John Lahart (Dublin South West, Fianna Fail)
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Deputy Billy Kelleher was in possession and he has 16 minutes remaining.

Billy Kelleher (Cork North Central, Fianna Fail)
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I wish to share the remainder of my time with Deputies Mary Butler and Fiona O'Loughlin.

Mary Butler (Waterford, Fianna Fail)
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Fianna Fáil will support the Bill, which makes minor technical amendments to the relevant Act and will facilitate the implementation of the decision to protect the title, physical therapist. This decision was taken following a consultation process and was welcomed by the professional bodies involved. The Bill will amend provisions of the Health and Social Care Professionals Act 2005 to address identified gaps in the provisions relating to the appointment of professional members to the Health and Social Care Professionals Council and to registration boards. It will permit a registration board to apply training and education conditions to applicants for registration who have not practised their profession and it will provide further conditions for the registration of physiotherapists and physical therapists in the register of physiotherapists.

The issue of the protection of the title of physical therapist as a variant of the title, physiotherapist, relates in the main to the confusion among the public and other health and social care professionals regarding the similarities and differences in the role of physiotherapists and physical therapists. The legislation proposes to protect both titles under the one prescribed, protected title of physiotherapist to eliminate the ongoing risk of title confusion and the consequent risks to public safety.

The Irish Society of Chartered Physiotherapists welcomed the decision made to protect the title "physical therapist" under the Health and Social Care Professionals Act 2005 which will eliminate the ongoing risk of confusion between the titles "physiotherapist" and "physical therapist". The Irish Association of Physical Therapists also welcomed the decision to introduce a new regulatory regime for physical therapists and physiotherapists. However, concerns have been raised by the Irish Society of Chartered Physiotherapists and these issues will need to be considered on Committee Stage. I would like to address some of them now.

The society is actively liaising with the Minister, Deputy Simon Harris, and Department of Health officials on its concerns which are as follows. First, the Bill provides for access to the register for persons without a qualification. This is a huge public protection issue as anyone calling himself or herself a physiotherapist or a physical therapist without a qualification can apply to join the register. The only clinical requirement will be to pass an assessment of competence. This will expose the public to huge risk.

Second, access for those who have never practised the profession does not have a time limit. This is a loophole that needs to be closed. Any assessment of professional competence must be equivalent to that for the physical therapy profession in order that all registrants will have a similar level of professional competency in order to ensure public protection.

Third, the assessment of professional competence needs to be set at the standard of an IPTAS qualification, not a physiotherapy qualification. As this is the register for the profession of physiotherapists, the assessment of competence should be based on the physiotherapist qualification. It is imperative that all registrants have the same level of professional competency to ensure protection of the public.

The fourth issue is one I hope the Minister will consider. I also hope it will be discussed on Committee Stage. It arises because the Bill does not include the decision that registrants shall be required to confine their practice to musculoskeletal therapy. This is a requirement the Irish Society of Chartered Physiotherapists believes is necessary in order to safeguard the public.

Given the urgency of all of these matters, I urge the Minister to ensure they will be discussed when the Bill moves to Committee Stage.

Fiona O'Loughlin (Kildare South, Fianna Fail)
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I welcome the opportunity to speak to the Bill and outline some of my reservations about it. I hope they will be taken up on Committee Stage by way of amendment.

My essential reservation about the Bill is that it makes more than minor technical amendments to the relevant Act, particularly in its protection of the title of "physical therapist". I have discussed this issue with chartered physiotherapists and others in the medical and health profession and they share these concerns. Physiotherapists are trained in a medical system and share lectures with students of pharmacy, medicine, occupational therapy, speech therapy, radiology and so on. They also receive compulsory training in hospital settings as part of multidisciplinary teams, which leads to an holistic understanding of the whole self. This training is even more important in the isolated private setting in which we have a duty to protect the public. The networks of cross-disciplinary knowledge built mean that red flags are picked up and that there is an appropriate system for referral to other medical professionals. For example, chartered physiotherapists fast-track referrals to GPs and oncologists where there is a need to do so.

