Finian McGrath (Dublin North Central, Independent)

I thank the Ceann Comhairle for the opportunity to speak on this very important legislation. The debate on the Health and Social Care Professionals Bill is both relevant and important because it is about change and improving quality, professionalism and accountability. It must be broader than that, however. This debate has to be about the creation of provision for people who work in the services in a caring and considered manner. It is interesting that we have different views on this legislation, but in view of its importance all views should be carefully listened to so we can make a final decision on it.

The debate is about professionalism, caring and accountability. These are three key words in the Bill because health is a major political issue, particularly as regards assisting those who are ill, people with disabilities and supporting those who need major back-up services. Before I was elected in 2002 I was a member of the Independent Health Alliance. A group of us got together and campaigned on the health and disability issue, to bring it into the political arena and into the Dáil. I had the great honour and privilege to be elected by the people of Dublin North Central, on a strong health and disability platform in particular. We have arrived today and this is part of the discussion as well, because it is very important.

The Bill is also very relevant for people with disabilities. We have seen over the past 24 hours the passing of the Disability Bill in Dáil Éireann, which for many people was flawed legislation. It is very important that in this debate we get the opportunity to highlight the weakness in the legislation and also to talk about its positive aspects. On the issue of health care and professionalism, even in the last few days a young child with Down's syndrome in the west was denied resource teaching hours because of a decision made by a number of professionals working in the field. This is totally unacceptable and disgraceful. The Disability Bill has not been passed 24 hours as yet.

As regards the details of the legislation, the Bill is entitled:

An Act to provide for the establishment and functions of the Health and Social Care Professionals Council and of registration boards for certain designated health and social care professions; to provide for the registration of persons qualifying to use the title of a designated profession and for the determination of complaints relating to their fitness to practise; and to provide for related matters.

That, basically, is what the Bill and the debate is about. In Part 1 of the Bill, dealing with preliminary matters, one sees "council" means the Health and Social Care Professional Council, established under section 6. The word "court" in this section means the High Court, while "designated profession" means a health and social care profession, as designated in the Bill. These are important terms to grapple with before we get into the details of the legislation.

Section 4(1) says: "For the purposes of the legislation the following health and social care professions are designated:" I will concentrate on the psychologist, the social care worker, the social worker and the speech and language therapist. Nowadays, it is accepted by the mainstream political establishment in Dáil Éireann and broader society that there must be quality professionals, working in the services, and some of these people are the psychologists. They will play a major role over the next three to five years in dealing with services for people in the broader sector, but also children and people with disabilities, especially children.

As Members talk about the designated professions in this section, I remind the House of the words "care" and "professions". I would like to see quality people working in the field of psychological services. Many such people have gone into this area in the last 12 months as regards the provision of services for children with disabilities. However, I would like to see them more involved directly in ensuring a child with disability is treated in a caring and professional manner. As regards radiographers, these people, as well, have a major role to play. They are already saving lives in the mainstream health service. I commend the people directly involved in the radiography services in this State. However, we need more professions to be more involved directly in the services. This is a political issue. Why are there too few radiographers? Given the hundreds of millions of euro we spend each year on the health service, why is there no proper radiography service?

Section 4 covers the designation of health and social care professions. It is vital to have the right people making the right judgments. While I accept the necessity to require certain baseline academic qualifications, I am also concerned that many professions have developed in a flawed manner over the past five or six years. We are obsessed with points and the race to achieve professional status and qualifications. Why are many boys and girls in second level education who would love to become social workers, health care workers or psychologists prevented from entering these professions because they cannot achieve the high points required to enter the third level system? We are losing many quality people as a result. The other side of the current system is that some trained college graduates discover after two years in the job that they do not like working with children or people with disabilities and then decide to jump ship. This matter needs to be examined.

During my regular discussions with transition year and fifth year students in schools in my constituency I meet wonderful young boys and girls who would make fantastic physiotherapists or speech and language therapists. However, they are precluded from entering these professions when they do not obtain a set number of points in the leaving certificate examination.

