Wednesday, 10 November 2004
Health and Social Care Professionals Bill 2004: Second Stage (Resumed).
Members of the public must be informed of this legislation through press releases and public relations exercises. Those who drafted the Bill should be proud of it, as well as those who will see it through to enactment.
The issue of identity between physiotherapists and physical therapists needs to be addressed. Senators were contacted by the school of physiotherapy which believes that the term "physical therapist", as is used in Northern Ireland, the United Kingdom, Europe and the US, should be used in the context of a physiotherapist. It means one and the same thing in other jurisdictions but it does not in this State. The international organisation of physiotherapists would also like to see the two terms recognised as meaning the same thing.
I am in no way demeaning the role of physical therapists as they do excellent work. I have seen their scope of practice which is excellent and no Member is seeking to damage their livelihoods or practices. From speaking to physiotherapists, they want to work hand-in-hand with physical therapists. They see the need for them but under a different title and I suggest those who drafted this legislation could rejig the name "physical therapist".
I look forward to the Bill's progress through the House. Minor items that were tinkering around the edges of the medical practitioners Acts and the nurses Acts have been put right in this Bill, particularly on the issue of fitness to practise measures and the health committee.
He is most welcome in the House as an old friend.
I feel the Chartered Society of Physiotherapists had a point on the use of language, particularly having read its admirably succinct submission. So many bodies believe that unless a submission is 20 pages long, one will not be impressed. The opposite is the case and I share the views of the former Taoiseach, Mr. Reynolds. If it cannot be put on one page, then the writer does not know what he or she is talking about.
The Tánaiste's speech was a mixture of brave and interesting comments. The brave ones referred to the health strategy again. Until some part of it begins to work as distinct from being an aspiration, the bravest action for the Government is not to mention it. However, the Tánaiste, being the woman she is, did refer to it. Whether one agrees with her, her comments are often interesting in a provocative way. The country should take seriously her reflections on professional regulation. Although I do not agree with her, there is a way of doing things in this country that achieves the worst of both worlds. For example, when one buys a brand new car to use as a taxi, one must have the national car test done on it. This is a classic example of regulation gone mad.
I have always expressed scepticism about self-regulating professions. My profession, engineering, is to a degree self-regulated but it is also regulated by a competitive market. In spite of occasional efforts by the engineering profession and its prominent members, the numbers of engineers qualifying in third level institutions has increased dramatically. The professional institutions have had no real option but to recognise all as professional engineers. Any self-regulatory mechanism must not become a vehicle for protectionism. I am intrigued that there is no section on poor professional performance in the appropriate legislation governing regulation in the Bar Council and Law Society. Although there is a provision for malpractice, no authority is given to either body to adjudicate on a lawyer or barrister who has done a bad job. It is an extraordinary omission and is the best argument against our understanding of self-regulation.
I welcome the Bill yet we are slow to take actions, which are self-evidently necessary. Let us consider the issue of unqualified people practising as physiotherapists. Their victims may have civil cases against them, but they must be entitled to more from the State than just the right to go to court when their spine has been permanently damaged by quackery. I have no political objections but certain issues in this process need to be addressed. I am glad that the councils to be established under this legislation will have a substantial lay membership. No profession should be regulated by a body controlled exclusively by its own members. There is a need for lay participation in, dare I say, the Law Society, the Bar Council and accountancy.
I am glad the Bill's remit covers poor professional performance. In this area, the public must believe there is a simple straightforward process for dealing with a person claiming to be professional, yet manifestly failing to do his or her job.
We often hear people say in dealing with allegations of medical malpractice that if somebody had only told them the truth from the beginning and let them know what was happening they would have had no interest in pursuing the matter through the courts. There is a conundrum there because if one admits to having done something wrong one gives one's opponents a strong case. That is why mediation serves a very useful purpose in this legislation. There are many people who simply want to feel vindicated in their belief that nobody looked after them properly in any profession, including engineering and teaching, the two hats I wear from time to time. I would be delighted to see some proposals to extend this remit on poor professional performance to other professions as well.
The listed professions are the nub of the Bill. I read the Minister's speech on how these professions were chosen with great interest. I do not have a major argument with her about the professions, none of which should be absent from the Bill. One might ask, however, what else should be in it. I am not entirely happy with the criteria. The Minister stated: "The 12 professions to be subject to the provisions of the Bill in the first instance were selected because they are long-established providers of health and social care within the health service and in most instances have experience of self-regulation." I accept some of that but I worry about many new quasi-medical professions in the area of therapy, counselling and so on which are not long established or well regulated. In many cases that is because the practitioners do not want too much regulation nor do they want any suggestion that they would be regulated in the same way as the medical profession. I am married to a consultant psychiatrist and while I have no professional interest in this I might be accused of being part of a lobby, which is not the case.
There are wonderful people working as therapists and counsellors but there are many who appear to be able to do a six or 12 month course in any university and put up a plate declaring themselves counsellors or therapists. This is very dangerous and is why I am not happy with the Minister's emphasis on "well established". This is not a political argument. We must also consider new professions. I am sceptical about practices such as homeopathy. The State has a role in evaluating many of these new remedies which may well work but consumers are entitled to some attempt at objective assessment of their effectiveness. If people want to sell coloured liquids which are otherwise harmless and claim they are cures for baldness then let them at it, as long as we are sure they will not do much harm.
There is no profession in the list to which I object. I am not suggesting that chiropody should not be on the list but while the harm a chiropodist can do is quite significant, the harm a poorly-trained therapist can do when starting to explore people's subconscious and working into that area is significant for individuals, for their relationships and sometimes for society. The area of therapy, psychotherapy and counselling desperately needs regulation. Whether it needs as much regulation as this Bill contains at this stage I do not know but the nettle must be grasped to convince people that this is not a takeover by the medical profession, because that is how many people would see it, but is in their interests. There is a need for formalised recognition of who can call himself or herself a counsellor or psychotherapist and so on.
