Dan Neville (Limerick West, Fine Gael)

I welcome the opportunity to speak on the Bill. I raised some issues last night with the Minister of State at the Department of Health and Children, Deputy Seán Power, who has agreed to examine them and I am awaiting a reply.

Doctors are often criticised for refusing to make a complaint against a colleague. It is sometimes believed that this is the result of an old boys' club approach. However, it has more to do with the fact that they have no protection in law if they raise issues of concern. The Dr. Neary affair was a case in point. That issue came to public notice because two student midwives, who had trained in Northern Ireland where is a different legislative framework, were horrified by what they saw taking place in Our Lady's Hospital in Drogheda and complained to their supervisor. The matter came to light when the supervisor took the complaint further.

Why are consultants, who are very important and powerful people in hospitals in their own right, afraid to report their colleagues even to the Medical Council? The main reason is fear of litigation. If one cannot prove an accusation, one may find oneself in the High Court even if the allegation is true. Hearsay and circumstantial evidence are not sufficient. One must be in a position to demonstrate a problem exists. If one is proved wrong, the accused person can sue for defamation, even if the information is true but unproven. This creates a serious gap in ensuring safety in hospitals and that issues that arise from time to time are addressed are reported.

The Minister must address the absence of political and administrative support for consultants and other medical personnel who make a complaint and find themselves out on a limb as colleagues close ranks. Legislation on the medical profession, including this Bill, does not protect patients or doctors because it is ineffective when those at the top show weakness or lack of leadership. Fundamental changes are required to make this type of legislation work. The Bill is too reliant on people being genuine and well intentioned. We must bear in mind that if someone wishes to play the legal system or has ulterior motives or another agenda, the legislation will fail those it is meant to protect. For this reason the Government should consider the introduction of whistle-blowing legislation.

It may transpire that a complaint made against a person is not completely true. Many such cases have become before the Medical Council which receives a large number of complaints about medical practitioners. Patients, for example, complain about the manner in which they have been treated by doctors. This is quite a regular occurrence. Many of these doctors are caring and considerate people and can be very upset and badly affected by complaints made against them. Such complaints are not always malicious as patients may genuinely believe they have been badly treated. Even if it is shown by the Medical Council that the doctor was not negligent or incompetent and is declared innocent after 12 months or so, the doctor still feels wronged if it takes 12 months to vindicate his or her good name.

There is nothing in place at present to protect consultants who make a complaint, even if the complaint is not substantiated in the long term. This is the case throughout the public service, including the Garda Síochána, the teaching profession and the medical profession, from psychotherapists to chiropodists and all the professions the Minister has included in the Bill, as well as those that will seek registration on the new body. We do not have a proper mechanism to enable people to make their views and concerns known without having to worry that if they put their concerns in writing or make a complaint, a lily-livered or weak-hearted administrator will release the information.

Legislation is the way forward. I therefore welcome the Bill. There is far too much ad hoc regulation of the health care professions. I have been concerned for some time that somebody can call themselves a counsellor, put up a plate and operate as a counsellor without any training. There is very little regulation of such people, whether they are marriage counsellors, career guidance counsellors, bereavement counsellors or any other type of counsellor, and that can be quite dangerous, particularly where a person is in crisis. We have heard scary stories from time to time regarding the advice given by counsellors to people and the lack of proper regulation of such people who sometimes charge well. People inside and outside the House are also aware of complaints regarding people involved in alternative medicine claiming they have cures for cancer and so on. Large amounts of money are charged by such people on questionable grounds. There is a need to ensure there is regulation of this area and that penalties apply where there is abuse.

Some professionals believe they have been left out of the legislation as some titles are not specifically mentioned. One of the most important issues to arise since the introduction of the legislation relates to the title of physical therapist. Most of us have been contacted about this issue and we have received correspondence on it. It must be addressed on Committee Stage. If it is not resolved before the legislation is enacted, the title of physical therapist will remain outside the Bill's scope, thus creating more problems in the future. The Government should take the bull by the horns and deal with this issue now as it will arise in the future. I look forward to a more detailed discussion on Committee Stage.

