Mark Daly (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister for Health, Deputy Donnelly, for coming into the House for this legislation. Before I invite the Minister to make this contribution, I welcome to the Distinguished Visitors' Gallery Rebecca, Sam, Kay and Hope Staples who are all the way from Jackson and Laurel, Mississippi. They are friends of Josh Harkins who is a good friend of mine and a state legislator in Mississippi. Thank you for coming to Seanad Éireann; you are most welcome.

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I am pleased to have the opportunity to address the House on Second Stage of the Regulated Professions (Health and Social Care) (Amendment) Bill 2022. The Bill was initiated in the Dáil in September of last year and passed all Stages on 10 May. The Bill is fundamentally about health practitioners, who are the individuals working tirelessly to deliver the health and social care services upon which our patients rely.

Mark Daly (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister.

Lorraine Clifford-Lee (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister. We very much welcome the Bill coming to the House. It will streamline and modernise our health service and I commend him on taking those steps because they are long overdue. He outlined comprehensively the system of registration for social care workers, and the complaints investigation function of the Medical Council will be strengthened and enhanced by the Bill, which is important in this era of greater awareness and greater participation of patients in their own care.

The enabling of holders of UK medical degrees once again to take up intern positions is welcome. I am sure the Minister and all of us in this House have been contacted by people who have studied in the UK over the years and want to return to take up intern positions in Ireland. It is good that this will be once again facilitated and it will help our health service. I hope we will have cross-party support in the House for this very good work.

Mark Daly (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Before I call on the next speaker, I welcome from County Mayo the group from Breaffy National School. I am sure they are enjoying their visit to Leinster House and that they enjoyed the game last Saturday, when Kerry were for some reason beaten by Mayo. I cannot understand why that was, but they should not worry. We will make sure we get Mayo into the All-Ireland final. I hope they enjoy their time here. Of course, when the President of the United States is supporting Mayo in winning the All-Ireland, given he has a lot more in his arsenal than we do in Kerry, I think this year will be Mayo for Sam for sure. I thank them for coming.

Mary Seery Kearney (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister to the House and congratulate him on this legislation, which, albeit in large part technical in nature, is a comprehensive provision in what it sets out and in the objectives it seeks to achieve. Certainly, we need to strengthen those healthcare professionals who are awaiting greater security following the precarity that arose out of Brexit, which is also faced by our doctors.

I was contacted this week by someone I represent who had had a fantastic experience at the Royal Victoria Eye and Ear Hospital thanks to the efficiency and everything about the way they had been treated from beginning to end. They had a couple of problems along the way but the staff were incredibly helpful. Over the course of their experience, however, they met about eight people of whom not one was Irish, which shows how dependent we are on people coming in and being part of our health service, and the exceptional support patients get throughout the country as a consequence of people coming in and enhancing that patient experience.As everything we do in this regard is absolutely to be congratulated, well done to the Minister on that.

We must address, though, other areas in which we are wanting. The Minister's sentiment regarding the regulation is absolutely spot on. I welcome his comments on CORU. We know it is stand-alone and independent and that it has a regulatory function and everything about the safeguards that are in place on its independent functioning. However, we have to ask about whether is it sufficiently resourced. We have, let us say, psychotherapists who were in process there for year. We had the issues with psychologists. When we look at issues within health and within the area of the care of children with disabilities, in particular, we have fantastic schemes for outsourcing health, such as the National Treatment Purchase Fund and all those schemes, that we cannot always adequately apply to the area of disabilities or wherever because of the lack of regulation. Psychologists outside of the HSE may very well be qualified to the same proven standards applied by the HSE. However, we cannot verify that because of the CORU process, which seems to take an eternity. I note that when we look at how many board meetings it has had, since 2019, it appears to only have had 20. One would question why that is when we are in a place of emergency. Why is that? I am sure the Minister has made inquiries because he is at the front line of trying to ensure that our health service is completely resourced. I am sure he has views on this and I would welcome them. Is CORU resourced enough? Is there a method of carrying out regulation and verifying a particular profession? Is that too long? I understand all the stages they have to make along the way. To be fair, to be able to state that a particular person is indeed a psychologist does take a lot. I have gone through each of the stages myself. It certainly seems to take forever, however. The cause and effect on patients is somewhat intolerable. We have situations of parents getting assessments done by psychologists who were not real psychologists at all. I know the Minister is fully aware of that. In that regard, what is our view towards CORU? Is there anything more we can do? If so, it is important that we do so.