There is most certainly a role for physical therapists in the health system, but there needs to be a clear division in the interests of public health and safety between physical therapy and physiotherapy. None of us would like to hear that our dentist was regulated without proper and appropriate qualifications because of a dubious amnesty. We cannot have a dilution of services or the standards of appropriately trained professionals. We have a duty of care to ensure the best possible professionals are available with appropriate training and education for all in the health care system.

I want to deal with some of the specific issues outlined by my colleague, Deputy Mary Butler. The Bill provides for access to the register for persons without a qualification. This is a huge public protection issue as anybody calling himself or herself a physiotherapist or a physical therapist without a qualification can apply to join the register. The only clinical requirement is to pass an assessment of competence. This certainly exposes the public to huge risk. We believe the assessment of professional competence will be set at the standard of an IPTAS qualification, not a physiotherapy qualification, the designated profession in this case. The assessment of competence should absolutely be based on the physiotherapist qualification, not a lower one. It is imperative that all registrants have the same level of professional competency to ensure protection of the public.

There is a loophole in the Bill in that access for those who have never practised the profession does not have a time limit, an issue which needs to be addressed. In addition, the Bill does not include the decision that registrants shall be required to confine their practice to musculoskeletal therapy. There is a requirement to include this issue, purely to safeguard the public, which is at the forefront of the issues we are raising.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Health and Social Care Professionals Act 2005 provides for the statutory regulation of the 14 professions currently designated under the Act, namely, the professions of clinical biochemist, dietitian, dispensing optician, medical scientist, occupational therapist, optometrist, orthoptist, physiotherapist, podiatrist, psychologist, radiographer, social care worker, social worker and speech and language therapist. Its main aim is to ensure greater patient care and tie all of those professions under one registration body known as CORU. Regulation is primarily by way of the statutory protection of professional titles by confining their use solely to persons granted registration under the Act.

This is a necessary Bill which is essential for the professions in order to ensure only those who are properly qualified and subject to statutory regulations will be allowed to practise the various disciplines outlined in the Bill. There is no doubt but that the public needs this statutory protection and guidance in order to be confident that those from whom they receive treatment are fully competent and accountable within their respective professions.

Before addressing the specifics of the amending Bill, it is appropriate to make a brief comment on the issues surrounding health and social care professionals in Ireland today. The issue of accessibility to the skills, knowledge and care of these professions is central in health and social services. Access to care for many citizens is very difficult and often denied. While citing the above named professions, one cannot fail to acknowledge the dreadful waiting lists on which young children with special needs must linger in order to access speech and language therapy, occupational therapy and physiotherapy.

The undercapacity of the public system means that parents are forced to spend hundreds of euro every month on private therapy if they want to see their child talk, walk, or have any hope of realising their individual potential. This is wrong. The level of funding and efforts to alleviate this crisis have been grossly inadequate, and I call on the Minister of State and her colleagues to ensure this most urgent matter is addressed in the upcoming budget.

The Bill being debated today seeks to amend the Health and Social Care Professionals Act 2005, and the main measures provided for in the Bill are to address gaps in respect of appointing professional members to the Health and Social Care Professionals Council, CORU, and to registration boards; to permit a registration board for the designated professions to apply training and education conditions to applicants for registration who have not yet practised their profession; and to provide further conditions for the registration of physiotherapists and physical therapists in the register for physiotherapists. Sinn Féin has concerns about the last of these three main measures of the Bill. This is the proposal to amend the 2005 Act by allowing practitioners to enter the physiotherapy register and continue to use the title "physical therapist" in their practice.

We note arguments made by the Irish Society of Chartered Physiotherapists, ISCP, that this timeframed arrangement must be firm and specific. IMPACT, the union which represents social care professionals, has not only voiced concerns but its opposition to the measure. It believes this has the potential to cause confusion for the service users whom the regulations are designed to protect. It argues that if the physiotherapist register allows access to practitioners who do not possess the equivalent qualifications and competencies to practice as a physiotherapist, the rights of the service users, patients, are diminished. Their access to the type of treatment and advice they require is effectively denied if they are unable to make a distinction between the effectiveness and the training of different professional practitioners. There can be no doubt about this, and it is at the core of what I believe is the whole tussle about the proposal involved. Patients should be able to make an informed choice between different service providers, and to do so with support from a clearly regulated system.