The psychologist is defined here quite precisely and correctly but as the role of the church in society declines, a profession is growing of replacements for the clergy who are being paid to do all the listening that good clerics used to do. Most priests, however, had a reasonable five or six years training and before the church would allow them undertake that sort of delicate work they were presumed to have some maturity. I am astonished at the number of people who, on getting stuck in a job they do not like, decide it would be more satisfying to be a counsellor and move from something utterly unrelated to counselling people, having completed a 12 month course. I worry about this. The capacity exists in the legislation to add other professions but apart from the reference to "well established" if one accepts — and I do — the criteria listed by the Minister, which includes "the potential for harm to the public", that area carries a considerable potential for harm.
I do not wish to go on at length about the Bill. I welcome the level of lay participation. Senator Feeney spoke yesterday about the importance of having a health committee as well as a fitness to practise committee. I accept her expertise on the matter as she suffered the Medical Council, which is probably a reasonable way to describe it. She knows it better than we do. I am always worried about the possibility of people being targeted for malicious complaints but that is the world in which we live. Those of us involved in politics do not have any reason to be too touchy about it. We live with malicious complaints. Anyone claiming to be a professional must do likewise. The balance in the legislation is reasonable in terms of protecting a person's good name while also protecting the public. With those reservations I welcome the Bill.
I welcome this Bill and the Minister of State, Deputy Tim O'Malley, to the House. The Minister herself was very welcome here yesterday. When we think of health reform we think of hospitals closing, the Hanly report and various other matters. However, that is not what health reform is all about. This Bill is part of the health reform programme whereby the consumers, the patients availing of the services of the ten bodies enumerated in the Bill, will be ensured a proper regulated service. It is the right kind of legislation and regulation. We often think of regulation as being heavy handed and demanding. This regulation will guarantee that if one goes to a chiropodist or to another health provider or social worker enumerated in the Bill, one receives a certain level of service, knows what this person can do for one and where to lodge a complaint if one feels hard done by. This is serious medical reform that has nothing to do with infrastructure, hospital buildings or anything of that nature. It serves the patient and the consumer.
Patients and consumers are often overcome with mystification about the particular services a practitioner can carry out. I note that we will have legislation on medical practitioners and nurses, which will update and regulate these professions in the light of modern trends and the demands made on people today. Senator Feeney's idea of obliging practitioners to display their qualifications on the wall is a good one. When a Bill is published, we normally receive many letters and telephone calls. In this case, we only received correspondence from physiotherapists.
A survey was done that showed that more than 90% of Irish adults are aware of physiotherapists and almost 30% are aware of physical therapists. I have never heard of a physical therapist, but I have heard of physiotherapy and how difficult it is to get into it, how long and arduous is the course and the work undertaken by physiotherapists. When I hurt my ankle three years ago, I was lucky to have a chartered physiotherapist living near me and to whom I repaired very often. She displayed her qualifications on the wall explaining what she was entitled to do. I found that she was a wonderful woman practitioner.
I had never heard of physical therapists. A physical therapist clearly does more or less the same work, but does not have the same qualifications. There is room for confusion because the terms are interchangeable in 90 countries. If that is the case, we should clear it up and create a common parlance for the remit of the profession. I thank the physiotherapists for sending us the information, because it is useful and was backed up with a survey.
More than one in four people in the survey believe that a physical therapist requires a university qualification, which is not the case and therein lies the danger. We are not being elitist when we talk about a university qualification, but if one spends five years learning one's profession and receives a hands-on training, then one is highly qualified and is capable of carrying out one's profession. If that is not the case, then there is a danger for customers. While someone can claim to be a beauty therapist, how do we know that the person is one? The person may look beautiful, which is a good advertisement for what the person is practising. The person's name is often followed by a puzzling set of qualifications because we do not know where the person got them. I am suspicious of someone who parades 14 letters after his or her name. What does it mean?
I agree with the point made by Senator Ryan. We all become public representatives and we perform a counselling service in our clinics. I do not like the word "clinic" because it betokens that someone who attends it is ill. I do not use the word myself, but it has become common parlance for people doing constituency work. I often find that people who come to see me do not have a real query, but want to tell me something, so I have to develop a listening technique. Senator Ryan was worried that in so doing, we are professing to have a profession for which we have not been trained. It is an interesting question, but life brings forward those skills in people and listening is not a difficult component to acquire. It only requires that we shut up ourselves and listen to someone else. We like talking and like being listened to, so every Saturday there is a change of emphasis in our lives as we are doing the listening.
I have often commented on the lack of engagement between people. If they talked to one another rather than at one another, then the doctors' clinics might be empty. Doctors do not have the time for this. When someone goes to a doctor, the doctor wants to know that person is ill, what is wrong and then wants to write a prescription and send the person on his or her way. The lack of communicative skills is difficult in dealing with patients.
It is interesting that we are now going to impose strictures, qualifications and parameters on all of these practitioners. Years ago, if a patient was ill and in a hospital, he or she would lie there meekly while the doctor would discuss in loud tones what was wrong, where the patient would have to go and what would have to be done. Female doctors would be more discreet in what they were doing, yet no one questioned doctors. No one questioned their qualifications or their pronouncements and the patient went meekly along with it. We were supposed to assume that doctors know best.
This legislation will give us empowerment, a word I dislike but I use it here. Consumers will be empowered and will know the shape and the make of the person to whom they will have to consult on a one to one basis about their ills. That is real power for the consumer. The fact that it is enshrined in legislation will mean that the person who feels that he or she has been wronged by a practitioner can seek redress. I welcome that.
The Tánaiste previously worked in a Department where regulation was heavy handed. I believe in giving more power and knowledge to consumers. They should have a right to find out about who they wish to consult. If they feel that they have been badly handled, they will be able to find out how they can take a case against such practitioners. I like the idea that the general council is composed of 12 members who are from the professions and 13 who are outside people. Why should the professions have a majority? They would only regulate themselves if they had one. It should be weighted in favour of the consumer and that is what will happen with the proposed membership of the council. I welcome the Bill.
I welcome the Minister of State, Deputy Tim O'Malley, to the House. I wish the Health and Social Care Professionals Bill, which is supported on all sides of the House, every success. The Fine Gael spokesperson in the Seanad spoke in favour of it yesterday.
