Liz McManus (Wicklow, Labour)

Many people will be surprised to learn that many disciplines in the health sector are not already regulated by law. This Bill has taken a long time to come before the House. It has been mirrored in the long wait for the medical practitioners Bill, sought for many years. I only hope we are not going to have the same drawn-out process for legislation to establish an inspectorate of institutions caring for the elderly. Unfortunately, the track record indicates these matters take some time.

The Bill presents an elaborate structure with 180 appointments to be made. The Health Service Executive does not have a role in this, although it was established to manage the health service, implement Government policy and ensure services ran in a streamlined way. Instead, the Minister for Health and Children will make the bulk of appointments and, in some cases, with the consent of the Minister for Enterprise, Trade and Employment. This type of structure provides rich and fertile ground for Fianna Fáil and the Progressive Democrats to extend their patronage far and wide.

We need to be conscious of this when ensuring best practice is followed. The record is not very reassuring, particularly when the Minister has total power in making appointments across a whole swathe of disciplines. In recent times, we saw the former Minister for Health and Children, Deputy Martin, refuse to accept any responsibility for duties he should have discharged and clearly did not. It does not augur well, not because the legislation is wrong but because we have bad government in good times. This presents the possibility of extending that bad government into new areas.

The complaints procedures set out in the Bill have been carefully thought out. However, it shows up that, for some time, there has been a lacuna whereby there is no complaints authority. Legislation was promised but was absorbed into the Health Service Executive. It is difficult for people to see where and how they can make a complaint against any treatment or care they have received.

Already the Bill's terms will have to be extended because so many disciplines have developed at community and primary care level for which provision must be made. We all recognise this is a process that must be continued. One example is the role psychotherapy plays in health care. It is being widely availed of where people can afford it. It plays a significant part in providing therapy for people and it needs to be recognised in a statutory way.

The points made about a whistleblowers Bill are valid but have not been answered. Recently, the Minister of State at the Department of Finance, Deputy Parlon, said that a whistleblowers Bill was proceeding when he rejected an amendment to the Civil Service Regulation (Amendment) Bill. On the other hand, both the Tánaiste and the Minister for Finance said on the Order of Business that the Government had determined there would be no whistleblowers Bill. Instead it will be done on a sectorial basis. The Government cannot have it both ways. By trying to do so, it is simply looking foolish. That is not to reduce the importance of the issue. The Labour Party presented the Government with an opportunity to provide a much-needed whistleblowers Bill. However, it is regrettable that this state of affairs continues. When one examines health care provision, we have terrible examples of where whistleblowing would have saved people from suffering and, in some cases, death. However, this did not happen because people felt unprotected and unsure about their rights.

In general, I welcome this legislation which seeks to introduce a system of statutory registration for health and social care in Ireland. The stated purpose of this Bill is to establish a system to ensure that members of the public are protected and informed so that they may be confident that the professional providing the service is properly qualified, competent and of good standing. It is vital that the legitimate concerns of members of the public are addressed and legislated for in this way. The proposed system rightly seeks to ensure professional conduct and the promotion of a high standard of professional education and training among health and social care professionals. A health and social care professionals council will be established to facilitate this.

No one would argue with the stated aim of this council, which is "to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions".

All this is to be welcomed by both the public it seeks to protect and the professions it targets as it will help to ensure the protection of their name and reputation and offers a new level of transparency and accountability. The Labour Party's health policies and documents have long advocated a health service that delivers the best quality of care efficiently to all citizens as a right.

However, there are issues of quantity as well as quality which the Government must address and which are not covered by this Bill such as the delays caused by a shortage of occupational therapists at health board level and the costs levied, at times unfairly, on medical card patients for scarce chiropody services. It is not acceptable that there is a wide variation in the level of services available in different parts of the country. While there are instances — this requires further clarification — where medical card holders are entitled to community care services, it is not always possible to get the required services. Community care services include the public health nursing service, home help, day care, respite care and so on. These are the services which one would normally consider to be community care. The rules about which community care services must be provided differ in accordance with the different services. In some cases, health boards are obliged to provide services, while in others, they have discretion about whether to make the service available. This entire area must be clarified and clear guidelines must be published.

There is a lack of clarity about eligibility and entitlement to the services. Health boards were established to provide certain services, set out in statute. That function now belongs to the HSE. The omnibus term "health and personal social services" is undefined but is used to cover all services provided under previous legislation.

