Paddy Burke (Fine Gael)
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I welcome the Minister for Health. I call Senator Gerard P. Craughwell

Gerard Craughwell (Independent)
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It is a pleasure to welcome the Minister. He has been invited here to discuss the important issue of physiotherapists and physical therapists. He is already familiar with the current situation regarding physiotherapists and physical therapists, having addressed the relevant committee on the matter and answered parliamentary questions relating to it in the Dáil. We are joined in the Visitors Gallery by the CEO and president of the Irish Society Of Chartered Physiotherapists, ISCP, and a physiotherapist with a large practice who employs both physiotherapists and physical therapists. We hope this issue has been progressed by the Minister and his Department and that he is here to give us some good news. We hope that, having reviewed the case made by the ISCP, he will agree in the interests of patient safety to protect the titles of physiotherapist and physical therapist in one register for use by the physiotherapy profession.

There is a great deal of confusion among members of the public about the role of physiotherapists and physical therapists and their respective places in the medical profession. From my experience, people are now using the terms interchangeably without any real awareness of the significant difference in training and approach. The public is not to be blamed for this as the terms "physiotherapist" and "physical therapist" mean the same thing in many other jurisdictions.In fact, in the rest of the world the titles of physical therapist and physiotherapist are protected in law, used only by members of the physiotherapy profession and they mean the same. In Ireland, in the absence of regulation, the titles of physiotherapist and physical therapist can be used by any person. Members of the public are naturally confused when deciding from whom to seek treatment. Where there is confusion and a real risk to public safety. The Physiotherapists Registration Board, which includes a majority of lay people and is charged with protecting the public, has already brought a recommendation to the Minister to the effect that both titles should be protected in one register. If the titles are not protected in one register for use by physiotherapists, I believe the level of public confusion will not only continue, but will increase.

Since the Minister is a doctor, I imagine he will be more than aware of the type, level and duration of training that physiotherapists undergo. Irish-educated physiotherapists and those educated abroad with equivalent qualifications are health professionals educated to provide care in the core areas of musculoskeletal, cardiorespiratory and neurological treatment. People currently trained in physical therapy in Ireland are not educated to this level. Their training may include some techniques used by physiotherapists to treat musculoskeletal injuries but they do not receive any training in cardiorespiratory or neurological diagnosis or treatment.

Physical therapist courses in Ireland are run on a part-time basis at weekends for anything from six months to 15 months to three years. The highest qualification is a level 7 degree in applied health science; it is not a degree in physical therapy. It is of a lower standard and has a different course content to Irish degrees in physiotherapy, which are all level 8 qualifications and four-year full-time courses in universities. In addition, physiotherapy students receive a minimum of 1,000 hours supervised clinical placement in public hospitals and primary care centres.

The counterargument has been made that this is about protecting physiotherapists' patch from competition. Nothing could be further from the truth. This is about high standards and excellence in diagnostics and treatment. The Irish Society of Chartered Physiotherapists recommends that when both titles are protected, any established physical therapist should be offered the opportunity to undergo further training and upskilling. We also need to re-educate the public to the fact that physiotherapists are experts in many well-established specialty areas, such as orthopaedics, paediatrics, cardiorespiratory, care of the elderly, neurology, rheumatology, musculoskeletal, sports medicine and women's health. The list is extensive. The remit of the physiotherapist is broad and comes with immense responsibility, a responsibility that we need to acknowledge and respect. I would not like to think there is an accident waiting to happen or that a person who believes he is being treated by a highly-skilled professional is being treated by someone who, while very competent within a particular sphere, is not trained to make what can be life-saving diagnostic decisions. I thank the Minister for his time and I look forward to his reply.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Senator for raising this issue. Protection of the title is a core function of the Health and Social Care Professionals Council, known as CORU. When people access health services, it is vital that there is no ambiguity about the profession and competence of the health service provider they are attending. Statutory regulation of the profession is designated under the Health and Social Care Professionals Act 2005 and comprises registration boards for the professions, a committee structure to deal with disciplinary matters and the Health and Social Care Professionals Council with overall responsibility for the regulatory system. These bodies are collectively known as CORU and are responsible for protecting the public by regulating 14 professions currently designated under the Act.

Regulation under the Act is primarily by way of statutory protection of professional titles by confining their use solely to persons granted registration. The Act provides for a two-year transitional or grand-parenting period from the date of the establishment of the register during which existing practitioners must register on the basis of specified qualifications. After this period, only registrants of the registration board, who are subject to the Act's regulatory regime, will be entitled to use the relevant protected title. The Physiotherapists Registration Board is finalising its drafting of the by-laws necessary for the establishment of its register early next year. This means that by early 2018 only registrants of the Physiotherapists Registration Board will be entitled to use the title of physiotherapist.

In other English-speaking countries, physiotherapists use the title of physical therapist interchangeably with that of physiotherapist. In Ireland, however, for the past 25 years or so and in the absence of State regulation and title protection, the title of physical therapist has been used by providers of musculoskeletal therapies in the private sector who are not physiotherapists.Some are highly qualified to degree level while others are not.

Concerns were raised that the use of the title "physical therapist" by practitioners who were not physiotherapists was causing confusion and could lead to patient safety risks. The concern is that doctors and their patients and people self-referring might view both titles as interchangeable and believe that they are being treated by qualified physiotherapists in all cases when they are not. The Irish Society of Chartered Physiotherapists, ISCP, has been seeking for some time to have the use of the title "physical therapist" protected for the exclusive use of registrants when the two-year transitional period ends.

Towards the end of last year and in accordance with the legislation, I consulted the Physiotherapists Registration Board about options for addressing this issue. Having considered the board's detailed response, I wrote to other interested organisations seeking their views on my proposal to make a regulation, to come into effect after an appropriate lead time, to protect the title of "physical therapist". Several submissions have been received and are being examined. I expect to be able to make a decision on the matter shortly. The key issue is to ensure public protection. I hope to be in a position to conclude this matter in the next few weeks.

Gerard Craughwell (Independent)
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I thank the Minister for his reply. It is worth pointing out that there is a delay in the work of the statutory registration board for physiotherapists pending the Minister's decision, which will be critical for the future. An urgent decision is necessary. Is one likely before the election is called? None of us can predict that date, but does "the very near future" mean in the next week or two?

Leo Varadkar (Dublin West, Fine Gael)
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Yes, I intend to make a decision in the next week or two. I have sought clarification on just one point. I am not quite so smart as to leave it conveniently until after the election. That is not my intention. We want to protect the titles "physiotherapist" and "physical therapist" for exclusive use by fully qualified physiotherapists, but many of the couple of hundred physical therapists who are practising in the private sector are well qualified and do a good job, with those who see them often being satisfied. We need to find a mechanism that allows them to retrain or rebrand or a grandparenting provision that would accommodate them. This would be along the lines of the joint proposal, made without prejudice, from the ISCP and the Irish Association of Physical Therapists, IAPT, but it might require a change in legislation. I hope to have this issue clarified in the next week or so.

Paddy Burke (Fine Gael)
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The former Minister for Health and former Ceann Comhairle, Dr. Rory O'Hanlon, is keeping a watching brief on this matter. He is very welcome to the Gallery.

Gerard Craughwell (Independent)
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I thank the Minister for his response.

Paddy Burke (Fine Gael)
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I welcome the Minister of State, Deputy Hayes.