Dan Neville (Limerick West, Fine Gael)
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I welcome the opportunity to speak on the Bill. I raised some issues last night with the Minister of State at the Department of Health and Children, Deputy Seán Power, who has agreed to examine them and I am awaiting a reply.

Doctors are often criticised for refusing to make a complaint against a colleague. It is sometimes believed that this is the result of an old boys' club approach. However, it has more to do with the fact that they have no protection in law if they raise issues of concern. The Dr. Neary affair was a case in point. That issue came to public notice because two student midwives, who had trained in Northern Ireland where is a different legislative framework, were horrified by what they saw taking place in Our Lady's Hospital in Drogheda and complained to their supervisor. The matter came to light when the supervisor took the complaint further.

Why are consultants, who are very important and powerful people in hospitals in their own right, afraid to report their colleagues even to the Medical Council? The main reason is fear of litigation. If one cannot prove an accusation, one may find oneself in the High Court even if the allegation is true. Hearsay and circumstantial evidence are not sufficient. One must be in a position to demonstrate a problem exists. If one is proved wrong, the accused person can sue for defamation, even if the information is true but unproven. This creates a serious gap in ensuring safety in hospitals and that issues that arise from time to time are addressed are reported.

The Minister must address the absence of political and administrative support for consultants and other medical personnel who make a complaint and find themselves out on a limb as colleagues close ranks. Legislation on the medical profession, including this Bill, does not protect patients or doctors because it is ineffective when those at the top show weakness or lack of leadership. Fundamental changes are required to make this type of legislation work. The Bill is too reliant on people being genuine and well intentioned. We must bear in mind that if someone wishes to play the legal system or has ulterior motives or another agenda, the legislation will fail those it is meant to protect. For this reason the Government should consider the introduction of whistle-blowing legislation.

It may transpire that a complaint made against a person is not completely true. Many such cases have become before the Medical Council which receives a large number of complaints about medical practitioners. Patients, for example, complain about the manner in which they have been treated by doctors. This is quite a regular occurrence. Many of these doctors are caring and considerate people and can be very upset and badly affected by complaints made against them. Such complaints are not always malicious as patients may genuinely believe they have been badly treated. Even if it is shown by the Medical Council that the doctor was not negligent or incompetent and is declared innocent after 12 months or so, the doctor still feels wronged if it takes 12 months to vindicate his or her good name.

There is nothing in place at present to protect consultants who make a complaint, even if the complaint is not substantiated in the long term. This is the case throughout the public service, including the Garda Síochána, the teaching profession and the medical profession, from psychotherapists to chiropodists and all the professions the Minister has included in the Bill, as well as those that will seek registration on the new body. We do not have a proper mechanism to enable people to make their views and concerns known without having to worry that if they put their concerns in writing or make a complaint, a lily-livered or weak-hearted administrator will release the information.

Legislation is the way forward. I therefore welcome the Bill. There is far too much ad hoc regulation of the health care professions. I have been concerned for some time that somebody can call themselves a counsellor, put up a plate and operate as a counsellor without any training. There is very little regulation of such people, whether they are marriage counsellors, career guidance counsellors, bereavement counsellors or any other type of counsellor, and that can be quite dangerous, particularly where a person is in crisis. We have heard scary stories from time to time regarding the advice given by counsellors to people and the lack of proper regulation of such people who sometimes charge well. People inside and outside the House are also aware of complaints regarding people involved in alternative medicine claiming they have cures for cancer and so on. Large amounts of money are charged by such people on questionable grounds. There is a need to ensure there is regulation of this area and that penalties apply where there is abuse.

Some professionals believe they have been left out of the legislation as some titles are not specifically mentioned. One of the most important issues to arise since the introduction of the legislation relates to the title of physical therapist. Most of us have been contacted about this issue and we have received correspondence on it. It must be addressed on Committee Stage. If it is not resolved before the legislation is enacted, the title of physical therapist will remain outside the Bill's scope, thus creating more problems in the future. The Government should take the bull by the horns and deal with this issue now as it will arise in the future. I look forward to a more detailed discussion on Committee Stage.

A number of other organisations are omitted from the scope of the Bill. Given the complexity of medicine and the many qualifications now available, many other bodies will seek to be included in the legislation. In the same way as the Medical Council has given the medical profession status, patients want all health care providers to be covered by governing councils. The public will think those who are not included in the legislation are alternative or unqualified practitioners. That will have a detrimental effect on many people with qualifications who believe they should be included in the legislation. We must reduce ambiguity to serve the public interest and the Government must legislate for alternative practitioners at some stage. It is becoming so complex that people do not know where they stand.

Psychologists are included in the Bill. However, some people call themselves psychologists and counsellors. We must clarify the qualifications required in that regard. People who qualify as psychologists have studied at a third level institution for a long time. They may be left out of the legislation, although we currently consider them psychotherapists. These people often have qualifications other than those attained at university. Others who do not have a qualification will also be left out. Perhaps the legislation could differentiate between patients and doctors because they do not know the qualifications of those described as counsellors and psychotherapists. It is a profession and it should be included along with the other 12 already mentioned in the legislation. Are there any means to consider that? If that group is established and meets the rules, can the Minister issue a regulation to include it in the legislation?

Perhaps a regulatory body with 13 members will have to be set up. How would that fit in with the council proposed by the Minister? Would it be difficult to nominate a member to the council? The majority of the 12 organisations mentioned participate in the public service. Perhaps the Minister believes that once they are covered, the public service remit will have been fulfilled. Does the Minister intend to look after the other bodies which do not have a public service role?

We often ask about the definition of a medical scientist. It was stated that it is included in the Bill. Is it someone working in a pharmaceutical company, a laboratory or a hospital or is it a science graduate who is perhaps doing controversial research on embryos in a university? Perhaps this issue should be teased out on Committee Stage. We must bear in mind that there are also external factors to be considered. If someone is carrying out stem cell or embryo research, will he or she come under this legislation? Would he or she break the law if he or she did something which this House had not approved?

Has the Minister named the representative bodies of the 12 professions mentioned in the legislation? Physiotherapists are represented by two organisations which will be nominated as being responsible for looking after their needs. Many of the bodies have at least two representative organisations and there could be conflict if one is chosen over the other. We must examine this issue on Committee Stage because the Bill is not clear in that regard.

All the organisations mentioned by the Minister are involved in either the health or social welfare services. Why then are the ministerial nominees of these bodies named by the Minister for Enterprise, Trade and Employment and not by the Minister for Health and Children? I am interested to hear the Minister's response in that regard.