On the one hand, Members are familiar with the issue of health services to which there is statutory entitlement but which are not provided, while on the other hand, the statutory basis of some services which are provided by the HSE is uncertain, to put it mildly.

The Department of Health and Children appears to be aware of the problem and there are hopes it will address it in a comprehensive way, in the context of a general updating and clarification of the health service framework. My concerns are, first, that chronic structural problems, which are left unresolved, are prone to explode in an acute manner. The nursing homes debacle must have taught us that. Second, the programme of health service reform seems to have concentrated on assessing what services need to be delivered and what mechanism should be adopted for their delivery, to the complete exclusion of the question as to what services must be delivered by statutory mandate and the need to review and update that mandate.

I do not argue that unauthorised personal social services should be immediately cancelled. On the contrary, these are vital services and are provided for people with the highest degrees of dependency. My point is that the failure to legislate properly can only result in ad hoc, non-statutory service provision that is piecemeal, disjointed and entirely inadequate to satisfy widespread unmet needs.

I wish to conclude this point by quoting from the famous legal opinion on nursing home charges provided to the South Eastern Health Board in October 2002: "It is a remarkable feature of the health services in Ireland that such vast sums of money are expended on a system, the statutory basis for which is so confused and haphazard and where practice seems so dislocated from statutory theory."

I will now address some other outstanding issues concerning this Bill, which it is important to put on the record. The Irish Society of Chartered Physiotherapists, the professional body representing physiotherapists in Ireland, has expressed its concerns to me regarding the issue of protection of title. Since the early 1980s the ISCP has worked with successive Ministers and departmental officials regarding statutory registration for the profession and hence for the protection of the public. However, due to the slow progress of this work, the present difficulties have arisen, which essentially pertain to the use or lack of use of the term "physical therapist".

There are grave concerns about the issue of title as it appears in the present Bill and there may be serious implications to the detriment of the public which it does not address. These must be considered further and the Government must address it when we deal with this legislation on Committee Stage.

Within Great Britain and Northern Ireland and possibly some other countries, the titles "physical therapist" and "physiotherapist" apply to the same profession with the same professional qualifications. The titles are interchangeable and the professional qualifications and requirements are the same for both titles. This possible area of confusion must be addressed.

In Ireland in recent years a group of practitioners has begun to use the title "physical therapist". In the absence of relevant legislation protecting title up to now, Irish physiotherapists could not prevent this perceived misuse of their associated title. The use of the title "physical therapist" in Ireland by a group with less education and training standards has led to confusion among the public. Members of the public have, it is claimed, contacted the office of the Irish Society of Chartered Physiotherapists to find out why their physical therapy fees had not been reimbursed by VHI or BUPA, only to discover that the practitioner they attended was not a physiotherapist. This is a possible area of confusion in the public eye concerning the two practices.

The ISCP commissioned Millward Brown IMS to carry out a survey of public opinion on this issue. The results showed that only one person in every three surveyed stated that he or she knew the difference between a physiotherapist and a physical therapist, the latter title being that used incorrectly in Ireland at present. The results also showed that more than one in four believe that a physical therapist requires a university qualification, which is not the case. When representatives of the older population were asked how similar or different they thought a physiotherapist and a physical therapist might be, half of those aged 65 and over answered that they did not know.

This demonstrates an even greater degree of confusion among a potentially more vulnerable, older population. The ISCP believes that the best way to protect the public would be to protect both titles for the profession of physiotherapy in Ireland in the Bill.

There are differences between the two bodies currently practising in Ireland, both in terms of the level of education requirements and the extent of involvement and interaction with the medical profession and other allied health professions.

While the ISCP states that it respects the rights of the groups currently calling themselves "physical therapists" to practise and to their livelihood, the issue is not about livelihood or practice but the use of title and the confusion it causes.

The practitioners who have adopted the title "physical therapist" could continue to carry out their practice, possibly under a different title, because they also have legitimate concerns which no one would disregard. However, confusion of this type does not benefit the person availing of the services and it is important that this is not disregarded by the Minister. Various arguments have been put forward about using different titles such as "State registered physiotherapists" or "certified physical therapists". This is an area that we must address.

