Seymour Crawford (Cavan-Monaghan, Fine Gael)

I welcome the opportunity to speak on this important legislation. Our health and social care and the different professions covered by this Bill provide a vital service to the country. It is important that those under their care can be assured they are fully qualified and trained professionals.

The registration system must ensure that the best possible service is delivered to patients, clients and service users. However, it is vital that the new structures do not have adverse effects on competition in the various professions. I welcome the proposed system of self-regulation that includes members of the professions involved and members of other sectors, including the general public. Registration of health professionals is necessary to ease the legitimate concerns of the general public that they are visiting a health professional who is properly trained and competent to look after them. Registration gives both professionals and the public protection from quacks and non-qualified persons working in specific health areas. Registration can also protect the good name of a profession.

A proper registration system gives the public and the professions protection because it allows investigation into all allegations of misconduct or incompetence. The registration framework of statutory regulation allows for the appraisal and approval of education and training courses, examination, qualifications and institutions, thus ensuring a proper development of education and training across the professions. It also allows consistency in the application of EU directives concerned with mutual recognition of third level qualifications in EU member states.

While section 4 allows for the addition of other health and social care professions in the future, this Bill deals with 12 professions. However, the health service has approximately 35 grades that come within the overall terms of health and social care. Will this section also allow the registration of specialties or will this issue be left to the registration boards? Health and safety officers were included in the initial consultation process and I ask the reason they are not included in the provisions of this Bill.

Physiotherapists as a group seem to be more concerned than most regarding this Bill. I have received representations from physiotherapists in the past week and also representations from the physical therapists. They are anxious regarding the protection of title of their professions. Many members of the public consider the two professions to be the same but this is not the case. Efforts to have the two separate titles included in section 4 were not accepted. I ask that the Minister consider this matter again to avoid confusion. I received a letter today from a constituent who has a degree but is now in his third year as a student of physical therapy. He believes his study and work should be recognised in its own right. In his opinion, the role of physical therapist should be recognised and the position should be clarified. I am currently receiving treatment from a physiotherapist. I am biased in that direction as she, hopefully, is doing an extremely good job.

In dealing with health and safety aspects related to the legislation, I cannot but refer to the recent controversy about nursing homes. This was obviously a case where lack of supervision brought an important sector into dispute. It was shown by the "Prime Time Investigates" programme and other reports that individuals in different professions have failed completely to honour their role in regard to patients and thereby damaged the credibility of the whole system. It is vital that new criteria are put in place to make sure that this neglect does not happen again not only for the sake of the elderly and the disabled in the long term but also for the credibility of the health service.

There seems to be no measure in the Bill to protect consultants or others who may make a complaint. One cannot but reflect on the extremely serious incidents that happened in Our Lady of Lourdes Hospital in Drogheda in my health board area, as it used to be known. For years practices were not reported as people were afraid to report them because of what might happen to them. There is ongoing litigation and a demand for an inquiry into those incidents. This Bill, prior to being passed, must provide that where a consultant or a practitioner at that level believes it is necessary to make a complaint, he or she can do so in confidence to ensure that at least such a complaint is investigated so that the highest standards of health care obtain. I urge the Minister of State to examine that aspect of the Bill.

Having met the victims of the controversy in Our Lady of Lourdes Hospital, Drogheda, on numerous occasions, I have nothing but admiration for the courage it took for those people to raise these incidents. However, one must be concerned about a system that allowed such practices to continue for so long as a result of which many people suffered.

I want to refer to a number of remarks made by the Tánaiste on the Bill in the Seanad — I do not believe she spoke on it in the Dáil. She said this is the first of three Bills to reform the regulatory environment for health professionals, with legislation for medical practitioners and nurses to follow. It was pointed out that we have been waiting for this legislation for almost 20 years. It is important that these are not only fine words but that there is a follow-through on this commitment and that the other Bills will be enacted. The Tánaiste said that the vision adopted in the strategy for our future health system set great store on treatment, treating people with dignity and respect. She said that the health strategy envisaged that action would be taken to strengthen the customer focus of service providers. Those are fine words and if one were not dealing with some of the cases with which I and my constituency colleagues are dealing in Cavan-Monaghan, where there is a shortage of professionals and a lack of services, one would not be so concerned. When dealing with a case such as one I dealt with the other day where a person could not be treated in Cavan hospital due to the shortage of personnel because of an internal problem rather than a shortage of professionals, one realises the serious nature of the problem. The Tánaiste said that there must be a patient-centred approach to the delivery of services, with which I am sure we all agree. This Bill is important to ensure that good quality professionals are in place, but there must also be good management.

