Dáil debates

Wednesday, 24 September 2014

Health (Miscellaneous Provisions) Bill 2014: Second Stage (Resumed)


Question again proposed: "That the Bill be now read a Second Time."

1:15 pm

Photo of Clare DalyClare Daly (Dublin North, United Left)
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I listened before lunch to Deputy Buttimer berate the Opposition for the fact that there were no Opposition Members present when he was giving us his deliberations and it is somewhat striking that there are no Government representatives here now either. It is a ridiculous point to make, given that what is happening in the health service and the future of that service is being dictated outside, rather than inside, of here. I refer to the fact that today there is the first ever GP protest outside the doors of this House because ordinary doctors feel they have not got the wherewithal to continue and many new entrants to the profession are being forced to leave these shores because they simply cannot make ends meet. We listened to them on the radio this morning talk about the significant reduction in income to their practices.

We must see this Bill, yet another on the health service, in the context of the overall situation with the health service, which is not unfair to characterise as a bit of a shambles. There was the recent appointment of the Minister, Deputy Varadkar, who verified what we all knew anyway about the ridiculous universal health insurance proposal that the Government had put forward lying in tatters. As nearly once a week there is some sort of health service amendment Bill in the House, we must start by asking whether the best way forward is this patchwork quilt of changes onto a dysfunctional health service and whether we would be better off stepping back and looking at the whole proposition.

Sadly, in terms of context, the Irish people have never had access to a universal health care system. We rely on a procedure whereby there is a means-tested medical card giving access to State-funded care or, if one does not meet that means test, one can opt to apply for private health insurance, or else one can take one's chances and not do anything. The VHI was set up as a semi-State body with the Minister for Health as the sole shareholder. In the absence of proper State-funded health care, it was supposed to provide affordable health insurance subsidised through income tax relief for those who would not qualify for a medical card. Instead, there is this hybrid system which is in tatters. In terms of private health insurance, while it may mean faster access to care facilities, in fact, waiting lists are still a problem. The reason for such waiting lists is that the number of inpatient beds has been cut by over 5,000 since 1981, and this has not been compensated for by the increase in day places. Cuts in public beds have led to growing inequalities of access, waiting lists and all of the other problems that were highlighted earlier in the debate. There is an Irish apartheid in the health system. The idea of universal health care and all of the other grandiose proposals that were flown like kites reflect an influence from the private health market and the globalised private health insurance allegedly promoting competition but, in effect, introducing an American health model into Europe which the public does not want. We must look at any changes we make in the context that in basic health care we are in Ireland way behind the European average. Ireland has lower mortality ages, a higher burden of chronic long-term illnesses, poorer outcomes and survival rates etc. We must look at this legislation in the context of that background.

I do not agree with the piecemeal approach. In an overall sense, it is good to raise the standards of health and care professionals. The idea, for example, of including opticians, is a laudable objective, but we would be one-sided if we looked at the addition of that profession being covered by CORU and did not look at the experience of how CORU has been working already. If the body that is supposed to regulate is not working all that well, there is no point in adding a new profession. I would like to look at that because the addition of opticians per sein some ways is neither here nor there. The opticians made the point articulated already that it is a little excessive that the new registration would require all staff, including non-clinical staff, to be registered with CORU. That seems excessive. Such non-clinical staff are not involved in medical procedures and in giving medical advice and in that sense, they should not be included.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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They are not.

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

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

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

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

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

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

1:25 pm

Photo of Michael KittMichael Kitt (Galway East, Fianna Fail)
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I call on Deputy Seán Kyne who I understand is sharing time with Deputy Dan Neville. Is that agreed? Agreed.

Photo of Seán KyneSeán Kyne (Galway West, Fine Gael)
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I welcome the introduction of the Health (Miscellaneous Provisions) Bill 2014. The regulation of health services is essential for patients and also for genuine professionals who spend so much time training and studying to become practitioners. Unfortunately, in most sectors we have seen cases where regulation failed, leading to negative consequences. However, there are few other sectors than health care where regulatory failures can be as devastating and actually be a matter of life or death. The Bill represents another step by the Government in further regulating health services and improving safety, confidence and, hopefully, medical outcomes.

The Bill builds upon the Health and Social Care Professionals Act 2005 which empowers the Health and Social Care Council, CORU, to regulate 12 professional groups. That principal Act played an important part in establishing that a health or social care profession is any profession in which a person exercises skill or judgment relating to preservation or improvement of health; diagnosis, treatment or care of persons with illnesses; resolving, through guidance or counselling of psychological conditions; and care activities for any person in need of protection or support.

These definitions emphasise how important this area is and how legislative amendments must be thought through and thoroughly drafted. We are gradually moving, perhaps not fast enough, from a system whereby only five professions were regulated, namely, doctors, dentists, nurses, opticians and pharmacists, to a system where the majority of medical professions will be regulated. This is necessary for several reasons.

