John Dennehy (Cork South Central, Fianna Fail)

I also welcome the opportunity to speak on this important Bill in the area of health care regulation. I am happy the Fine Gael spokesperson has welcomed the Bill. We should all work to improve this area. I am sure issues will arise which will have to be teased out on Committee Stage.

The Minister of State, Deputy Seán Power, told us last week that the Bill will provide a system whereby individual members of the 12 listed professions will be certified as competent to practise. Unlike the present voluntary system, this will be a legally binding process with a mechanism for the prosecution of offences. That is an important aspect of the Bill. We were told its establishment would bring a system of statutory registration which we all agree is essential to ensure that members of the public are guided, protected and informed so that they can be confident that the health and social professionals providing services are properly qualified, competent and fit to practise. The system will ensure professional conduct and the maintenance of high standards of professional education and training among health and social care professionals. The statutory registration of the 12 health and social care professionals listed, regardless of whether they work in the public or private sector or are self-employed, is long overdue. This work has been ongoing since at least 2000. It is critically important legislation for the reasons outlined by Deputy Neville and others.

I welcome the fact that the legislation will cover the private sector and the self-employed. Many of us involved in the public health care area have been concerned for many years about the lack of control over people who set themselves up as professionals, particularly in the private and self-employed sectors where few or no checks are carried out. There are concerns about several professions, especially those dealing with clients accessing mental health care such as psychologists and counsellors. Whether coping with alcohol or drug problems or other psychological difficulties, clients are especially vulnerable to coming under the care of people who do not have the professional expertise to deal with their problems and who are not, to put it mildly, best qualified to provide assistance.

My focus in considering the Bill is the need to protect the public from a medical care perspective. In that context, I notice the expression of concern by the Competition Authority about restrictive practices that might emerge on foot of the passing of the legislation. While medical care must be the overriding concern of the Oireachtas, I acknowledge warnings in the authority's report that professions may be able to manipulate the conditions of entry and the numbers being trained for their own benefit. The Committee on Health and Children has spent the past few years attempting to deal with orthodontics but the vested interests have beaten us until now. They have been able to manipulate matters to the extent that there are so few practitioners that the cost of treatment has become prohibitive. As I have said, however, our priority must remain the health care aspects of the legislation. Restrictive practices can be dealt with elsewhere and at a later date.

On 28 October 2004, the Taoiseach announced the publication of the Bill and said the purpose of establishing a regulatory system was to ensure that members of the public would be guided, protected and informed to give them confidence that health and social care professionals providing services are properly qualified, competent and fit to practice. The worries of the Competition Authority about pricing can be addressed later, but it is the job of the Tánaiste and the Ministers of State, Deputies Seán Power and Brian Lenihan, to ensure that purely health issues are dealt with in the legislation. I agree with Deputy Seán Power and the Tánaiste that the legislation is a key action in the health strategy on quality and fairness to expand and strengthen the regulatory environment in the health sector. It is long overdue. Like Deputy Neville, I am worried by the emergence of alternative medicine and practices and, in particular, by the proliferation of people who describe themselves as professional counsellors. It is imperative to introduce controlling mechanisms in these areas.

The Tánaiste described the system of statutory regulation proposed in the Bill as open and transparent and characterised by strong public interest representation that will serve to enhance the quality and accountability of health and social care services provided to the public. While most people will welcome her statement, the IMPACT trade union has expressed concerns as the representative body for quite a number of those who will be regulated under the legislation. IMPACT argues that the professions have waited for the legislation for a long time and makes a case, rightly or wrongly, that its members are being treated as second-class professionals within the health service.

IMPACT says there is no good reason for introducing different approaches for different professions and cites the example of the Irish Medical Council and An Bord Altranais, which regulate doctors and nursing staff, respectively. The majority of members of the boards of those bodies are members of the relevant professions. While I may have misread the report and the earlier documentation from the Tánaiste, I got the impression that the report was the first of three and that arrangements for the medical profession and nursing will also change. I understand the Tánaiste intends to bring forward further proposals to ensure that everyone is treated in practically the same way or according to the same criteria. I would appreciate a comment on that from the Minister of State in his reply. While I appreciate the need of trade unions to ensure their members are treated properly, IMPACT's concern is misplaced if it relates to the ratio on a board of members of the profession to people appointed from outside. While serving on a health board for many years, I found that a very fair balance had been struck. A 6:7 breakdown on registration boards is not too bad.

Unlike the Ceann Comhairle, I am not qualified to decide what is required in a good counsellor or therapist. I respect fully, however, the other professions listed in the Bill and am concerned about the untold damage a quack could do practising in mental care. Some of the people who have gone into the area have a chip on their shoulder. Some who have earned degrees or status in other walks of life have simply put a plaque on the wall and immediately become professional counsellors. If a person does not have relevant training, even if he or she holds a related degree, he or she should not be in a position to function as a professional in the discipline in question. It is the duty of the State to ensure that cannot happen in the health care field.

