Brian Lenihan Jnr (Dublin West, Fianna Fail)

I thank Deputies on all sides for the broad welcome they have extended for this measure. I agree with Deputy Durkan that while we can put legislation in place to ensure a high standard in a given profession or occupation, the basic motivation and spirit must exist among members of that profession to observe the highest standards. His point was well made in that regard, especially in respect of the need for one to take responsibility for one's actions. It is often forgotten that the health and child care services often include many of the social services as well as the physical and mental health services. A vast number of employees are encompassed and no political head of a Department or public servant charged with administration on the permanent side in the Department can hope to implement policy without the wholehearted co-operation and taking of responsibility by everyone within the system.

Deputies raised the introduction of statutory registration for health professions over and above the 12 apostles outlined in the Bill. It is important to note that these 12 professions were selected because they are long-established providers of health and social care within the health service and, in most instances, have established experience of self-regulation. The qualifications of the majority of these professions are regulated within the public health service.

Environmental health officers were involved in consultations with the Department on the development of the proposals for statutory registration. They were to be covered by the system but, following discussion with the relevant union and professional body, the view was taken that as the majority of the work of environmental health officers involves monitoring compliance with legislation on food safety and environmental matters, the participation of their profession is not appropriate to this legislation at this point. However, there is a provision in the Bill whereby environmental health officers or other professionals can be brought into the statutory registration system. Deputies will find this provision in section 4.

The regulation of counsellors and psychotherapists in particular was raised by Deputies. I fully appreciate their concerns in this matter and am very aware that the provision of counselling and psychotherapy services to the public has increased over recent years. The former health board chief executive officer group had established a working group to examine the role of psychotherapy in the health service to assess the requirement for the future. The working group's report has been finalised and the next step will be for an action plan to be put in place for making progress on the issues, including issues regarding the development of an appropriate model of service. The outcome of this work will form an integral part of the formal process that would be required, as set out in the Bill, to determine whether statutory registration is warranted. An integral part of the legislation is that it will always enable the designation of further professions.

While welcoming the Bill for its contribution to enhanced regulation of conventional health care professions, Deputies also spoke of the need for better regulation of complementary therapists. These practitioners do not come under the provisions of the Bill. I agree that the regulation of these therapists is especially important bearing in mind the increasing number of people who have recourse to such practitioners. I agree with Deputy Durkan that recourse to these practitioners can have beneficial results. That said, the often informal nature of how some complementary therapies are practised requires more scrutiny. Greater controls in the complementary therapy area are also in the interest of all reputable practising therapists as the presence of some unscrupulous practitioners undermines the sector as well as presenting risks to those using the therapies.

A national working group on the regulation of complementary therapists was established in May 2003. It has met regularly and was expected to report by the end of this year. In light of the urgency attached to this matter, the Tánaiste asked that the work of the group be expedited. I understand the report will be finalised within the next few months. The approach to putting in place the most appropriate framework to regulate the activities of complementary therapists will be informed by the group's recommendations.

The issue of protection of title was raised by a number of Deputies. The position is that one title is protected for each profession under the legislation, with a provision that variants can be protected by regulation under section 95(3). This is in line with the legal advice available to the Department. It will clearly be an offence for an unregistered practitioner to use a protected title or to represent himself or herself falsely as being a registered practitioner.

There has been a debate within the chiropody-podiatry profession on the most appropriate title for that profession within the primary legislation. I am well aware of this debate. The title "chiropodist" is used in the Bill because it reflects the current more common title by which the profession is known to the public. However, the profession is having discussions on its title and varying views are entertained by groups within the profession on the most appropriate title to be used in the primary legislation. Some groups have expressed a preference for the title "podiatrist". The professional bodies representing chiropodists and podiatrists have not yet been able to reach a unanimous decision on which title to protect under the primary legislation. The Department's position has been to encourage all stakeholders involved to develop an agreed solution to the issue of the protection of title and I hope the matter can be resolved.

The Bill also provides for the protection of the title "physiotherapist" for use by those professionals registered with the physiotherapists registration board. As Deputies are aware, the Irish Chartered Society of Physiotherapists is also seeking the protection of "physical therapist" for use by those professionals registered with the physiotherapists registration board. Several Deputies referred to this in the debate. The society considers both titles to be interchangeable in an international context and believes there is a risk of confusing the public if the title of "physical therapist" were not protected for use by physiotherapists. However, members of the Irish Association of Physical Therapists, who train with the Institute of Physical Therapy and who use the title in this country want to retain the title. There are complex legal, competition related and public interest issues involved in resolving this matter.

