Clare Daly (Dublin North, United Left) | Oireachtas source

They will be reassured by that. It does not get us away from the bigger picture of what being included in CORU means. Have we created a myth that this is a professional standard, to which the professionals are being asked to sign up and which means that everything is going well, or is it merely a fig-leaf where everything is not going well? It also does not get us away from the question of how to improve standards because simply bringing a profession under the scrutiny of CORU will not automatically achieve that. I will use the example of social workers to illustrate that point. There is a crisis in social work at present. Everyone will be aware of the tragic reports of thousands of children waiting to be assigned a social worker because of the shortage and yet less than 3,700 social workers have signed up to register with CORU. Hundreds of those social workers have not been approved. Earlier in the year, the former Minister, the new Minister for Children and Youth Affairs, Deputy Reilly, told us he would give us a report on these figures, but there is a differential in that regard.

We have been led to believe by some social workers that some people are being paid by the HSE but have not been approved by or registered with CORU while qualified social workers are struggling to come up with the fees for the body. We need to examine this anomaly. How can health professions confirm to a standard if it is being implemented against the backdrop of vicious cuts in health budgets? Is it the case that these professions will be scapegoated for not meeting the standards expected of them as a result? They have to pay a fee to CORU but get no representation if something goes wrong.

The point was previously made that these fees are applicable to students and the unemployed who registered with CORU before they qualified. This led to scenarios of unemployed social workers not being accepted for interviews unless they had already registered with CORU. At the time the fee was €350, ten times the amount charged in Britain. While I accept this fee has been reduced since, where is the analysis that CORU was working to raise standards? How can standards be raised against the overall backdrop of cuts in health services?

For example, the Nurses and Midwives Act 2011 was meant to provide an efficient, transparent and accountable regulatory system, in effect good governance. Who is going to argue against good governance? No one. That is an objective to which we all strive. Those at the coalface, namely, the nurse and midwives, however, made the point that section 40 of that Act has led to serious problems and incursions into their professional autonomy which needs to be re-examined. As a result, we have had cases of midwives being suspended with patients left without appropriate care. There is a belief there is micromanagement, making it difficult for these professionals to do their job and threatening their professional autonomy and livelihoods because of this Big-Brother-is-watching-you scenario. Some involved have described it like an Iranian theocracy where orthodox viewpoints are foisted upon the State which in turn creates a state-surveillance system, monitoring people trying to do their jobs. How will the regulatory process enable professional autonomy to be maintained and strengthened for the professions involved? That is critical if we are looking at good governance.

In harmonising this Bill with existing legislation, how will a transparent process of redress for recipients of services be built into the regulatory framework? As well as the professionals involved, patients and service-users need to be protected too. We need to get the balance right between these two. I do not have a particular problem with opticians being included in this system but the debate needs to go far more than that so as to examine how the health professions are regulated. Is it reasonable to expect health professionals to conform to standards against a backdrop of cutbacks in health services which make it difficult for them to do their jobs? Are we setting up the scenario where they could actually be scapegoated if something goes wrong because of cutbacks?

Section 3 deals with the statutory changes for those who support residential support services. As the home help area operates without proper scrutiny by HIQA, the Health Information and Quality Authority, and other organisations, how are we monitoring this area? There have been horrific reports of how many people who availed of FETAC level 5 courses to upskill to work in this area are going into an industry that is more or less unregulated. Many of them are asked to care for someone for half an hour some 30 miles away but do not get a basic allowance or recompense. This undermining of the HSE system of home help is not healthy. If we are talking about improving governance in health care and of health care professionals, we need to examine it at this level. If people have to pay for these services, then they have to be on a better regulatory footing than they are currently.

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