The sections of the Bill on registration, education, training, complaints, inquiries and disciplinary procedures are welcome. They follow the criteria used by the Medical Council on making complaints. The council, however, is moving towards all professional conduct committee hearings being heard in public. That has created anxiety for members of the medical profession because if a committee hearing is held in public, it will be reported in the media. If the committee finds that all charges are baseless, the media will not report that. There is no story if someone is innocent, only if someone is found guilty. The media is not obliged to report a story if someone is found innocent. However, in the interests of balance and fair play one would like to ensure that information about a person who has been publicly subjected to charges or suggestions about their profession but who has been found innocent is fully reported.

Many professions will find themselves in a unique position when complaints are made about them. It is difficult for patients to get a hearing. Many of the professionals will be surprised when this legislation is enacted. At least the health committees will be held in private because they will deal with emotional subjects for everyone involved.

We would welcome a statement from the Minister on the number of professionals available in the psychiatric services. I am talking about psychotherapists and occupational therapists who are important in that area. The Irish College of Psychiatrists has informed us that 70% of its psychiatrists do not have a psychotherapist available to them. Some psychiatrists handle up to 600 patients at any one time. One psychiatrist told the Oireachtas Joint Committee on Health and Children that. We would welcome a debate on the need for multidisciplinary psychiatric teams to deal with hospital and community psychiatry.

John Dennehy (Cork South Central, Fianna Fail)
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I also welcome the opportunity to speak on this important Bill in the area of health care regulation. I am happy the Fine Gael spokesperson has welcomed the Bill. We should all work to improve this area. I am sure issues will arise which will have to be teased out on Committee Stage.

The Minister of State, Deputy Seán Power, told us last week that the Bill will provide a system whereby individual members of the 12 listed professions will be certified as competent to practise. Unlike the present voluntary system, this will be a legally binding process with a mechanism for the prosecution of offences. That is an important aspect of the Bill. We were told its establishment would bring a system of statutory registration which we all agree is essential to ensure that members of the public are guided, protected and informed so that they can be confident that the health and social professionals providing services are properly qualified, competent and fit to practise. The system will ensure professional conduct and the maintenance of high standards of professional education and training among health and social care professionals. The statutory registration of the 12 health and social care professionals listed, regardless of whether they work in the public or private sector or are self-employed, is long overdue. This work has been ongoing since at least 2000. It is critically important legislation for the reasons outlined by Deputy Neville and others.

I welcome the fact that the legislation will cover the private sector and the self-employed. Many of us involved in the public health care area have been concerned for many years about the lack of control over people who set themselves up as professionals, particularly in the private and self-employed sectors where few or no checks are carried out. There are concerns about several professions, especially those dealing with clients accessing mental health care such as psychologists and counsellors. Whether coping with alcohol or drug problems or other psychological difficulties, clients are especially vulnerable to coming under the care of people who do not have the professional expertise to deal with their problems and who are not, to put it mildly, best qualified to provide assistance.

My focus in considering the Bill is the need to protect the public from a medical care perspective. In that context, I notice the expression of concern by the Competition Authority about restrictive practices that might emerge on foot of the passing of the legislation. While medical care must be the overriding concern of the Oireachtas, I acknowledge warnings in the authority's report that professions may be able to manipulate the conditions of entry and the numbers being trained for their own benefit. The Committee on Health and Children has spent the past few years attempting to deal with orthodontics but the vested interests have beaten us until now. They have been able to manipulate matters to the extent that there are so few practitioners that the cost of treatment has become prohibitive. As I have said, however, our priority must remain the health care aspects of the legislation. Restrictive practices can be dealt with elsewhere and at a later date.

On 28 October 2004, the Taoiseach announced the publication of the Bill and said the purpose of establishing a regulatory system was to ensure that members of the public would be guided, protected and informed to give them confidence that health and social care professionals providing services are properly qualified, competent and fit to practice. The worries of the Competition Authority about pricing can be addressed later, but it is the job of the Tánaiste and the Ministers of State, Deputies Seán Power and Brian Lenihan, to ensure that purely health issues are dealt with in the legislation. I agree with Deputy Seán Power and the Tánaiste that the legislation is a key action in the health strategy on quality and fairness to expand and strengthen the regulatory environment in the health sector. It is long overdue. Like Deputy Neville, I am worried by the emergence of alternative medicine and practices and, in particular, by the proliferation of people who describe themselves as professional counsellors. It is imperative to introduce controlling mechanisms in these areas.

The Tánaiste described the system of statutory regulation proposed in the Bill as open and transparent and characterised by strong public interest representation that will serve to enhance the quality and accountability of health and social care services provided to the public. While most people will welcome her statement, the IMPACT trade union has expressed concerns as the representative body for quite a number of those who will be regulated under the legislation. IMPACT argues that the professions have waited for the legislation for a long time and makes a case, rightly or wrongly, that its members are being treated as second-class professionals within the health service.

IMPACT says there is no good reason for introducing different approaches for different professions and cites the example of the Irish Medical Council and An Bord Altranais, which regulate doctors and nursing staff, respectively. The majority of members of the boards of those bodies are members of the relevant professions. While I may have misread the report and the earlier documentation from the Tánaiste, I got the impression that the report was the first of three and that arrangements for the medical profession and nursing will also change. I understand the Tánaiste intends to bring forward further proposals to ensure that everyone is treated in practically the same way or according to the same criteria. I would appreciate a comment on that from the Minister of State in his reply. While I appreciate the need of trade unions to ensure their members are treated properly, IMPACT's concern is misplaced if it relates to the ratio on a board of members of the profession to people appointed from outside. While serving on a health board for many years, I found that a very fair balance had been struck. A 6:7 breakdown on registration boards is not too bad.

Unlike the Ceann Comhairle, I am not qualified to decide what is required in a good counsellor or therapist. I respect fully, however, the other professions listed in the Bill and am concerned about the untold damage a quack could do practising in mental care. Some of the people who have gone into the area have a chip on their shoulder. Some who have earned degrees or status in other walks of life have simply put a plaque on the wall and immediately become professional counsellors. If a person does not have relevant training, even if he or she holds a related degree, he or she should not be in a position to function as a professional in the discipline in question. It is the duty of the State to ensure that cannot happen in the health care field.

Deputy Neville mentioned the significant changes that have taken place with the development alternative medicine and the split in specialisms. I thought a cardiac surgeon was someone who did heart operations, but then I found out there was a cardiac thoracic surgeon. As we have seen professions coin titles in the United States of America at the drop of hat, I fear that practitioners here will simply change title to operate free and easy. There is a need for provisions to control those who might attempt to avoid regulation as a member of one of the 12 professions designated in the Bill. The matter will have to be kept under observation.

