Stage and secondly, about the purpose of the register, the question of fees for registration and the area of fitness to practice. I hope that the Minister will be prepared to consider changes, alterations and amendments in these cases.
Mr. Daly: This Bill gives us an opportunity, one of the few that we have had in this House in recent times, to dwell on  some of the issues relating to the nursing profession and hospitals generally. While there are certain items in the legislation with which I would not be totally satisfied, overall this is a Bill in which many practical procedural issues are dealt with, which are timely and necessary. My reservations have already been highlighted by our spokesman. Nevertheless, some practical, sensible, reasonable proposals are contained in the legislation which are important to the future development of the nursing profession.
I welcome the establishment of the new Bord Altranais, with one reservation. We have seen in recent times the establishment of boards dealing with specific areas and issues which after their establishment, because of lack of finance and adequate staffing, have been totally incapable of dealing with the areas with which they were established to deal and with the purposes for which they were established. We have seen this happen with regard to the Central Fisheries Board and regional boards, the Youth Employment Agency and a number of agencies and boards which have been established in recent times. While the frameworks appeared to be adequate to deal with what needs to be done, their high ideals were baulked by lack of finance. My one word of caution today is that unless the Minister is prepared to give the new board the necessary financial support and staffing resources to deal with the issues involved, this will be an exercise which may very well lead to criticism and further complaint in the next number of years. I do not want to see a board all dressed up but with nowhere to go. We want an Bord Altrantais to have the facilities, resources and finances to do what they have been established to do.
I do not wish to go through the Bill section by section, but there are a few items to which I want specifically to refer, not in great detail. One is in relation to section 17 which deals with the appointment of officers and servants to the board. I had thought at this stage that we had done away with this term “officer and servant”. This has been the case for a long time in local government legislation  and I expected an enlightened approach from the Department of Health. Can we not find a better phrase?
In relation to this section, appointments appear to be made by the Chief Executive Officer. What role will the Local Appointments Commission have in regard to appointment of key personnel? We must avoid some of the causes of recent complaints by the Minister for the Public Service when dealing with interference with appointments. I hope the Minister will practice what he preaches in this regard. I fear that in section 17 (5) there is the possibility of ministerial interference in these appointments. The air should be cleared in relation to this particular section. The Minister for the Public Service made very grandiose statements recently about TDs making representations in connection with appointments and the action he would take in this connection. Here we have a section where the Local Appointments Commission seem to be ignored. The section leaves it open to criticism that there can be ministerial interference in relation to these appointments. The Minister needs to clear that point up before we finish Second Stage.
In relation to committees of the board there is provision in section 13 whereby committees can be established to deal with certain specific areas of interest and concern. I strongly believe in regional committees and I would like to put it to the Minister that in relation to the establishment of the new board the headquarters and personnel should be in one of the regions. I also believe there should be regional representation on the board and that the regional committees should coincide with the various health board regions. From time to time specific problems will arise in different areas which may not be of importance to the board but may be very relevant in a particular region. Perhaps, under section 13, a regional structure can be established which should involve people from the various regions coinciding with the health board regions. This should form the nucleus of the overall board to give a regional input into the deliberations of the board. It would be very useful if the  new board were established in one of the regions. I would like to see it in the Mid-West Health Board region.
Other Deputies have spoken about the membership of the board and have said they are not completely satisfied with the representation on the board. I have a complaint in relation to this section. I feel one of the areas the board will be concerned about and will have an interest in is the recruitment and training of student nurses and personnel. It should be possible to amend the section to include a representative of the student nurses. It has been the subject of discussion in other places that we have the views of young people in relation to their training and conditions of employment. It will be an inadequate board unless a representative of student nurses is appointed. It is important to have somebody who is in one of the training schools on the board. This can be done by one of the ministerial appointments. The section states that two should be representative of the general public, so one of those should be a nurse. If the Minister has fixed his figures and does not want to change this it is certainly necessary to have student representation on that board. He should consider how that can be done. The board have a time spell of five years and a nurse's training takes approximately four years. It is possible, with some slight organisation on the Minister's part, to ensure that we have representation from the students on the board during the term of office of the board.