There are professionals across all fields. I did an enormous amount of work to attain a particular standard in counselling psychology. The idea that anybody could get a brass plaque and put the word "psychologist" after his or her name is appalling. We cannot tolerate people trading under an esteemed professional title, one that a person would assume has an awful lot of training and experience behind it only to find that it does not. We need regulation; that is important. What more can we do on that? I would really welcome the Minister's comments in that regard. I congratulate him, however. It is really good legislation.

Fintan Warfield (Sinn Fein)
Link to this: Individually | In context | Oireachtas source

On behalf of Sinn Féin, I welcome this Bill from the point of view of restoring the ability of holders of medical degrees from Britain and the North to take up interim training posts in this State. This is essential for attracting trained doctors into the HSE. Brexit has had, and continues to have, a very real impact on the mutual recognition of qualifications on this island and between Ireland and Britain. Prospective students across all sectors must have confidence that their qualifications will be recognised in other jurisdictions. It is incumbent on all stakeholders to work together to minimise the Border's ability to separate us and to limit the education options for students and employment opportunities for graduates. This Bill is a welcome first step toward addressing those concerns.

However, while the provisions of the Bill are welcome, they do not address the fundamental problem of our doctors and other healthcare professionals leaving the State. In the first five months of 2022, 402 work visas were issued by Australia to Irish doctors. This is nearly a 50% increase on the same figures from three years ago. The policy decisions and failures of this Government have created a situation that leaves talented graduates with little choice but to seek better opportunities and conditions overseas. It has left communities and regions with a severe shortage of doctors and other healthcare professionals.

Patients are left waiting for significant periods of time before a GP appointment. Many struggle to find a local GP who can take them as a patient in the first instance. Hospital waiting lists continue to lengthen. Recent figures show us that 885,000 patients are waiting in total, more than 500,000 of whom have been waiting longer than the Sláintecare target of ten to 12 weeks. Chronic overcrowding and unsafe conditions continue to place staff and patients at increased risk, while home care providers continue to operate in an unregulated manner.

I could go on. I know the problems can appear to be seemingly unsurmountable but healthcare providers and patients cannot continue like this. While any measures that seek to boost the workforce are welcome, the Government also needs to act to retain healthcare professionals who have qualified here. The greatest trick ever pulled by Fine Gael and Fianna Fáil is the idea that the health service cannot be fixed, but it can. The solutions to this crisis will not appear out of thin air. They require planning and investment. This Bill should be a first step in addressing the chronic issues in our health service. I urge the Government to work with my colleagues in Sinn Féin to bring about real change for healthcare workers, patients and their families.

Emer Currie (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I congratulate the Minister on this legislation to deal with the registration of social workers, to look at UK medical degrees and to make sure there is access for training posts in Ireland. I am probably going to be in the same territory as my colleague, Senator Seery Kearney. As we know, CORU is a multi-professional regulator that looks after the nine professions and the hugely valuable work of physiotherapists, speech and language therapists, radiographers, social workers and dieticians but not, at present, psychologists.

Yesterday underlined the urgency of this for me. We know the scale of both the delay and shortages for children in accessing therapists. Yesterday, we heard the Minister of State with responsibility for disability state that she would look at the short-term solution of reimbursing families who resort to private assessments. However, we have a major issue, in that if a person is using a psychologist through the HSE, at least that psychologist has gone through a rigorous screening process to be hired by the HSE. However, that is not in place when it comes to the private sector as far as I am aware. That means children and families are not protected. We know that in desperate situations, people are turning to private psychologists and therapists. Members will have seen the "RTÉ Investigates" programme. I heard that this is really the tip of the iceberg when it comes to rogue operators. I have had my own dealings with professionals in the sector. I believe the Minister's working group was tasked with this in 2017 and given nine months to come up with a solution. We are at the point of an outline plan and a dual-track approach. However, I am also hearing that this is the same approach that has been taken in the UK and that not everybody has confidence in that approach. When a person registers as a social worker, that is perhaps one title, whereas in psychology, there are many different fields. A person who cannot initially be registered under the title of "psychologist" can change his or her title to "child psychologist" or a different kind of psychologist.As it could take years for all the various types of psychology to be covered, we need to adopt a dynamic approach.

Regarding the legislation, CORU issued a press release on 31 March 2023 stating, "The current legislation requires that there must be one common set of qualification requirements and one register for the entire profession." Where is that requirement stated in the Bill and what prevents the title of psychologist from being protected under the legislation? I ask the Minister for Health to engage with the sector on its views about the matter. I believe that down through the years, papers have been written about this issue.