I emphasise that I do not take issue with alternative medicine and am not qualified to argue against it. I do not argue against the use by people of faith healing provided there are controls and that people are aware of what they are buying into. Issues of mental health, for example, are simply too sensitive to leave unregulated. A fractured leg is an obvious injury to treat, but matters are much more difficult where mental health is involved.

The debate in this area has been ongoing since at least 2000. The consultative document, Statutory Registration for Health and Social Care Professionals: Proposals for the Way Forward, was published in October 2000. As the matter has been in gestation for quite a long time, it is important to make progress. Deputy Neville referred to a further matter of contention, the representation of chartered physiotherapists by two separate bodies. While the Department will have to make a ruling on who is in and who is out, I sound a note of caution that people with bona fide qualifications should not be pushed aside simply because there is a group with a longer-standing title. The people who are qualified to adjudicate the matter are the officials and line Ministers in the Department.

Each registration board will have 13 members, six to be members of the particular profession and seven from outside the profession to be appointed by the Minister. Each registration board will determine criteria for registration and so on. One of my concerns relates to numbers. With just the first tranche of professions we already have at least 156 people, plus 25 on the health and social care professionals council, plus the chief executive and his or her staff. I am not sure how many more professions it is intended to add to the list but it appears that the final number of people involved will be very unwieldy. I would hazard a guess that it is almost back to the health board figures already. I take the point that each registration board must have a separate group and that each profession must be individually monitored, but there is a significant number of people involved in that. I am concerned that the left hand will not know what the right hand is doing.

It is intended that the chief executive officer would operate between the 12 bodies. We have been there and done that and it does not operate that way. Nobody can keep track of all these people. Will the Minister look at this proposed arrangement to see if it can be made less unwieldy? Speaking from my health board experience, I do not know how it could function efficiently. It was difficult to keep in touch with the three former standing committees on mental health, community care and general hospitals. It was mission impossible.

This is an important document. One section deals with protection of titles. The Minister is empowered to protect additional titles by regulation. That area must be copperfastened. It would be an offence for an unregistered practitioner to use a protected title or to falsely represent himself or herself as being a registered practitioner. Will practitioners of alternative medicine have to come up with alternative names for a particular practice? Will there be a mechanism for ensuring that the practice cannot be one of the listed ones?

The issue of physiotherapists has been discussed. New names are regularly coined in the United States such as sanitary engineers for dustbin collectors and so on. This area must be tightened up. It was stated in committee that people will not be able to work their way around it. As we have seen with all forms of medicine, the public is willing to buy into anything if they have the money. The public must be protected. I accept that the Bill, which is long overdue, is a key action in the health strategy, Quality and Fairness — A Health System for You. It is intended to expand this list. Deputy Neville referred to a few possibilities. I am interested in finding out what is proposed.

Section 9 deals with the 25-member council about which I am concerned. Deputy Neville also referred to the fact that appointments would be made with the consent of the Minister for Enterprise, Trade and Employment. I was tempted to ask him about this when I had lunch with him today but I did not want to spoil his lunch. It is surprising that it is not the Minister for Health and Children.

The coherence and consistency of the system is critical. The intention is to promote uniformity of practice among registration boards. I am concerned that each of the 12 bodies would only look after its own bailiwick. There must be consistency. Deputy Neville expressed concern about the proceedings being held in public. Many disciplinary hearings that should be easily dealt with appear to require the involvement of junior and senior counsel. Very often they beat the system. Natural justice crops up and the courts find in favour of people. I am concerned that with 156 people vying for different things, we could be in trouble in this regard. I would like to hear how this matter would be handled.

In the past, some of the right to practise groups such as nursing groups and the medical board were challenged legally. Deputy Neville outlined how the three statutory committees, the preliminary proceedings committee, a health committee and a professional conduct committee, would operate. It is complicated. I am concerned that, as we have seen in so many cases, the intervention of the legal profession would make it unworkable. Are these powers stronger and how do they differ from the powers of the nursing board or the medical disciplinary board?

In that context, I welcome the fact that in extreme and urgent circumstances the council may apply to the High Court to suspend a practitioner pending completion of an inquiry. There has been a failure to do that in the past in certain circumstances where the outcome was tragic. It is important that people can take the initiative. It is not just business or an environmental issue that may be able to wait. We are talking about health and it is important that we would be able to move fairly quickly.

The battle between the therapists will have to be adjudicated upon but it should be dealt with quite quickly. It is not just the Irish Society of Chartered Physiotherapists and its competitors that are involved. It relates to the area of regulation and of people being able to set up a separate category, separate title and to move on from there.

I compliment those involved in the committee that was set up to examine social care professionals. They have done a great deal and examined the issue of house parents and so on. They have looked at the child care area and having done an audit of the needs, they are willing to train people, which is crucially important. Many people will need training once the legislation is put in place. We should remember that and help to supply that training.

Simon Coveney (Cork South Central, Fine Gael)
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I am pleased to have an opportunity to say a few words on this Bill. The Fine Gael Party welcomes the thinking and purpose behind it. It provides for the establishment of a system of statutory registration for certain health and social care professionals as well as ongoing regulation. The Bill is not before time. It is quite extraordinary that the Government or previous Ministers under various Governments did not see fit to introduce such legislation before now. It is surely a vital responsibility of legislators to ensure that those professionals who provide health and social care to citizens are adequately and independently regulated by a suitable system.

I am pleased to hear the Bill is the first of three which form part of the reform process of the health provision regulatory environment. The Minister made it clear in the Seanad that this Bill is the first of three steps to improve legislation in this area. Legislative measures to cover medical practitioners and nurses are to follow. I urge the Minister to introduce these as soon as possible. Perhaps the Minister of State, Deputy Brian Lenihan, will indicate when they are likely to be introduced.

This Bill covers statutory registration for chiropodists, clinical biochemists, dietitians, medical scientists, occupational therapists, orthoptists, physiotherapists, psychologists, radiographers, social care workers, social workers and speech and language therapists. A broad range of vital health services is covered by these professions. Members who have worked on health boards, as I have done, will be aware of the importance of the combination of skills such professionals possess.

We must ensure the consumer is provided with a constant standard of care throughout the country. When a child needs specialist care, for example, its guardian or parent has no way of assessing accurately whether the available specialist, if there is one in the area, operates to an acceptable standard or has an acceptable skill level. Parents need to rely on the State and professional bodies to ensure a common standard of excellence is applied. That is the essence of this Bill and the reason it must be welcomed. The State is responding, albeit belatedly, to put a system in place to ensure that when parents take a young child to an occupational therapist or speech and language therapist, whether he or she is in Cork, Galway, Limerick or Mayo, they can be sure of a certain standard of skill or care.

The national health strategy has many themes but the most important may be that of so-called patient-centred approaches to health care policy. This Bill represents a step forward in strengthening the regulatory environment pertaining to health professionals.