It is not necessary for me to emphasise how important it is to streamline our activities here with the developments taking place in the European Community. I am a member of the Joint Committee on Secondary Legislation of the European Communities and I had a discussion some time ago about some of the developments in the European Community, how they affect our situation and how in our legislation we can introduce the measures which are necessary, such as training courses to bring our training facilities into line with the developments taking place in the European Community. This would enable us to have free interchange in the European Community which will be very  important as the Community is strengthened over the years. The changes which are taking place in relation to terms of employment and working conditions of people within the European Community as well as the massive technological changes that are taking place should be kept in mind. This would ensure that we are part of any new and evolving changes in relation to education, training, procedures and structures. We would then have streamlined our efforts to that we can give the same lead in the European Community as we have given to the nursing profession over past generations.
I do not believe it is necessary for me to highlight the importance of the Irish nursing profession in the general hospital services, care of sick people generally as well as care of the aged and the handicapped over the years. They have been to the forefront here in relation to the problems we have had in the health services and they have been an example to many of the professions in the efforts they were prepared to make, often under appalling conditions. In the general hospital in Ennis nurses are working under appalling conditions with beds in the corridors and overcrowding in all the wards. I am not just highlighting the case of Ennis hospital. This applies to many other hospitals throughout the country. It is necessary, when dealing with the Nurses Bill, that we look at this area as well and see how we can in the future steamline our activities to ensure that there are proper conditions for people working in the health services, especially nurses.
As well as being to the forefront in relation to dedication and hard work in Ireland our nurses are highly regarded in other countries. They are an example in the way they tackle very difficult jobs in remote places and difficult situations, sometimes even political problems. They have always been an example to many larger nations in their dedication and working in very trying conditions. They have given sterling service all over the world in the care of the sick, in the fight against poverty, hunger, malnutrition and starvation. Our nurses have not only  been involved in underdeveloped countries but have also given sterling service in many of the newly developing countries in the Middle East.
Many young Irish nurses are finding useful employment in the United States and gaining great experience. I am personally aware of many nurses who have comeback from working in very sophisticated hospitals abroad where they gained skills and expertise which we do not have here. We must ensure that the necessary training and resources are provided so that the Irish medical profession can continue to give the sterling service they have provided through the years.
I welcome the decision to have a new central recruitment system. We have all seen the hardship, expense and inconvenience of students and their parents in endeavouring to secure places in training schools. Thousands of applications pour into these schools each year.
I note that the new board will be examining the restructuring of the existing training schools. I am not satisfied that we should reduce the number of such schools from 62 to 15 and I do not think this is the Minister's intention. In any discussions relating to the streamlining or restructuring of the 62 training schools there must be the fullest consultation and co-operation between all those involved. Many of the training schools have their own specialist needs and requirements and they have developed their own expertise over the years.
There must not be any interference with the voluntary hospitals. The dedicated personnel in these hospitals, religious and lay, have contributed an enormous amount and I do not believe our health structures would survive without their contribution. Developments must only take place following the fullest consultation between all the interested parties.
We must keep in line with developments in the European Economic Community. We must have adequate funding, resources and staffing. There must also be student representation on the new board and the fullest possible consultation. We in this Parliament must provide a framework which will ensure the  maintenance of the high standards, the dedicated service and the professionalism we have seen in the hospital services. We must ensure proper working and living conditions for the dedicated people who have made such an enormous contribution to health services here and throughout the world.
Mrs. Glenn: Like most of my colleagues, I welcome aspects of the Bill and have serious reservations about others. I am pleased that the Minister is extending the board and that the nursing profession will have the majority of representatives. They will have 15 members while the Minister's appointees will number 12. I have serious reservations about these appointees.