I wish to discuss an issue which needs to be addressed. Many resources are used to ensure that our doctors are trained to a high international standard after seven or eight years of preparation. A significant proportion of those who qualify as doctors leave the country immediately afterwards to study elsewhere or to travel around the world. I accept that the role of the State does not involve telling people what they can and cannot do, but we have to cop ourselves on in this regard. Substantial public resources are expended on training doctors, nurses and care professionals who are needed as never before, especially as the population of this country has increased by 500,000 in the past ten years. We should include certain obligations in the contracts of people who have benefited from public resources. The Government's hands are tied when a person on whom resources have been spent leaves the country at the end of his or her period of training, for example, to engage in international travel. We should consider whether that is acceptable in light of the current level of demand on our health service. We have to find a solution to this problem.
I would like to raise a consumer issue which is not directly related to the Bill. GPs in the Dublin area impose charges which can vary from €35 to €50 per visit. As a consumer with two small children, I regularly use the GP service. One third of people in this country get everything for nothing through the free medical care system, while the other two thirds have to pay for everything. There is nothing in between.
That is the great dilemma in our free health care system. When the health and social care professionals council has been established, medical scientists will have to deal with this issue in terms of general practice. Why is the wide variety of cost to families and consumers who use the GP service acceptable? I ask the Irish Medical Organisation to take up this issue. It is not acceptable for a wide variety of charges to be imposed by GPs who are providing services to a community. It is an important point.
The problems caused by a cowboy element who offer a way out to those who are trying to cope with difficult diseases have regularly been raised by Senators on the Order of Business. The cowboys to whom I refer offer miracle cures to those suffering from cancer and other diseases for which there is no hope. I hope the council will come down heavy on those offering such miracle cures because they cause people facing a terminal illness misery and suffering.
This matter has been raised many times during the proceedings of the House. I hope the council will do some significant work in this area.
I was approached some time ago by practitioners of alternative medicine who have been calling for an alternative medicine registration system for many years. While such a register cannot be provided in the Bill, has the Department considered the establishment of a registration body outside the ambit of the council? Such a body would facilitate some form of registration on the part of this country's thousands of practitioners of alternative medicine. I do not know if the alternative medicinal practices stand up to medical scrutiny, but I am aware that significant sums of money are being spent on them. Therefore, there should be a registration process.
There are real problems in our schools because the demand for speech and language therapists, which has increased following the expansion of the speech and language therapy service in recent years, is not being met. According to a quote in an article in The Irish Times of 2 November last, "there are 500 speech and language therapists in the country but only about 400 are working." The article also referred to a new organisation which has been established to offer hope to people with autism. Many such bodies have been established in the United States over the past ten years to offer something other than a quick-fix solution to the parents of children with autism. I do not doubt that there is a need for the services of those who are qualified and those who are establishing a commercial activity, but we need to distinguish between them in the area of speech and language therapy. I hope the new council will penalise those who offer hope to people but who simply take money from their pockets.
I am not in favour of self-regulation, generally speaking, because it is important that people outside a profession should be involved in regulating it and deciding how complaints can be made against those involved in it. In this regard I welcome section 9(3)(b)(iv), which states that nine ordinary members of the council will be "representative of the interest of the general public." That is very important. The section also states that they will be "appointed with the consent of the Minister for Enterprise, Trade and Employment." As the Departments of Health and Children and Enterprise, Trade and Employment are involved, I assume that the Tánaiste and Minister for Health and Children will have the power to appoint various people under the seal of the Minister for Enterprise, Trade and Employment, or at least to recommend that they be appointed. It is important that as wide a group as possible should be part of the council to represent "the interest of the general public."
The Third Schedule lists the Irish qualifications which are required by existing practitioners if they are to qualify to register at the outset. It is not clear that similar provisions will apply to those who qualified outside Ireland but have been validated and are entitled to work in this country. Can the Minister of State clarify this matter? Does the Third Schedule deal specifically with those who received their qualifications in Ireland? Does it cover those who are practising in Ireland, even though they received their qualifications in other jurisdictions? I ask for some clarity in that regard.
I welcome the Bill, which will lead to much more public confidence in a range of professional services in the medical and educational spheres. The House will do its utmost on Committee and Report Stages to progress the Bill.
I express my gratitude to Senator Maurice Hayes for his courtesy in allowing me to speak before him. Perhaps his generosity was inspired by the profusion of Hayeses in the House. I am grateful for his kindness because I am scheduled to do an interview. I would like to take up a point made by Senator Hayes——
——number one, which relates to one of my principal reasons for wanting to speak on the Bill, which I welcome. I congratulate the leader of the Minister of State's party, Deputy Harney, for choosing the poisoned chalice of medicine. It was an extraordinarily courageous act because the job of the Minister for Health and Children is probably one of the most difficult in the Government. I hope she will make a difference and I believe she will.
I regret that the Bill before the House does not address the development of quackery throughout the country. In the past year, there has been a series of horrendous cases of people promising wildly unrealistic cures for cancer to the vulnerable. Sick people have been offered medicines and various forms of treatment which do not have any impact. Some of them have been persuaded to leave the course of chemotherapy or radiation therapy on which they had embarked. Patients and their families will grasp at any straw of hope in such circumstances. This practice should be stamped out because it is utter cruelty. I am amazed that such people have not been disbarred by the medical profession. I am surprised that they have not been prosecuted. It may be that it is difficult to persuade grieving people to take on an additional burden, but I think the State has a duty of care and guardianship to those who suffer from the extraordinarily cruel actions of others.
One could understand the practice if it involved people who genuinely believe they have a cure and are keen to try it out on a couple of people. However, when they continue to pursue it and to charge exorbitant sums for medicines that are patent rubbish after they have received evidence that they do not work it is one of the cruellest activities in which so-called medics can engage. They dishonour the noble profession of medicine.
I would also like to turn to the question of chartered physiotherapists. I am glad the Leader of the House, Senator O'Rourke, raised this matter, but there are several other worrying issues to which I do not think she referred. They concern the confusion between physical therapists and physiotherapists. I mean no disrespect to some practitioners of physical therapy, who I am sure may be good. The difficulty arises principally because, in the United Kingdom and many other European jurisdictions, the title "physical therapist" is synonymous with "physiotherapist". To practise as the former, one must have certifications, qualifications and so forth. However, in this country that situation does not obtain. I am sure that there are good physical therapists who would welcome a process of registration. It is necessary that the Bill review the matter, if necessary by amendment, since serious consequences result from the confusion.