It is tempting to refer to some of the many areas where the Government's so-called patient-centred approach would be considered a joke if it were not so serious, but I will try to confine my remarks to the content and purpose of the Bill. First, let me consider the issue of the statutory registration of professionals. The proposed structure seems sensible enough. A registration board for each of the 12 professions listed will be set up and each board will have 13 members. Six of the 13 will be from the relevant participating profession and seven, appointed by the Minister, will be from outside the profession, thus ensuring independence and balance. While I agree entirely that there should be a majority from outside the relevant medical profession, I believe some difficulties might arise over how members of a board are chosen. In some cases, the professions concerned are represented by a number of bodies, as has been pointed out by various speakers. Perhaps the Minister of State will address this issue when he has the opportunity to do so. I will be interested to see the Minister's assessment criteria for deciding who should be on the boards.

Consider the recognition of qualifications and assessment procedures. Having had the benefit of being involved in European politics for the past year, I believe it is essential to have automatic recognition of the qualifications of professionals from all 25 member states. A very interesting debate is taking place in the European Parliament at present on the services directive in term of whether health care should be part thereof and whether we should have absolute recognition of skills and qualifications of professionals from all 25 member states in all other countries. Will this Bill take into account the services directive if it includes health care provision?

I seek clarity on the recognition of qualifications of professionals from non-EU countries. I recently dealt with a very good example of the problem to which I refer. A dentist from Russia, who is married to an Irish person and is an Irish citizen, received her qualifications from a recognised university in Russia, yet she is having great difficulty having her dentistry degree recognised in Ireland. If she had received her qualifications in Latvia, she would have no problem. We need to streamline a system for recognising qualifications of medical practitioners, especially those from countries that border the European Union. Although the example I cited concerns a dentist, whose profession is not covered by this legislation, the principle is the same.

The principles of this legislation are welcome because we are ensuring a common standard, but when one reads the list of professions covered by the Bill, one realises that, in the majority of cases, there are not enough professionals in Ireland to provide adequate services. A parent looking for an occupational therapist or speech and language therapist for a child, or a physiotherapist for an elderly person, will note a shortage of staff. If one talks to social workers, they will tell one they are over-worked. Although we need to ensure a common standard, we also need to ensure that when we bring in health and social care professionals from outside the European Union, as we will have to do, we will adopt a streamlined approach to recognising their qualifications.

On registration, there is a need to add further professions to those covered by the Bill. Other speakers have referred to this. An osteopath visited my office recently and spoke about UK legislation, dating from 1993, which created a new registrar for qualified professionals, run by the General Osteopathic Council. Nine organisations representing osteopaths were amalgamated into a single registrar. We have no such registrar in Ireland. Regardless of whether legislation is required in its own right to address this issue or whether it can be addressed through this Bill, we must consider it.

Deputy Neville referred to the difference between physical therapists and physiotherapists. More clarity is required in this area and I hope the issue will be explored on Committee Stage.

If the Minister of State chooses to add another profession to the list of 12, the Dáil and Seanad should be consulted. I am unclear how this can be done, or whether a Minister can do it of his or her own accord.

After registration issues, one must consider the ongoing regulatory procedures dealt with in the Bill. Complaints of malpractice will be dealt by the health and social care professional council which is comprised of 25 people. Is it necessary to have so many? This number, however, was chosen in a bid to represent the 12 sectors concerned with the Bill together with 13 other individuals nominated by the Minister to ensure a majority of non-health care people.

We should consider Deputy Twomey's point with regard to this matter. There is a need for whistleblower legislation in health care, as well as across a range of other sectors. Deputy Rabbitte raised the issue this morning and it has been promised time and again. Such legislation needs to be brought forward as a priority so that people who need to make a complaint can do so without fear of intimidation or potentially losing their job because of internal medical politics or downright bullying.

Junior doctors may feel they should report something resulting from the work of a more senior consultant doctor in a hospital. Systems should be put in place to ensure that if somebody makes a complaint, whether they are a member of the public or, more importantly, another health care worker, they and their job are protected and they will not be discriminated against.

This Bill moves regulation in health care in the right direction and, most importantly, protects the public. We should not expect parents or people who are ill to attempt to assess the doctor or professional they attend. That must be a given. Those people must be sure that the State has provided the necessary structures to ensure they can go to a health professional in the knowledge that the person is of an acceptable standard for them, their child, parent or family member.

The Bill protects the integrity of the health professional's title. People deserve recognition if they go to the trouble of educating themselves, sometimes over a period of ten years, to obtain a qualification. Others who take shortcuts and set themselves up as so-called health experts without the necessary qualifications must be exposed. This is not happening to a sufficient extent at present. The protection of professional titles is extremely important in health care because it also ensures that titles and professions are associated with excellence by rooting out people who are not suitable or capable of being health care professionals, doctors, social workers, physiotherapists etc.

The Bill also protects the State. In years to come, people may well ask why we did not introduce the legislation earlier. There is a State responsibility if people have suffered as a result of malpractice and this legislation provides for necessary protection in the future.

Perhaps the Minister of State would outline when we are likely to see similar legislation for nursing and medical doctors, so that we in Opposition can add our support when it comes forward. This is a move in the right direction. It is only a very small sector within the overall health portfolio. However, positive decisions such as this should be recognised.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I thank the Chair for allowing me the opportunity to speak on this legislation. I welcome the Minister of State, Deputy Brian Lenihan, and always take every opportunity to praise his work in the Department of Health and Children.

I am glad we are having such a civilised debate at the end of the Dáil term and compliment Deputy Coveney on his speech. It is important that legislation which is good and regarded as helpful and useful is welcomed by all sides of the House. I am happy that this is the case in respect of the Health and Social Care Professionals Bill.

I acknowledge the representations I received from my constituency and professional organisations, some of which have been referred to. People, particularly those in the professions, are very glad that this overdue legislation is now before us.

When launching the Bill on 28 October 2004, the Tánaiste said it would provide for the establishment of a system of statutory registration for health and social care professionals. She went on to explain that the legislation is key to the health care approach, particularly in respect of the Quality and Fairness strategy and will expand and strengthen the regulatory environment in the health sector.

Like Deputy Dennehy, I am happy to sketch my own interest in this matter. I was a member of South Dublin County Council in 1994 and fortunate to be appointed to the then Eastern Health Board where I remained until the establishment of the Eastern Regional Health Authority. I was the founder chairman of the South Western Area Health Board. Apart from the everyday experience I have had in my life, the time I spent working in the health boards gave me tremendous experience which I can now bring to my work as a Deputy and legislator.