First, advances in medical treatment and health care in recent decades have caused the establishment or recognition of new professions, of new distinct areas of care including dieticians, occupational therapists, biochemists, social care workers, speech and language therapists and radiographers. We can see the continued progression of this trend in this Bill where it divides the category of radiographer into two - the first being radiographer, the second, radiation therapist. The former is concerned predominantly with the traditional role of diagnostic services in hospital X-ray departments while the latter is more concerned with radiation treatment services for cancer patients, an area of treatment which is thankfully improving and advancing all the time.

Second, self or voluntary regulation has been the norm. While this type of system might be less expensive, faster to organise or in decision-making, it can also have substantial failings in independence, transparency and objectivity. Oversight and scrutiny will be better served by having independent regulation. The current Health and Social Care Council achieves this by getting the balance right on the council. The council has 12 representatives, one from each of the professions, as well as 13 representatives not connected to the professions, thereby ensuring a lay majority on the council.

Provision of proper, adequate care and treatment is an integral aim of our health care system. However, of equal importance should be the aim of keeping people out of the hospital system by providing enhanced primary care in the community. The Association of Optometrists Ireland welcomes this Bill, describing it as good for eye care. The association has also identified that it will facilitate the development of the role of optometrists by enabling them to “provide more care at primary level in the community rather than have to make immediate referrals to secondary or tertiary care”. This is an objective which must be facilitated by the Government and the Department of Health.

Another important objective to be achieved is ensuring the public has confidence in health care and in the professionals administering that care. It is particularly important considering the vulnerable position which a person with an illness will be in. It is thus encouraging to see the amendments contained in sections 27, 29 and 38. Section 27, which amends section 53 of the principal Act, promotes the public interest by enabling the council to cancel registration of a professional in the case of a complaint on the grounds of a conviction secured by judge and jury.

Similarly, section 29 amends section 60 of the primary Act which empowers the council to apply to the High Court to secure an order suspending the registration of a practitioner. However, in accordance with natural justice, the hearing will not be held in public in order to protect the reputation of the practitioner pending the outcome of investigations.

Another section - section 38 - creates a new section in the primary Act which further strengthens the council's powers to protect the public through powers to investigate contraventions of the Act by persons other than practitioners. The Bill continues the important role of regulating medical services. It strikes the important balance of ensuring the highest safeguards for the public while providing certainty and reassurance to genuine practitioners. I welcome the Bill.

1:35 pm

Photo of Dan NevilleDan Neville (Limerick, Fine Gael)
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I welcome the opportunity to contribute to the Bill, which is fully supported by all in the House. This is the second amendment to the Health and Social Care Professionals Act 2005. I welcome the amendment. I wish to restate what I said during the debate in 2005 on the proposal that psychotherapy and counselling be included as designated professions. At present, there is no regulation in this country for the registration of psychotherapists and counsellors and no State control over the qualifications held by those practising in the area. It is dangerous for untrained and unskilled people to probe a person's unconscious. They are dealing with human vulnerability and serious damage could be done to such delicate people.

The Act provides for the registration of persons qualifying under the title of a designated profession for the determination of complaints relating to their fitness to practise. Some 12 professions are listed as designated professions under the Act and the Bill introduces two further professions. The professions of psychotherapy and counselling are not included. When I challenged the former Minister of State with responsibility for mental health, Mr. Tim O'Malley, who dealt with the Bill in 2004, he stated that the professions included in the legislation had become so regulated by a process of discussion and consensus. However, at the time psychotherapists and counsellors failed to agree an approach to such registration. The then Minister of State indicated that statutory regulation in such circumstances would have serious legal implications, which we accepted. He accepted the principle that all psychotherapists and counsellors should be properly qualified and pointed out that he would not be in a position to regulate the area without consultation with the professional groups involved. He was anxious to obtain agreement.

In response to the position of the then Minister of State, 22 organisations established a psychological therapies forum for counselling and psychotherapy. The forum accepted that it is imperative that the public is protected by the promotion of high standards of conduct, education, training and competence among the professionals of counselling and psychotherapy. The forum pointed out that all of its constituent bodies provided a code of ethics by which their members must abide. The forum stated that, while this form of self-regulation provided protection to clients of the organisations, it fell short of optimal protection as, under our common law system, it was possible for any person to take the title of counsellor or psychotherapist and practise accordingly, without training or competence. Any person could put up a sign to say that he or she is a counsellor or psychotherapist and charge to perform psychotherapy and counselling, but I am sure Members would agree that it is extremely dangerous for such untrained people do so.

I am aware of the provision of certain courses. One course that ran for a duration of eight weekends lead to one gaining a diploma in eating disorders. I have a copy of the brochure. I was informed the course was only open to professionals. I asked my parliamentary assistant to apply for the course which was to run for eight weekends. The area of eating disorders is one of the most difficult areas involving experience in psychological, psychiatric and physical difficulties. It is a psychiatric disorder that can be fatal for young people. My parliamentary assistant was accepted on the course. The eight-week diploma started at 11 a.m. on Saturday and ended at approximately 4 p.m. on Sunday. The diploma was provided by the Eating Disorder Resource Centre of Ireland. My parliamentary assistant received a note, as follows:

Enclosed booking form for 2010. Training commences this Saturday 27 March. I don’t have any hard copies of the module info as they are being printed up for next course (2011). It is available online... If you can ring me to confirm if you wish to attend 2010 training course that would be great.
The note was signed by the director and founder, a certified trainer in practitioner skills for eating disorders and obesity. The course duration was eight short weekends to obtain the diploma.