I note that in the categories of nursing representation outlined in the Bill there is no mention of public health nurses or domiciliary midwives. Both of these categories are extremely important to the community. A ministerial decision was taken only last year to remove the emphasis from hospitalisation and to place it instead on community care, particularly in regard to the aged and the permanently infirm. This requires a great extension of the public health nursing service, yet here we are setting up a board which takes no account whatever of the impact of that aspect of the nursing profession. I will be asking for a review of this point so that it can be corrected.
It is generally accepted in medical practice throughout Europe that because of the improved circumstances of most families women now live in hygienic and well maintained homes and the standard of health has improved so much that there is very little risk to a woman in deliveries taking place at home, subsequent to the delivery of the first child. There is no mention in the Bill of the inclusion of the board of the domiciliary midwife who has such an important role to play in community care.
The Minister will appoint 12 people, two of whom will be members of the general public. As chairman of a health board, I must point out that this terminology has been used on several occasions in the recent past. It happened  when we discussed a board in Loughlins-town. It would appear to constitute a new departure on the part of the Minister and the Department. I put it to the Minister on the last occasion — and I am putting it to the House again now — that the most appropriate representation of the general public are their elected representatives who received a mandate to so do and who must have accountability. I say that because a motion of the Eastern Health Board in the not too distant past required that people from the community, expectant mothers and so on, serve on hospital boards. It is my view that elected representatives only are suitable because, at the end of the day, they must be accountable. I would plead with my colleagues in this House to make it perfectly clear to the Minister that it is not acceptable that two persons from the community, other than those with a mandate from the people, be considered for service on any board. I might add that this is a matter of grave concern to many other people who serve on hospital boards.
The next matters with which I wanted to deal where those of registration and retention. Nobody argues that registration is not desirable or that a fee should not be paid, but I do not think an ongoing fee for retention is acceptable. Furthermore it is not sufficiently explicit in the Bill for the simple reason that many nurses today will have a multiplicity of specialisations. They may be general nurses, midwives, psychiatric nurses and, at any given time in the course of their careers, they may specialise in any one of those areas. Would such nurses be required to pay a fee in respect of each category of nursing in which they wanted to practise? Most nurses, in the course of their careers, will leave this country to practise elsewhere, through necessity or for experience. Some may leave to undergo a midwifery course they may be unable to take here because of overcrowding and cutbacks. One might ask: what happens those girls who are registered who must go away to train or to gain experience? Where do they fit into the registration process? Must they reapply for registration on returning? There  is a grey area there about which we require much more information.
Reading through section 31 — on the registration of persons in ancillary profession — a recent motion of the Eastern Health Board was brought to my mind. I want to pay tribute to the nursing profession on this incident because I do not think the general public will be aware of their generosity. The nurses, through their union representative on the board, offered their services to the community. There were 675 of them unemployed and, because of the nature of their profession and the rapid changes taking place, to be on the dole, out of touch with what they were trained to do constitutes a great frustration for them particularly when they are all too well aware that throughout the community and in the many hospital wards there is gross understaffing for the requirements of our people. Through their union representative they placed a motion before the board asking that they be allowed to work for the community for the £45 to £50 per week they were drawing in unemployment money. They said they did not want to be taking money from the taxpayer, they wanted to give the community the benefit of their caring profession and work in the community.
Everybody was in agreement that this was a marvellous gesture. That generosity would also have been a tremendous example to other young people. What happened when that offer was put to the Minister and the Department? They advanced all sorts of reasons that it could not be done despite the fact that it was the nurses' union representative who was advancing it. Had there been the will it could have been done and I believe it could be done still. In that way those young nurses would be kept in touch with their profession while rendering a badly needed service to the community. A rethink in those kinds of areas would not go astray, and I want to pay tribute to those young nurses who so generously offered their services rather than take taxpayers' money for doing nothing.
I totally reject the inclusion of persons in ancillary professions as proposed in  section 31. As Deputy O.J. Flanagan and others have said, this is a Nurses Bill and that is what it should and must remain. Some years ago in Great Britain, because of lack of nursing personnel, they introduced another category, the SEN. We have never had any need for such a category, our problem being that we have a surplus of highly skilled, trained young people. We do not want any people in this category and we should reject that proposal totally. If there are other categories who need to organise themselves, let them do so as do the medical profession, but let us confine this Bill to nurses and the interests of their profession.