The purpose of establishing this regulatory system is to ensure members of the public are guided, protected and informed so that they can be confident that health and social care professionals are properly qualified, competent and fit to practice. When the Bill was published, the Department described the system of statutory regulation proposed as open and transparent, characterised by strong public interest representation which will serve to enhance the quality and accountability of health and social care services provided to the public. We have moved on since the health boards but I am sensitive to the need to make the health services accountable. Some process should be found to allow public representatives make a contribution in that regard.

I find the Health Service Executive is now dealing with our queries and correspondence in a professional way and that is as it should be. It is important we stress to the executive that those of us who are privileged enough to represent our communities often have many health queries and it is important that it would continue to provide a service for us so we can serve people in the community.

The system of statutory registration will apply in the first instance to 12 health and social care professions, including chiropodists, clinical biochemists, dieticians, medical scientists, occupational therapists, physiotherapists, psychologists, radiographers, social care professionals, social workers and speech and language therapists, irrespective of whether the professional works in the public or private sector or is self-employed. This is the first of three pieces of legislation to reform the regulatory environment for health professions, with legislation for medical practitioners and nurses to follow. It should be said that not everybody welcomed this legislation when it was published and many Deputies were in receipt of correspondence and representations from IMPACT, among other groups, making its case regarding the provisions in the Bill.

I represent Dublin South-West which embraces Brittas, Bohernabreena, Firhouse, Greenhills, Templeogue and Tallaght and the issue of the lack of speech and language therapists crops up regularly through representations from parents, schools and Tallaght Hospital. While not wanting to divert from the issues relating to the Bill, I wish to make the Minister of State aware that there is still a great demand for speech and language therapists in various communities and my constituency is no different from anywhere else in that regard. Since I became a Dáil Deputy three years ago, I have had a number of queries in that regard from Tallaght Hospital and from a local school, St. Mark's primary school, in Springfield where I live.

It is important that we maintain pressure to ensure that speech and language therapy is delivered, and that we continue to support people and stress to the Department of Health and Children that there is a difficulty in recruiting speech and language therapists. Apparently there is a difficulty in training a sufficient number of therapists and we should take the opportunity on every occasion to stress our support for what the Government is trying to achieve on this issue. I hope the Minister of State will send a note down the line on that point, not only for Tallaght, although principally for that area, but also for other communities.

The Health and Social Care Professionals Bill provides for the establishment of a system of statutory registration for health and social care professionals. We must acknowledge that the Government has always emphasised the importance of building consensus by using a highly consultative process with the professions involved. In this particular case, and if my mail is anything to go by, that is being achieved. The purpose of establishing this regulatory system is to ensure that members of the public are guided, protected and informed. In the past, the work of some of these professionals, through no fault of theirs, was not really known to the public. People did not always know what was involved and being done on their behalf by such professionals.

We live in a society that demands information and it is important that we all take our responsibilities seriously in that regard. People need to know what is involved with a procedure and what is being done on their behalf. They also need to feel safe, as a number of contributors have already stated. This Bill has been broadly welcomed and it will do much good with regard to increasing people's sense of safety.

Only a handful of health care professions are subject to statutory regulation at present, namely, doctors, nurses, dentists, opticians and pharmacists. I do not want to single out doctors as I have noticed that the last two occupants of the Chair during this debate have been doctors. That reminds me that those of our colleagues who are medical doctors will be telling Members of the House tomorrow to try to relax and take some time off during the summer. I know that members of the media do not want us to do that but I hope that the public does not think that we are going off for three months because we are not. I look forward to just taking a couple of weeks off and I will take any advice that any medical doctor gives me in that regard and rest for a couple of weeks.

Most Deputies received telephone calls from one of the national newspapers yesterday inquiring about our holiday plans. I am not sure if they reached the Ceann Comhairle's office.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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The Ceann Comhairle is always away.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I told the journalist that I was too busy to make plans at present and would wait until the Dáil was in recess before making any arrangements, but that I would be staying at home. I am always happy to stay at home. I have no problem with going abroad but as many of us as possible should stay at home and enjoy the countryside and I am happy to do that.

The titles of the various professions referred to in the Bill will be protected and it will be an offence for a person who is unregistered to offer professional services to the public. I have already listed the organisations that are involved in that regard. Other colleagues have referred to the conflicting — I hope that word is not offensive — correspondence we have received from the Irish Society of Chartered Physiotherapists and the Institute of Physical Therapy. Both organisations made their case strongly and their respective positions are now a matter of record among Members. To a great extent, it is incumbent on both organisations to make their case and to explain their views regarding the divisions between them. I will not necessarily put all of the documents on record, but it is important the Minister of State is aware in the context of this debate that Deputies are in receipt of a great deal of correspondence on this matter. Perhaps the Minister of State could note that point and provide us with some advice on the matter when he is summing up at the end of this debate.

Many people will ask why particular legislation is being introduced but the case has been well made regarding this Bill. I have spoken to many people in my constituency who have said that they are happy that a regulatory system for these professionals has come to fruition, even if it is a little overdue. The important and positive point is that the legislation is now before us and the matter is being dealt with.

Moves to introduce legislation to provide for the registration of certain health and social services professions have, according to the Department of Health and Children, been under consideration for a significant period. The Department has explained that, for various reasons, it has not been possible to proceed with legislation in the past. There are several pressing reasons such legislation should now be introduced. There are legitimate and genuine concerns among members of the public who need to be guided and protected so that they are confident that the professionals providing services are competent and qualified.

The professional bodies have made the point in all their representations that they require protection where normal operational procedures and ethical factors make it impossible to exclude those who are unqualified or insufficiently qualified from engaging in professional activity. Among other reasons, this is because the professional bodies can only apply an ethical code to their own members. The good name and reputation of the majority can be damaged by the actions of a small minority that bring the profession into disrepute, unless there is a mechanism for sanctioning professional misconduct and misdemeanour.

A proper system of registration can allow for the investigation of allegations of incompetence or misconduct and enable disciplinary action to be taken. It can also provide a mechanism whereby practitioners who are compromised by ill-health or addiction can be dealt with appropriately and that is something which would be generally welcomed.

Registration provides a legislative framework for the evaluation and approval of education and training courses, examinations, qualifications and institutions. This guarantees the proper development of education and training across the professions and some professions are already discharging these functions.

Registration also provides a more widely informed and participative forum for the administration and implementation of the EU directives on the mutual recognition of third level qualifications in EU member states. It will also lead to greater consistency in the application of those directives. Voluntary codes of registration, while very useful in themselves, cannot by definition offer the legal protection afforded by a system of statutory registration. There must be a strong commitment to deliver the best possible service to patients and clients. This must be the primary concern of all when developing a system of registration for health and social care professionals in the State.