I am aware of another weekend course which lead to a higher diploma in suicide studies. It is highly dangerous for people to counsel anyone with suicide ideation following such a short course, as one would not be fully competent or trained to do so. My objective is to include psychotherapy and counselling in the Bill. A leaflet advertising the advanced course in suicide studies states: "Participants will gain sufficient knowledge, skills strategies, and theoretical background to enable them to serve those who are at risk of taking their own lives, those who are survivors of suicide, and the family members of those who have taken their lives." Two weekends cover suicide prevention. Another two weekends cover suicide intervention, while a further two weekends in January cover suicide postvention. Following the course, one is awarded an advanced diploma in suicide studies.

The Health and Social Care Professionals Act, an amendment to which we are discussing, provides a mechanism to drive forward the clinical governance agenda. It creates a framework through which practitioners are accountable for continually improving the quality of their service and safeguarding high standards of care by creating an environment in which excellence will flourish and optimal protection is offered to members of the public who access psychotherapy and counselling.

I am conscious that my time is running out. I compliment the Minister of State, Deputy Kathleen Lynch, on her great interest in this area. It is two years since I raised the matter so she can hardly say I am raising it every day of the week. I also compliment the previous Minister for Health, Deputy Reilly, who wrote to me on 20 March 2014. I will read from the letter:
I have today written to Mr. Tom Jordan, Chairman of the Health and Social Care Professionals Council, informing him that I intend, in the public interest, to designate by regulation the profession(s) of counsellor and psychotherapist under section 4(2) of the Health and Social Care Professionals Act 2005.

Under section 4(2) of the Act, I am obliged to consult with the council in the first instance and to give interested persons, organisations and bodies an opportunity to make representations to me concerning the proposed designation. I have requested my officials to put the necessary arrangements in place to initiate this consultation process as soon as possible.

I am also awaiting the report of Quality and Qualifications Ireland, QQI, on the academic standards necessary for the accreditation of courses in counselling and psychotherapy. This is an essential element as it will inform, for the purpose of registration, the assessment by the H&SCPC [Health and Social Care Professionals Council] of the qualifications of those currently in practice. QQI has now advised that this report will be available in May, 2014.

Once the outcome of the consultation process has been assessed, I will then be in a position to make the decisions necessary to proceed with regulations designating the profession(s) to be regulated and prescribing the title(s) to be protected. The registration board will then be established by [statutory instrument] SI and the Public Appointments Service will be requested to advertise for expressions of interest in being appointed to the registration board.

Can the Minister of State inform us how this has since developed? Mr. Tom Jordan asked to meet me with the chief executive of the Health and Social Care Professionals Council and he informed me of the difficulties he experienced. It is often worth doing something difficult. I compliment the former Minister for Health, Deputy James Reilly, on acting on this issue because some forces suggest this should not happen and things should be more open. I understand how complicated the process of regulation can be and the difficulties involved but it has been done in other countries. I spoke at a conference on this elsewhere in Europe and regulation was in place in that country.

It is important to protect the public from unqualified mavericks who want to make a quick buck from the vulnerabilities and difficulties experienced by those with mental illness and emotional problems. We must protect such individuals as they seek help and doing so will create a framework in which practitioners are accountable for improving service quality. We must safeguard high standards of care by creating an environment in which excellence will flourish and optimal protection is offered to people accessing psychotherapy and counselling.

I have a copy of the report of the Psychological Therapies Forum on public protection and the statutory regulation of counsellors and psychotherapists in Ireland. It is an excellent document, though I do not say we should treat it as a bible for this framework. It will be helpful to the Health and Social Care Professionals Council. Some 12 professional organisations are involved and their practitioners are regulated. I do not suggest that psychotherapists and counsellors are not regulated - they are regulated by their professions. We aim to regulate those not already members of those professions. The 22 organisations involved produced the document as a response to the difficulties faced by the former Minister, Tim O'Malley, relating to the original Bill - those difficulties related in part to psychotherapists and counsellors. I congratulate the 22 organisations involved and they include Accord, the Catholic marriage care service, the Association for Psychoanalysis and Psychotherapy in Ireland, the Irish Association of Cognitive Analytical Therapy, the Irish Association of Alcohol and Addiction Counsellors, the Irish Association of Christian Counsellors, the Irish Association for Counselling and Psychotherapy, the Irish College of Psychiatrists, the Irish Council for Psychotherapy, which incorporates cognitive behavioural therapy, the Family Therapy Association of Ireland, the Irish Analytical Psychology Association, the Irish Association of Humanistic and Integrative Psychotherapy and the Irish Forum for Psychoanalytic Psychotherapy. I want to give a flavour of how broad this area is.

I know the Minister, Deputy Varadkar, is supportive of this and I have thanked the former Minister, Deputy James Reilly. I had not yet raised this with the new Minister, Deputy Varadkar, but I felt this was an opportunity to do so.

