David Norris (Independent)

I move amendment No. 6:

In page 13, subsection (5), lines 5 to 7, to delete all words from and including "shall" in line 5 down to and including "Executive)" in line 7 and substitute the following:

"shall be carried out by a multidisciplinary team (who may be employees of the Executive)".

This deals with the multidisciplinary aspect of the assessment group, and assessment is at the core of this section of the Bill. The amendment refers to section 7(5) which states: "The assessment referred to in subsection (4) shall be carried out by [the following is a description of the composition of the team] a person or persons (who may be an employee or employees of the Executive) who, in the opinion of the Executive, are suitably qualified to make that assessment and prepare a report in relation to the assessment." This is general and vague in that "a person or persons ... may be ... suitably qualified". In this area, we have a particular tradition and particular advice from within the professional bodies, which is also endorsed by the HSE. I want to replace that very loose definition with the simple phrase "shall be carried out by a multidisciplinary team (who may be employees of the Executive)". This is the first and most important amendment.

The second important amendment is No. 13, which seeks to tighten up subsection (7), which currently states: "A care needs assessment may include an examination of the person concerned by, as appropriate, a registered medical practitioner, a registered nurse, an occupational therapist or a chartered physiotherapist, or any combination thereof." However, that combination is an internal reference. It does not expand or allow for expansion but it constrains by numbering off these elements. It allows for a combination of this entire group, but it does not make reference to any other groups such as therapists, social workers and so on. In assessing family and community support one really needs the input of professionals, adequately and properly trained, to review and assess social variables. A document has been produced by the Nursing and Midwifery Council this very year entitled Guidance for the Care of Older People and I wish to quote a sentence from it. It states, "You need to recognise your limitations in the scope of your practice and refer to a colleague, for example older people's nurse specialists, psychiatric and palliative care nurses or other members of the multidisciplinary team, to ensure that the most appropriate care is provided". I accept that section 7(5) states the assessment should be carried out by persons suitably qualified to make the assessment and that section 7(6) goes much further in explicitly setting out professions whose service will be guaranteed in care needs assessment, but social workers are not included, which is a concern.

I refer the Minister of State to the HSE's 2009 code of practice for integrated discharge planning, which argued strongly for patient assessment that is thorough, that covers pathological, physiological, psychological, social and cultural needs with a multidisciplinary and multiagency approach. It is useful to put on the record the professional definition of a multidisciplinary approach as understood generally within the service. Multidisciplinary teams are groups of professionals from different disciplines who work together to provide comprehensive patient assessment and treatment. The team usually consists of medical staff, a consultant registrar, a nursing team, a discharge co-ordinator, community services, a discharge liaison officer, a dietitian, physiotherapists, occupational therapists, speech and language therapists, pharmacists, social workers, a public health liaison nurse, a chaplain and a spiritual adviser. This definition is from the HSE itself and yet a constriction or narrowing is applied. Either it should have been left vaguer to allow for these additional inputs, which are very valuable, or it should have been specified in the way I suggested. One reason is the type of vulnerable patients involved very often have a complex background and medical situation. It may well be necessary to draw on the resources and professional capacity of people who have a specialised interest or capacity in this area.

I have been briefed by Age Action Ireland and I refer to its position. It believes assessments ought to be made by a multidisciplinary team because of the proven benefits in making appropriate and timely referrals. It quotes several academic papers published in this area including O'Dell, 2006; Wilson, 1998; BMA, British Medical Association, 2000; and Paul et al, 2000. Multidisciplinary teams are advantageous in reducing the likelihood of mistakes and also subjectivity. In other words, there is a group or variety of specialists all of whom bring expertise to bear. Otherwise things may be missed, especially if people are suffering from strokes. There may be an apparent incapacity but someone with a particular skill may unlock a capacity on the part of that person. Multidisciplinary teams are advantageous in resolving the likelihood of mistakes and also subjectivity from the decision making process. In addition, because the assessment is used to determine what health or personal social services may be appropriate for the person, correct assessment is fundamental for people going into care and the nature and extent of services they will be deemed to need.

In 2006 the HSE itself advised that assessment of need for residential care would be carried out throughout the country by multidisciplinary teams of health care professionals in the course of that coming year. It used the phrase "multidisciplinary teams" again. We know what it means and we know also that certain elements are excluded from the operation of the Bill as it stands. I refer again to the complex needs of patients. The benefits of such co-operative working include timely and effective patient discharge, increased patient confidence, continuity of quality care, enhanced communication, partnership regarding resources management and so on.

My final argument, for the moment at least, in support of the amendment is to quote the Minister of State on the subject. On 26 May 2009 the Minister of State at the Department of Health and Children, Deputy Áine Brady, stated: "By maintaining the function of undertaking care needs assessments within the HSE, the legislation ensures that the applicant has access to a multidisciplinary team of health care professionals located close to his or her place of residence". The belief generally is this is not comprehensively catered for in the wording of the Bill before the House and that a guarantee of access to such teamwork and professional expertise needs to be written into the Bill on this Stage. For this reason I put my amendments before the House and I believe the same applies for my colleagues who have placed either similar or related amendments.