Jimmy Deenihan (Kerry North, Fine Gael)

I welcome the opportunity to speak on the Bill. Members have been intensively lobbied by two professions in particular. I will refer to the arguments put forward by both bodies.

This Bill is 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 professionals to provide for the registration of persons qualified 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.

As the Minister for Health and Children said when introducing the Bill in the other House, statutory registration is best described as a system whereby individual members of a profession are recognised by a specified body as being competent to practise within that profession under a formal mechanism provided by law.

I welcome this development which has been requested for some time. The Bill has been in preparation for a number of years. Unlike systems of voluntary registration, this is a legally binding process with a mechanism for the prosecution of offences. It is integral to the delivery of the commitment in the health strategy to strengthen and expand provisions for the statutory registration of health professionals. This is the first of three Bills to reform the regulatory environment for health professionals, with legislation for medical practitioners and nurses to follow.

The aim is to protect the consumer and provide a reassurance that the professional is competent and qualified and is answerable to a body. In the past those who were not treated properly suffered and the mistakes were buried with them when they died. It was strongly emphasised in the health strategy that gaining people's trust in the health system is achieved by guaranteeing quality.

People used to spend their money on material possessions such as homes, gardens, kitchens and cars, but now they are spending money on their health. Ireland is a richer country. People are better off. They have all the material possessions and now they are concentrating on their health and that of their families, especially their children. They want to live longer and healthier lives. As a result they expect a greater quality of service from the professionals they attend when they are sick or have concerns about their health.

People want to know that the service they receive is based on best practice and meets approved and certified standards. Improving quality in the health care system requires implementation of internationally recognised evidence-based guidelines and protocols and ongoing education and commitment from health care institutions and professionals. Trust requires that deficiencies in the system be identified, corrective action taken and future progress monitored. The principle of people-centredness includes ensuring that consumers are given greater control and greater responsibility for their own health and increased involvement of consumers as partners in planning and evaluation. This Bill involves members of the public more in regulating the professionals on whom they depend to ensure they have a long and healthy life.

The legislation on statutory registration of health and social care professionals contains a comprehensive legal process for the investigation of complaints against individual professionals and that is to be welcomed. In light of the recent experience in Mayo and other experiences in different parts of the country, we all know that there will be a number of health therapists and others who will not come under the ambit of this Bill. Freelance operators in the health care industry must be answerable in some way for their activities. The professionals are answerable but the freelance health therapists are not. That is a contradiction in the Bill. This Bill is only the beginning of a process that must be continued in terms of dealing with people who advise on people's health on a daily basis.

Some such operators are neither qualified nor hold the necessary education qualifications and in the end the patient suffers except in some instances where by a stroke of luck the operators are successful in administering medicine that happens to work. How does the Minister or the Department propose to deal with that group of people, many of whom have no qualifications other than some cure was handed down to them or they may have attended a course for a few months and subsequently described themselves as professionals and set up in business? I would like the Minister of State, when replying, to refer to such freelance operators in health care.

Strengthening and clarifying accountability and measurement mechanisms is a priority. Professionals now practise in a more demanding environment. Evidence-based guidelines tied to professional standards, the requirements of health care organisations and patients' rights and expectations all add to these demands. That is another aspect of accountability strengthened by these legislative proposals. The establishment of a system of statutory registration for certain health and social care professionals is therefore considered essential to the delivery of the quality and accountability objectives of the health strategy. It will ensure that members of the public are guided, protected and informed so that they can be confident that health and social care professions providing services are properly qualified, competent and fit to practise. These are all welcome developments, but they will only apply to the people in whom we normally have trust. The legislation does not have a broader application.

Section 4 designates the health and social care professions to be subject to the provisions of the Act, and they have been mentioned by a number of speakers. Members of a number of the professions were referred to with whom we would come in contact on a regular basis, such as chiropractors, acupuncturists and several more people who describe themselves as professionals. Some of these people would be described as a doctor of acupuncture. Many genuine members of different nationalities who have emigrated here practise in this field.

Regulations covering the qualifications of such practitioners should be in place. Many practitioners, for example, a doctor of acupuncture, may be genuine but there should be a system whereby people could ask such practitioners dealing with the important issue of people's health to specify their qualifications and where they obtained them, and such qualifications should be checked. There should be some way of tracking where these people are from, where they got their qualifications and if their qualifications are recognised. There might be a European dimension to this aspect in terms of people who emigrate to member states of the Union. The EU might have a role in such regulation.

