Áine Brady (Kildare North, Fianna Fail)

Similarly, geriatricians and psychologists are omitted. Consistency of approach is important in acknowledging and respecting each of the health care professionals who work in front-line health services and who may form part of the multidisciplinary team, as required. The danger of a prescriptive definition in primary legislation is that it may be restrictive and could omit certain professionals. Experience has shown that the omission of a particular professional from a list of designated persons within primary legislation can undermine that profession's right to undertake certain actions, even where the policy intention and the professional's training and scope of practice dictates otherwise.

The term "multidisciplinary team" is widely used across many different care areas and means different things in different care areas. For example, it is used in mental health, disability, children's and cancer services. It is also used for primary care teams and for general discharge planning for all those leaving the acute sector and not just for people in need of long-term residential care. Defining the term in primary legislation for the first time could have unintended consequences for these other care areas.

The matter of defining multidisciplinary team requires careful consideration. Accordingly, I will endeavour to examine the many complex issues I have outlined and to define multidisciplinary team in guidelines in the immediate term. I also propose to provide for this matter to form part of the review of the legislation three years from now. For these reasons, I do not propose to accept amendment No. 2.

Amendment No. 8 proposes that care needs assessments should be undertaken by a representative of the Health Information and Quality Authority, HIQA. The function of HIQA will be to register and inspect all designated centres, including public, private and voluntary nursing homes. The undertaking of care needs assessments is outside HIQA's role and would distract from its critical role as a national regulatory authority. It would also represent an inefficient use of public resources. By maintaining the function of undertaking care needs assessments within the HSE, the legislation ensures the applicant has access to a multidisciplinary team of health care professionals located close to the applicant's place of residence. Such health care professionals will be engaged simultaneously in the provision of care either within the acute sector as part of primary care teams or in the community setting generally. The transfer of this function to HIQA would require significant dedicated resources to be provided with a resulting drain on the provision of front-line health care staff from the HSE. The fact that HIQA is a centralised regulatory authority would also present problems in term of providing efficient and cost-effective assessments to applicants at local level. I do not propose to accept the amendment.

Amendment No. 9, and amendments Nos. 24, 27 and 28 which are consequential on amendment No. 9, raise the same issues as amendment No. 2. Amendment No. 9 refers to a team and, therefore, requires a definition of "multidisciplinary team". It also requires mandatory assessment by a geriatrician. This is contrary to the policy intention that care needs assessments would be flexible and person-centred and would involve assessment by various health care professionals as required. In the cases of people who are already in a nursing home, assessment by a geriatrician will not be necessary. A mandatory requirement would divert a health care resource that is already much in demand. Not only would this be inefficient in terms of the use of resources, it would also impact on applicants by increasing the overall waiting times for assessments. For these reasons, I do not propose to accept amendments Nos. 9, 24, 27 and 28.