Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

This is a technical Bill amending the Health and Social Care Professionals Act 2005. It is uncontroversial, seeking to ensure the continuing and effective functioning of the structures established under the 2005 Act - the Health and Social Care Professionals Council and the registration bodies for the 12 designated health and social care professions.

The main purpose of the Bill is to allow the Minister for Health to continue to appoint professional members to the council until such time as the 12 registration boards are established under the Act and are in a position to nominate elected members. We are told in the explanatory memorandum that the Minister has been unable to appoint professional members to the council on the completion of the terms of office of the 12 members appointed when the council was first constituted. We are told this was due to "unforeseen circumstances". In the interest of clarity, I ask that the Minister explain those circumstances. We should have a detailed explanation of the reason he has not been able to proceed as initially intended.

This Bill is being introduced in very different times from those that saw the principal Act introduced. In 2004 and 2005, the years in which the Health and Social Care Professionals legislation was processed in the Oireachtas, there were unprecedented opportunities to transform health services and create a truly equitable and efficient system. Instead of availing of them, there was bureaucratic change, with the establishment of the HSE. The two tier system remained firmly in place and was reinforced by the privatisation policy of the former Minister, Ms Mary Harney, and the rest of the then Government. We are now in dire economic straits. Cruel cuts are being imposed by this Government on public services and the privatisation policy remains in place. What does this mean in practice? It means that a system that should be wholly designed to allow patients to receive the best care and to allow health and social care professionals to provide that care is instead built around the HSE bureaucracy and the private profit motive.

The system values professional expertise more for the profit it can generate than for the good health outcomes it can help to bring about. As a result, our public health services are short in all of the 12 professions listed in the Bill. Public patients struggle to gain access to the expertise that is readily available. It would be readily available only if access were assured. The recruitment embargo denies patients access to timely care and qualified young people the opportunity to work.

The speech and language therapy profession is one of those listed in the Bill. Let me quote from a letter, dated 29 May 2012, from the Irish Association of Speech & Language Therapists to the Irish Examiner, a paper I am sure the Minister of State, Deputy Kathleen Lynch, reads given her roots in a certain part of the island.

There is huge demand for speech and language therapy for adults and children in services across Ireland. There are significant numbers of unemployed fully qualified therapists. The recruitment embargo has meant that services cannot recruit for vacant posts and few new posts are being created.

Some graduates are working in volunteer positions and these can vary in terms of content. These can provide excellent opportunities for skills maintenance and professional development. However, they are not equivalent to working as an autonomous speech and language therapist under professional supervision and are not considered under the competencies framework for full membership of the professional body.

[T]here is both a supply of qualified, highly skilled therapists and a demand for their services, but in the current situation there is a gap between the two, such that children and adults wait unacceptable durations for access to the fundamental human right to communicate.

That is a very measured, thoughtful and accurate description of the reality faced by health professionals and patients today. This reality is not peculiar to speech and language therapists. We can all relate to it because I am sure every Deputy in this House knows of examples of children and adults with special needs who have not received the professional speech and language therapy they need. It is shameful, especially in the case of children. Children's most vital language learning years pass so rapidly that the system put in place by successive Governments fails to match patient need with professional service provision. The same could be said of the other listed professions, including that of social workers. We are very conscious of this in the context of the referendum Bill we passed in this House last week.

I wish to raise the issue of cross-jurisdictional recognition of qualifications and cross-jurisdictional working of professionals. That is addressed in sections 11 to 15 of the Bill which implement EU directives and are especially relevant to Ireland given the continuing existence of partition. The North-South feasibility study on cross-Border co-operation in health care provision, which was carried out jointly by the two Departments, North and South, and on whose publication and content we had to wait for such a long period, addresses this issue. I wish to cite the report extensively because I believe absolutely that there are powerful gains to be made and real progress to be achieved by turning around two back-to-back health delivery systems on this small island and having them face each other and work together in the common interest and good. The study states:

5.19 Both jurisdictions face significant challenges in terms of sustaining high quality, highly specialist tertiary services normally only provided in centres servicing large populations. The availability of appropriately qualified and skilled staff for such specialist areas is key and for populations of either jurisdiction, the small number of hospital consultants providing care in these areas inevitably means that services are inherently vulnerable.


5.20 In a number of service areas, increased sub-specialisation is evident and in newly developing services it is inevitable that the expertise will reside among a small clinical team. For such highly specialised services the population based in either jurisdiction may not be sufficient to sustain a team of appropriately trained skilled clinicians and the longer term sustainability of a high quality service may only be possible if considered on an all-island basis. Where patients have to leave both jurisdictions for treatment, the impact on individuals and their families is very significant in terms of patient well-being and accessibility for the family in sometimes very traumatic circumstances. Combining resources for the provision of such services on a North-South basis makes sense.


5.21 The development of new highly specialist acute and certain other services and the changing pattern of increased specialisation in existing acute services provides a unique opportunity for both jurisdictions to work together. In principle, both jurisdictions should consider developing these services in a collaborative manner, particularly where low patient throughput makes it difficult to sustain highly specialised services and for health professionals to maintain their skills.

It continues:

5.46 It is recognised that both populations would benefit from flexible working arrangements which would enable staff to work in another jurisdiction, for example, practitioners with scarce clinical skills might reasonably offer a service to both populations. However, there are some obstacles to workforce mobility, which can be effectively dealt with provided there is a clear focus on tackling such issues. These aspects include indemnity for staff working out of jurisdiction and mutual recognition of qualifications between professional bodies in both jurisdictions as well as registration and pension issues associated with working in both jurisdictions.


5.47 While great progress has been made, further work needs to be undertaken to extend the facilitation of cross-border working for health and social care staff. Furthermore access to an effective resource, which sets out procedures and protocols, to facilitate work across jurisdictions, would be advantageous.

These recommendations are not from a Sinn Féin election manifesto, nor are they taken directly from the health policy that I anchored and published with colleagues in 2005 for my party. I have just cited a jointly commissioned report. For all the same and practical benefits that it recounts, I again commend to the Minister of State, Deputy Kathleen Lynch, to impact with her senior Minister, if that is at all possible, and to acknowledge this as an area of neglect. There is little evidence of focused endeavour, North or South, to bring about the promise of such an agreed report. However, a willingness clearly exists. It is a significant step forward and should be seized in the interests of ordinary people the length and breadth of this island. All that holds us back is a nervousness of a new step forward and a sense of ownership over whatever part of the island on which we live.

At the end of the day, if the Minister and the Department do not take the initiative to give life to the promise of that particular report, including the section I have just cited on the record, it will be lost again and the report will be left to gather dust on a shelf. I urge the Minister of State not to allow that to happen and to help ensure health professionals on this island can provide the best possible service to patients, which is what they are trained to do and is what the overwhelming number of them want to do. It is the reward of their lives' choice that they get the opportunity to deliver their skills on a continuous basis and have the prospect of development within their chosen career paths. I commend the report strongly to the Minister of State and I am happy to record that I will support the Bill.

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