Wednesday, 24 September 2014
Health (Miscellaneous Provisions) Bill 2014: Second Stage (Resumed)
I thank the Leas-Cheann Comhairle for the opportunity to speak on the Health (Miscellaneous Provisions) Bill 2014, which has three main objectives. First, it will provide for the subsuming of the Opticians Board into the Health and Social Care Professionals Council, CORU. Second, it will make certain amendments to the Health and Social Care Professionals Act 2005 in the interest of efficiency and to ensure consistency with legislation governing other health regulators. Third, it will amend the Health Act 1970 to ensure the statutory contribution payable by recipients of residential support services who are maintained, though not directly accommodated, by or on behalf of the Health Service Executive.
The regulatory body, the Health and Social Care Council, currently has the power to regulate 12 professional groups under a series of registration boards. Under the system of statutory registration that is being rolled out by these professions, individual members of a profession are recognised by a special body as competent to practise that profession under a formal mechanism underpinned by law. The council voted to establish a corporate requirement for the organisation to oversee and co-ordinate the registration board and to deal with complaints against registrants of the profession through the establishment and management of a fitness for practice regime.
The object of the council is to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions. To date, six registration boards have been established for the professions of social workers, radiographers, dietitians, speech and language therapists, occupational therapists and physiotherapists. It is planned to have all 12 boards and registers established by the end of 2015. When all the registration boards are in place, CORU will be responsible for the regulation of approximately 20,000 professionals. The word CORU originates from the Irish word cóir, meaning fair, just and proper. In time, when the registers are established for the receipt of registrants and a two-year transition period is completed, during which existing practitioners can register on the basis of recognised qualifications, only registrants of a registration board, who will be subject to the Act's regulatory regime, will be entitled to use the relevant designated title.
The dissolution of the Opticians Board will result in the statutory regulation, under CORU, of the professions of optometrists and dispensing opticians. A specialist regulation board, the optical registration board, will be established for this purpose. The change, supported by the Association of Optometrists Ireland, will affect 739 optometrists and 176 dispensing opticians who are currently registered with the Opticians Board and are likely to transfer to the new board.
The profession of radiographer will be divided to distinguish radiation therapists, who have distinct training and experience. Radiation therapists work with cancer patients and radiographers work in diagnostic X-ray departments.
The Bill amends the Act to allow registration boards under CORU to regulate more than one profession, such as the two professions to be regulated by the Radiographers Registration Board. Under existing legislation, CORU may only provide full registration. The Bill provides that where a person has a physical or mental disability, the council may register him or her with conditions attached to practise.
I wish the Minister, Deputy Leo Varadkar, the best and I thank the former Minister, Deputy James Reilly, for the work he did over the past three and a half years.
I welcome the Minister of State, Deputy Lynch, and congratulate her on her reappointment. I welcome our friends from Iran to the House and thank them for being here. It is very important that we build on democracy throughout the world and I hope we can forge new friendships and mutually benefit each other in the pursuit of democracy on the world stage.
Today is an extraordinary day because we are beginning the design stage of the national children's hospital and I had the privilege of being at the launch at the Chester Beatty Library this morning when the Minister, Deputy Varadkar, and the team unveiled the plans. At 2 p.m. GPs will come to Leinster House to advocate on their behalf and we are also dealing with the Health (Miscellaneous Provisions) Bill. It is extraordinary that we speak about reform of the Dáil and the Houses of the Oireachtas, but no members of the Opposition are present. They lament the Government putting a guillotine on Bills but where are they now?
As Chairman of the Oireachtas Joint Committee on Health and Children, in my opinion the Department of Health is the most important Department. In this Bill we see a continuation of reform and updating our systems of regulation for health professionals. This process has been going on since the enactment of the Health and Social Care Professionals Act 2005. At present, 12 professions are regulated by CORU, which is Ireland's multi-professional health regulator. The Bill will add to this list and will bring the regulation of opticians in line with the new regulatory regime. As Deputy Fitzpatrick alluded to in his remarks, the Bill also reclassifies radiographers into two groups, namely, radiographers and radiation therapists.
The changes introduced in the Bill are very much a welcome development. If we analyse and examine health care professions, it is important that we have a proper and robust system of professional registration and regulation in place which protects patients and health professionals. I state this as somebody who was in the teaching profession; the introduction of the Teaching Council caused much commentary in the education system. I have met various groups and when we exercise our legislative role in health it is always important that we have at the centre of everything we do the protection of the patient and that the patient remains paramount to everything we do. It cannot be about saving money or introducing change unless that change is to the betterment of the patient. By improving the system of regulation, we are doing just this.
I compliment the Minister of State on her speech to the House yesterday. The Federation of Ophthalmic and Dispensing Opticians, which represents independent and corporate opticians, has concerns about the Bill and I met its representatives in this regard. We should tease out their concerns, which include that the Bill as it is drafted could result in restrictions in access to eye care including sight tests, which would raise the cost for members of the public and the taxpayer and would increase prices for patients, and may threaten the continued employment of optical assistants in the business. During the passage of the Bill through the House on Committee and Report Stages, it is important that we examine this.
At present, an optometrist conducts an eye examination and the prescription is dispensed by a dispensing optician. They are assisted by other trained members of staff with regard to selecting frames and processing payments. The role of the optician has changed completely over the past decade with regard to family-run shops and corporate businesses and how we view eye care and eye testing. Competition in the market has made it better for customers and patients which is to be welcomed.
With regard to the specifics of the Bill, sections 81A (1) and (2) to be introduced by the Bill state spectacles may only be dispensed or sold by a registered medical practitioner or a registrant of the designated profession of optometrists or dispensing optician. This section is a source of concern, as it may put an end to the current practice whereby the examination is conducted by an optometrist, the dispensing optician dispenses the prescription and both are assisted by trained members of staff. I am sure the intention of the Bill is not to impact on how services are developed, provided or delivered but to ensure we maintain the excellent quality already in place in the provision of eye care for members of the public. The Department of Health is acutely aware of these concerns and as the Bill progresses through the House it is important that we examine this. Perhaps an amendment can be made to the Bill or clarification and reassurance will be provided to allay these concerns so we will have a Bill which is mutually beneficial to the customer and the health care profession.
On the wider issue of regulating various medical professions, the matter of the registration of counsellors and psychotherapists is still outstanding. The Oireachtas Joint Committee on Health and Children has debated this and Deputy Dan Neville, who has been a very strong member of the committee, raised it with the former Minister, Deputy Reilly. The two professions are not regulated. The survey published in theIrish Examineryesterday and today regarding mental health in rural Ireland shows the issue of psychotherapists and counsellors is one we need to examine and address as a society. There is nothing to stop me from attending a ten-week course and setting up as a counsellor. I am sure members of the Opposition would be very welcome to come along and I would be happy to hear their concerns and share with them a platform to go forward.
On a serious level, the quality and availability of psychotherapy and counselling is not something we can leave to chance. We must avoid the five-eighth merchant setting up an operation which could do more harm than good. This concern has been expressed by many people at meetings of the Oireachtas Joint Committee on Health and Children and on the floor of the House. We must consider the qualifications and training available to counsellors and psychotherapists because if we do not regulate them, we will have serious trouble. We also have a duty of care and we owe it to highly qualified and reputable counsellors and psychotherapists to put in place a regulatory system which recognises and supports them and gives them a safety network.
The Minister of State knows the issue of mental health quite well. The country has made significant strides through the National Office for Suicide Prevention. I do not mean to patronise her, but the Minister of State has been a very strong advocate with regard to mental health issues. We must take another step forward on this issue.