In 2005, when the Act was being discussed, I raised serious concerns regarding the establishment of undemocratically accountable quangos. That concern remains today, and our apprehension regarding the lack of accountability has not been abated. It is proposed in sections 3 and 4 of the Bill that the Minister would have the power to appoint professional members to a registration board within CORU during the transitional period of the profession concerned. We believe that this should be done and overseen by the Public Appointments Service. Furthermore, we are disappointed that there is a possibility that the Minister missed a chance to bring counsellors and psychotherapists under a cohesive body with this amending Bill, although I did note the opening contribution of the Minister, Deputy Harris, on Second Stage of this legislation earlier in the week. In November, the Minister said he would do this, following a Private Members' debate on seeking to regulate crisis pregnancy counsellors. The Minister, Deputy Harris, started a consultation on this last August, but, to date, there has been very little information about the outworking of that consultation, until his contribution here on Tuesday.

There are elements to the Bill which we support, such as the amendment to permit a registration board to make by-laws to apply conditions in relation to education and training to applicants for registration who are qualified for a specified period of time but who have never practiced their profession. The Act already has such provisions in respect of applicants who wish to resume the practice of that profession after not having practised the profession for a period specified in the by-laws.

Sinn Féin would commend a revisitation of this amending Bill. We will, of course, table amendments to address all our concerns on Committee Stage. I look forward to hearing further comment from either the Minister of State or the Minister, Deputy Harris, before the conclusion of this Stage of the Bill's passage.

John Lahart (Dublin South West, Fianna Fail)
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I call Deputy Clare Daly who has 20 minutes.

Clare Daly (Dublin Fingal, Independent)
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I may be sharing time with Deputy Pringle, if he appears. If not I will keep talking.

John Lahart (Dublin South West, Fianna Fail)
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I am sure that the Deputy would.

Clare Daly (Dublin Fingal, Independent)
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No, I may not.

The Bill is broadly welcome. From our point of view, it is more notable for what it does not do rather than what it does. In concentrating my points on the bits that are not in it, it is no reflection on the bits I favour that are in it. I will begin by echoing by the points made by some of the other Deputies earlier on the concerns that have been highlighted to us today and yesterday by the Irish Society of Chartered Physiotherapists which, as other Deputies have said, has raised a number of concerns and suggests putting forward minor amendments to protect physiotherapists' professional title. From the bits I have read on it, it would appear to be to be eminently reasonable that we would accede to these amendments. No doubt they will be dealt with at a later stage.

One of the issues not dealt with, which is something I have raised with the Minister on a number of occasions, is the gap in the law around section 47 on family law reports, which are compiled by psychologists and psychotherapists. The Bill could have addressed what is a gaping gap but did not do so. It probably addresses the deficit in terms of psychologists because when the psychologist registration board is established and the members appointed in the coming weeks it will bring the profession under full statutory regulation, which is obviously very important and will allow CORU to be empowered to investigate complaints which, to date, we have not been able to do. The gap with regard to psychotherapists is still wide open, and the Bill is disappointing in that we are speaking about legislation which is designed to increase regulation and oversight in the health sector but we are not doing anything about it with regard to psychotherapists.

Section 47 reports are an incredibly important element of family law and custody cases. The reports are carried out by either a psychologist, a psychiatrist or a psychotherapist, with a view to determining the best interests of the child in separation or custody proceedings. Obviously, it is an incredibly delicate and stressful situation for all involved. The outcome can be decisive in terms of a child's life and whether it is joint custody, full custody or visitation rights. The potential for upset is vast, like everything in family law, and everything has to be transparent. The problem is that it is not. I have had a huge number of complaints from parents with regard to the lack of professional behaviour by people who are supposed to be professional in dealing with these section 47 reports.

