John Gormley (Dublin South East, Green Party)

I wish to share time with Deputy Catherine Murphy. I welcome the publication of this legislation of which there are a number of aspects I wish to address. We have waited for this Bill for some time. We also await similar legislation in other branches, such as the medical practitioners Bill for which the Oireachtas Joint Committee on Health and Children has asked repeatedly and which has been called for in this House. Legislation for which I have called repeatedly concerns the area of complementary and alternative medicine. Unfortunately, there is a number of charlatans operating in this area who have given the area of complementary and alternative medicine a bad name. Some tragic cases have emerged where people have been robbed of their money. These were people suffering from terminal cancer who were looking for a cure and were only too happy to dispense with their money. They were ripped off and treated in an appalling way. I will not mention the specific cases; we know them.

People practising in this area have asked again and again for regulation. A committee has met in this regard, of which the Tánaiste is aware. Under the then Minister, Deputy Martin, a group was set up under Terry Garvey to examine this area to enable it to be properly regulated. Practitioners operating in this area want and have sought regulation to enable members of the public to have confidence in their work. We are talking of therapies ranging from aromatherapy to shiatsu and others which have been recognised as having enormous benefits. The benefits of holistic medicine are there to be seen but it requires legislation. People need to know they have some redress.

In this legislation we are giving the client some means of redress. However, like the previous speaker, I have concerns about appointments to a plethora of boards that will now emerge. The Opposition has concerns about perceived patronage in terms of the way these appointments can be handed out. I am not sure what remuneration applies to these positions. I suppose it is a nice way of assisting the party faithful in many cases and such appointments are handed out. There must be greater transparency and accountability in the way these appointments are made.

Much of the discussion on this Bill in the Seanad and in this House centred on the distinction, or lack of it, between physical therapists and physiotherapists. I listened to what Deputy McManus said on this. It must be acknowledged on the floor of the House that we have been lobbied by physiotherapists and physical therapists. It seems to be a case of claim and counter claim. It is important to record all the available information.

This Bill proposes to register by statute 12 named health care professions, including physiotherapy. Physiotherapists are asking to be allowed to protect for their exclusive use the title "physical therapy" in addition to "physiotherapy". The Institute of Physical Therapy and the Irish Association of Physical Therapists are resisting this because they believe it will undermine their existence as a competitor in the provision of physio-therapeutic health care. Physiotherapy and physical therapy have operated successfully here for the past 15 years as distinct entities with distinct training courses, professional representative associations, treatment approaches, functions, scopes of practice and opportunities for employment. Legislation restricting practise might conflict with the constitutional rights of physical therapists to earn a living. This is their concern as the Minister of State is probably aware. The effective loss of the entire physical therapy profession would eliminate competition and restrict the choice of patients without offering them any guarantee of an improved quality of service.

The Bacon report of 2001 advocates the recruitment of physical therapists to hospitals to alleviate an agreed and existing shortage. The removal of up to 350 physical therapists from the health service would worsen this situation for many decades according to the physical therapists.

Irish physiotherapists claim the titles "physiotherapists" and "physical therapist" are interchangeable, yet there has been a clear differentiation between the two separate groups here for the past 15 years. "Physical therapy" and "physiotherapy" are generic titles and should not both be available to one group to own. Appropriation of two titles by one group facilitates regulatory capture. Although physiotherapists argue that internationally physiotherapy is exactly the same as physical therapy, they do not recognise physical therapists from many English speaking countries such as the United States and the Philippines.

The qualification awarded by the Institute of Physical Therapy in Ireland is recognised at home and abroad for the purposes of academic progression and access to master programmes.

The Competition Authority argues that auxiliary professions, such as physical therapy, should be free to emerge which, it says, would not happen in the event of such regulation.

Deputy McManus quoted from what was stated by the Irish Society of Chartered Physiotherapists in its position paper. It stated:

Members of the public often contact the ISCP office to find out why their physical therapy fees have not been reimbursed by VHI or BUPA only to discover that the practitioner they attended was not a physiotherapist. The confusion in the public eye surrounding the two practices is constantly being reinforced to our members through their contact with members of the public.

There is a rebuttal to that by the physical therapists. They state:

This is nothing more than hearsay. Both VHI and BUPA have officially confirmed ... [this was in November 2004] that they have no record of any such claims for reimbursement being made — proof that physical therapists explain the nature of the care and profession fully to their patients.

To return to what Deputy McManus said on this matter, the ISCP commissioned a Millward Brown IMS poll. The idea was to find out whether people knew the difference between a physiotherapist and a physical therapist. The results showed that only one in three people surveyed knew that difference. The point was made as to whether people know the difference between a certified accountant and a chartered accountant or a podiatrist and chiropodist. I confess that in many cases I do not know the difference between all these professionals. Such confusion exists which I fully recognise.

With these differences having emerged over the past 15 years, we face the problem of how we should deal with this issue. We could consider a number of means. I do not know if changing names is possible. The potential for confusion could be minimised by the Irish Association of Physical Therapists and the Irish Society for Chartered Physiotherapists obliging their members to explain their agreed differences between physical therapy and physiotherapy to potential clients at their first consultation. It should be part of the legislation that the differences are made clear. This is what both branches of the professions would like to happen. It is clear that the professional qualifications required for physiotherapy are much higher than for physical therapy. I understand why physiotherapists might feel aggrieved that practitioners are coming in from the side and taking some of their business and that confusion has grown because they have acquired the name physical therapists. It is up to us for the sake of the patient to ensure the differences are clarified. It would not help to have one title for both therapies because there is no question but they are different. An amendment to this effect will be tabled on Committee Stage by Green Party.

As to the fees that can be claimed and reclaimed, members of the public can reclaim physiotherapy fees from the VHI and BUPA has said the position is under review.

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