Thursday, 15 December 2011
Dáil Éireann Debate
Minister of State at the Department of Health (Deputy Róisín Shortall): These are technical amendments to replace Minister for Finance with Minister for Public Expenditure and Reform as these functions have been transferred from the Minister for Finance to the Minister for Public Expenditure and Reform under the recent Ministers and Secretaries (Amendment) Act 2011 and the Finance (Transfer of Departmental Administration and Ministerial Functions) Order 2011 — SI 418/2011.
Deputy Caoimhghín Ó Caoláin: I accept the Minister of State’s explanation on these substituting Minister for Public Expenditure and Reform for Minister for Finance. While I was opposed to the final passage of the Nurses and Midwives Bill because of the inadequacy of the Bill’s provisions for the profession of midwifery, I see no reason to object to these changes that are technical and reflective of the new departmental terminology.
Deputy Róisín Shortall: After the Bill had progressed through the Dáil and prior to its passage through the Seanad, legal advice was received on the need to include more detail on what the board may include on criteria in rules. These amendments are for clarification on this matter.
Amendment No. 3 clarifies what criteria can be used for assessing applications for registration. It provides that criteria can include qualifications, education and training, and relevant competencies for registration, possession of sufficient knowledge of language or languages necessary to practice as a nurse or midwife in the State, requirements for relevant post-registration experience or clinical experience, and any other matters in relation to the setting of criteria that is necessary or desirable for the protection of the public. It is important that this is clarified, in particular, in relation to language proficiency.
Amendment No. 4 sets out proposed amendments to section 13(2)(l) and (m) which provide for the setting of criteria on education and training rules and also the setting of criteria on nurses who have not practised for a time. The amendment clarifies that the criteria in the rules regarding education and training relate to persons seeking admission to education and training programmes, bodies which may deliver education and training programmes, and any other matters in the setting of criteria necessary for the protection of the public.
This amendment also sets out the board’s power to set criteria and conditions for persons wishing to return to practise nursing or midwifery after not having practised for a period, which the board specifies in rules. The criteria or conditions will include the education and training of those persons, possession of sufficient knowledge of language or languages necessary to practise as a nurse or midwife in the State, the manner of verifying that the person possesses the relevant competencies, and any other matters on the setting of criteria that is necessary or desirable for the protection of the public.
Deputy Caoimhghín Ó Caoláin: I want to make a general remark. This is the last Stage in the passage of this Bill. It is important to offer additional clarification on the position my colleague Senator Cullinane took in the Seanad. The Minister of State, Deputy Shortall, will be familiar with his arguments and with those I pursued on Committee and Report Stages in this House.
The concerns of many midwives have not been addressed adequately, as I have stated time after time. The Community Midwives Association made it clear that it felt there was too much scope for misuse and misunderstanding under the Bill, as currently worded, and a recognised lack of consensus among all those involved which was far from reassuring. I re-emphasise that at no point did midwives wish to be uninsured and to leave mothers and themselves open to the consequences. Any suggestion to the contrary is without foundation and false.
It is important to bear in mind that the issue at stake is not about whether one is insured or indemnified but about the current wording and its interpretation. The very real fear is that the insurer, the State, will attach such conditions that will make it impossible for midwives to provide the services they provide today. This is not idle speculation but a real concern. Those with whom I have engaged, who represent the profession of midwifery, are not imagining this. It is very real for them and their profession.
I urge the Minister of State, her officials and the Minister for Health to continue dialogue with midwives and, despite the negative aspects of this Bill, to seek to maximise rather than restrict the role of midwives as key providers of care to expectant women. That is a very reasonable position for the accountable elected representatives associated with the Department of Health to take.
Accepting that amendments Nos. 3 and 4 are, in real terms, adding further detail and are specific to a range of various aspects of both the nursing and midwifery professions, I do not object to either of them.
Deputy Róisín Shortall: The issue Deputy Ó Caoláin raised was very well ventilated during the passage of the Bill through both Houses. It does not fall within the scope of any of the amendments today and, therefore, I understand it is not in order to have a discussion thereon. The HSE and the Department will continue to engage with midwives. They are part of the new set-up. This is ground-breaking legislation and puts nurses and midwives on a new footing in terms of the recognition of both professions. There will continue to be ongoing engagement with them in regard to their vital role in the health service.
Deputy Róisín Shortall: Seanad amendments Nos. 7 and 8 are technical amendments. The term “or permitted”, which is being deleted in subsection (1), was included in the Bill as published to ensure information could be disclosed in regard to the Ethics in Public Office Act 1995. After the Bill had been passed by the Dáil, but prior to its consideration in the Seanad, the Office of the Parliamentary Counsel advised the Department that it should be amended to remove the words “or permitted” and to insert a new subsection to make explicit reference to the relevant sections in the Ethics in Public Office Act 1995. This is reflected in Seanad amendment No. 8.
Deputy Róisín Shortall: This amendment removes a provision that prohibited members of the board or committee members from being members of a local authority. This issue was raised in the Seanad and the amendment was accepted in that House. It reflects amendments agreed earlier in the passage of the Bill through the Houses which removed the provision prohibiting board employees from being members of local authorities. This had unanimous support in the Seanad.
