Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I begin by thanking Deputy Howlin for raising this timely and very important issue and for the co-operation he has demonstrated with me and my officials in working on this matter in recent weeks. I am supporting this Bill on Second Stage because I am fully supportive of the objective behind the legislation, which is to protect the public and women of Ireland. I pay tribute, as Deputy Howlin has done, to the investigative work of Ms Ellen Coyne and Ms Catherine Sanz that has resulted in us perhaps having this worrying issue that we are now endeavouring to address on the floor of the Dáil this evening.

The people requiring protection in this case are women who are experiencing crisis pregnancies and seeking support at a time of extreme distress and vulnerability. Instances have come to light where services purporting to provide objective advice and support were serving their own agenda with little regard for women, their health or welfare. Health information should be just that, not an opportunity to push an agenda, mislead or scaremonger.

My Department has assessed the Bill, as drafted, and we do have some concerns, alluded to by Deputy Howlin, and there is a need to rework some elements to achieve our shared objectives. However, I look forward to engaging constructively with the Deputy on the Bill. Rather than doing what has been done before in the House with a timed amendment, we are, as I discussed with Deputy Howlin, taking a different approach because I was worried that it would send a signal that we are not attaching the required degree of priority to the issue. It is appropriate that the House pass this Bill on Second Stage and that we work constructively to formulate the appropriate solutions to achieve our shared objective. Subject to the Bill passing Second Stage, I will make available the resources of my Department for this purpose. I hope we can work with Deputy Howlin to achieve the best result for women.

I know Deputy Howlin, as a former Minister for Health, is very much alive to the duty to protect the public when availing of health or social care services. As I have said, this concern is shared by me and the Government, especially when it comes to pregnancy counselling services. A crisis pregnancy is perhaps one of the most stressful events in a person's life and can place a woman in a very vulnerable position. Positive Options, the crisis pregnancy service that is funded and overseen by the Health Service Executive, provides counselling in 50 locations nationwide and provides women with free, non-judgmental counselling. We are all aware, however, that some other bodies providing counselling to pregnant women may not adhere to the same standards. There have been media reports, as I have alluded to, of such bodies providing information that is not truthful or objective and this is a cause of concern. It is more than that; it is repulsive, spineless and unacceptable to any right-thinking person. It should not and cannot be tolerated. To address that concern Deputy Howlin has put forward this Bill, which seeks to address the matter by regulating crisis pregnancy counsellors. I have some legal and practical difficulties with the detail of these proposals, as I noted, but I agree there is a very important role for the regulation of relevant professionals in this area. I hope we can find a means of achieving such regulation and I will outline developments for the House that are very relevant in doing so.

Before I do so, I am announcing tonight that, in tandem with our consideration of this Bill, my Department is commencing a review of the Regulation of Information (Services Outside the State for Termination of Pregnancies) Act 1995 as part of our response to addressing the concerns that have arisen. This is an issue that has been raised with me by Deputy Howlin and the Terminations for Medical Reasons group at our meetings, as well as by individual women I have met over the past six months or so. The 1995 Act provides it is an offence for bodies or counsellors to provide information on termination of pregnancy that is not truthful or objective. Allegations of providing such information may be referred to the Garda Síochána for investigation. These provisions are already on the Statute Book and it is important that people with concerns about the veracity of information given by service providers are aware that there is an existing basis for having their concerns addressed. The review I asked my Department to conduct will set about establishing if these provisions need to be strengthened. We will also examine other relevant issues and concerns that have been raised.

On the issue of professional regulation, it might be useful for me to outline the progress that has been made in implementing the Health and Social Care Professionals Act 2005 and to provide some information on how it operates in practice. The 2005 Act provides for the statutory regulation of 14 designated health and social care professions: clinical biochemist, dietitian, dispensing optician, medical scientist, occupational therapist, optometrist, orthoptist, physiotherapist, podiatrist, psychologist, radiographer, social care worker, social worker and speech and language therapist. I hope that is 14.

Regulation under the Act is primarily accomplished through the statutory protection of professional titles by confining their use solely to people who have been granted registration. The structure of the system of statutory regulation comprises registration boards, a committee structure to deal with disciplinary matters and the Health and Social Care Professionals Council, known as CORU, which has overall responsibility for the regulatory system. CORU is responsible for protecting the public by regulating health and social care professionals in Ireland. CORU is also charged with promoting high standards of professional conduct and professional education, training and competence among registrants. The 2005 Act provides for a transitional "grandfathering" period of two years during which existing practitioners must register on the basis of specified qualifications. After this period, the only people who are entitled to use the relevant protected title are those registered with the registration board who are subject to the Act's regulatory regime. To date, the registers of eight of the designated professions have been established. The remaining professions are following close behind. I expect that the registers of all 14 professions will be open by the end of 2017.

While it has been a long and difficult journey for all involved, much valuable learning has been gained along the way. From a public protection viewpoint, a crucial milestone in the regulation of the designated health and social care professions designated under the 2005 Act was the introduction at the end of 2014 of the fitness to practice regime under the Act. This allows complaints about the conduct or competence of registrants to be investigated and, where complaints are substantiated, disciplinary sanctions up to and including cancellation of registration to be imposed. The regime is similar to that which applies to medical practitioners, nurses and midwives. A code of professional conduct and ethics, which sets out the standards of conduct, performance and ethics to which registrants must adhere throughout the course of their work, is central to CORU’s fitness to practice regime. Each profession that is registered has its own code. As part of an application to join a register, all registrants will have signed a statutory declaration stating that they have read, understood and agreed to abide by the code for their profession. Failure to adhere to the relevant code is grounds for a fitness to practice complaint.

