Pat Carey (Dublin North West, Fianna Fail)

With the permission of the House, I wish to share time with my colleague, Deputy Devins.

I welcome the opportunity to speak on this Bill. The statutory registration of health care professionals is a necessary and welcome development from all points of view. It will benefit practitioners and the general public alike. I wish to respond to a point made by Deputy Catherine Murphy in her contribution with which I agree. The registration is but one aspect of this matter and I had intended returning to it during my remarks and I hope to do so.

Apart from registration, which is acutely important, yesterday's High Court judgment regarding autism highlights the need for ceilings to be lifted in the numbers of occupational and speech therapists being trained. Even more urgent is the need for relevant sectors to talk to each other. Independently the education and health sectors do significant work. However, Deputy Catherine Murphy has outlined the situation in Kildare and the same applies in my area. While there is considerable goodwill to provide services for children with autism it is proving quite intractable to get coherence in the provision of services between the Departments of Education and Science and Health and Children. Even with the enactment of the Bill we urgently need protocols so that what happened in the High Court yesterday does not continue to occur. Significant numbers of children with conditions across the autism spectrum are in need of support and the sooner those protocols are put in place the better.

The statutory registration will give recognition by an authorised body to all members of the relevant sectors and pronounce them as competent to practise within that line of work. By placing registration of the listed professions on a statutory footing, the Bill will give these professions the commendation they deserve. At present, only a handful of health care staff are subject to statutory regulation, including doctors, nurses, dentists, opticians and pharmacists. This new system will regulate the activities of a further 12 separate professions involving more than 11,500 people in the public sector and thousands more in the private sector. While I support the Bill as published, I take this opportunity to show how this may guide and direct us as we tackle some of the more contentious areas of the health care sector.

The legislative framework before us will allow for the appraisal and approval of education and training courses, examinations, qualifications and institutions, and ensuring the proper and timely development of education and training facilities. Improving quality in the health care system requires implementation of internationally recognised and evidence-based guidelines and protocols, and ongoing education and commitment from health care institutions and professionals.

An example of the need for coherence is in the service delivered by chiropodists. At least two organisations represent chiropodists with two avenues for qualification. In Dublin it is proving very difficult for medical card holders, particularly older ones, to get chiropody services. It is now common for chiropodists to charge a top-up fee of up to €15 in addition to the GMS fee paid by the Health Service Executive. Despite my attempts and those of many colleagues in the House to raise the matter in various ways, all I have ascertained from parliamentary questions is that the Department of Health and Children wrote to the HSE in January reminding it of its obligations in this area. While it may be a small and niggling matter in the context of the overall budget and service delivery of the Department of Health and Children, to the recipients of that service it is extremely important.

While I congratulate the Tánaiste and Minister for Health and Children on the proposal, I call on her to consider the number of college and training places compared with demand in these areas. For example, when I see that psychologists, social workers and social care workers are included on this list, the first thing that comes to mind is the dire need for increased staff and services for adolescents, particularly in counselling services, and for families, particularly in family conferencing facilities. When we consider the level of adolescent suicide or the increase in anti-social behaviour, this regulation should aim to improve services in this regard.

I again reiterate the urgency of providing greater numbers of places for those who wish to train as occupational and speech therapists. I also highlight the significant lack of provision of psychiatric services for adolescents, which is completely inadequate and needs to be addressed. We also need to address the issue of psychiatry for older people. The referral procedures are extraordinarily complicated. While I am sure these are appropriate and ethical, I know of a reclusive couple who everybody recognises are in need of psychiatric intervention. However, because no general practitioner referral has been made, the consultant psychiatrist for the HSE is not prepared to intervene in their case. These people live in appalling conditions. I have rarely if ever come across anything like it before. It is incumbent on the HSE to be able to direct professionals to intervene in serious cases of abject neglect such as this one.

I appeal to the Tánaiste the urge these new bodies to increase both the number of courses that give recognition to these professions and the number of courses that are approved to remove the cap on numbers taking these subjects. The legislation also allows for greater consistency in the application of EU directives concerned with the mutual recognition of third level qualifications. I know this has caused disruption in many of these professions and in many more. Therefore, by including it in this legislation, it will inform how best we can go about such recognition in other areas. While the mutual recognition of qualifications has been addressed reasonably well in the education profession, it has been dealt with unsatisfactorily in many others and some significant gaps need to be filled.

As outlined in the 2001 health strategy, gaining people's trust in a health system is about guaranteeing quality. Statutory registration such as this is in line with this goal as it guarantees that people receive proper treatment when they enter a particular practice. People want to know the service they receive meets approved and certified standards. This system will ease their legitimate concerns that they are visiting health professionals who are properly trained and competent to look after their ailments or injuries. Extending this statutory registration to other professions will increase the trust the public has in our health care system.

The Bill is also good for the professionals as regulation will protect their good name and reputation and allow them to stand over their titles. Established professionals are not afraid of being part of a regulatory system whereby they must uphold standards because that is what is meant by being a professional. Many realise that the good name and reputation of the majority can be damaged by the actions of a very small minority and that a profession can be brought into disrepute without a mechanism for sanctioning professional misconduct and misdemeanour. In this way, the Bill gives the professionals and the public protection from those working in specific health areas without any proper qualifications and from those who provide substandard or questionable services.

Extending this system to other areas will provide the same protection. For example, we are all aware of the tragic death of a Limerick woman earlier this year following plastic surgery in New York at the hands of someone who was under investigation for negligence at that time. We all want to ensure that such tragedies are prevented and, by ensuring that all major health care professions are adequately trained and regulated, we can achieve this. I also note what Deputy Cowley said about people in the non-medical area.

A proper registration system gives the public and the professions increased protection because it allows for the investigation of allegations of misconduct or incompetence. Any complaints can be followed up and rectified and in an extreme case a person's name can be erased from the register.

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