Having just passed my 60th birthday, I place myself in the vulnerable category of the elderly. People, including the elderly, can easily be confused, leading to a situation where they go for treatment — they may be living on a pension — under the illusion that a course of treatment provided by a physical therapist is regarded by the insuring bodies in the same light as a physiotherapist and that they will be reimbursed by the VHI, BUPA or whoever. However, that is not the case. Vulnerable elderly people take a course of treatment that has not been assessed professionally and find, in addition, that they will not be reimbursed. That is a great pity.
Although I represent the graduates of Dublin University, I am less worried about the question of university qualifications. In nursing and so on, there may now be a little too much emphasis on university and academic matters. I was an academic for a while, and I do not denigrate that, but nursing is a caring profession, and experience, motivation and personality are just as important. One can over-academicise matters.
The Irish Society of Chartered Physiotherapists makes the point in a position paper that there are differences between physiotherapy and physical therapy, and this continues the confusion. I ask the Tánaiste and Minister for Health and Children, Deputy Harney, to examine this aspect of the legislation with a view to addressing the matter. She should also bear in mind that physiotherapists are not being snobbish or elitist. They say at the end of their submission that they would be very happy to work under a proper arrangement with their colleagues in physical therapy.
I welcome the Bill. I wish that it went further by attacking the quacks. I look forward to a vigorous assault on their noxious practices from the Department. I thank Senator Brian Hayes for his courtesy in allowing me to speak.
I too welcome the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, to the House. It is always a pleasure to have him here. I also welcome the Bill. I am strongly in favour of its main thrust and have just a few points to make, most of which will echo what Senators have already heard.
I am concerned about the qualifications and how they are described, particularly, as Senator Brian Hayes said, in the Third Schedule. The Minister may tell us that people who qualify in Northern Ireland or elsewhere in the UK will be covered by the recognition of EU degrees, but it is very important that qualifications be stated in such a way that there is both recognition and transferability on the grounds that many of the courses proposed as proper for recognition were pioneered on this island by the University of Ulster. They are of very high quality. Equally, when I was working in Northern Ireland, we were blessed with people in various disciplines who had trained in Dublin and elsewhere in the Republic of Ireland. They made an enormous contribution to services.
In passing, perhaps I might deal with the point that Senator Brian Hayes made about tying people to service. I believe that it will be very difficult. I have seen it tried in the past, and when tested it becomes extremely difficult to enforce. There must be a matching of the number of training places to the number of professionals likely to be needed in a society, and that is also a difficult piece of arithmetic. However, I argue for the expansion of most professions supplementary to medicine. Most of the time we have been thinking of such people in hospital settings, but they can transform primary care and keep many people out of hospital through work in the community. I have a little difficulty with the description of a social care worker. I know what a social worker is, but I am less familiar with a social care worker, apart from the child care aspect. I need a little more definition.
I would not like to see bodies tying themselves to the chariot wheel of a university qualification in everything. Some professions, in a desire for legitimacy, have over-estimated the need for university degrees. There is a great deal to be said for the introduction of what in the North are known as NVQs and HNVQs — vocational qualifications. There is much to be said, particularly in hospitals but also for those caring for the elderly in the community, for enriching the jobs of people such as home helps and care workers to give them an interest. Cleaners in hospitals, for instance, are an enormously important part of the caring team, and there should be a way of recognising that too. I am glad that the Tánaiste and Minister for Health and Children, Deputy Harney, has left room for the recognition of other groups. I am thinking of people such as chiropractors, since I am lucky enough to be looked after by one with a four-year degree. Their body seems to be as professionally competent and controlled as any other.
The Bill provides for dealing with malpractice and complaints. However, it does not deal with the question of insurance as opposed to indemnity. Many such people will be working in a health board setting where the employer will look after them, but some may not. There must be something roughly comparable with the Medical Defence Union so that patients who feel that they have suffered and have a case for civil action do not find that there is ultimately nothing with which to compensate them. Like other Senators, I am worried by the emergence of counsellors of various kinds, some of them of doubtful provenance, but some very good. An effort must also be made to provide definition and regulation in that field.
I would like to see attention paid to alternative medicine for two reasons. Some is very good, and some practitioners are excellent, but in recent years many abuses have arisen in the field, including cases of people being exploited both financially and emotionally. The matter is worth addressing, be it in the Bill or elsewhere.
I commend and welcome the Bill. It is a good idea to bring together professions which are supplementary to medicine, and have one body rather than a proliferation thereof. I am concerned about the transferability and mutual recognition of degrees and qualifications across the island.
I welcome the Minister to the House and welcome this long overdue Bill, which has been spoken of for many years. It is good to have some sort of proper regulation. It is also an issue of public confidence and it is important we assure the public those involved in these professions and disciplines are qualified and capable of treating people. I welcome the establishment of the council and the registration boards for the various disciplines.
Other Members have alluded to the danger of self-regulation. We must monitor this situation regularly to ensure there is no over-regulation. There is also a danger in terms of competition. There is a need for competition in every discipline. We must have a complaints and mediation procedure. There is also the issue of appeals to the High Court in the event of people not agreeing with the complaints or mediation procedures.
There is no need for university degrees for some of the positions within the health service, many of which require caring people with experience. They should not be barred from entering these professions.
On the Order of Business I often raised the issue of cowboys, as I call them, who advertise cures for cancer. Most other speakers have mentioned such people within the medical profession. Under the terms of the Bill, sufficient procedures are now in place to tackle these cowboys. However, I am worried about those outside the medical profession who advertise these cures. When regulation is in place to tackle people within the medical profession, we will be able to come down harder on those outside. It is despicable to give people hope where there is none. Some of these cures have been proven, in some instances, to be nothing more than water. People will go anywhere if they think they can find a cure for their illness. We should come down heavily on those outside the medical profession. Such measures may not come under the remit of this Bill, but it will give us greater powers to strongly tackle such people.