I would like to update the House on the relevant proposals to regulate counsellors and psychotherapists, as alluded to by Deputy Howlin. At present, these professions are not designated under the 2005 Act, which provides that the Minister for Health may designate by regulation health or social care professions not currently designated if he or she considers that it is in the public interest to do so and if the specified criteria have been met. A previous Minister for Health, Senator James Reilly, wrote to the Health and Social Care Professionals Council on the question of designating, in the public interest, the profession or professions of counsellor and psychotherapist under section 4(2) of the Act. The 2005 Act provides that the Minister for Health is obliged to consult with the council in the first instance concerning a proposed designation and to give interested people, organisations and bodies an opportunity to make representations to the Minister. The council was asked to consider a number of issues concerning the proposed designation and was requested to take into consideration Quality and Qualifications Ireland's report on the academic standards necessary for the accreditation of courses in counselling and psychotherapy. This was the first stage in the consultation process under the Act.

On 31 August last, having received and considered the report from the council, I proceeded to the next stage, which involves a public consultation to include all interested parties. As mentioned earlier, I have asked that submissions be forwarded to my Department by the end of this month. While a number of key issues remain to be clarified, including decisions on the title or titles of the profession or professions and the minimum qualifications to be required of applicants for registration, I hope the necessary designation regulations can be submitted to the Oireachtas for its approval next year. Expressions of interest will then be sought via the Public Appointments System from suitably qualified people who are available for appointment to the new registration board that will be established to regulate counsellors and psychotherapists. This is a massive body of work. It is important for the Oireachtas to get it done for once and for all in an appropriate way.

The forthcoming developments with regard to the registration of counsellors under CORU are highly relevant in determining the best means of regulating pregnancy counselling other than that provided by professionals such as doctors, nurses or social workers, who are already regulated. As Deputy Howlin has outlined, his Bill proposes to amend the 2005 Act to designate crisis pregnancy counsellor as a profession. It would treat pregnancy counsellors separately to counsellors generally and would define their scope of practice. While I am not convinced that this would be the best approach in practice, I wish to tease out the issue further with the Deputy. The establishment of crisis pregnancy counsellor as a profession separate and distinct from the profession of counsellor would give rise to difficulties. Pregnancy counselling does not meet the standard criteria for designation under the 2005 Act. In particular, it has not established itself as a separate profession with its own professional body, defined routes of entry and distinct entry qualifications etc. Unlike the general profession of counsellor, the number of people in the profession of pregnancy counsellor would be very small. Most providers of pregnancy counselling are members of other regulated professions such as counsellors, medical practitioners, nurses and social workers.

The Bill also seeks to regulate the profession by defining the activity engaged in by pregnancy crisis counsellors. The 2005 Act regulates professions by setting qualifications and protecting title; it does not regulate activity or define scope of practice. As I mentioned earlier, registrants are obliged to adhere to a code of conduct and ethics specific to their profession. Failure to do so is a ground for a fitness to practice complaint. The Act provides that only those who are registered can use the protected title. The ultimate sanction under the Act is the cancellation of registration and the consequent removal of entitlement to use the title. For that reason, the inclusion of references in the Bill to "the activity of giving information, advice and counselling to pregnant women in relation to crisis pregnancies" needs further careful consideration. A range of professionals engaged in such activity are regulated by CORU and other regulators such as the Medical Council. We want to retain the everyday important contribution of such professionals to supporting women in crisis pregnancy situations and in a way that relies on their existing professional regulation, which reflects their professional affiliation and standing. In addition, the Bill before the House does not take account of the difficult but key requirement to set grandfathering qualifications, which is central to the registration of existing practitioners. There is also the matter of having to provide for the establishment of a registration board and a range of consequential amendments to the 2005 Act.

I make all of these points in the desire to be constructive and make progress. I will ask my officials to continue their current engagement with Deputy Howlin and other interested Deputies on these issues so that we can arrive at the points that I believe we collectively as a House wish to arrive at with regard to this important issue. While I support the Bill being read on Second Stage, I feel obliged to point to the additional work we need to do in this area. I am committed to working with Deputy Howlin on this matter. I have asked my officials to give timely consideration to ways of better protecting the public from certain crisis pregnancy agencies or counsellors that are providing information that is clearly neither truthful nor objective. The intention will be to make progress through forthcoming registration of counsellors, the existing Regulation of Information (Services Outside the State For Termination of Pregnancies) Act 1995 and the review of the 1995 Act I am announcing this evening as a sizeable and important body of work. I look forward to keeping the House updated. I look forward to this legislation progressing beyond Second Stage, as I hope it will do, so that we can work together to make sure women in this country are provided with factual and truthful information, rather than some of the despicable and disgusting issues we have read about in the media recently. The women of this country deserve better. I am determined to work with Deputy Howlin to achieve the objectives he is setting out to achieve.

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