1:45 pm

Photo of Paul KehoePaul Kehoe (Minister of State and Government Chief Whip, Department of An Taoiseach; Minister of State, Department of Defence; Wexford, Fine Gael)
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I welcome the opportunity to speak on this Bill as it will bring changes to health professions. If we are to improve the health system changes are necessary. This is a technical Bill with 44 sections and some primary objectives. First, the Opticians Board will be subsumed into the Health and Social Care Professionals Council. Second, the Bill will make amendments to the Health and Social Care Professionals Act 2005 to ensure consistency with legislation governing other health regulators. The Health and Social Care Professionals Act 2005 currently provides regulations for 12 professions, including clinical bio-chemists, dieticians, medical scientists, occupational therapists, orthopaedic physiotherapists, podiatrists, psychologists, radiographers and other social care workers, such as speech and language therapists. CORU now regulates and oversees all of these professions and upholds high standards in professional education, training and competence. All of these professions are phasing in registration - social workers are now obliged to be registered and radiographers will have to be registered by October. Speech and language therapists, dieticians and occupational therapists will be registered by the end of the year. All registers will be complete by the end of 2016.

The Bill refers the meaning of the term "health and social care profession" and it is defined as "any profession in which a person exercises skill or judgment relating to any of the following health or social care activities". It goes on to refer to activities such as the preservation or improvement of the health and well-being of others, the diagnosis, treatment or care of those injured, sick, disabled or infirm and the resolution through guidance counselling or otherwise of personal, social or psychological problems. It also refers to the care of those in need of protection, guidance and support.

The people to whom this Bill applies are in caring professions that form a crucial element in the introduction of the fitness to practice regime for health and social care workers. Part 6 of the Bill will allow complaints to be made about registrants. Another objective of the Bill is amending the Health Act 1970 to ensure that statutory contributions are payable by recipients of residential support services who are maintained, though not directly accommodated, by or on behalf of the Health Service Executive. The aim is to modernise the contributions regime in residential settings to reflect current models of residential care, particularly as it pertains to mental health, the disabled and older people. Accommodation needs must be met by agencies of the State, such as local authorities.

3 o’clock

The fair deal scheme is raised with me on a regular basis. When a family applies for the scheme, it is an anxious time with regard to a mother, father, aunt or uncle. Will the Minister of State examine the delay in processing fair deal scheme applications? Is there a better or more simple system which would help the applicants and their families? It would be very welcome if the Minister of State examined this area. When I put people in contact with the local HSE office in Wexford it is very helpful, but it can be an anxious time for families as they wait for an application to be processed. Part of the Bill deals with this issue.

It is vital that the people of all counties, including my home county of Wexford, are legally protected with regard to health and social care professionals. The Bill provides for this and I commend the outgoing Opticians Board, which has existed for more than 60 years, on protecting the interests of the public. I also commend the work of CORU. Since it came into existence it has played a very important role in the oversight of professional qualifications in extremely sensitive areas such as social work.

I welcome the news from the Minister of State, Deputy Kathleen Lynch, that the registration of professions such as occupational therapy, podiatry and speech and language therapy will be included by the end of 2016. These are three professional areas in which I have seen a shortfall in my county, and I do not speak just for Wexford. Parents want a service to be available for their children. The HSE, the Department of Health and the Minister of State are well aware of the financial strains which exist. If one compares Wexford to Kerry, Tipperary or Sligo, one sees it is lagging behind with regard to speech and language therapy services. The earlier one treats a child, the better the diagnosis will be and he or she will be able to receive therapy and treatment. A large number of families in Wexford are being forced to obtain services privately because they want the best for their sons or daughters. They are unable to afford this private service and are straining other areas of their household budgets, and we know the financial strains some families face. Will the Minister of State examine County Wexford and ensure an equal service is available throughout the country and that everyone is treated equally?

I welcome the Bill and I believe that change is good. Further improvements can be made after the Bill has gone through the House when the Minister examines regulation and professionalising other areas. I am not sure what the financial saving will be but I have no doubt the Bill contains a financial saving.

1:55 pm

Photo of Joe O'ReillyJoe O'Reilly (Cavan-Monaghan, Fine Gael)
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When I and other Members of the House go around our respective constituencies and hold advice clinics, one of the perennial complaints we receive from people in business, farmers and various interest groups is that they are overregulated and that the EU has imposed too much regulation. I have never met, and I am never likely to meet, someone who would not accept the need for the most stringent regulation of health professionals. This is not to suggest for one moment that we should not be thankful and very happy with the high professional standards of the medical people in the country. Having said this, a person in the vulnerable position of being sick or dependent on a service should receive the service in the absolute knowledge it is subject to the most stringent regulation, and that the most stringent disciplines and standards of a professional nature apply. Those who are ill, people with intellectual disabilities, people with addiction and people with various illnesses and, in this very specific instance, people with difficulty with vision and related areas are vulnerable and dependent, and when one is in a position of dependency one needs to be assured of the highest standards and complete care. In this context I welcome the legislation and the tightening up and administrative changes involved.