I will not go on about it too much, but one parent wrote to me about how she was relieved when she started the process because she thought that at last someone would listen to her children. She stated the first meeting took place in December and she felt from the beginning the therapist had taken an instant dislike to her and made no secret of it. It continued to Christmas and she explained the difficulties experienced and how, by the end of the assessment, she felt extremely vulnerable. She stated she was walking on egg shells, afraid to speak and afraid to say something that would annoy her. She said her devastation was set to continue as the report issued, as it was unbalanced, biased, completely inaccurate and highly critical of her as a mother. She stated the trauma and manner in which the report was conducted will remain with her for a very long time, and that she is beyond words to describe how she feels. She stated the psychotherapist failed her and her children.

Obviously, as none of us was there, we do not know what happened and cannot comment on the details of the case, but we know that despite this woman's deeply traumatising experience, there is no one to whom she can complain and nobody to investigate it, which is appalling. There is a missed opportunity to regulate psychotherapists under this legislation.

In the absence of regulation and as an interim measure, it would be possible for complaints about psychotherapists producing section 47 reports, for example, to be investigated through a minor amendment to a statutory instrument. Like Deputy Caoimhghín Ó Caoláin, I note the Minister's comment last Tuesday that he will examine this issue, but it is past time for examining it. The reality is that anyone can set up as a psychotherapist without qualifications, experience or training. It is good that we are considering this legislation and I welcome the Minister's statement on Tuesday about his decision to proceed with the designation of two distinct professions under the 2005 Act, counsellor and psychotherapist, but it is a question of how long we will have to wait for this. The Bill is a missed opportunity to do it. I should balance my remarks by pointing out that there are thousands of brilliant and dedicated psychotherapists who have undergone extensive training. It is also unfair on them because the hard work they have done is not recognised by statute; they are, therefore, on the same footing as the man or woman who undertakes a six week programme online and puts up a plaque stating he or she is a psychotherapist.

There is incredible urgency attached to regulating this area. A woman who had suffered a miscarriage of a much wanted pregnancy rang my office recently. She was distressed and upset at the loss of her baby. The counsellor to whom she had gone had actually told her it was her fault, that she obviously did not want the baby enough and that that was the reason the baby had died. One can imagine the trauma that caused. We have heard about so-called therapists telling people to do their garden or clean their house as therapy. There were the scandals at Roebuck Counselling Centre where management tried to scalp money from clients and their families. One farmer from County Mayo whose wife was an alcoholic and being treated there was asked to hand over €200,000. There is no regulation. While I acknowledge that the Minister has said he will address the issue, the reality is that if we do not do something in this legislation, it will probably be years away. It is urgently required.

To emphasise how dangerous it is to leave professions unregulated, I will refer briefly to the case of Joseph Maskell, a defrocked priest who was accused of sexually abusing young girls while working as a counsellor in the United States. He fled from America back to Ireland in the 1990s and set himself up as a psychologist in Wexford. He was employed by the South Eastern Health Board for a time before setting up in private practice in Wexford. As well as being an alleged serial child abuser, he was also allegedly involved in the murder of a nun who had exposed some of his activity in America. What is interesting about this case is that it was the diocese of Ferns, rather than the health board, that first rang the alarm bells after he had said mass one day in Curracloe. The Ferns diocese had been alerted by the diocese in America about him. However, it is worse than that. The diocese tried on several occasions to warn the health board to stop this individual from practising, according to a file disclosed by the diocese which we have seen. Despite this, it was two years before the health board received an undertaking from him that he would not work with children under 18 years of age in his practice. It is incredible to note that the health board did not make him stop practising but just accepted an undertaking.

That is what happens when professions are not regulated. If the registration of psychologists had been compulsory in the 1990s, would it have been as easy for a paedophile priest to be employed by the State and work as a psychologist with children? These are the consequences. The dysfunctionality of the South Eastern Health Board is well known and perhaps it might not have made a difference, but we must hope it would have. The desired impact of regulating professions which the Bill seeks to do is laudable. In that sense, I support it and believe it is urgent. However, there are still substantial gaps that must be addressed and I am keen to examine how we can address them.

Again, I support the proposals for amendments on a later Stage relating to chartered physiotherapists.