The proposal is for a system of statutory self-registration for social care professionals and the other 12 health and social professions involved. The regime would provide a formal legal framework and administrative infrastructure within which the quality of the services provided to the public and the future development of the professions can be assured.

The regulatory system will comprise a registration board for each profession to be registered, a health and social care professionals council with overall responsibility for the system and three statutory committees to deal with disciplinary matters. A chief executive officer and staff will administer the system. To ensure consistency across the registration boards, the chief executive officer will act as a registrar for each registration board.

This House has dealt with many interesting and important issues over the past months and it would be unfair to single out one Bill. However, in this Dáil term the Department of Health and Children has been to the forefront in a number of major debates on legislation. Like everyone else, the Department will be glad to pause and draw breath in the summer recess. I wish the Tánaiste, the Ministers of State and the departmental officials well. It has been a somewhat difficult time during which they have dealt with different issues. They provide a public service and they have the public's confidence in that regard.

There will be other occasions when I will talk about the needs of Tallaght and Tallaght Hospital. I will certainly talk more about child care issues in my constituency. I am always happy to invite and welcome the Minister of State, Deputy Brian Lenihan, to my constituency. I hope he will take every opportunity to come.

I will support this important legislation. The professions concerned regard it as a ground breaking Bill. As Senator Ormonde has often stated, one must look after the public and continue to give the public what it wants. This Bill will regulate various professions and services provided to the public on a daily basis and as such will be welcomed.

I take this opportunity to wish the Ceann Comhairle and the staff of the House well and hope they have a good summer.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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Before Deputy O'Connor leaves the House I wish to comment on his contribution. I was glad to hear him admit that he regretted voting for the demise of the health boards. They were useful to Deputies because we now have no avenue of access to the health services. The Minister in her replies to our parliamentary questions states the Health Service Executive must deal with questions and everything is brushed aside.

Charlie O'Connor (Dublin South West, Fianna Fail)
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A Fine Gael Government would have done the same.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I wish the Deputy well. I heard him on radio explaining that he was the first person nominated for the next Dáil but he should remember that is only the first hurdle and there will be many other hurdles to overcome. Unlike his colleague and my constituency colleague, he is not in the safest seat.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I am in the most marginal seat in the country.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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Our colleague has the safest seat in the country, unless his horse falls.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Ceann Comhairle cannot be included.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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It takes a good man to admit that mistakes were made so I wish the Deputy well personally but I hope plenty of his colleagues fall.

Charlie O'Connor (Dublin South West, Fianna Fail)
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Can I quote the Deputy in my leaflet?

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I welcome the opportunity to speak on this important legislation. Our health and social care and the different professions covered by this Bill provide a vital service to the country. It is important that those under their care can be assured they are fully qualified and trained professionals.

The registration system must ensure that the best possible service is delivered to patients, clients and service users. However, it is vital that the new structures do not have adverse effects on competition in the various professions. I welcome the proposed system of self-regulation that includes members of the professions involved and members of other sectors, including the general public. Registration of health professionals is necessary to ease the legitimate concerns of the general public that they are visiting a health professional who is properly trained and competent to look after them. Registration gives both professionals and the public protection from quacks and non-qualified persons working in specific health areas. Registration can also protect the good name of a profession.

A proper registration system gives the public and the professions protection because it allows investigation into all allegations of misconduct or incompetence. The registration framework of statutory regulation allows for the appraisal and approval of education and training courses, examination, qualifications and institutions, thus ensuring a proper development of education and training across the professions. It also allows consistency in the application of EU directives concerned with mutual recognition of third level qualifications in EU member states.

While section 4 allows for the addition of other health and social care professions in the future, this Bill deals with 12 professions. However, the health service has approximately 35 grades that come within the overall terms of health and social care. Will this section also allow the registration of specialties or will this issue be left to the registration boards? Health and safety officers were included in the initial consultation process and I ask the reason they are not included in the provisions of this Bill.

Physiotherapists as a group seem to be more concerned than most regarding this Bill. I have received representations from physiotherapists in the past week and also representations from the physical therapists. They are anxious regarding the protection of title of their professions. Many members of the public consider the two professions to be the same but this is not the case. Efforts to have the two separate titles included in section 4 were not accepted. I ask that the Minister consider this matter again to avoid confusion. I received a letter today from a constituent who has a degree but is now in his third year as a student of physical therapy. He believes his study and work should be recognised in its own right. In his opinion, the role of physical therapist should be recognised and the position should be clarified. I am currently receiving treatment from a physiotherapist. I am biased in that direction as she, hopefully, is doing an extremely good job.

In dealing with health and safety aspects related to the legislation, I cannot but refer to the recent controversy about nursing homes. This was obviously a case where lack of supervision brought an important sector into dispute. It was shown by the "Prime Time Investigates" programme and other reports that individuals in different professions have failed completely to honour their role in regard to patients and thereby damaged the credibility of the whole system. It is vital that new criteria are put in place to make sure that this neglect does not happen again not only for the sake of the elderly and the disabled in the long term but also for the credibility of the health service.

There seems to be no measure in the Bill to protect consultants or others who may make a complaint. One cannot but reflect on the extremely serious incidents that happened in Our Lady of Lourdes Hospital in Drogheda in my health board area, as it used to be known. For years practices were not reported as people were afraid to report them because of what might happen to them. There is ongoing litigation and a demand for an inquiry into those incidents. This Bill, prior to being passed, must provide that where a consultant or a practitioner at that level believes it is necessary to make a complaint, he or she can do so in confidence to ensure that at least such a complaint is investigated so that the highest standards of health care obtain. I urge the Minister of State to examine that aspect of the Bill.

Having met the victims of the controversy in Our Lady of Lourdes Hospital, Drogheda, on numerous occasions, I have nothing but admiration for the courage it took for those people to raise these incidents. However, one must be concerned about a system that allowed such practices to continue for so long as a result of which many people suffered.

I want to refer to a number of remarks made by the Tánaiste on the Bill in the Seanad — I do not believe she spoke on it in the Dáil. She said this is the first of three Bills to reform the regulatory environment for health professionals, with legislation for medical practitioners and nurses to follow. It was pointed out that we have been waiting for this legislation for almost 20 years. It is important that these are not only fine words but that there is a follow-through on this commitment and that the other Bills will be enacted. The Tánaiste said that the vision adopted in the strategy for our future health system set great store on treatment, treating people with dignity and respect. She said that the health strategy envisaged that action would be taken to strengthen the customer focus of service providers. Those are fine words and if one were not dealing with some of the cases with which I and my constituency colleagues are dealing in Cavan-Monaghan, where there is a shortage of professionals and a lack of services, one would not be so concerned. When dealing with a case such as one I dealt with the other day where a person could not be treated in Cavan hospital due to the shortage of personnel because of an internal problem rather than a shortage of professionals, one realises the serious nature of the problem. The Tánaiste said that there must be a patient-centred approach to the delivery of services, with which I am sure we all agree. This Bill is important to ensure that good quality professionals are in place, but there must also be good management.

