Dan Neville (Limerick West, Fine Gael)

I with to share time with Deputy Reilly.

I welcome the Medical Practitioners Bill. It is very important and timely legislation that will ensure the protection of patients. It is important to ensure doctors have appropriate insurance to cover all aspects of their very important work. There is no implication that doctors do not have insurance. I could not put a percentage on it - I am certain Deputy Reilly would agree - but I suspect more than 90% of doctors have insurance. As the Minister stated, the Department does not know how many doctors have insurance or not. The Bill makes insurance compulsory for all doctors.

I refer to the registration of medical people, including the areas of counselling and psychotherapy. There is no registration of counsellors and psychotherapists. There is growing interest in the issues related to counselling and psychotherapy and their regulation in Ireland. The roles of counsellor and psychotherapist are now recognised as being part of best practice in dealing with the health and social care needs of our population. We have regularly discussed multidisciplinary, community-based psychiatric services, which should include the availability of counsellors and psychotherapists as part of the team dealing with psychiatric illness in the community and in hospitals.

It is imperative that the public is protected by promoting high standards of conduct. Education, training and competence in the professions of counselling and psychotherapy are crucial. Protection is currently offered through self-regulation. The relevant bodies drew up the public protection report and made a submission related to the statutory regulation of counsellors and psychotherapists in Ireland. It was commissioned by the Government and reported in 2008. Some 12 of these bodies provide codes of ethics and practice by which their members must abide. Each organisation also provides standards which a person must attain before he or she is accredited as a counsellor or psychotherapist. While this form of self-regulation provides protection to clients of those organisations, it falls far short of optimal protection because under our common law system it is possible for any person to take the title of "counsellor" or "psychotherapist" and practice accordingly without the required teaching and competence. The current anomaly does not lend itself to good clinical governance and maintenance or the improvement of standards of patient care.

The Health and Social Care Professionals Act 2005 creates a mechanism to drive forward the clinical governance agenda. It creates a framework through which practitioners are accountable for continually improving the quality of their service. It safeguards high standards of care by creating an environment in which excellence will flourish and optimal protection is offered. Regularly, I raise with the Minister the matter of having counsellors and psychotherapists included under the Health and Social Care Professionals Act. In other medical professions there is a requirement for a basic qualification in medicine and professionals then continue to specialise. The absence of clear roles and dedicated procedures for those roles creates confusion in the absence of regulation. It also creates a situation in which many calling themselves counsellors in the community and in private practice do not warrant professional recognition. One does not need a recognised qualification or skill base to call oneself a psychotherapist or a counsellor. All that is required is a premises, a gold plaque outside the door and a neck to charge the fee.

At present, there are no means to regulate the situation. The opportunity for untrained people to act as psychotherapists and counsellors and the opportunity for such people to do damage is frightening. I welcome the report in response to this, although it is now more than 12 months old. The report contains the submissions of the psychological therapist forum and outlines a programme of qualification, training and evaluation of skills before practitioners would be admitted under the Health and Social Care Professionals Act.

Vulnerable people in crisis who need professional help can be severely damaged. This situation has been exploited by some practising alternative medicine and some people have been duped out of life savings. There is an urgency by which a regulatory process is introduced in the area of administration of all areas of therapeutic intervention. There is ignorance and not a little confusion among the public as to what is entailed by psychotherapy and counselling and the difference between them. This is compounded by the fact that, according to United States estimates, there are over 400 different named therapies which are used to tackle many medical and social problems, including marriage and family difficulties, anxiety, depression, addiction, sexual abuse, rape, psychosexual difficulties, eating disorders, bereavement, adolescent difficulties, Aids, HIV and many more. There is a range of people operating in these areas, but they must be supervised and regulated to ensure best practice so that people entering them have the necessary training. I have come across people who had bad experiences with so-called counsellors who were not professional and only had a few weeks' training. This was totally inadequate but they set themselves up as counsellors. People have had bad experiences following treatment from such individuals.

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