The substantive matter in the Bill is to subsume the Opticians Board into the Health and Social Care Professionals Council. It merits saying, and I am very proud, that my niece has just opened her own business as an optometrist in Loughrea in the Leas-Cheann Comhairle's constituency. I know from her and the young people in the profession whom I meet that the educational standards and entry requirements are very high. It is encouraging there will be transparent and very clear regulation. The work of the Opticians Board in ensuring the standards we have today needs recognition, but the Bill is an important reform and it is important every profession in the health area is brought into a very transparent and defined regulatory process.

The second objective of the Bill is to make certain amendments to ensure efficiency and consistency with the legislation governing other health regulators. The Bill will also ensure statutory contributions payable by recipients of residential support services who, while maintained, are not directly accommodated by or on behalf of the Health Service Executive. The Minister of State has explained this is custom and practice at present, and I understand it to be so, but it needs to be included in the legislative and regulatory framework.

The Health and Social Care Professionals Council is an independent regulator established to protect the public by promoting high standards of professional conduct and professional education, training and competence among the registrants of 12 designated health and social care professions. The highest educational standards are crucial.

It was established under the Health and Social Care Professionals Act 2005. It is the extension to include opticians that is at issue. The objective 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 regulation boards have been established for the professions of social worker, radiographer, dietician, speech and language therapist, occupational therapist and physiotherapist. It is planned to have all 12 boards and their registers established by the end of next year. That is all to be welcomed.

I turn to a question that was raised earlier and is very dear to my heart; I look forward to the Minister of State's response. I refer to the registration of psychotherapists and counsellors. We have an increasing need for psychotherapy and counselling in so many spheres to deal with the results of substance abuse and various psychiatric or psychological difficulties arising from the various stresses of modern living. People now tend to search the Internet for everything, including accessing the name of a counsellor or psychotherapist, and without much thought just become a dependant and client of that professional. Happily in many instances, there is no difficulty. However, if there are a few, we need to know that the highest educational standards exist, that the highest training and clinical practices exist, and that the counsellor or psychotherapist is of the highest standard or as they would say in the first language of our country, loved by you and me, a Leas-Cheann Comhairle, that they are den céad scoth, tharr barr or nach bhfuil amhras ar bith fúthu. It is important that they are of the highest standard possible and that people can enter into what is an extraordinarily dependent relationship fraught with all sorts of danger because in many instances the client becomes very dependent on the psychotherapist or counsellor.

Tragically, the whole country is blighted by death by suicide. It is particularly prevalent and I have come across many instances in my own community and area. It is a tragic outcome for people. Those who die by suicide do so through no fault of their own; they are in a very dark place from which there is no escape. I am told anecdotally that we need more intervention here. I would be interested in the Minister of State's response. I believe we need a better cohort of professionals - not better in the sense of a higher standard, but a bigger number of professionals functioning in this area, in the whole area of addiction and the whole area of therapy to prevent death by suicide and to prevent various outcomes. This was drawn to my attention as late as yesterday when I met people at home. That is an important area. I look forward to the Minister of State responding in this regard. I understand from a remark I made privately to the Minister of State that it is her intention to ensure that psychotherapists and counsellors come under this legislation and are so regulated very shortly. It would be nice to hear that again on the record of the House during her response.

It is important that we have a system that investigates complaints which will be the case here. If there are specific professional complaints, we need a procedure for them to be investigated. There must be an assumption that there is a basis for a complaint without demonising the professional or putting his or her career in jeopardy for the rest of his or her life. At the same time, there must be a transparent process of examining complaints, following due process and ensuring that complaints are taken to the nth degree and fully investigated. It is very necessary for the public to know that process exists and that complaints will not just be treated as fanciful or fantasists' material and they will be properly dealt with. Often tragically in the psychiatric area and in that space around depression and addiction there can be a tendency on all our parts to be slightly dismissive of complaints. That should be the last area that we are insensitive or unresponsive about.

It is important that the legislation brings optometrists and opticians into the regulatory framework and the proposal is to so extend into the future. I share the concern expressed by the Minister of State, Deputy Kehoe, and would be interested in hearing the response on the number of professionals available in the various spheres.

I ask the Minister of State to ensure the regulation of psychotherapists and counsellors, and to ensure there are an adequate number of these professionals to deal with the awful blight of suicide in our society and community. Tragically, the community that I have the privilege of living in and representing has been very blighted by death by suicide right up to the present day. I am particularly concerned in that regard and I look forward to the Minister of State's response.

2:05 pm

Photo of Regina DohertyRegina Doherty (Meath East, Fine Gael)
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I am grateful for the opportunity to say a few words on the Bill. I welcome the changes it brings to the Health and Social Care Professionals Act. Obviously, the amalgamation of the 12 registered bodies under the one umbrella and under the one consistent regulatory code of practice with the same guides of quality and consistency in coming months is very welcome. The purpose of the body is to protect the public by promoting high standards of professional conduct through education, training and competence among registrants of designated professions. That will ultimately result in a better and consistent approach of service across all the professions for the public, which is welcome.

I wish to talk about one specific change. Subsuming the Opticians Board into the Health and Social Care Professionals Council is very welcome. However, one of the changes in updating the previous Act, which is 50 years old, does not quite make sense to me or to the professionals. They have asked me to represent them today, which I am doing.