The Irish Society of Chartered Physiotherapists is worried about duplication with regard to physical therapists and physiotherapists. Internationally, these titles are synonymous and interchangeable, and the professional qualification requirements are the same. This is recognised in the 92 countries which are members of the world organisation of physiotherapists. Almost every speaker has referred to the matter, and it must be addressed on Committee or Report Stage. When people visit a physical therapist and then go to claim back money from BUPA or the VHI, they find they are not eligible for reimbursement. This should be dealt with now rather than later. I know the Minister of State, together with the Minister, will look at the situation and come back with amendments to address it.
I commend the Minister of State and his officials for bringing the Bill to the House. It is long overdue, and we will do everything possible to ensure its passage and to improve it on Committee and Report Stages.
I welcome the Minister of State to the House and I also welcome the Bill. It is important that a system of statutory registration for health and social professionals is put in place.
I am happy the emphasis of the Bill is on protecting the public. I received an e-mail from the Irish Society of Chartered Physiotherapists which stated it has concerns regarding adequate protection of the public under the terms of the Bill. I hope the Minister of State can allay these fears.
Some months ago, a survey was carried out of people who had used the health service. Up to 92% were very happy with services at the hospital where they had been patients. An even higher figure of 94% expressed satisfaction with the GP service. That is a good starting point and places in context any criticism I make with regard to people's worries about health services.
Senator Cummins raised the issue of so-called alternative medicines. Some people have preyed on the fears of those with serious illnesses. People have touted a cure for cancer, when there was no basis for their claims. This has been made evident thanks to the media and, in particular, the Joe Duffy show which highlighted the practice. I am glad steps are being taken to ensure people do not prey on the sensitive nature of this illness, when people and their families are at a delicate stage.
It is amazing there are so many so-called cures for arthritis and back injury, from drinks to acupuncture to operations. The national treatment purchase fund has been successful in allowing people to travel outside their own area for operations, in some cases to Northern Ireland or Great Britain. However, much damage has been done to those who have perhaps undergone the wrong type of treatment for back injury.
I wish to say a few words about the 12 health and social care professions dealt with in the Bill. I look forward to the day when we have similar legislation for medical practitioners and nurses, which I understand will follow. There have been some concerns expressed about the situation of the professions listed. I am glad that whether one is in the public or private sector one is covered under the designation. I am also glad the Bill has, on the whole, been welcomed. It has given an assurance to the public that there will be some accountability in the area. That is stressed in the first page of the Minister's speech. The issue of registration being legally necessary is also dealt with as it is no longer good enough to have voluntary registration. We now want a mechanism for prosecuting offenders, which is very much part of the Bill.
Under the new legislation it will be an offence for an unregistered practitioner to use a protected title or to falsely represent himself or herself as a registered practitioner. That too is very welcome because we have had indications that such misrepresentation was taking place in the health system.
The main emphasis of the Bill is on protecting the public. That emphasis comes from the Minister and the Department, as well as from the professionals, and it is welcome. I hope the Bill can be passed quickly and that the necessary registration will take place. There are other health issues which I am not allowed to discuss today. The opportunity may arise when the legislation dealing with medical practitioners and nurses is introduced. I welcome the Minister of State to the House and I fully support the Bill.
I welcome the Bill and support all that has been said on both sides of the House. One aspect of registration is very welcome. As the Leas-Chathaoirleach may well know, we have what are termed "gifted persons" or "quacks", or the seventh sons of seventh sons, all of whom reputedly have the ability to cure pain or to heal, or whom people believe to have such ability. When all conventional professionals have failed to ease a problem, some people resort to that group of people, who according to many people have given them relief. That group of practitioners is not on the list included in the Bill. Does section 90 provide for this "gifted group", for want of a better term, to be included, provided its members stand up to scrutiny by some professional body which examines their qualifications?
It is important that the gifted group would be given the opportunity to be included by the council in the registration and that the group would then fulfil all the requirements with which the other professional groups must comply. I know that many people have referred to "rogues". I am not referring to people who operate on a profiteering basis. Those of whom I speak are genuinely committed in their own right to relief of pain and are traditionally successful, in many people's minds, with regard to the treatments they provide. There are such people, bone-setters being one example. Traditionally in Ireland they have had great success. They are not called on so much now because one can go to an accident and emergency unit and——
Yes. The bone-setter was on duty 24 hours per day, round the clock in the traditional way, and was always accessible. I do not know if there are any bone-setters currently practising but in the past they provided an important service to many people in rural, isolated parts of Ireland.
I am also referring to those practitioners bordering on physiotherapy. How they do their work is best know to themselves, but they provide relief for many people with back aches and all sorts of sports injuries which would not necessitate formal referral through the usual hospital route. Many of these practitioners never charge any fee and leave it to the discretion of a person making a return visit to make a financial contribution or offer a gift. Does section 90 of the Bill allow for some of those people outside the listed bodies to be included?
There is a crisis in Ireland with regard to many of the listed professional groups, particularly speech and language therapists. There is a great need for those people, especially given the Education for Persons with Special Educational Needs Act. Many parents face great frustration in trying to access the professional care badly needed by their children. There is a very slow throughput of professional persons in this area in particular and we see its consequences. The delays experienced are one of the greatest factors preventing any improvement in school children with special needs. It is a cause of great concern that so many people are denied the appropriate help. We should do whatever can be done to accelerate the throughput in that professional area.
The same applies to psychologists. How many national school principals have, over the years, seen school years pass by before getting the psychological services recommended for pupils? Senator O'Toole will verify the facts in this area to a greater extent than me. It is vital that we see a much greater throughput of people qualifying in speech and language therapy and psychology.
We have a standardisation and acceptance of qualifications within the EU. However, in the west there are people from outside the EU, not necessarily the United States but from Australia, who come to Ireland and present their credentials and qualifications. I am not sure if those people reach the professional standards of those who have qualified in Ireland. I am not opposed to these people, but some people have been disappointed with their level of professionalism and the treatments offered. There have been instances of people who got through the net, who presented themselves as qualified medical practitioners and who were not detected until something went wrong. At that stage, they were nowhere to be found. Do adequate methods exist to scrutinise the bona fides of those who present themselves as professionals under the headings listed in the Bill?
