Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

My experience of opticians is that they are very careful people and they refer patients on. Clearly, as the first point of contact for people in terms of eye care, they are experts. My experience - not personal experience - is that when a difficulty is encountered people are advised to go further, wherever that is. I take the amendment in that vein. For all the reasons expressed by various speakers, I cannot accept the amendment. I hope I can explain the reason, but I take it in the spirit in which it was offered. I believe it would introduce unnecessary and inappropriate provisions into primary legislation and would apply to the optical profession when the Bill is enacted. The amendment proposes to effectively resurrect certain provisions of the Opticians Act 1956 which the Bill will repeal and to insert them into the Health and Social Care Professionals Act 2005. It would impose in primary legislation requirements on members of the optical profession to inform patients of suspected diseases or medical conditions, and to recommend that patients so informed consult with a medical practitioner. I do not take it that the Senator is saying that necessarily as a GP. I understand that perfectly.

I believe the existing robust regulatory provisions would adequately address these issues. There are three by-laws that the optical registration board will have to make when it is up and running, one of which is about conduct and ethics. That can be fleshed out at that point. The provisions in the Bill relating to the future regulation of the optical profession were subject to extensive consultation. A departmental working group on subsuming the Opticians Board into CORU, which informed the drafting of the legislation, comprised representatives of the board, including ophthalmologists, as well as members of CORU, the Irish Association of Dispensing Opticians, the Association of Optometrists of Ireland and the Department's professional regulation and primary care units. Separately, the Department met and corresponded with representatives of the Irish College of Ophthalmologists on the proposed legislative provisions. I am pleased to see evidence of increasing co-operation among all the eye professionals. For example, the HSE national clinical programme for eye care is aspiring to increase interdisciplinary activity among professions in order to deliver a cost-effective, safe, high-quality eye care model for patients in the community. That is what Senator Fidelma Healy Eames was talking about when she mentioned the clinical care pathway.

I understand that care pathways are currently being agreed by all stakeholders. The model envisages an ophthalmic referral process in the community for sight-threatening eye diseases such as glaucoma, age-related macular degeneration and cataracts. This would ensure that management is provided for as long as possible by optometrists within the community setting and that only those with referable eye disease are directed into the secondary and tertiary setting. This would free up clinic time to treat those patients most at risk of sight loss sooner in order to achieve better outcomes for patients in terms of preventing vision loss, improved quality of life and independent living.

The Bill proposes to transfer the regulation of the optical profession from the 1956 Act to the more modern regulatory model set out in the 2005 Act. The model is reflective of the current realities experienced by today's eye care professionals. By the end of next year, the 2005 Act's regulatory model will apply to 16 health and social care professional areas. The Act comprises title protection provisions linked to a registration scheme. It also provides for codes of professional conduct and ethics to be adopted by by-law and a fitness-to-practice regime similar to that applying to medical practitioners, nurses and midwives. Under the 2005 Act, any health professional, including an ophthalmologist, optometrist or dispensing optician, who did not recommend that a patient consult with an appropriate health professional about a suspected disease or health condition would be guilty of professional misconduct and would be liable to disciplinary sanction, including cancellation of his or her registration. That is a fairly robust and severe penalty in terms of what Senator John Crown wishes to achieve. I agree with him that it is hugely important, but the Act already provides for that. Such omissions would be in breach of the code of professional conduct and ethics that is adopted by each registration board. Each code is framed in accordance with statutory guidelines set by the Department and CORU, and its objective is public consultation prior to its adoption by by-law. The codes require registrants to act within the limit of their knowledge, skills, competence and experience and to refer on patients or service users when necessary. I believe they do this already.

The code of professional conduct and ethics for the optical profession is currently being drafted by the inter-optical registration board, which includes on its board two eye doctors. Members of the interim board will be appointed to the statutory board when this is enacted. For these reasons, I believe the amendment is unnecessary and would not fit with modern legislation or professional regulation. I am also concerned that it would result in optometrists and dispensing opticians being treated differently from other professions registered under the 2005 Act.