The practice that will come into play if the Bill, as it stands, is passed will mean that opticians will be involved in the process of dispensing glasses right from the very beginning where patients come in, get their eyes tested, get a prescription and have their glasses made and presented. This continues right up the point where a patient leaves the shop and pays for their glasses. Their concern is that no other profession is quite as restrictive as that. I can go to a doctor in the morning, get a diagnosis of a sore throat, and then go out and pay the lady on reception the 50 quid I have to give her for the privilege for being there. That is the current practice in our opticians and the practice they would like to see remain.

I am not sure what the benefit is of having the legislation as drafted which ensures that the optician is there from the very beginning of the process right up to the writing of the cheque for the glasses at the end. I ask the Minister of State to consider changing that so that the receptionist in the optician's practice can take the final payment and hand over the product at the end. That would obviously allow the opticians more time to conduct the eye tests and carry out the consultations with patients, as is their wish.

Otherwise, I am very supportive of the Bill. It will offer a consistency and equality of approach across a wide variety of professions that we do not currently have. Deputy O'Reilly spoke about dieticians, speech and language therapists, occupational therapists and suicide counsellors all being involved and brought under the one umbrella. I do not want to be disparaging to any of those people but because there is a potential inconsistency in the quality of care provided, that will now be changed and the regulatory processes will apply to all and one.

I am happy to support this Bill, with the possible exception of asking the Minister of State to consider again the amendment that potentially could be made to free up or loosen the restrictions on opticians.

2:15 pm

Photo of John Paul PhelanJohn Paul Phelan (Carlow-Kilkenny, Fine Gael)
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While I am happy to support the Bill, I wish to make a couple of points. The opticians did not contact me, although as is pretty clear from what is on the bridge of my nose, I contact opticians from time to time. However, my colleague, Deputy Regina Doherty, made an interesting point and raised a fair question on some of the standards these changes might impose on opticians, as opposed to other health professionals. I welcome the progress that is being made on the registration boards for the various health professionals, and this legislation is another step along that particular route. I have no other particular observations to make specifically about the role of opticians.

However, I wish to take this opportunity and as this issue is relevant to the Minister of State who is present, she might be able to allay some of my concerns and answer some questions about a group that has contacted me repeatedly in recent years. I refer to psychologists and this carries on from some of Deputy O'Reilly's earlier remarks and on the standards that are employed within the HSE regarding the hiring and promotion of psychologists. Psychologists tend to be broken down into two principal categories, namely, clinical psychologists and counselling or educational psychologists. There appears to be a practice in play - perhaps this has been rectified in the recent past but it certainly had not been earlier - that opportunities for promotion and for further hiring appear to be limited to the role of clinical psychologists, to the exclusion of counselling and educational psychologists. As matters stand, this practice is not commonplace either in the neighbouring jurisdiction or in other countries I have been able to take as examples. The professional organisation to which I refer has raised a legitimate concern that effectively since 2009, the previous Government and the Health Service Executive operating under it more or less formally blocked promotional opportunities for counselling or educational psychologists within the system. I understand that more than 20 vacancies existed for a period of between 18 months to two years, two of which were filled in the end by clinical psychologists. However, educational psychologists - these are people who are working within the HSE at present - were more or less barred from applying for those positions.

I reiterate that in the North of Ireland, across the water and further afield, including the United States, Canada and Australia, such differentiations do not appear to exist. Moreover, I note that in a reply to a question I tabled a number of months ago, the then Minister outlined that a working group had been established within the HSE to agree appropriate eligibility for a set of criteria for the recruitment of senior psychologists. I am not clear at this point whether this particular group has reported, whether its report has been acted upon or whether its report seeks to remove what many within the educational psychologist profession would regard as an artificial differentiation between the categories of psychologists that operate within the health service. While I acknowledge this may be at a slight tangent from the issues under discussion with regard to this particular health Bill, the Minister of State might be in a position, either now or at some later stage, to address the concerns of this particular group, which I consider to be legitimate and which have not been addressed heretofore.

Photo of Patrick O'DonovanPatrick O'Donovan (Limerick, Fine Gael)
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I welcome the opportunity to make a few brief points on the main thrust of this Bill. I feel like a character in the film "Titanic", because I am about to ask whether there is anyone alive out there and whether anyone can hear me. I do not know whether it is me or the Minister of State but it appears as though each time I rise to speak on legislation in this Chamber, I am stunned by the presence, or the lack thereof, of some of our Opposition colleagues. While the legislation before Members is technical in nature and seeks to tie down a few loose ends with regard to representative bodies and so on for a number of health care professionals, it also is an opportunity to reflect on the work actually done by some of the professionals named in the legislation. There are two such groups to whom I wish to refer briefly, the first of which relates to orthodontics while the second is to follow on from my colleague, Deputy John Paul Phelan, with regard to psychology services and child psychology services in particular.