A sizeable portion of the legislation is dedicated to monitoring the continuing suitability of education and training programmes. What is the position vis-À-vis the ongoing training of people in the professions covered by the Bill? There should be a new mandatory examination process for professionals who come from countries other than Britain or North America in order that they will meet the standards we have set for their Irish counterparts. This matter must be addressed because not all the rogue professionals operating here are Irish. It is time we standardised the entire process in this area.
I welcome the Bill which has been in gestation for a long period. I speak as a psychologist and psychology is the only one of the 12 professions in which I am interested. However, I am sure the others are just as important.
I have been involved in the profession for 30 years and I have a number of concerns. Psychologists have their own professional body, namely, the Psychological Society of Ireland. For many years, we have had the ranks of fellow and associate fellow of the Psychological Society of Ireland. In recent times, a registration process was introduced. When one, as a psychologist, is accepted as having attained a certain level of professional competence, one becomes a fellow or associate fellow and this entitles one to append the postnomial letters FPSI or AFPSI, as appropriate. On registration, one may append the further letters Reg. Psychol. A similar system operates in the United Kingdom, with the exception that one would be a chartered as opposed to a registered psychologist.
These letters after one's name are a symbol or signal of professional competence to patients, clients or members of the general public that the person they are attending has attained a certain level of competence. However, there is nothing in law to prevent anyone calling himself or herself a psychologist. A person with a diploma in hypnosis or someone who had attended a two-day course in some form of esoteric psychotherapy could call himself or herself a psychotherapist. Someone with no qualifications at all can still call himself or herself a psychologist. One of the reasons the Bill will prove extremely valuable is that, under its provisions, the situation I have outlined will no longer obtain. That is a laudable development and it is one of the main reasons I support the Bill.
While the Psychological Society of Ireland could impose sanctions on those members who violate its professional code of ethics, there is nothing to oblige a psychologist — even one working in the health service, a hospital or whatever — to become a member of the PSI. One can, therefore, operate as a psychologist and hold all the degrees in the world but one is not obliged to be a member of the society. In that context, the controls and regulations contained in the Bill are needed and will prove useful.
There is one further problem which I do not believe has been tackled, although I understand many negotiations took place between psychologists, the Department, etc., in respect thereof. There are many different kinds of psychologists, namely, clinical psychologists, educational psychologists, military psychologists, forensic psychologists, neuropsychologists, comparative psychologists — who deal only with animals — and occupational psychologists. Does the Bill apply to them or does it only apply to those psychologists working in the area of health or in social care situations? This is an important point. Would, for example, a person with a degree in occupational psychology who works in the Irish Management Institute be entitled to call himself or herself a psychologists? I do not raise this matter, which has been debated by psychologists for many years, for spurious or contentious purposes.
When one becomes a psychologist one can, in theory, work in the various fields. In practice, however, one must specialise for many years in the field one chooses in order to become competent therein. However, there would be nothing to prevent me from working in occupational psychology or any other field of psychology. In doing so, could I call myself a psychologist and then return to clinical psychology? Does the Bill address this point? It does not arise in respect of most of the other professions because one is either an occupational therapist or one is not. However, it arises in the profession of which I am a member. For many years, there was a debate within the Psychological Society of Ireland regarding whether only clinical psychologists should be registered. Perhaps the Minister will consider the matter and see if an amendment is required.
In essence, I support the Bill. It has been a long time coming and it will provide good safeguards for the public in respect of all of the professions it covers. Senator Kitt said that another Bill will be introduced in respect of medical practitioners and nurses. That would be no harm. When one operates in the areas of health or social care, one is in some way influencing people's lives. One must be competent, serious about one's work, registered and consider the care of one's patients or clients paramount at all times. If the Bill helps to achieve these ends, it is laudable.
I welcome this progressive and necessary legislation. Other Members have referred to the difficulties that have arisen in many different parts of the country in recent times as a result of people putting themselves forward as being medically qualified in certain areas.
I should have done so already but I welcome the Minister of State. This is my first engagement with him since his promotion. Following many years of engagement with him in the bar lobby, I am glad we will be able to deal with him in more superior lobbies in the future. I congratulate him and wish him good luck with his work.
I compliment those who drafted the Bill on their up-front attempt to protect the various titles of the professions. Titles are crucially important and in the past we failed to protect them on a number of occasions. There was a Bill before the House last week which changed the title of "veterinary surgeon" but also protected it. However, we failed to pass a Bill to protect the title "accountant" on a previous occasion. Given his background, the Minister of State may snigger at what I am going to say. The accountants could not get that legislation through because there was a danger people might confuse chartered accountants with turf accountants. I must admit that I do not see any great difference between the two.
I wish to raise the issue of those who practise alternative medicine. Senator Ulick Burke referred to a number of such people. He spoke, in particular, about bone-setters, of whom there are still a number operating throughout the country. There are also acupuncturists, whose activities must be quite well regulated throughout the world and who operate to a strict set of rules.
The list contained in the Bill does not refer to psychotherapists. There must be some good reason they are not in the list. I assume that as they are fully functioning and qualified and are part of the system they should also be included. I note that Oireachtas Members are not precluded from membership of any of the boards and that is a welcome recognition that Oireachtas Members can be trusted to sit on boards. I note, however, that Oireachtas Members may not be employed by a board. I regard that provision as being in breach of equality legislation. I wish the drafters of the Bill to know that I find it highly offensive that this legislation discriminates against Members of the Oireachtas and debars them from applying to work for these boards. I await a reasoned, logical and rational explanation why this provision is in the Bill.
I know people hate politicians and think they cannot be trusted to go anywhere or do anything at any time. I regard it as offensive when the only group in the whole country who are precluded from doing a particular job are Oireachtas Members. I promise that before I leave Leinster House I will take an equality case on that issue to prove that it is both illegal and unconstitutional. It is invidious discrimination and I believe it is illegal under the equality and equal status legislation. Members of the Oireachtas, whether Deputies or Senators, are of no lesser status in society than other citizens. I ask the Minister of State to bear that point in mind when dealing with this legislation. I know the drafters will be keen to indulge me on this matter and I look forward to hearing the Minister of State's response.
