John Minihan (Progressive Democrats)

I welcome the Minister of State at the Department of Health and Children, Deputy Tim O'Malley. As previous speakers have noted, this welcome legislation is long overdue. It is vital that the legitimate concerns of members of the public are protected to ensure they are confident that professionals providing services are properly qualified and competent.

The professions require protection where normal operational and ethical factors make it impossible to exclude unqualified or insufficiently qualified persons from professional activity. The reason, among others, is that the professions can only apply an ethical code to their own members. Unless a mechanism is in place for sanctioning professional misconduct, the good name and reputation of the majority can be damaged by the actions of a few who bring a profession into disrepute.

The Bill will provide for a proper system of registration which allows for investigation of any allegations of incompetence or misconduct and disciplinary action to be taken if deemed necessary. It also provides a mechanism to deal appropriately with practitioners compromised by ill health or addiction. It is vital that a system of statutory registration provides a legislative framework for the appraisal and approval of education and training courses, thus ensuring the proper development of education and training across the professions.

In dealing specifically with one aspect of the Bill, I bring to the attention of the Tánaiste and Minister for Health and Children the legitimate concerns of the Irish Society of Chartered Physiotherapists. I met representatives of the society and listened carefully to their briefing. While the ISCP welcomes the publication of the Bill, it has concerns about the issue of title. It believes that issues which have implications for the general public have not been addressed.

As Senator Henry stated, the title, "physical therapist", as distinct from the "physical terrorists" to which Senator Quinn referred, is synonymous with the title of "physiotherapist". These titles are interchangeable and the professional qualifications and requirements are the same. In recent years, a group of practitioners has adopted the title "physical therapist", which has led to confusion regarding the difference between the two practices. The matter has only come to the attention of members of the public when their claims to VHI or BUPA have been rejected and, on investigation, they have discovered they were not treated by a physiotherapist.

In hospital settings some doctors who trained or practised in other countries refer to chartered physiotherapists as physical therapists. As previous speakers have noted, this leads to confusion which can impact on patients. While the legislation may focus on statutory regulations for professionals, the interests of patients must be to the fore at all times. The differences between the two practices which currently operate here are profound, both in terms of the different level of educational requirements and the extent of involvement and interaction with the medical profession. This is nowhere more evident than in pharmacy in which there is a distinct difference in the qualifications of assistant pharmacists and pharmacy technicians who work alongside pharmacists. It is imperative that the legislation recognise and clearly set out this difference.

The Institute of Physical Therapy awards the qualification of physical therapist. While this is a legitimate qualification and its practitioners provide a specialised service to the public, it is not the same as the qualification or service provided by a physiotherapist. These two qualifications must be recognised and regulated, while also being separated in the eyes of the general public. I hope the Tánaiste and Minister for Health and Children will address these concerns on Committee Stage.

I also hope the Tánaiste will be in a position to give an assurance that she will, through statutory instrument, protect the titles of physiotherapist and physical therapist for the profession of physiotherapy in the legislation and thereby protect the general public from the current confusion engendered by the fact that a separate group of practitioners whose members are not physiotherapists is using the title "physical therapist", which is interchangeable with the title "physiotherapist" elsewhere in the world.

Recent developments in a changing arrangement between general practitioners and pharmacists must be addressed. While I am aware the Tánaiste recently addressed the issue in the Dáil, I re-emphasise it in the hope that she will examine it in the short term in accordance with existing legislation. Lest some may not know this, I declare a conflict of interest in that I own a pharmacy. However, it does not change my view.

Co-operation between health care professionals is vital in the operation of an effective health care system. However, team working among health care practitioners must have its limitations, for example, in the case of general practitioners coming together to build health centres and putting pharmacies on site, or pharmacists building health centres and inviting general practitioners to relocate their local surgeries to their health centres. Clearly, there should be no business arrangements of this kind between the prescriber and the dispenser as recommended in the pharmacy review group report. This is not in the best interests of either profession or in the best interests of the public. Each profession has its own separate and autonomous role and it is important that this independence should not be, or be perceived to be, compromised in any way.

On the wider issue of health centres generally, I have serious concerns about allowing a pharmacist or a few doctors to control the market in a particular location. Apart from possible ethical considerations, what would this mean for patients in terms of choice, accessibility and quality of care in the long term? I ask the Tánaiste to examine this issue carefully and to set out clearly how she proposes to address the matter.

In conclusion, I welcome the Bill and look forward to examining it in more detail on Committee Stage. The Bill is long overdue and should be welcomed by the professions, as I feel it is. More important, it is in the interests of the patient. All our initiatives and the direction of the health services must be geared towards quality of service for the patient, which should be to the fore in all legislation.