In the previous two Dáileanna, extensive work was carried out by the Oireachtas health committee on the treatment of young people, that is, children in primary school, with regard to orthodontic care. Although a number of recommendations were made at the time in respect of the roll-out of orthodontics and on the time being taken for the delivery of good orthodontic services, to be honest we still are long distance from this in 2014. At the outset, I pay tribute to a man from my own part of the world, who will not mind me saying this. I refer to the orthodontic surgeon in Limerick, Dr. Ted McNamara, who over a number of years has pioneered the need for reform of this sector and to bring practice in Ireland into line with what happens elsewhere around the world, which is that orthodontists work with orthodontic therapists to carry out the work that is needed for young people in particular. This is with a view to doing two things, namely, saving the State money and, more important, seeing children at a much earlier stage and thereby reducing the waiting lists. While previous speakers may have referred to this point, for many parents of primary schoolchildren, their children's teeth are of huge concern to them. The question, as the children emerge from primary school to go into secondary school, is whether their teeth will be dealt with but at present, the length of time it is taking on the waiting lists is unsustainable. A solution is being proposed, which is that orthodontic therapists could work in parallel with and under the supervision of orthodontic surgeons. This would ensure that some work that need not necessarily be carried out by an orthodontist could be carried out by a therapist, thereby reducing the waiting list.

This reform has been spoken about since Job was a boy but, until recently, very little has been done. I welcome the recent encouragement by the Department of Health and the Minister of the engagement of the Dental Council, the HSE and others to try to resolve this issue because, ultimately, the key point is that the child whose bite is wrong or whose teeth are in great need of such treatment should receive it much faster. If this can happen in continental Europe, and there has been much talk recently about Dutch, Norwegian, Finnish models and so on, why not make use of best practice from elsewhere to examine this issue from the perspective of the delivery of treatment to children who ultimately will be its main beneficiaries? As all Members are aware from their constituency office work, the alternative is that parents will take their children out of the waiting lists or will opt for private care, thereby incurring massive costs and in some cases even being obliged to borrow to so do. Not only does it lead to obvious issues with the physical appearance of the child's mouth, as the child gets older it also leads to difficulties with teeth being taken out and lost unnecessarily because of the existing delays, many of which could be dealt with through dental therapy.

The other area, which is of equal importance to many people, concerns child psychology services. As a teacher, I have seen at first hand the good work that is available from the child psychology services in respect of getting children assessed for intervention at primary school level in particular.

However, there is more than anecdotal evidence, as the Minister of State will know as well as anybody else from her constituency, that in some cases parents are able to jump to the top of the queue if they can afford to have their child's psychological assessment carried out privately, and may thereby have quicker and easier access to hours. It is not fair that children whose parents cannot afford a private assessment are thereby disadvantaged and will spend more time on the waiting list before being assigned hours.

I have emphasised on previous occasions the importance of early intervention, and the earlier the intervention the better. I have seen this at first hand in my constituency, where the Limerick early intervention service recently opened a new premises in Newcastle West, which was partially funded by the Department. The excellent staff provide a safe place there for children and their families, as well as for the psychologist. The system is family and community inclusive and, most important, child inclusive. For too long, these types of services were designed merely as box-ticking exercises whose only purpose was to ascertain whether a child required X, Y or Z. Now, however, we are moving to a situation where intervention does not just happen at the start but is extended over a period of time, thereby giving parents, communities, schools and the psychological services themselves the capacity to see a child's progress over a period of time. That is ultimately what we should be striving for across the board. Budgetary constraints notwithstanding, no child should be disadvantaged in terms of his or her ability to access that type of service. Specifically, no child should be disadvantaged on the basis of his or her socio-economic background. As I said, middle class parents with disposable income can secure a psychological assessment privately for their child, and good luck to them. However, such capacity should not in any way disadvantage the child who does not have that access.

We have seen evidence in recent months that the economy is beginning to improve. The Government's position in this regard has been proven correct, contrary to what the Opposition would have us believe. There is no more vulnerable group than children who require orthodontic, eye, ear or psychological care, much of which is encompassed in this Bill in respect of the professionals who deliver it. In the past three years the two cohorts with which I have interfaced most often are those children requiring psychological services and orthodontic care. In both instances, the professionals involved have tangible and positive contributions to make by way of their views on how waiting lists can be shortened and services enhanced within existing budgets. We must engage with these professionals and encourage them to bring forward any suggestions they might have. If they are off the wall, so be it. When one hears that recommendations made by an Oireachtas health committee in 2002 or 2004 are only now, in 2014, at the pilot stage, it is easy to see how a level of frustration has built up among professionals and parents. The Minister of State is committed, together with the Minister, Deputy Leo Varadkar, to address that disservice.

This is a technical Bill which might not light too many fires in terms of the headlines it attracts. However, the people who deliver these services and the representative organisations to which they subscribe can have a real impact on individuals, families and communities. Anything that helps them to carry out their work must be welcome.

2:25 pm

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I thank Deputies for their constructive contributions and broad support for the legislation that is before us today. As I indicated earlier, the chief purposes of this mainly technical Bill are to subsume the Opticians Board into the Health and Social Care Professionals Council, make a number of 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, and correct a lacuna in the Health Act 1970 concerning residential support services maintenance and accommodation contributions.