Deputy Caoimhghín Ó Caoláin: I fully support the amendment. Not wishing to be mischievous, I ask why Members of the Houses of the Oireachtas or MEPs are not also included. Why only members of local authorities? I fully support the inclusion of members of local authorities. It would be fair and reasonable for the Minister of State to tell us once more why Members of these Houses or MEPs could not also be accommodated as the amendment proposes for local authority members.
Deputy Róisín Shortall: There would be much potential for conflicts of interest if the people making the legislation also served on some of the public bodies established under the legislation and which were governed by it. This issue relates to a prohibition that existed in regard to the involvement of members of local authorities. There is no reason whatsoever they should not be involved with bodies such as those in question. They perform a very important public role and devote a considerable part of their lives to public service.
Deputy Caoimhghín Ó Caoláin: I agree in regard to local authority members. I was wondering whether the Minister of State had further information on Members of the Oireachtas or MEPs in this regard. It was not that I was putting the case for the inclusion of Oireachtas Members and MEPs, I was just teasing out the question. I fully support the change to allow members of the board to be members of local authorities also.
Deputy Róisín Shortall: This amendment amends section 28 by the inclusion of a new subsection, subsection (7), to provide for circumstances where the CEO is absent or the position of CEO is vacant. In such cases, the board can designate an employee to perform the functions of the CEO.
Deputy Caoimhghín Ó Caoláin: Deputy Kelleher raised the issue of timeframes. Can further information be provided regarding how the board will make a selection from its employees? What is the methodology for the selection process? Can the Minister of State elaborate on what she has already said?
Deputy Róisín Shortall: The purpose of the amendment is to address a situation that is likely to arise where, for example, a CEO is ill for a certain period. Clearly another member of the board would have to take on the functions of the CEO in such circumstances. The amendment enables the board to continue functioning. It might transpire that a CEO dies in office and until such time as the position is advertised and filled, the board would be unable to meet unless another member of the board could be nominated to step into the role in the interim period. It is a temporary arrangement.
Deputy Billy Kelleher: I accept the necessity for the amendment. The only issue at stake is the length of time that an acting CEO could be retained. I am concerned about the absence of a deadline for the appointment of a new CEO.
Deputy Caoimhghín Ó Caoláin: With respect to the Minister of State’s officials, we need absolute clarity on this amendment. Either the Minister of State was correct when she stated that another member of the board would fill the position or it will be, as the amendment states, an employee of the board. These are very different roles. Perhaps the Minister of State can clarify the matter in light of the conflicting information.
Deputy Billy Kelleher: I do not want to be awkward but the Minister of State has not responded to my question about the timeframe. Is it open ended and how long can an employee continue as acting CEO? A CEO could be absent for two months or six months. It would be appropriate to set out a mandatory timeframe for appointing a new CEO. It is not good governance to allow an employee of the organisation to act as CEO for an indefinite period.
Deputy Róisín Shortall: I am not aware of any legislation that sets out the length of time that a CEO may be absent. It is a question of good governance. The amendment provides for the replacement of a CEO on a temporary basis while he or she is absent, for example, on sick leave. If the CEO was absent for an extended period, the board would presumably address the governance issues arising. I am not sure we can set out in legislation the acceptable period for a person to be out sick from a particular role. That would have to be judged by the board.
Deputy Caoimhghín Ó Caoláin: I agree with the Minister of State and I do not intend to speak further on the matter because Deputy Kelleher outlined his argument very clearly. However, if we can determine when a vacant seat must be filled, we can certainly set out when a position of this importance should be filled in the event of a vacancy that is not temporary in nature. The amendment clearly indicates this is not a question of a temporary hiccup. We certainly can set out a clear direction that the position should be filled within a reasonable timeframe determined by the Minister of State and her team. The amendment is flawed in that respect and we are bound as Opposition Members to point out what we believe to be an inadequate measure.
Deputy Billy Kelleher: It is not necessarily the case that the CEO will be absent due to illness. The legislation refers to a vacancy. When a vacancy arises an employee of the organisation could fill in as acting CEO forever and a day. Vacancies should be filled by advertising and recruiting procedures based on best practice.
Deputy Róisín Shortall: This amendment permits another employee to be appointed as acting CEO so that the board can continue to function. It is not appropriate to set a time limit on the length that somebody could be absent on sick leave or for another reason. If the CEO is absent from his or her post for an inordinate length of time, thereby causing difficulties for the board, it is the latter’s responsibility to take action where it believes the period of absence is unacceptable. If, for some reason, the board failed to act it is open to the Minister for Health to instruct to replace the person who is absent. If the post falls vacant, it is the board’s responsibility to advertise for a new CEO. If the board is not performing its duty satisfactorily it is open to the Minister to instruct it to advertise the post and fill it in the normal course. Safeguards have been put in place in that regard.
Deputy Billy Kelleher: I do not want to delay the debate but I genuinely believe that allowing an employee of a company to act as CEO for an extended period of time is not good governance. This legislation could allow that to happen.
Deputy Róisín Shortall: Seanad Amendment No. 17 requires the board to seek the consent of the Minister for Public Expenditure and Reform in addition to the Minister for Finance when borrowing money. This amendment is required due to the functions being transferred to the Minister for Public Expenditure and Reform. The Minister for Finance is not removed because the provisions involve borrowing by a State body, which remains in his remit. In these circumstances, permission will be required from both Ministers.
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