The Department has met the Irish Society of Chartered Physiotherapists and the Irish Association of Physical Therapists before and since the publication of the Bill with a view to encouraging both organisations to develop an agreed solution to the issue of the protection of title that takes account of the issues involved. I salute the great work of the officers in the Department who endeavour to conduct a number of peace processes in regard to these titles.

The question of registration of practitioners who do not hold national qualifications was raised during the debate. The Bill provides for the assessment of qualifications obtained within or outside the European Union. This matter will, however, be kept under review as the Bill progresses to ensure that it deals comprehensively with the issue.

Several Deputies referred to the composition of the health and social care professionals council and registration boards. The membership provisions are designed to ensure the best balance of professional expertise, health sector knowledge and public interest. There will be consultation on these appointments.

The effect of the inclusion of additional professions in the system on the number of council members is provided for in the Bill. It will therefore deal with an increase in the number of professionals, or any additional professions recognised.

The role of the Minister for Enterprise, Trade and Employment was mentioned in the context of the appointment of members to the council and boards. Several Deputies tried to see very far-reaching implications in that proposal. According to the old adage, all professions are in conspiracy against the public. The Minister took the view that it was not enough for the Minister for Health and Children to regulate the professions and that the Minister for Enterprise, Trade and Employment should also have a role in the matter. This is in the public interest, because the Minister for Enterprise, Trade and Employment must protect the public interest with regard to matters of competition. Professions often become anti-competitive and succeed in persuading the Department that it is supposed to regulate them in an anti-competitive manner. Therefore it is desirable, in a measure such as this, to have provision for the consent of the Minister for Enterprise, Trade and Employment. The Bill provides that members who are representative of the public interest be appointed by the Minister for Health and Children with the consent of the Minister for Enterprise, Trade and Employment.

The Bill's provisions in regard to the constitution of the council, registration boards and disciplinary committees will facilitate openness and transparency and ensure that the right talents and experience are put at our disposal with regard to the regulation of these professions.

Concern was expressed about the need for consistency among the registration boards. The health and social care professionals council will have a co-ordinating role ensuring uniformity of procedures throughout the system. The chief executive officer of the council will act as registrar for the registration boards.

Deputies showed considerable interest in the provisions for dealing with complaints about persons on the register and expressed concern that health professionals might feel fearful of suffering adverse consequences in bringing a complaint against a colleague. The provisions of the Bill facilitate a fair, just and open process for bringing and dealing with complaints. I appreciate the concern that peer pressure may hinder a practitioner from making complaints. However, practitioners are aware of the need to act in the immediate interest of patients to protect patient safety and in the wider interest of their profession to ensure that it is not brought into disrepute by the behaviour or incompetence of a minority.

Deputies also referred to the provisions of section 61, which facilitate a situation where a registrant accepts admonishment or censure from a committee of inquiry following a complaint. A committee of inquiry has particular powers under the proposed legislation and the health and social care professional council can apply to the High Court for an order directing a registration board to suspend the registration of a registrant against whom a complaint has been made if the council considers that the suspension is necessary to protect the public until further steps are taken with regard to the complaint.

The role of the representative bodies was also raised. Each of the professions designated under the Bill already has one major professional body, the role of which has been significant in the past and will remain so.

Deputies referred to the importance of the work of the national social work qualifications board. The continuity of the work and contribution of the NSWQB to professional development, education and training of the social work profession will be maintained and built upon in the legislation. Deputies mentioned university courses for chiropodists and podiatrists and the Department is examining the education of the profession with the Department of Education and Science.

With regard to a lack of student places and staff shortages, there have been significant advances in recent years in terms of increasing the number of students coming into the professions covered in the Bill. There has been a very clear increase in the numbers employed in the public health service. The medical profession is the subject of different legislation which is promised and will deal with some of the issues raised by the Deputies about medical practitioners engaging in complementary therapies. The registration boards will be empowered to make by-laws that can encompass continuing professional development.

I thank Deputies for the attention and care they have given this legislation. If improvement is required on Committee Stage, the Tánaiste and I will be open to any reasonable suggestion.

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