Deputy Neville mentioned the significant changes that have taken place with the development alternative medicine and the split in specialisms. I thought a cardiac surgeon was someone who did heart operations, but then I found out there was a cardiac thoracic surgeon. As we have seen professions coin titles in the United States of America at the drop of hat, I fear that practitioners here will simply change title to operate free and easy. There is a need for provisions to control those who might attempt to avoid regulation as a member of one of the 12 professions designated in the Bill. The matter will have to be kept under observation.

I emphasise that I do not take issue with alternative medicine and am not qualified to argue against it. I do not argue against the use by people of faith healing provided there are controls and that people are aware of what they are buying into. Issues of mental health, for example, are simply too sensitive to leave unregulated. A fractured leg is an obvious injury to treat, but matters are much more difficult where mental health is involved.

The debate in this area has been ongoing since at least 2000. The consultative document, Statutory Registration for Health and Social Care Professionals: Proposals for the Way Forward, was published in October 2000. As the matter has been in gestation for quite a long time, it is important to make progress. Deputy Neville referred to a further matter of contention, the representation of chartered physiotherapists by two separate bodies. While the Department will have to make a ruling on who is in and who is out, I sound a note of caution that people with bona fide qualifications should not be pushed aside simply because there is a group with a longer-standing title. The people who are qualified to adjudicate the matter are the officials and line Ministers in the Department.

Each registration board will have 13 members, six to be members of the particular profession and seven from outside the profession to be appointed by the Minister. Each registration board will determine criteria for registration and so on. One of my concerns relates to numbers. With just the first tranche of professions we already have at least 156 people, plus 25 on the health and social care professionals council, plus the chief executive and his or her staff. I am not sure how many more professions it is intended to add to the list but it appears that the final number of people involved will be very unwieldy. I would hazard a guess that it is almost back to the health board figures already. I take the point that each registration board must have a separate group and that each profession must be individually monitored, but there is a significant number of people involved in that. I am concerned that the left hand will not know what the right hand is doing.

It is intended that the chief executive officer would operate between the 12 bodies. We have been there and done that and it does not operate that way. Nobody can keep track of all these people. Will the Minister look at this proposed arrangement to see if it can be made less unwieldy? Speaking from my health board experience, I do not know how it could function efficiently. It was difficult to keep in touch with the three former standing committees on mental health, community care and general hospitals. It was mission impossible.

This is an important document. One section deals with protection of titles. The Minister is empowered to protect additional titles by regulation. That area must be copperfastened. It would be an offence for an unregistered practitioner to use a protected title or to falsely represent himself or herself as being a registered practitioner. Will practitioners of alternative medicine have to come up with alternative names for a particular practice? Will there be a mechanism for ensuring that the practice cannot be one of the listed ones?

The issue of physiotherapists has been discussed. New names are regularly coined in the United States such as sanitary engineers for dustbin collectors and so on. This area must be tightened up. It was stated in committee that people will not be able to work their way around it. As we have seen with all forms of medicine, the public is willing to buy into anything if they have the money. The public must be protected. I accept that the Bill, which is long overdue, is a key action in the health strategy, Quality and Fairness — A Health System for You. It is intended to expand this list. Deputy Neville referred to a few possibilities. I am interested in finding out what is proposed.

Section 9 deals with the 25-member council about which I am concerned. Deputy Neville also referred to the fact that appointments would be made with the consent of the Minister for Enterprise, Trade and Employment. I was tempted to ask him about this when I had lunch with him today but I did not want to spoil his lunch. It is surprising that it is not the Minister for Health and Children.

The coherence and consistency of the system is critical. The intention is to promote uniformity of practice among registration boards. I am concerned that each of the 12 bodies would only look after its own bailiwick. There must be consistency. Deputy Neville expressed concern about the proceedings being held in public. Many disciplinary hearings that should be easily dealt with appear to require the involvement of junior and senior counsel. Very often they beat the system. Natural justice crops up and the courts find in favour of people. I am concerned that with 156 people vying for different things, we could be in trouble in this regard. I would like to hear how this matter would be handled.

In the past, some of the right to practise groups such as nursing groups and the medical board were challenged legally. Deputy Neville outlined how the three statutory committees, the preliminary proceedings committee, a health committee and a professional conduct committee, would operate. It is complicated. I am concerned that, as we have seen in so many cases, the intervention of the legal profession would make it unworkable. Are these powers stronger and how do they differ from the powers of the nursing board or the medical disciplinary board?

In that context, I welcome the fact that in extreme and urgent circumstances the council may apply to the High Court to suspend a practitioner pending completion of an inquiry. There has been a failure to do that in the past in certain circumstances where the outcome was tragic. It is important that people can take the initiative. It is not just business or an environmental issue that may be able to wait. We are talking about health and it is important that we would be able to move fairly quickly.

The battle between the therapists will have to be adjudicated upon but it should be dealt with quite quickly. It is not just the Irish Society of Chartered Physiotherapists and its competitors that are involved. It relates to the area of regulation and of people being able to set up a separate category, separate title and to move on from there.

I compliment those involved in the committee that was set up to examine social care professionals. They have done a great deal and examined the issue of house parents and so on. They have looked at the child care area and having done an audit of the needs, they are willing to train people, which is crucially important. Many people will need training once the legislation is put in place. We should remember that and help to supply that training.

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