I welcome the objectives of the new council which are to protect the public by promoting high standard professional conduct and professional education, training and competence among registrants of the designated professions. There is a problem concerning the shortage of such professionsto which Deputy Coveney referred. I can think of several professions where there is a shortage of personnel to deal with the people's needs. For example, there is a shortage of psychiatrists to evaluate children who require an assessment and even when such children are evaluated there is a difficulty in securing necessary resources in terms of finance and personnel.

I sought in recent days to raise a matter on the Adjournment concerning Rockcorry national school. As that school approaches the next academic year, some of its personnel were evaluated, which it understood had been approved by the Department of Education and Science, but suddenly these personnel did not meet the criteria laid down although they are on the relevant education list. Now the school does not know whether it will have special needs teachers, the services of whom some children attending that school badly need next September. Regulations are all very well, but there must be a follow through on the part of management.

I welcome the fact that each of the designated professions will be represented on the council and that there will be a representative of the public, the voluntary sector and the third level sector. The fact that the council will comprise 12 members from the professions and 12 members from other sectors will create a healthy balance among its membership, but will this balance be affected when additional professions come into the registration system? This Bill provides for the registration of 12 professions — there cannot be many more that may come into the registration system. How long will members of the council hold office? Can members be reappointed to office or will there be a fixed term of office?

Section 28 deals with membership of the registration boards. IMPACT did not agree with the composition of those boards. It was concerned that the professions are outnumbered on the boards and that their representatives should be in the majority in terms of education and training issues. However, there would be a concern about the representatives of the professions constituting a majority in regard to complaints, inquiries and discipline issues.

In regard to section 32, following concerns raised by my colleagues in the Seanad, we welcome the amendment to the Bill in the Seanad which requires the registration boards to submit to the Competition Authority draft by-laws that relate to the adoption and revision of a code on professional conduct and ethics. Although the council does not have to accept the options put forward by the Competition Authority, the authority is happy that its opinion must be taken into account by the council, which is made up of numerous professions when deciding on such by-laws.

I also welcome section 38 which provides that each registration board must register each person who holds an approved qualification and satisfies the board that he or she is fit and proper to engage in practice of the designated profession. Are proper regulations in place to provide for those professionals who come here to work from other countries given that we depend greatly on such personnel? While such personnel do their very best and are essential to our health service, families encounter great problems communicating with them, which leads to difficulties. Can more be done in this area in terms of the provision of education or interpretation services?

The Bill will play a major role in regulating health professionals. I wish to refer to the running of the health service generally. I cannot but refer to one element of it of which I am extremely conscious because of the area I represent, especially my immediate parish. I refer to psychiatric treatment and the direction we are going in that area. I am concerned because of the number of suicides that have taken place. I mentioned one case in the Dáil a few weeks ago, that of a close friend of mine, Fred Williamson, who sought professional help but failed to get it and in desperation took his life. We need to look at how this whole issue is monitored and dealt with. We all agree people, whether aged, psychiatric or whatever, should be dealt with as far as possible in their own homes or as close to home as possible. Each individual case has to be taken into account. We must have some professional responsibility. As we consider the Bill before us we must examine that whole aspect as well. There are buildings and beds as well as staff — whom I have talked to — who are prepared to look after some of these people in care, whether for a short or long term. We must respect the right to life and realise there are individual situations which are different from others. There are individual family situations that are different to others. Some families have great back-up services and availability of help. Others do not. A patient just cannot be looked at in isolation. He or she must be looked at in the context of the entire situation as it stands.

It is only when one is faced with issues such as this involving very close friends directly that one realises the problems that exist within the health service. Problems arise when basic rules are set down as regards doing something this way or that. I would like the professional groups to really examine this situation. I am a lay person. I am a farmer by background and a politician by profession. However, I have some understanding of human relations. I have seen marvellous work done by the psychiatric services, both in-house and in home service. However, we are in a serious situation when senior people set down rules and laws that cannot be broken. While it is not totally relevant to the Bill before the House, I cannot help on this my last opportunity to speak in Dáil Éireann, possibly, before the summer recess, to bring this issue forward and put it on the record of the House. It is one I feel very strongly about, as I do about alcoholism and the lack of services in that area as well. When one sees young people being buried because they cannot get help for alcoholism, and the buildings and the opportunities to help exist, one has to worry.

I welcome the fact this Bill is before the House. I welcome the fact the 12 groups which have been looking to have their positions regulated for so long are seeing this achieved, finally. Psychologists are included in the legislation, but some people call themselves both psychologists and counsellors. My colleague, Deputy Twomey, mentioned this in addressing the Bill earlier. I agree with him that we must make the qualifications crystal clear. There are big differences and a proper structure needs to be put in place.

Whenever psychologists decide that young people need a service, as with Rockcorry school, it should be ensured that staff are provided for this purpose. There are only 31 pupils in Rockcorry school, and six children there need a proper service. There is no point in an evaluation being done if the service is not available.

Finian McGrath (Dublin North Central, Independent)
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I thank the Ceann Comhairle for the opportunity to speak on this very important legislation. The debate on the Health and Social Care Professionals Bill is both relevant and important because it is about change and improving quality, professionalism and accountability. It must be broader than that, however. This debate has to be about the creation of provision for people who work in the services in a caring and considered manner. It is interesting that we have different views on this legislation, but in view of its importance all views should be carefully listened to so we can make a final decision on it.

The debate is about professionalism, caring and accountability. These are three key words in the Bill because health is a major political issue, particularly as regards assisting those who are ill, people with disabilities and supporting those who need major back-up services. Before I was elected in 2002 I was a member of the Independent Health Alliance. A group of us got together and campaigned on the health and disability issue, to bring it into the political arena and into the Dáil. I had the great honour and privilege to be elected by the people of Dublin North Central, on a strong health and disability platform in particular. We have arrived today and this is part of the discussion as well, because it is very important.

The Bill is also very relevant for people with disabilities. We have seen over the past 24 hours the passing of the Disability Bill in Dáil Éireann, which for many people was flawed legislation. It is very important that in this debate we get the opportunity to highlight the weakness in the legislation and also to talk about its positive aspects. On the issue of health care and professionalism, even in the last few days a young child with Down's syndrome in the west was denied resource teaching hours because of a decision made by a number of professionals working in the field. This is totally unacceptable and disgraceful. The Disability Bill has not been passed 24 hours as yet.

