Seán Ryan (Dublin North, Labour)

I welcome the opportunity to make a brief contribution on the Health and Social Care Professionals Bill 2004. It is long overdue and in that context it is appropriate that it is being debated in the House before the summer recess.

Before I forget or run out of time, I ask the Minister to respond to the following question, when he is summing up. In view of the fact that a BSc in podiatry is listed under the Third Schedule as the minimum qualification required for registration and there is no school of podiatry attached to any university in the State, is it proposed to establish such a school at one of the universities and will the call for tenders go out before the end of this year? The Minister will be aware that at present students must go to the University of Ulster at Jordanstown or to one of 12 universities providing the course in Britain. In the context of that being referred to in the Bill it is important that the Minister clarifies the situation as regards access to that professional qualification.

Few of us can disagree with the main objectives of the Bill to provide for the establishment of the health and social care professionals council as well as registration boards for certain health and social care professions. It also provides for the registration of persons qualifying to use the title of a designated profession and for determination of complaints relating to their fitness to practise, and related matters. How can these objectives be best realised, initially in this legislation and thereafter through its practical implementation? I am not convinced the Bill meets these objectives or addresses many of the outstanding issues.

On reading the Bill, I was struck first by its elaborate structure. It provides for at least 180 appointments to be made to various councils and committees. Who will make these appointments? According to the Bill, this task will fall, by and large, to the Minister for Health and Children. The notion of jobs for the boys and girls is the first thought to come to mind. Unfortunately, the record of such appointments over the years has been less than reassuring and this must be a concern for the public.

Section 4 designates the 12 professions provided for in the Bill. It is appropriate at this stage to refer not only to the objective of having high standards in the professions, to which we all aspire, but also to the level of service being provided — or not provided — to the public. Many of the designated professions, for example, chiropodists, occupational therapists, physiotherapists, social care workers, social workers and speech and language therapists, are vital to the community care service. In reality, however, the idea that community care is available is essentially a fallacy, particularly for older people. Surveys and reports have clearly shown that the vast majority of older people want to be cared for in their homes with minimum health service involvement. It is shameful that community care is totally inadequate and is not being delivered as envisaged.

The availability and willingness of family members to care for their elderly relatives make the major difference in terms of keeping elderly people at home. Notwithstanding its many promises, the Government has failed to adequately acknowledge the role of community carers. Any debate on health and social care must include an acknowledgement of their role. The Labour Party has put this issue at the top of its agenda and will continue to vigorously pursue it. If the Minister fails to deal effectively with carers, the Government will feel the wrath of voters at the next election.

The community care system must be developed to ensure older people receive the support they need and families providing care do not become isolated. Community care services are essential to achieving the aim of keeping at least 90% of people aged 75 years or over in their own homes. It is obvious to political representatives that insufficient finance has been provided to develop these services.

The key community care services urgently required for older people and their carers are domiciliary nursing, general practitioner and home help services, respite and day care centres, meals and transport services, paramedic services and several of the services specifically referred to in the Bill, including occupational therapy, physical therapy, chiropody, speech therapy and social work. It is a scandal that, at a time when health and social care services are being put on a statutory footing, the availability of such services is restricted in the community. For example, medical card holders are obliged to make a contribution towards the cost of chiropody. In addition, according to the most recent figures available to me, the home help service, which is essential if we are to ensure people are cared for at home rather than in acute beds in hospital, was cut back by 300,000 hours in 2003 as compared to 2002. Is it not a scandal that while medical card holders are being deprived of the home help service to which they are entitled, Minister after Minister has been returning departmental moneys to the Department of Finance?

If we are to implement a comprehensive community care service that would reduce dependency on acute hospital beds, emphasis must be placed on the shortage of occupational therapists and chiropodists at Health Service Executive level. The delay in providing these services means costs of providing scarce services are being unfairly levelled on medical card holders. Furthermore, we must address geographical variations in service levels, which a number of delegations visiting the Houses have described. Surely a basic, uniform service should be available throughout the country.

Representations received from the Irish Society of Chartered Physiotherapists and the Institute of Physical Therapy made particular reference to the protection of title. Time and again, Deputies have highlighted the case expressed in the position paper submitted by the Irish Society of Chartered Physiotherapists, which I have read.

It is also important, however, to place on record the views of members of the Institute of Physical Therapy. During my sporting days I suffered major back problems and often sought treatment from experienced physiotherapists, and I have always found them to be highly professional. I must also acknowledge that physical therapists, who treat clients from sporting and general backgrounds, have built up 350 practices throughout the country. Clients come from both sporting and general backgrounds and are largely referred by existing clients.

The Institute of Physical Therapy 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 musculoskeletal conditions. The therapist uses a range of gentle techniques, including stretching and immobilisation that have proven to be safe and effective in the treatment of most muscle related disorders. These are natural, drug free treatments that are individually tailored, do not conflict with conventional medical treatment and are founded on the principle of health science. It is safe and effective in the treatment of back, muscular and joint problems. In the 15 years since the institute's foundation, no physical therapist has faced a negligence claim.

The Institute of Physical Therapy offers a three year course designated for mature students. The professional association of practitioners, the Irish Association of Physical Therapists, was established in 1992 and regulates the profession in Ireland. Physical therapy presents itself at all times as an alternative to physiotherapy and physical therapists explain to clients unsure of what to expect that the treatment is not available under a medical card.

In its submission, the institute notes the Bacon report on the current and future supply and demand for physiotherapists forecasts a shortage projected to last until 2016. The report recommended the immediate recruitment of physical therapists into the public service to address this. Any restrictions on the work of physical therapists will exacerbate the current shortages for many years and the removal of 350 therapists would have a negative impact on a health service already unable to cope.

Both physiotherapists and physical therapists provide a service and we must ensure the public get the best possible service and have a choice of which they prefer and which will meet their needs. There is room for both professions to complement each other. They have worked together for the last 15 years and, irrespective of this Bill, they can coexist. The Minister can get it right in this Bill and I recommend that the Institute of Physical Therapy's recommendations are taken on board. She should not remove them from practice, which would be a negative step. We can deal with this in detail on Committee Stage.

Page after page of the Bill refers to the establishment of committees and mechanisms to deal with complaints. The Bill does not make it clear, however, how a person would go about initiating a complaint against someone who has been negligent.

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