Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I thank the Minister. The point I am making is that people are entitled to protection against fraudulent use of material which is then put into a person's body. The difficulty is that while the Irish Medicines Board may have oversight within the State, if something happens outside the State, people may have difficulty seeking redress afterwards. In fairness, the Minister and the Department responded in a very humane and passionate way when the issue arose to address the concerns of the many women who received the implants. However, there is no form of redress for the many people who were implanted with industrial grade silicone. The implants were approved in Germany or somewhere else at some stage - the company was in France but I believe the patent was German - after which they arrived in Ireland. The Minister, the chief medical officer and others moved swiftly to try to address the concerns of these women, but we cannot pursue anyone and it will be very difficult to seek redress for the fraudulent use of silicone.

With European integration comes obligations for the European Union. It is fine to agree a directive and for member states to transpose it into national law, but oversight is very important and it must be supported at European level in terms of resources and cost. It is unacceptable that a situation such as the PIP implants can arise or that a member state could have diminished ability to oversee the domestic competency of qualifications, training and education.

The Minister stated four councils will be established by the end of the year and that others will be rolled out. Considering the medical and care professionals included in the scope of the Bill, it is important we have oversight and that the councils are established to ensure proper training, education, qualification assessment and continual monitoring. The Bill deals with high level qualifications including clinical biochemist, dietician, medical scientist, occupational therapist, podiatrist, physiotherapist, psychologist, radiologist, social care worker, social worker and speech and language therapist. The difficulty we have had in recent years is recruitment and attracting highly qualified people in the various professional categories outlined in the Bill to work in Ireland. Now our highly trained professionals are beginning to drift abroad to seek opportunities in other countries. This is a disturbing development. We all say the fees, salaries and remuneration of general practitioners and consultants should be addressed, but we must be conscious of encouraging people to enter these professions and keeping a percentage of them in the country after they are trained for our own health and social care services.

We welcome the experience that people gain and bring back when they go abroad, and high-end professionals will always move in and out of the country. However, we have a difficulty if there is only one-way traffic and everyone is moving out. The Department of Health, the HSE and the various professional bodies which oversee their membership must be very conscious of this and monitor it to ensure the people who go abroad and gain experience bring it back to this country. During the 1980s the most able people drifted away and it caused difficulties. They returned in the 1990s and the first decade of this century and had a major impact through bringing new ideas and procedures, especially in medicine.

I will not delay the House much longer. The establishment of the various oversight councils is to be rolled out and I would like the Minister to make a commitment that this will happen.

People will always have concerns about the conflict of interest in respect of self-funding, self-regulation and discipline and what flows from that in the event of a fitness to practise meeting or professional misconduct hearing. People may sometimes have a view that there could be a conflict of interest in self-assessment, self-regulation and self-monitoring. I believe the legislation is robust enough in terms of ensuring that is not the case and that, in general, there is no major conflict.

The Health and Social Care Professionals (Amendment) Bill before us is a follow-on from the 2002 report entitled Statutory Registration for Health and Social Professionals: Proposals for the Way Forward and the 2005 Act that flowed from it. In bringing this legislation to the Dáil, which is an obligation, we continually upgrade the oversight of health and social care professionals in every way to ensure it is flexible in dealing with the changing environment that exists. We should ensure there is flexibility, opportunity, oversight and strong regulatory powers in terms of sanction if there are breaches of professional conduct or what can flow from an internal inquiry which may find a person to be in breach of professional conduct. That is critical but what is as important is that if there is a view held by the State or individuals that there is no proper oversight or disciplinary procedures by one of the quora, there is a mechanism in place for the State to step in and have a fully independent inquiry if there is a serious breach by a individual professional under the Health and Social Care Professionals Act 2005 and the amending legislation.

It is important to do this to give people confidence and belief in the quality of the people providing health and social care. Deputy Ó Caoláin has raised this issue numerous times, such as, for example, the Dr. Neary case and many others that have flowed from that. That, in itself, is an issue of concern. We had the debate in this House on symphysiotomy and there was all-party agreement. People will debate the rights and wrongs of symphysiotomy but there are many whose lives have been destroyed because of this barbaric act. We heard at first hand stories that were very emotionally told and felt by those who listened to the impact it had on their lives. I am not saying that the people who carried out symphysiotomy were doing something that was illegal at the time. However, when there is clearly an evolving technology and change of practice, it is important there is continual training and re-evaluation of what is considered the norm in medicine and social care. Let us be quite clear, many practices carried out in psychiatry for a number of years would now be considered almost barbaric. There has been a changing and evolving ethos about how we deal with people with mental health and psychiatric issues and in general medicine itself.

It is for those reasons that there is an obligation on the various quora under this legislation to ensure that, as the Minister referred to, there would be training, continuing evaluation, upskillling and professional development. We see it in many other areas and I believe it should be in the medical and care profession as well. What can very often happen is that individual professionals are very competent and eminently qualified but may not continue to evolve and train themselves in the most up-to-date techniques, procedures and thinking in whatever profession they are involved in. That can have disturbing effects for people down the road. I have cited a number of cases, with symphysiotomy being the very obvious one. This was practised in this country up to the 1970s, after which it was considered to be a procedure that should not be visited on anyone except in the most exceptional circumstances. Even at that, there was a strong body of medical evidence in this country, across Europe and especially in the UK that it should never be used and that a caesarean was the way to deliver a child if there were huge difficulties in delivery. We have had discussions on this issue and I am not sure whether the individuals said this was the right procedure based on the ethos of the hospital or a religious ethos or whether they just did not continually upskill in the most modern techniques and changes in practice in the medical profession. The same is true of social care and psychiatry, with the move from institutionalisation to dealing with and treating people in their immediate home and community environment. That is very welcome but there are still people within the professional community who would say that perhaps we might look at that again. Continually training and upskilling and continuing personal development are very important in the quora overseeing the qualifications of people.

Those are my thoughts with regard to this Bill before us and the 2005 Act. In other fora over the years, I have raised the issue of how oversight and governance at European level should be resourced at European level and the need for a centralised system to ensure all countries play by the same rules in respect of scrutiny of professionals' training and qualification. This is something about which I feel very strongly because all we need is for one or two people from other countries to be found not to be eminently qualified or to have done something wrong in their professional conduct and straight away it will be used by bigoted people and racists to undermine people who are here for a good reason, namely, to assist us in the delivery of our health care. This is why I have always said, as I did at the Oireachtas Committee on Health and Children, that people who have come from abroad are welcome and must be welcomed with open arms and that we must insist on the highest standards, not just for ourselves but for their integrity in order that people would have absolute confidence in them. If not, the sinister element in society could jump on a particular incident and use it to further their own narrow-minded, bigoted agenda.

I welcome the Bill and hope the Minister moves expeditiously in establishing the various councils of the professions and that we would continually upgrade and monitor things to ensure there are additions and the ability to add quora to oversee varying professions.

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