If for no other reason the Bill is necessary in regard to the central bureau. I have had the experience of sitting on interview boards for the selection of young nurses, which has been the most frustrating experience of my lifetime. One will find oneself in a situation in which there may be approximately 16 vacancies with 300 young women applicants from all over the country. Always there seemed to be a predominance of young girls from County Tipperary; every young girl there seems to want to be a nurse. Those young girls would sit all day awaiting their turn, each one beautifully groomed. Very often parents would have driven them to the various venues from the farthest corners of the country. In truth it would be difficult to say I ever met a young woman who presented herself who was an unsuitable candidate, because they all had the necessary qualifications and characteristics. The difficulty arose from the few vacancies vis-à-vis the number of applicants. I contend that it constitutes a disgraceful exploitation of a potential labour force, to draw them from all over the country, incurring such expenditure. It should be remembered also that that will be the case in one hospital today and the same in another tomorrow. Therefore this central bureau is long overdue and much to be welcomed; the sooner it gets into top gear the better. However, I do not think they should have the authority to select candidates for any given hospital. That must remain with the tutors, matrons and  members of the board of any given hospital. I say that because there are no two hospitals today in the city of Dublin that engage in the same type of nursing; they all engage in specialisations and seek different kinds of expertise and characteristics. This central board must not have the autonomy, it must remain with the individual hospitals to which young nurses will apply.
The Board shall carry out such functions, other than the functions assigned to it by this Act, as may be assigned to it from time to time by the Minister in relation to nursing education and training or other matters relating to the practice of nursing and the persons engaged in such practice.
That is farcical because, while the Minister is setting up this board to do all of that he appears to be saying that the ultimate power will lie with him. I suggest that that provision be deleted from the Bill. There is no reason why the Minister, after setting up a board, should interfere with its operations. I have no doubt that the members will be chosen because of their expertise. Ministers will change and they do not have a grasp of everything that takes place in the medical profession. The provision I have referred to is highly dangerous and should be deleted.
When reading the provisions of the Bill I get the impression that the Minister is taking on to himself a role that has never before been sought by a Minister. That is dangerous because when there is ministerial intervention the areas concerned become politicised. The Minister should stand back from these and permit the people he has appointed or paid to do the work to make the decision. He should trust them.
I agree with the compliments paid to the voluntary hospitals during the course of the debate. Over many years they have built up a reputation for medical and nursing standards that are the envy of many developed countries. In the course of a conversation with a member of the nursing profession recently I discovered that the city's best known voluntary hospital  can maintain a patient for £100 per week less than the cost in a comparable hospital in the city. If voluntary hospitals can thrive and carry out their duties to such an extent that the general public appreciate them why is it that the Minister and the Department, should interfere with them? I accept that bearing in mind that the Department, through the health boards, make finance available to those hospitals — last year I understand it was £167 million — there is a case to be made for representation from the health boards on the boards of such hospitals but there is no case for ministerial interference in the management of those hospitals.
There was reference this morning to the fact that the Bill was introduced rather quickly without Members having an opportunity of giving full consideration to its provisions. I must confess that I have not had sufficient time to analyse its provisions. Many of the provisions will need to be amended on Committee Stage. Deputy Flanagan has told the House that he will find it impossible to support some of them and I am in a similar position. I hope the Minister takes account of the view we have of some of the provisions and will show a willingness, like the Minister for Justice on another Bill, to amend them on Committee Stage.