As regards the details of the legislation, the Bill is entitled:

An Act to provide for the establishment and functions of the Health and Social Care Professionals Council and of registration boards for certain designated health and social care professions; to provide for the registration of persons qualifying to use the title of a designated profession and for the determination of complaints relating to their fitness to practise; and to provide for related matters.

That, basically, is what the Bill and the debate is about. In Part 1 of the Bill, dealing with preliminary matters, one sees "council" means the Health and Social Care Professional Council, established under section 6. The word "court" in this section means the High Court, while "designated profession" means a health and social care profession, as designated in the Bill. These are important terms to grapple with before we get into the details of the legislation.

Section 4(1) says: "For the purposes of the legislation the following health and social care professions are designated:" I will concentrate on the psychologist, the social care worker, the social worker and the speech and language therapist. Nowadays, it is accepted by the mainstream political establishment in Dáil Éireann and broader society that there must be quality professionals, working in the services, and some of these people are the psychologists. They will play a major role over the next three to five years in dealing with services for people in the broader sector, but also children and people with disabilities, especially children.

As Members talk about the designated professions in this section, I remind the House of the words "care" and "professions". I would like to see quality people working in the field of psychological services. Many such people have gone into this area in the last 12 months as regards the provision of services for children with disabilities. However, I would like to see them more involved directly in ensuring a child with disability is treated in a caring and professional manner. As regards radiographers, these people, as well, have a major role to play. They are already saving lives in the mainstream health service. I commend the people directly involved in the radiography services in this State. However, we need more professions to be more involved directly in the services. This is a political issue. Why are there too few radiographers? Given the hundreds of millions of euro we spend each year on the health service, why is there no proper radiography service?

Section 4 covers the designation of health and social care professions. It is vital to have the right people making the right judgments. While I accept the necessity to require certain baseline academic qualifications, I am also concerned that many professions have developed in a flawed manner over the past five or six years. We are obsessed with points and the race to achieve professional status and qualifications. Why are many boys and girls in second level education who would love to become social workers, health care workers or psychologists prevented from entering these professions because they cannot achieve the high points required to enter the third level system? We are losing many quality people as a result. The other side of the current system is that some trained college graduates discover after two years in the job that they do not like working with children or people with disabilities and then decide to jump ship. This matter needs to be examined.

During my regular discussions with transition year and fifth year students in schools in my constituency I meet wonderful young boys and girls who would make fantastic physiotherapists or speech and language therapists. However, they are precluded from entering these professions when they do not obtain a set number of points in the leaving certificate examination.

To be called to begin teacher training in the primary sector 25 years ago, a student first had to get a certain number of honours in what was the equivalent of today's points system. A second important step involved attending St. Patrick's College in Drumcondra for a tough interview. Sitting around the table was a group of psychologists and child experts who decided, following the interview, whether candidates were suitable to work with children. Interviewees had to perform simple, basic tasks such as singing a song. The selection process, therefore, combined a requirement to achieve good baseline academic results and undergo a tough interview in which candidates were examined and cross-examined to determine whether they could be trusted and were suitable to work with young children. This approach is relevant today, notably in the context of training health care workers.

The role of social workers arises in the context of section 4. Deputies will all have had good and bad experiences of social workers. On the one hand, it is vital to defend the professionalism and integrity of social workers while, on the other, social workers have a duty and responsibility to ensure that children who find themselves in crisis or are sexually abused in dysfunctional families are rescued. They must be prepared to use the law to take tough decisions. Disgraceful incidents of sexual abuse have been perpetrated against children. In recent days, for example, we have heard of the horrendous experiences of a girl at the age of 11 in the Dalkey case. Social workers must be focused and professional. The House will, through legislation, address the issue from a legal and constitutional perspective. We must ensure the right people are doing the job of social worker, whether they are providing services from 9 a.m. to 5 p.m. or late at night.

Section 4(3) defines a health or social care profession as:

. . . . any profession in which a person exercises skill or judgment relating to any of the following health or social care activities:

(a) the preservation or improvement of the health or well-being of others;

(b) the diagnosis, treatment or care of those who are injured, sick, disabled or infirm;

(c) the resolution, through guidance, counselling or otherwise, of personal, social or psychological problems;

(d) the care of those in need of protection, guidance or support.

Paragraphs (a), (b) and (c) highlight the overall theme of the Bill and emphasise the importance of ensuring that people with disabilities and the elderly are part of a broader debate. Sadly, we do not do enough for elderly people. It is unacceptable, for example, that some of them do not have access to top quality health care. I remind Deputies that the elderly helped build the economy that has delivered the sustainable growth we enjoy today. It is payback time.

The broader issue is that rather than placing elderly people in institutions or care settings without their consent, they should, where possible, be treated in their own communities with the assistance of support services. The Government has failed to provide sufficient community supports for the elderly, an issue on which I have tackled previous Ministers.

Paragraph (c) refers to "the resolution, through guidance, counselling or otherwise, of personal, social or psychological problems". Let us ensure that counsellors who try to advise and assist people in difficult circumstances are given maximum financial support. Resources allocated for this purpose should never be clawed back. The beneficiaries of the services provided by health and social care professionals are human beings and must be shown respect and treated with dignity.

Modern society is turning its back on the importance of providing care for people with social or psychological problems. The downside of economic success is that people are too busy to spend time listening to others or caring for them. Many elderly people live alone on estates in Dublin, Kerry, Galway or Cork and do not know the people who live two doors away. This was not the case 20 or 30 years ago when we had few resources. We need to implant in the minds of our children, at a young age, that there is nothing old-fashioned about caring for one's neighbour. Human and community services also include a responsibility on every one of us.

Section 7 defines the object of the Health and Social Care Professionals Council as: "to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions." Section 8 defines the council's functions, which include to:

(a) oversee and co-ordinate the activities of registration boards,

(b) provide administrative support and secretarial assistance to registration boards and their committees,

(c) receive applications and make decisions under Part 4 concerning the refusal of registration boards to grant or restore registration,

(d) enforce standards of practice for registrants of the designated professions, including the codes of professional conduct and ethics adopted by their registration boards,

(e) establish committees of inquiry into complaints under Part 6 against registrants of the designated professions,

(f) make decisions and give directions under Part 6 relating to the imposition of disciplinary sanctions on registrants of the designated professions,

(g) advise the Minister, either on its own initiative or at the Minister's request, on all matters relating to the Council's functions under this Act. . .

While I strongly support sections 7 and 8, I share the concerns expressed by the Irish Society of Chartered Physiotherapists, ISCP, that the protection of patients is not given paramount importance in the Bill, which it deserves.