I can find no reference in the legislation to the issue of the mutual recognition of qualifications. I read carefully the references to education and the need for agreeing qualifications, with which I agree. I would like to see that provision fleshed out. On the question of the recognition of various qualifications in different member states of the EU, the directive on the mutual recognition of third-level professional qualifications was passed 20 years ago but it still has not been implemented.
Senator Lydon referred to the case of psychologists. He explained that psychologists are divided into psychologists and registered psychologists. I understand him to refer to professionally recognised people as the registered psychologists, those whose qualification in psychology is a qualification which is recognised as a fitness to practise qualification. To put it in educational terms, one could have a BA in education which is a qualification but one would not be a qualified teacher. One could also have a doctorate in psychology but one would not be a psychologist, as the Acting Chairman, Dr. Henry, will be aware.
The question of registration is dealt with once a person is recognised on the list. I would like to hear Senator Lydon develop his references further. He spoke about the Psychological Society of Ireland and the British Psychological Society. The British Psychological Society refers to chartered psychologists and the Irish society refers to registered psychologists. However, the interesting point is that the British Psychological Society does not recognise the same people as are recognised by the Irish psychological society. That is where the system is wrong. In terms of mutual recognition of qualification, this makes life very difficult. On this small island, people North and South are recognised by different bodies. If a person comes to this State, having qualified in Queen's University, Belfast, which has a highly regarded school of psychology and is recognised professionally by the British Psychological Society, would the Minister of State envisage that person to be automatically recognised in this State? I do not mean any automatic recognition in the sense of merely pressing a button. The councils in this State should have a relationship with their equivalent council in the UK for a start but also in all of Europe.
The Good Friday Agreement had both a North-South and an east-west dimension. Every time legislation such as this is passed, division is being sowed. It is only a matter of taking a decision in principle and allowing the new council to ensure it works. I do not envisage a problem because there is no great difference. The only problem is the internal politics of the different registration councils. This is not to say that the qualification from Queen's University is better or worse than a qualification from any other university or third-level institution on either island. There should be an agreement to do this.
Some groups, such as accountants, do so already. The Institute of Chartered Accountants in Ireland is at this moment making a presentation to the Joint Committee on Finance and the Public Service. It recognises chartered accountants from England and Wales. I would like to see that happen in the case of psychologists. I ask the Minister of State to address that point in his reply.
I also wish to raise the issue of complaints. The complaints procedure outlined in the Bill is probably the best I have seen. It is far more extensive and far closer to the tenets of natural justice than that in the legislation dealing with veterinary surgeons which the House dealt with last week. In fairness, the Minister for Agriculture and Food has informed me she has taken on board the problems I have raised and she intends to change that provision.
I wish to draw the attention of the House to a number of items which are regularly missing from legislation. I compliment the Department of Health and Children on its correct drafting. Section 52(3) refers to the preliminary stages of a complaint. The preliminary proceedings committee shall notify the registrant, the person about whom the complaint is made, of the complaint, of its nature and the name of the person making the complaint. That is a provision for natural justice which should be in every complaints procedure. I applaud the drafters of the Bill for including it. I think this is the first occasion I have seen it in a Bill, unless it was in the Bill dealing with complaints about accountants.
Section 56 contains a small niggling item. When the complaint is being processed details of the nature and the matter that is to be the subject of the inquiry, including the particulars of any evidence, are made available to the person being complained about. It is not good enough nor is it judicially sound for the person to be given the particulars of the evidence; they should be given access to all the evidence against them. The use of the word "particulars" seems to imply it is qualified in some way; it cannot be qualified. If someone makes a complaint against me, I am entitled to see all the evidence.
One aspect of the hearing is missing, namely, the right of the person about whom the complaint is being made to cross-examine and to examine and test the evidence. I know people will not like that but unfortunately the principles of natural justice will allow for that to happen. If a complaint were made against me and were to go through all the processes and I did not agree with the complainant, I would want the opportunity to question that person and to test the evidence. If that opportunity were not afforded me and I were to challenge it on that point of law to the High Court, I believe it would be sustained. That should be included in the provision just as any kind of domestic procedure or redress allows for this, albeit that it is very cumbersome, not very attractive and very legalistic.
I compliment those who drafted the Bill on their anticipation of that point by inserting into the complaints procedure at a very early stage the importance of bringing in a mediation or other informal process. It shows great thinking on the Department's part. An informal mediation followed by a preliminary hearing and then a complaint procedure is precisely the way it should be done. I hope the few points I have made are not regarded as narky or niggly but rather as improvement to the Bill. I ask the Minister of State to consider them. This is fine legislation. I will support the Bill and I look forward to Committee Stage where I hope the issues raised will be taken on board.
I had not intended speaking on this Bill but I felt obliged to say a few words having listened to the debate. We are all aware of people working in the area of therapy against whom complaints have been made. It is important to have a statutory establishment of a professional council. The registration boards would give a curriculum vitae of their professional qualifications, education and training and if complaints are made, they will be on the register. That is welcome.
In my own area, that of psychology, the word "counsellor" can vary in meaning. We have financial counsellors, beauty counsellors and so on but we do not know how the word "counsel" became associated with my profession. I would prefer to drop the word and use "adviser" instead. We guide people or whatever, but we do not counsel them in the sense of the word I interpret. Perhaps that could be incorporated in the details of the compilation of the registration.
I listened carefully to what Senator O'Toole said about the complaints system. It is necessary to have a method in place to deal with the procedures but in cases involving a clinical or an educational psychologist, with the variation in the definition of each type of psychologist, if a complaint is made it does not necessarily mean that the psychologist was not qualified to do the job. It may just mean that the personality of the person concerned did not work in respect of the case in question. We need to be careful, therefore, how we process complaints made. I would like that noted on Committee Stage so that the professionals will be reassured in respect of complaints that will come forward. There will always be somebody who does not like them and they will question their adequacy to be professional. The types of complaint made and the personality of the person making the complaint should be taken into account under the complaints procedure. I can only speak from experience in my own area.
This legislation is welcome and long overdue. We have had many experiences in the professions, particularly in the therapy area, of people who are not suitably qualified setting themselves up as therapists. Putting in place the registration board and the other boards — there is a list of approximately 12 — might lend itself to the other professionals as well. I endorse the Bill and I hope the points made by Senator O'Toole will be taken into account, as well as my own view on the type of complaints that will be made.