I wish to return to the matter of the concern of physiotherapists regarding this Bill. They were anxious that the title of physical therapist would attached to the physiotherapists and be protected. There is provision in the Bill whereby the Minister may in future designate other professions. That will be an ongoing process. Physiotherapists are concerned that people who describe themselves as physical therapists can continue to operate, and that is a genuine concern. They have briefed us comprehensively regarding their concerns and they have been read into the record by a number of speakers.

Physiotherapists have been practising here for 100 years. The first Irish school of physiotherapy was founded in 1905. Physiotherapy is a full four-year honours degree course. The Irish Society of Chartered Physiotherapists has 2,000 members. Some 1,500 physiotherapists are employed by the Health Service Executive. Therefore, there are numerous physiotherapists and their organisation is influential.

The first letter we got from them was dated 28 June. Deputy Paul McGrath referred to that and more or less read their concerns into the record of the House, so I will not repeat them. Have the Minister and his officials studied their concerns and given any commitments to the Irish Society of Chartered Physiotherapists to the effect that in future physical therapists will be included in this Bill and that title would be protected? As a sportsman I have been in contact with a number of physiotherapists over the years and they are very professional. I have the highest regard for them. The fact that they spend four years studying the discipline of physiotherapy is significant. In one sense it is a broad area, but in another sense it can be very specific. I spoke to a young woman recently who is currently studying physiotherapy in the University of Limerick. She advised me that she has spent the whole year studying anatomy alone. That must be very intensive, and obviously these people have an in-depth knowledge of how the body works, and how it is affected by various treatments. Treatment is becoming more complicated as we know. Interferential therapy and ultrasonic treatment was introduced some years ago and there are other types of treatment that require deep medical knowledge. Otherwise damage could be done, especially where bones are concerned.

We have received a briefing from the Institute of Physical Therapy. I met a representative of the institute, whom I found to be very genuine. There are about 350 physical therapists in the country at the moment, although that figure varies. The Institute of Physical Therapy was established in 1989, unlike the Irish Society of Chartered Physiotherapists whose first school was established 100 years ago. The institute was established in 1989 to pioneer a course in physical therapy in Ireland. Physical therapy is a holistic natural approach to the prevention and treatment of musculo-skeletal conditions. It is worth pointing out that unlike the physiotherapists, the physical therapists utilise a range of gentle hands-on techniques, including stretching and mobilisation, that have proven to be safe and effective in the treatment of most muscular related disorders. The physiotherapists use interferential therapy, ultrasonic treatment and other means for treating injuries. Generally speaking, the physical therapists use their hands more and just work on muscles and tendons, without going any further. The physiotherapists obviously give more advice as regards the internal workings of the body and how other parts of the body affect the muscular system as well. They have expertise in the area of diet and other disciplines, too. We have both of those disciplines at this stage.

It is worth noting that the Institute of Physical Therapy offers a three year course designed for mature students. It is probably on at weekends and of its nature this could be regarded as part-time. However, most of the people who come through the institute have degrees already. Most of them are graduates, I understand, based on the submission we received. They are also very professional. I have come into contact with a few physical therapists, most of whom work with inter-county teams and generally speaking, they are very professional. They would not work with inter-county teams if they were not. If nothing else, this Bill has highlighted the conflict between the physiotherapists, on the one hand, and the physical therapists on the other.

It is very important at this stage that the Minister should offer some view on the concerns of both professional bodies. Normally in the lead up to a Bill we, as Deputies, are lobbied by various groups. However, the only people who have lobbied me are these two groups. It is important, therefore, that some clarity is given, based on the submissions of both of these groups, and it would be very helpful. It is more or less implied in the Bill that when people attend a certain therapist all the relevant documentation as regards qualifications, education and experience of the professional should be available. It is not just good enough to have letters after a person's name. Each professional should have a curriculum vitae setting out qualifications and the body of which he or she is a member.

I welcome this Bill and the debate on it. One major issue of contention is the distinction between physiotherapists and physical therapists. I would like if the Minister could give the House a direction as to the future position of both these professional bodies.

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