Parts 1 and 2 will achieve the first two objectives by repealing the Opticians Act 1956 and amending the Health and Social Care Professionals Act 2005 to apply its provisions to the optical professions. Part 2 also seeks to update the 2005 Act in many other respects. Part 3 ensures the new statutory framework for contributions by service users towards ongoing daily living costs will be applied appropriately across the various models in place to support independent living in community settings.

I agree with Deputy Billy Kelleher that a new, streamlined regulatory model will lead ultimately to increased public confidence in the health and social care professionals regulated under the Bill. People are sometimes at a loss to know where to go if a particular complaint arises. It does not happen very often, but that eventuality is covered in respect of the professions regulated.

In response to Deputy Caoimhghín Ó Caoláin, I can clarify that the rules regulating the prescribing and sale of spectacles will not change under this Bill. In other words, people who work within the premises can still deal with the cash or other transaction and may help with other aspects of the purchasing of spectacles. The current practice of employing sales assistants to help with choosing frames and processing sales will not be affected. In addition, since 2003, the definition of "spectacles" specifically excludes ready-made reading spectacles, and this is carried forward in the new Bill. It means that reading glasses can still be sold by persons other than opticians.

Deputy Finian McGrath raised concerns about staff transferring from the Opticians Board to the Health and Social Care Professionals Council. The Bill provides the standard public service provisions in these cases such that all benefits and conditions of employment will transfer with staff as on a no less favourable basis.

I share Deputy Olivia Mitchell's frustration with the relatively slow implementation of the provisions of the 2005 Act. However, the rate of progress is accelerating. Six registration boards have been established and the remaining six will be up and running by the end of next year. In addition, the order commencing the Act's fitness to practise regime will be made at the end of this year. This will be a crucial milestone in the regulation of these professions.

We have made significant progress on negotiations in regard to the regulation of counsellors and psychotherapists, and it is hoped the regulations can be made early next year. The first stage of the designation process, involving a detailed consultation with the Health and Social Care Professionals Council, is under way. I acknowledge the concerns expressed regularly by Deputy Dan Neville on this issue. Qualified and competent counsellors and psychotherapists are just as concerned about regulation and will welcome the provisions set out in the Bill. The details are still open for discussion, but we are making progress.

Deputies Kelleher, Ó Caoláin, Finian McGrath, Mitchell and Healy-Rae raised a range of issues relating to the resourcing of care and standards of care generally, particularly care in the community for persons in residential placements. Part 3, in common with the Health (Amendment) Act 2013, relates only to service users' contribution towards maintenance and accommodation costs. It is a case of keep, not care. Care standards and the resourcing of care are of crucial importance, however, and there will be many opportunities to debate these issues with a view to continual improvement of standards across the health system.

I refer to the contributions of Deputies Ó Caoláin, Finian McGrath, Mitchell and Kelleher. HIQA does not yet monitor, supervise or inspect the provision of care in the community. I hope that will happen as we progress, as it is essential. However, we have a whole set of standards and reports and it is the Government's intention that people in congregated settings will live in the community. It is important we regulate that as far as we can. There is a concern, which I share, in regard to residential settings for people with disabilities. The new regulations in regard to disabilities have been in place for 12 months and we will take a look at them because it is not fair to impose the type of regulations which are crucial for long-term care for older people. That is not how we want people with disabilities to live their lives. These places are their homes and we should not apply that type of medicalised standard to them. If HIQA came into my house to inspect standards, I probably would not pass, and I do not believe I would be in the minority in this respect.

I appreciate Deputy Mitchell's supportive comments in welcoming the Bill generally and, in particular, her supportive remarks in regard to the flexibility of the HSE in providing different models of provision of residential supports. Deputy Finian McGrath also welcomed the Bill. I take their contributions, not more seriously than other ones, but from the point of view that they are both parents and have had personal interaction with the disability services. From that point of view, it is important we listen to those issues raised.

Deputy Kelleher mentioned concerns regarding the potential impact of Part 3 on those in respite care. There is nothing in this Bill or in the 2013 Act which introduces any difference in regard to respite care as between the existing system and the new framework nor is there any separate reference to respite care or to any other subset of long-term residential support services. The current provisions in regard to charges for long-term respite services will continue under the new residential support services regime.

Deputy Ó Caoláin sought reassurance that reductions referred to in Part 3 could not be interpreted in a manner which could result in reductions in supports to service users or in reductions to service levels. I am happy to provide that reassurance. The Bill contains no provisions which could be interpreted as relating in any sense to reductions in supports or services to service users. There is a reference in section 43(c) to reducing the contribution amounts which service users will be required to pay, in certain circumstances, towards their accommodation and maintenance costs. I presume the Deputy has no difficulty with that. If it is considered beneficial that someone go on social outings maybe twice a week or whatever, the same are the rest of us, there will be enough flexibility in that section to allow the HSE or service providers to take that into consideration in terms of the contribution made. It is about standardising the system and giving a degree of security to people. These places are their homes and they need that degree of security.

I thank Deputies for their contributions to the Second Stage and look forward to further constructive examination of the Bill on Committee Stage.

Question put and agreed to.