I welcome the objectives of the new council which are to protect the public by promoting high standard professional conduct and professional education, training and competence among registrants of the designated professions. There is a problem concerning the shortage of such professionsto which Deputy Coveney referred. I can think of several professions where there is a shortage of personnel to deal with the people's needs. For example, there is a shortage of psychiatrists to evaluate children who require an assessment and even when such children are evaluated there is a difficulty in securing necessary resources in terms of finance and personnel.

I sought in recent days to raise a matter on the Adjournment concerning Rockcorry national school. As that school approaches the next academic year, some of its personnel were evaluated, which it understood had been approved by the Department of Education and Science, but suddenly these personnel did not meet the criteria laid down although they are on the relevant education list. Now the school does not know whether it will have special needs teachers, the services of whom some children attending that school badly need next September. Regulations are all very well, but there must be a follow through on the part of management.

I welcome the fact that each of the designated professions will be represented on the council and that there will be a representative of the public, the voluntary sector and the third level sector. The fact that the council will comprise 12 members from the professions and 12 members from other sectors will create a healthy balance among its membership, but will this balance be affected when additional professions come into the registration system? This Bill provides for the registration of 12 professions — there cannot be many more that may come into the registration system. How long will members of the council hold office? Can members be reappointed to office or will there be a fixed term of office?

Section 28 deals with membership of the registration boards. IMPACT did not agree with the composition of those boards. It was concerned that the professions are outnumbered on the boards and that their representatives should be in the majority in terms of education and training issues. However, there would be a concern about the representatives of the professions constituting a majority in regard to complaints, inquiries and discipline issues.

In regard to section 32, following concerns raised by my colleagues in the Seanad, we welcome the amendment to the Bill in the Seanad which requires the registration boards to submit to the Competition Authority draft by-laws that relate to the adoption and revision of a code on professional conduct and ethics. Although the council does not have to accept the options put forward by the Competition Authority, the authority is happy that its opinion must be taken into account by the council, which is made up of numerous professions when deciding on such by-laws.

I also welcome section 38 which provides that each registration board must register each person who holds an approved qualification and satisfies the board that he or she is fit and proper to engage in practice of the designated profession. Are proper regulations in place to provide for those professionals who come here to work from other countries given that we depend greatly on such personnel? While such personnel do their very best and are essential to our health service, families encounter great problems communicating with them, which leads to difficulties. Can more be done in this area in terms of the provision of education or interpretation services?

The Bill will play a major role in regulating health professionals. I wish to refer to the running of the health service generally. I cannot but refer to one element of it of which I am extremely conscious because of the area I represent, especially my immediate parish. I refer to psychiatric treatment and the direction we are going in that area. I am concerned because of the number of suicides that have taken place. I mentioned one case in the Dáil a few weeks ago, that of a close friend of mine, Fred Williamson, who sought professional help but failed to get it and in desperation took his life. We need to look at how this whole issue is monitored and dealt with. We all agree people, whether aged, psychiatric or whatever, should be dealt with as far as possible in their own homes or as close to home as possible. Each individual case has to be taken into account. We must have some professional responsibility. As we consider the Bill before us we must examine that whole aspect as well. There are buildings and beds as well as staff — whom I have talked to — who are prepared to look after some of these people in care, whether for a short or long term. We must respect the right to life and realise there are individual situations which are different from others. There are individual family situations that are different to others. Some families have great back-up services and availability of help. Others do not. A patient just cannot be looked at in isolation. He or she must be looked at in the context of the entire situation as it stands.

It is only when one is faced with issues such as this involving very close friends directly that one realises the problems that exist within the health service. Problems arise when basic rules are set down as regards doing something this way or that. I would like the professional groups to really examine this situation. I am a lay person. I am a farmer by background and a politician by profession. However, I have some understanding of human relations. I have seen marvellous work done by the psychiatric services, both in-house and in home service. However, we are in a serious situation when senior people set down rules and laws that cannot be broken. While it is not totally relevant to the Bill before the House, I cannot help on this my last opportunity to speak in Dáil Éireann, possibly, before the summer recess, to bring this issue forward and put it on the record of the House. It is one I feel very strongly about, as I do about alcoholism and the lack of services in that area as well. When one sees young people being buried because they cannot get help for alcoholism, and the buildings and the opportunities to help exist, one has to worry.

I welcome the fact this Bill is before the House. I welcome the fact the 12 groups which have been looking to have their positions regulated for so long are seeing this achieved, finally. Psychologists are included in the legislation, but some people call themselves both psychologists and counsellors. My colleague, Deputy Twomey, mentioned this in addressing the Bill earlier. I agree with him that we must make the qualifications crystal clear. There are big differences and a proper structure needs to be put in place.

Whenever psychologists decide that young people need a service, as with Rockcorry school, it should be ensured that staff are provided for this purpose. There are only 31 pupils in Rockcorry school, and six children there need a proper service. There is no point in an evaluation being done if the service is not available.

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