Mr. N. Andrews: I welcome some aspects of the Bill but there is a need for us to be given an opportunity to give the provisions more thought. There is also a need for more consultations with the Irish Nurses Organisation. Over the years that organisation has been patient and shown a lot of goodwill but, unfortunately, it has not been given the attention it is entitled to by the House. I have the honour of serving on the Eastern Health Board and it is appropriate that I should pay tribute to the last speaker, Deputy Glenn, who has been chairperson of that board. Few people have shown such dedication to the work of that board as Deputy Glenn has. I understand that this will be her last year as chairperson of that board and it is appropriate that her contribution on this Bill should be given careful consideration. That Deputy spoke  with concern about the issues confronting the nursing profession and I have no doubt that on Committee Stage she will put forward recommendations in regard to some of the provisions in the Bill. Members of the Eastern Health Board have a knowledge of and a concern for the nursing profession.
I should like to pay tribute to the nurses employed by the Eastern Health Board, particularly those working in St. James' Hospital. In that hospital the nurses deal with a variety of ailments. I can recall the rows that took place over the years about the pittance paid to nurses. They were treated with a great deal of contempt but I am glad that various Governments in recent years have pursued an open approach to that profession. I expect that we will be tabling a number of amendments to the Bill on Committee Stage.
My mention of St. James' Hospital reminds me of an incident that occurred there recently. A young man was treated there by a doctor who was carrying out experiments. As a life-long anti-vivisectionist and one who has tried here, and in Europe, to establish a reasonable code of conduct in the use of live animals in medical experiments, I should like to express my abhorrence at the use of people, students and others, in this way. As usual when a crisis is brought to our attention we deal with it by setting up a committee or a commission. On behalf of the nursing profession and members of the public who have spoken to me about this I should like to state that it is of vital importance that the experimental business in that hospital ceases now.
Mr. N. Andrews: I understand it did. Such experiments should cease until the House lays down proper standards. It is an appalling indictment that such experiments take place here although they are not permitted in America or Switzerland where the great multinational drug companies have their headquarters. Those countries prohibit such experiments by law but this small island State accepts  such experiments. I appeal to the Minister to stop these experiments now. It is horrific to think that human beings are being dealt with in this matter in a Christian country. It is totally irresponsible. It is irresponsible of us in this House to allow such experiments to continue. I make a public appeal for an end to them.
Mr. N. Andrews: I am sorry to disturb anybody at lunch. This Bill seems once again to centralise all power in the hands of the Minister. It is ironic that in the Minister's constituency on the way out to Blackrock we see an enormous private hospital being built while at the same time that socialist Minister, Deputy B. Desmond, a man committed to the purity of the socialist ideal of your party, a Leas-Cheann Comhairle, in this Bill attacks directly the voluntary hospitals here in Dublin. The voluntary hospitals are being closed rapidly while private medicine is being encouraged by the socialist Government. Thatcherite policies are being adopted as always by  the Labour Party participants in the Coalition Government. The Donnybrook set dominate.
Mr. N. Andrews: It is relevant. There is no question but that the Fine Gael Party, the Christian Democrat party represent the Thatcherite policies that are putting this country down the tubes rapidly with 3,000 nurses unemployed and unlikely to be employed.
Mr. N. Andrews: I would like to see employment at home created by the Minister for Finance, Deputy Dukes. However, that is most unlikely. It amuses me to hear the Coalition talking about employment of nurses. It is a pity that they would not address themselves to employment instead of unemployment. All the time the dole queues are increasing, unemployment continues, and unfortunately no Government Minister is addressing himself to the serious issue of unemployment in the nursing profession, or in any other profession for that matter. Dealing with nurses, 3,000 nurses are unemployed at the moment all over the city. Our nurses are welcome in the Third World, in Central America and one of our nurses in Ethiopia was missing, apparently kidnapped. A few precursory feelers were put out by various agencies from the Department of Foreign Affairs and nothing further was achieved. Her family do not know whether that young nurse is alive. She is one of the Florence Nightingales of the nursing profession who, because apparently we have no room for them to work at home because they are being encouraged to emigrate——
Mr. N. Andrews: The Government are collapsing gradually and bringing the country with them, unfortunately. I would not mind the Government collapsing, but it is a shame that a socialist Minister should participate in an administration who are overseeing a Bill that is discouraging young people who have spent their lives dedicating themselves to training as nurses. They find themselves in the dole queues and the voluntary hospitals are being closed. All over the world Irish nurses are welcomed. They are welcomed in the US, Canada, Africa, Asia and Latin countries and Central America. They have the finest ethical standards, the finest training—if they can get training any more — they are welcome everywhere, they are highly paid and every now and then we see advertisements in the newspapers seeking Irish nurses. We do very little to encourage them here at home. We treat them in this contemptous way in a Bill that tells them that we do not acknowledge their contribution, we are not going to consult with them in the way we should, we are not going to listen to them, we have no confidence in them, because we are going to take all their powers away from the nursing board and give them to the Minister. We are going to increase fees and to make sure that they continue to register. This is centralisation in the hands of the Minister.