To be called to begin teacher training in the primary sector 25 years ago, a student first had to get a certain number of honours in what was the equivalent of today's points system. A second important step involved attending St. Patrick's College in Drumcondra for a tough interview. Sitting around the table was a group of psychologists and child experts who decided, following the interview, whether candidates were suitable to work with children. Interviewees had to perform simple, basic tasks such as singing a song. The selection process, therefore, combined a requirement to achieve good baseline academic results and undergo a tough interview in which candidates were examined and cross-examined to determine whether they could be trusted and were suitable to work with young children. This approach is relevant today, notably in the context of training health care workers.

The role of social workers arises in the context of section 4. Deputies will all have had good and bad experiences of social workers. On the one hand, it is vital to defend the professionalism and integrity of social workers while, on the other, social workers have a duty and responsibility to ensure that children who find themselves in crisis or are sexually abused in dysfunctional families are rescued. They must be prepared to use the law to take tough decisions. Disgraceful incidents of sexual abuse have been perpetrated against children. In recent days, for example, we have heard of the horrendous experiences of a girl at the age of 11 in the Dalkey case. Social workers must be focused and professional. The House will, through legislation, address the issue from a legal and constitutional perspective. We must ensure the right people are doing the job of social worker, whether they are providing services from 9 a.m. to 5 p.m. or late at night.

Section 4(3) defines a health or social care profession as:

. . . . any profession in which a person exercises skill or judgment relating to any of the following health or social care activities:

(a) the preservation or improvement of the health or well-being of others;

(b) the diagnosis, treatment or care of those who are injured, sick, disabled or infirm;

(c) the resolution, through guidance, counselling or otherwise, of personal, social or psychological problems;

(d) the care of those in need of protection, guidance or support.

Paragraphs (a), (b) and (c) highlight the overall theme of the Bill and emphasise the importance of ensuring that people with disabilities and the elderly are part of a broader debate. Sadly, we do not do enough for elderly people. It is unacceptable, for example, that some of them do not have access to top quality health care. I remind Deputies that the elderly helped build the economy that has delivered the sustainable growth we enjoy today. It is payback time.

The broader issue is that rather than placing elderly people in institutions or care settings without their consent, they should, where possible, be treated in their own communities with the assistance of support services. The Government has failed to provide sufficient community supports for the elderly, an issue on which I have tackled previous Ministers.

Paragraph (c) refers to "the resolution, through guidance, counselling or otherwise, of personal, social or psychological problems". Let us ensure that counsellors who try to advise and assist people in difficult circumstances are given maximum financial support. Resources allocated for this purpose should never be clawed back. The beneficiaries of the services provided by health and social care professionals are human beings and must be shown respect and treated with dignity.

Modern society is turning its back on the importance of providing care for people with social or psychological problems. The downside of economic success is that people are too busy to spend time listening to others or caring for them. Many elderly people live alone on estates in Dublin, Kerry, Galway or Cork and do not know the people who live two doors away. This was not the case 20 or 30 years ago when we had few resources. We need to implant in the minds of our children, at a young age, that there is nothing old-fashioned about caring for one's neighbour. Human and community services also include a responsibility on every one of us.

Section 7 defines the object of the Health and Social Care Professionals Council as: "to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions." Section 8 defines the council's functions, which include to:

(a) oversee and co-ordinate the activities of registration boards,

(b) provide administrative support and secretarial assistance to registration boards and their committees,

(c) receive applications and make decisions under Part 4 concerning the refusal of registration boards to grant or restore registration,

(d) enforce standards of practice for registrants of the designated professions, including the codes of professional conduct and ethics adopted by their registration boards,

(e) establish committees of inquiry into complaints under Part 6 against registrants of the designated professions,

(f) make decisions and give directions under Part 6 relating to the imposition of disciplinary sanctions on registrants of the designated professions,

(g) advise the Minister, either on its own initiative or at the Minister's request, on all matters relating to the Council's functions under this Act. . .

While I strongly support sections 7 and 8, I share the concerns expressed by the Irish Society of Chartered Physiotherapists, ISCP, that the protection of patients is not given paramount importance in the Bill, which it deserves.

See this speech in context