A number of other organisations are omitted from the scope of the Bill. Given the complexity of medicine and the many qualifications now available, many other bodies will seek to be included in the legislation. In the same way as the Medical Council has given the medical profession status, patients want all health care providers to be covered by governing councils. The public will think those who are not included in the legislation are alternative or unqualified practitioners. That will have a detrimental effect on many people with qualifications who believe they should be included in the legislation. We must reduce ambiguity to serve the public interest and the Government must legislate for alternative practitioners at some stage. It is becoming so complex that people do not know where they stand.

Psychologists are included in the Bill. However, some people call themselves psychologists and counsellors. We must clarify the qualifications required in that regard. People who qualify as psychologists have studied at a third level institution for a long time. They may be left out of the legislation, although we currently consider them psychotherapists. These people often have qualifications other than those attained at university. Others who do not have a qualification will also be left out. Perhaps the legislation could differentiate between patients and doctors because they do not know the qualifications of those described as counsellors and psychotherapists. It is a profession and it should be included along with the other 12 already mentioned in the legislation. Are there any means to consider that? If that group is established and meets the rules, can the Minister issue a regulation to include it in the legislation?

Perhaps a regulatory body with 13 members will have to be set up. How would that fit in with the council proposed by the Minister? Would it be difficult to nominate a member to the council? The majority of the 12 organisations mentioned participate in the public service. Perhaps the Minister believes that once they are covered, the public service remit will have been fulfilled. Does the Minister intend to look after the other bodies which do not have a public service role?

We often ask about the definition of a medical scientist. It was stated that it is included in the Bill. Is it someone working in a pharmaceutical company, a laboratory or a hospital or is it a science graduate who is perhaps doing controversial research on embryos in a university? Perhaps this issue should be teased out on Committee Stage. We must bear in mind that there are also external factors to be considered. If someone is carrying out stem cell or embryo research, will he or she come under this legislation? Would he or she break the law if he or she did something which this House had not approved?

Has the Minister named the representative bodies of the 12 professions mentioned in the legislation? Physiotherapists are represented by two organisations which will be nominated as being responsible for looking after their needs. Many of the bodies have at least two representative organisations and there could be conflict if one is chosen over the other. We must examine this issue on Committee Stage because the Bill is not clear in that regard.

All the organisations mentioned by the Minister are involved in either the health or social welfare services. Why then are the ministerial nominees of these bodies named by the Minister for Enterprise, Trade and Employment and not by the Minister for Health and Children? I am interested to hear the Minister's response in that regard.

The sections of the Bill on registration, education, training, complaints, inquiries and disciplinary procedures are welcome. They follow the criteria used by the Medical Council on making complaints. The council, however, is moving towards all professional conduct committee hearings being heard in public. That has created anxiety for members of the medical profession because if a committee hearing is held in public, it will be reported in the media. If the committee finds that all charges are baseless, the media will not report that. There is no story if someone is innocent, only if someone is found guilty. The media is not obliged to report a story if someone is found innocent. However, in the interests of balance and fair play one would like to ensure that information about a person who has been publicly subjected to charges or suggestions about their profession but who has been found innocent is fully reported.

Many professions will find themselves in a unique position when complaints are made about them. It is difficult for patients to get a hearing. Many of the professionals will be surprised when this legislation is enacted. At least the health committees will be held in private because they will deal with emotional subjects for everyone involved.

We would welcome a statement from the Minister on the number of professionals available in the psychiatric services. I am talking about psychotherapists and occupational therapists who are important in that area. The Irish College of Psychiatrists has informed us that 70% of its psychiatrists do not have a psychotherapist available to them. Some psychiatrists handle up to 600 patients at any one time. One psychiatrist told the Oireachtas Joint Committee on Health and Children that. We would welcome a debate on the need for multidisciplinary psychiatric teams to deal with hospital and community psychiatry.

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