What about this great open Government that we were going to have? When a socialist Minister committed to socialist ideals comes into this House and presents a Bill such as this, it is a disgrace. I hope the people will be informed and be aware of what is happening in this Bill. Regulation of the courses of training, examinations, pre-registration and post-registration is among the stated objectives of the Bill. Who is to do all this? Is it the Minister? It is appalling that the powers are being taken on by the Minister.  The same is happening in regard to the health boards. In the final analysis we are privatising the nursing profession and medicine, and the nurses are the victims. We have evidence of that in the establishment of the fine private medical clinic on the Merrion Road, Dublin. That is encouraged by the Labour Minister for Health in his own constituency while inner city hospitals are being closed with consequent job losses. The Loughlins-town hospital is under threat.
Mr. N. Andrews: When it comes to the Deputy's turn she can speak about her constituency. I hope to represent the whole of Dublin city and county shortly. I do not say the Minister has not got a conscience but he has lost touch with reality in that Christian Democratic grouping on the other side, that Thatcherite element——
Mr. N. Andrews: Perhaps the Minister will give me his vote — he is very anxious to get rid of me. Closing down voluntary hospitals and opening up big hospitals throughout the city de-personalises the hospital system, and I feel very strongly about it. Small hospitals gave excellent medical services, and that is important. It is typical of the Government. They are always looking back——
Mr. N. Andrews: Many of our hospitals are finding it difficult to accommodate some of the geriatric patients. I must pay a tribute to the geriatric nurses for the manner in which they are looking after the patients in extremely difficult conditions. There is need for many more geriatric nurses. We have a commitment from the Government to care for the old and the unwell, but when accommodation is needed for the old it is not available and it causes enormous family difficulties. Many of the hospitals attached to the Eastern Health Board have half built, unfinished units which could be used to house geriatric patients.
The Board shall carry out such functions, other than the functions assigned to it by this Act, as may be assigned to it from time to time by the Minister in  relation to nursing education and training or other matters relating to the practice of nursing and the persons engaged in such practice.
It seems to me that the nursing board have established an excellent training record. The nurses have provided a first class service when they were allowed to do it and when employment was there for them. All over the world Irish nurses are welcomed and the contributions they have made in Third World countries on a voluntary basis have brought enormous credit to them. Now the training they will get is to be monitored by the Minister. He is taking powers he is not entitled to, particularly in view of the record of the profession. The Minister has taken other powers in other sections, and Deputy O'Hanlon dealt with that issue adequately. The amendments he will put down will show where the feeling is for the nurses and the medical profession. Once again this Bill exposes the weaknesses and inadequacies of the Government and their favouritism in respect of private medicine. The whole approach of the Minister is backward, and it will set the nursing profession back many years. He is taking too many powers to himself.
In the past 15 to 30 years our nurses have brough credit to their profession. This House has confidence in the nursing board for the way they have done their duties, but the Minister comes in now and takes away the powers they have. This is typical of the lack of confidence being generated by the Government, lack of confidence in anybody to do the work but themselves. They are making a mess of the nursing profession by this Bill, which is nothing more than a hotch-potch of loose ideas that does not give any significant acknowledgement to the contribution of nurses. The Donnybrook set to whom the Minister plays second fiddle regard everybody else as an inferior human. In his speech the Minister said: “I feel it desirable to vary the composition of the board”.
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