Senator Henry raised an issue highlighted by the Society of Chiropodists and Podiatrists in Ireland. While an amendment to delete the word "chiropodist" and substitute the word "podiatrist" was not accepted by the Minister of State at the Department of Health and Children, there was some confusion over the issue. The reason for the proposed amendment from the Society of Chiropodists and Podiatrists is as follows:

The reason we seek to have this amended is that professionals wishing to register are required to have a Bachelor of Science in Podiatry — qualifications required by existing practitioners, thus it would be anomalous to retain the name "Chiropodist" only. Both titles have been in use for over 20 years now. This degree qualification has succeeded the Diploma since the early eighties. If the name Podiatry is not so well known in Ireland this is because we do not yet have a School of Podiatry in Ireland and those wishing to study Podiatry do so at one of the Universities in the UK. Recent legislation in the UK has protected both titles "Chiropodist" and Podiatrist". Indeed we risk losing Irish graduates in Podiatry to the UK.

I would have thought such a Bill would have provided an opportunity to deal with that type of practical issue of title.

There are 12 professionals the Minister of State mentioned. They are all core professionals within the primary community care sector and are employed in the acute hospital sector. They have been selected for registration in this Bill because they are long-established providers of health and social care. In most instances, they have a system of self-regulation. However, it leaves scope for concern about the newer and increasingly popular disciplines of which people are availing, whether counselling or therapy. We need to discuss how standards are to be maintained in those areas which are relatively new, but which are growing and can be of benefit to many people who seek them out. However, people need some type of safeguard that the service of which they avail meets best practice and is regulated in a way that will protect the patient in terms of care. One hears stories of counsellors who are not properly trained and who in some cases do more damage than good. There are enough examples in the area of complementary medicine, of serious misdemeanours and damage being done which is not good for complementary medical practitioners and people in the area of complementary health who are trying to maintain good standards, to provide a service and who are seeking registration and regulation to protect their particular discipline.

The university providers of the State's four professional social work education and training programmes have also raised concerns. Again, while they welcome the registration and public protection aspects of the Bill, they have raised concerns about the implications of the Bill for social work education and accreditation. Social workers represent one of the largest groups among the 12 professionals covered by this Bill and is the only group to have an established statutory qualifications board as opposed to self-regulation.

The National Social Work Qualification Board has developed highly respected standards, procedures and expertise in the monitoring and regulation of professional education prior to awarding professional qualification. It has also developed its other functions of assessment of non-national qualifications, strategic manpower planning, research into the education and training of social workers, facilitating cross-border mobility, provision of induction training and the collection and publication of statistical information. There are concerns that the proposed social work registration board could have significantly reduced functions, capacity and resources in comparison with the NSWQB and that this change could have a detrimental effect on social work education and, therefore, ultimately on the quality of social work services. Disruption or delays in strategic manpower planning and accreditation of non-national qualifications may also generate considerable costs for public bodies and employers. This is an important point.

The area of social work has expanded enormously and, generally speaking, people will recognise the universities have performed an important role in developing that sector and in ensuring good standards, research and planning. It would be most regrettable if the impact of any change in the law was to downgrade standards. When statutory change is being made, there is always the possibility of an impact where a highly developed sector is being regulated or registered for the first time.

There are many examples of people who have, or who have tried to come here from abroad to work but who have faced all kinds of obstacles. Nurses, doctors and other health professionals from abroad, who we desperately need, cannot get registration to practise here for one reason or another. Most of us will have had the experience of a highly qualified health professional coming to our clinics to say he or she cannot get over a particular hurdle even though he or she has something to contribute. It may not be the fault of the Medical Council — there may be other reasons. It is an aspect of the registration of health professionals that we need to keep in mind now that we are living in this new Ireland with the new Irish. The multi cultural basis of much of our health and social care service is something of which we need to be aware. Generally speaking, it is something I welcome. It is wonderful to see people coming here providing us with the expertise. Irish people, particularly in the nursing profession, return the compliment. However, we need to ensure standards are maintained, registration is in place and people are not disadvantaged or exploited because they were not born and reared here.

This is a good, practical step forward. It is certainly a slow step in that we have been waiting a long time for it. However, generally speaking, there is support in this House for this type of regulation and registration. However, it places a responsibility on this Government. I go back to the point I made earlier about Government appointments. We need to see a serious commitment to ensuring best practice and the highest standards and that applies to Ministers, how they make appointments and how they live up to their obligations. Regrettably in the Department of Health and Children in particular there are serious questions about Ministers' lack of responsibilities and the resultant cost to the taxpayer, which was of enormous proportions. I hope in this instance, we will see legislation that will be of benefit not only to taxpayers but, specifically, to people who avail of services. People should be confident that they will get a good service from a competent, registered practitioner and that if something goes wrong — inevitably things go wrong but I hope they will go wrong with less frequency when this legislation is in place — proper recourse and safeguards are in place.

See this speech in context