I have enjoyed listening to a number of the contributions. Senator Ulick Burke mentioned bone-setters. I am not sure what the opposite of a bone-setter is but in footballing terms we would always consider the Meath footballers in that category.
Senator O'Toole was very concerned about the exclusion of Members of the Oireachtas from the council. That is something we will have to examine. We will revert to him on it. It reminds me of a former colleague of mine who retired some years ago. He was looking back and acknowledging the changes that had taken place since he became a Member of the House. He said that when he was first elected, if the position of a postman became vacant in one's area it was only a matter of nominating his replacement. That is the way he put it; I do not want Members to take me up the wrong way. He said that things have changed so much now that if the position became vacant and 100 people applied for it, the only way one could guarantee one's person would get the job would be to recommend the other 99. Members of the Oireachtas have been excluded from this aspect of the legislation. It appears to be a regular provision in a number of legislative measures recently. It reflects poorly on Members and it is something we will examine and come back to at a later stage.
I thank the Senators for their participation in the debate. I note the broad support for the introduction of this legislation, the need for which has been identified for some time, not least by the professionals themselves. The point was made by several Senators that the Bill supports patients and clients in taking greater control and responsibility for their own treatment and becoming empowered in terms of their own health status.
As emphasised by Senator O'Rourke, the Bill is a milestone in the updating of regulatory structures for health and social professionals generally, as identified in the health strategy, including medical practitioners and the nursing profession. Several Senators alluded to the fact that the professionals themselves fully realise the limitations of self-regulation in certain circumstances and that voluntary codes of practice and professional ethics have no legal force. As referred to by Senator Ryan, in establishing any new regulatory structures it is important to get the balance right in terms of competing objectives and interests and the overall benefits and costs.
I would like to respond to some of the points raised by Senators. The issue of protection of additional titles is an important one raised by Senator Henry in respect of chiropodists and podiatrists. It is not envisaged that additional titles will be protected in the primary legislation, rather the Minister is empowered under the Bill to protect additional titles by regulation. It is believed this is the most flexible mechanism for addressing that issue.
In this context, a number of Senators raised the question of the protection of the title of physical therapist. This is a complex issue, given such factors as the inter-changeability of the title internationally, the scope for confusion among the public and the significant number of practitioners currently earning a livelihood as physical therapists and competition aspects. It will require a practical solution that respects the rights of both parties in the best interests of the public.
The operation of grandparenting provisions will be critical to the effective establishment of the system of statutory registration. It is envisaged that registration boards will adopt an inclusive approach to bring practitioners under the supervision of a registration board. An assessment of basic professional competence ensuring safety will be required. If a registered practitioner does not demonstrate the standard of proficiency, competence and professional conduct expected of registered professionals, this will be grounds for a complaint and investigated under fitness to practise procedures.
Senators Browne, Ryan and Cummins emphasised the need for the Bill to promote appropriate competition. The level of lay representation on both the council and the individual registration boards is intended to ensure effective oversight and scrutiny of the work of the council and boards of any practices that might restrict competition, such as barriers to entry. In addition, each registration board is obliged to register every practitioner who meets its criteria for registration, including recognition of qualifications obtained within or outside the European Union, as raised by Senators Brian and Maurice Hayes, Burke and O'Toole. The issue is addressed under section 37.
Both Senators Henry and Ryan raised the level of lay representation on boards and the council. The proposed level of public interest representation should be regarded as underpinning the authority, credibility and public acceptability of decisions and recommendations made by the regulatory structure. It safeguards against any perception that the regulatory system is putting the interests of registrants ahead of the public as a whole.
The restriction contained in section 14 relating to Members of the Oireachtas is, I understand, a standard provision. In view of Senator O'Toole's comments, we will review the legal basis for that inclusion. My own view is that it reflects poorly on Members.
In considering the extension of the Bill to additional professions, the key guiding principle will be risk to the public and that legal regulation is proportionate to the risk posed. A set of criteria is included in section 4 to inform the inclusion of additional professions under the council by the Minister.
The Bill provides that registration boards should develop criteria for restoration to the register. The updating and maintenance of skills and knowledge required for registration would be expected to be included in such criteria. This should allay the concerns raised by both Senators Henry and Feeney regarding those practitioners who may remove themselves from a register for a period of time.
As emphasised by several Senators, the accountability of the council is critical to its success and will be secured in several ways. For example, the Minister is empowered to direct the council or a board to perform its functions. In addition, the council must submit an annual report to the Minister within three months of the end of its financial year and the Minister is obliged to lay this report before the Houses of the Oireachtas.
As several Senators remarked, the Bill embodies a contemporary and, in important respects, flexible fitness to practise system. As far as the investigation of complaints is concerned, it will be a priority for the council that fitness to practise investigations be processed thoroughly, efficiently and in a timely fashion, while fully respecting the requirements of due process. This requirement will be a standard demand by the High Court in confirming decisions by the council.
Several Senators highlighted the provision of alternative medical treatment for serious and life-threatening illnesses. As Senator Henry stated, it is difficulty to prevent the public from availing of such services, particularly in circumstances in which conventional treatments have not succeeded and where they are regarded as a last resort. The strengthening of the regulatory environment by such measures as the establishment of a health and social care professionals council will place the public in a better position to determine whether a practitioner is suitably qualified.
The broader issue can be addressed by better communication of public information, such as the Medical Council's recent warning concerning cosmetic surgery clinics which do not have recognised surgeons in residence, and strengthening an appropriate expansion of the regulatory system. As regards the contribution of the Bill to this issue, it will prevent unqualified occupational therapists, social workers, etc., from using professional titles and will open registered practitioners to investigation if they contravene their code of professional ethics. Contraventions would be expected to include agreeing on the scope of the practice in which a professional is trained and qualified.
A national working group on the regulation of complementary therapists was established in May last year to advise on appropriate regulation of complementary therapists. The working group is expected to submit its report by the end of next year.
I thank Senators for their interesting contributions. I look forward to the further Stages of the Bill, during which the views expressed in this debate can be considered in greater detail. I commend the Bill to the House.