Last night, I attended St. Vincent's University Hospital, which has been helping Ukrainian doctors. I had the honour of presenting 25 doctors with certificates following their completion of an inhouse English course. On previous occasions in this House, I have mentioned the barriers that prevent Ukrainian doctors from registering in this country and thank the Minister for Health for movement on the registration process. For instance, I raised the issue of access to the Professional and Linguistic Assessments Board, PLAB. I wish to acknowledge that the Minister has brought in three pre-registration examination system, PRES, 2 exams and has put in place English language courses and assessments. However, the people concerned must do the English language exam, then they have to do the PRES 2, then they go under a two-year supervision period and then they have to do their PRES 3 exam. If the Minister is making efficiencies in respect of other countries, can the Minister look at this? I ask because people who have qualified, have gone through PRES 3 and are considering specialist areas are starting their careers from scratch. Last night, I met a woman who has been a gynaecologist for 37 years and she told me that she must start her career from scratch here. What can we do about the current situation for Ukrainians? I ask because we know that there is a community of Ukrainians in this country who need people who are familiar with the Ukrainian language etc. to look after them and administer urgent care.

Finally, St. Vincent's University Hospital provided clinical observerships, yet the HSE has not been able to do the same. It also looks like it will be a requirement for Ukrainian doctors to have successfully passed the English exam, when clinical observerships are about observing and do not require people to be hands-on. Observerships give people an oversight of how our healthcare system works. Can we not make observerships happen in hospitals around the country? I ask because yesterday, I met many doctors from the midlands who have hugely benefited from having access to hospitals located around the country. While good work is being done, I refer to the area of supporting these people and ensuring they are included and integrated into the healthcare system wherever possible. I have cited two examples where we are telling people, after they have invested in their careers for years, that they must start over again. What can we do to speed up the process? Can we get people into the clinical observerships as soon as possible? I ask because they really want to work and we need them.

Vincent P Martin (Green Party)
Link to this: Individually | In context | Oireachtas source

The Minister, Deputy Donnelly, is very welcome to the Chamber as always and I realise that many of my points have been covered by previous speakers.

I confirm that the Green Party grouping will support this legislative initiative. The Bill is fundamentally about health practitioners. It contains a welcome development in response to Brexit in respect of UK medical graduates because since Brexit, UK graduates have been unable to avail of intern positions in Irish hospitals. This Bill allows for graduates of UK universities and colleges to take up positions in Irish hospitals. That is to be welcomed because we understand the crisis in the health service. We have an excellent relationship with our professionals across the water and, in turn, they have a very good reputational track record in the area of professional education in this sphere.

In respect of the registration of medical professionals, the Bill addresses a number of registration issues that people may often encounter when seeking to register with the Medical Council, and CORU, which is the regulating body for health and social care professionals. This Bill is of particular relevance to social care workers when registering in Ireland following the acquisition of international qualifications. The amended registration process will provide for those who seek to work in Ireland with international qualifications.

One aspect of the Bill concerns changes in how complaints are dealt with. The Bill proposes changes to how complaints by or against medical practitioners are managed and handled. Typically, investigations take quite a long time, which can cause distress for both complainants and doctors. The changes are intended to make investigations more efficient and faster and have been welcomed by the Medical Council. One of the most significant changes is that complaints will now be made to the CEO rather than the preliminary proceedings committee.

I am on record in this House as flagging an issue that concerns the Medical Council. I am sure that the Medical Council does a good job. However, I am concerned that certain professionals who appear before the council's inquiry can face a barrage of daily publicity because the proceedings are in public. In the end, the person might be vindicated but the damage to his or her professional reputation cannot be undone. I am thinking, for example, of the Supreme Court decision made in 2015 after a professor surgeon had to take judicial review proceedings in connection with a complaint in respect of lip surgery. The late Mr. Justice Adrian Hardiman said that the surgeon was subjected to extensive publicity which at times lacked fairness and moderation. It is very hard for a person when a member of this sensitive profession features in the news day in and day out. Eventually a judgment is published and a person may have his or her claim vindicated or challenged under judicial review proceedings regarding the hearing process. However, all that is forgotten about and irreparable damage can be done to the reputation of a professional. I believe in the transparency of a public hearing but wonder whether it is possible to anonymise the name of the professional and then, if there is an adverse finding, the name can be published. It is the one area of professions where negative publicity can do a lot of reputational damage. I am told that it is speculated that some of these professionals who came through the process have left the country to seek professional work elsewhere due to the damage done to their reputation. What I have said is not a criticism of the media and I know the Medical Council does its best but I urge sensitivity in these cases. I do not call for private hearings but for a redacted or anonymised version of the hearings. This is a matter that the Minster might consider in the long term. This issue has not been addressed in this Bill but I have raised it from time to time in this House.

Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister for being here to deal with this Bill that concerns certain cohorts of registrants with the Medical Council. As the Minister mentioned earlier, he has tabled amendments associated with the investigation of complaints by the Medical Council and this Bill also concerns the registration of social care workers.

I want to raise queries that I have received that concern CORU and physiotherapists from the UK who wish to work here. The Minister has already answered a number of question on this matter in the Dáil but I want to ask about the demands placed on people who wish to come here. The Bill concerns interns on the medical side but physiotherapists must either complete an aptitude test or a period of adaptation when they come to Ireland if the course they have done in the UK does not meet the requirements of CORU.The challenges arising in the two representations that came to me concerned delays. They want to start working as physiotherapists here but issues concern delays, additional costs and the frequency of exams. I understand but am open to feedback if the Minister is able to comment that for physiotherapists the exam is only twice yearly. It is an additional €500, which I understand is a cost to the candidate. If they do the aptitude test, that is one aspect of it and is on top of the actual exam, which is €400, but it happens only once or twice per year. If they choose to do a period of adaptation, I understand in this case there was not sufficient cardio-respiratory clinical expertise through their placements in the UK. They were advised to go back to the UK to do the placement because they were unable to find a placement and time in a hospital to complete that part of the requirements here. We need as many healthcare people as possible. If there is any way to review the process around physiotherapists, I would appreciate it.

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank colleagues for their support for the Bill and will address some issues raised. The first was whether CORU can do more and do it quicker. I would say most parts of the health service can do more and do it quicker. We have significantly increased the capacity in CORU for exactly these reasons. In 2018, it had 48 whole-time equivalents; now it has 79. There has been a big increase and we will look to do more as it regulates more professions.

The issue of psychologists is important. The background is as follows. The Psychologists Registration Board was set up in 2017. There was a public consultation in 2020 on draft standards for proficiency, criteria for education and criteria for training. There is not a common view within the sector. Many conflicting views were expressed on the use of the title, registration, continuous professional development and all of the other pieces involved. There is a phased approach being proposed. CORU came to me and asked if we could identify highest risk areas and get on with them rather than trying to do a one-size-fits-all. Regulation is always around patient safety. Put simply, who could kill a patient? Who can damage a patient? Those are the people who must be regulated most and quickest. It was proposed we would look at clinical psychology, counselling and educational psychology first as the highest priorities to regulate. I have agreed to that and that work is under way. They think it will take two or three years to regulate. There is a long process required. It is longer than it used to be because of a new EU directive around tests of proportionality that we have two go through.

At the same time, CORU will keep working towards the long-term objective of protecting the title "psychologist" for the reasons we all understand and which were raised. I have allocated €750,000 this year for counselling psychology training places. It is a help. The counselling psychologist were not getting the same support for their PhDs as others were. I met many of them, one of them on the main street in Greystones. We committed to doing it because we need a lot more psychologists trained. That is one useful thing that is being done.

On the political charges, I do not blame Senators for making them. It is fair enough. It will not surprise them to hear I fundamentally disagree. More importantly, the information to hand does not suggest healthcare is unfixable but the opposite. I do not think this is a political charge. I do not think Fianna Fáil and Fine Gael are on one end of it, nor anybody else in politics. The waiting lists were so bad for so long that, for the nation, the narrative was about whether this was fixable. The answer is that it clearly is. Two things need to happen and this Government is pursuing both. One, we have to increase capacity in the public health service to a level never before seen. Two, we need fundamental reform of our health service. Both of those things are happening. Clinicians called for more beds. We have delivered 1,000. There are about another 500 to be completed this year or next. That is about 1,500 beds. As colleagues will be aware, I am seeking agreement across Government for an additional 1,500 beds through a rapid-build programme. If I get Government agreement on that, this Government will have signed off on 3,000 hospital beds. Nothing like that has happened, to my knowledge, before, or certainly not in a very long time.

At the same time, we have increased the workforce. This has been the fourth record year of recruitment into the HSE in a row. It has been about 6,000 per year. We have more than 20,000 extra people working in our healthcare services today versus when Covid arrived. That includes more than 6,000 nurses and midwives, about 2,000 doctors and dentists and more than 3,000 health and social care professionals. We are building up a new community-based service. We have been investing heavily in GPs. I agree that access to GPs is a real problem.

The result of all this is that while in many countries waiting lists are growing up post Covid, in Ireland they are coming down. Last year was the first year waiting lists fell since 2015. This will be the second year. There is a huge amount to be done. I am not for a moment saying the current situation is good enough. It is not acceptable. The number of patients on trolleys is not acceptable but there are record levels of investment and growth in our public service, combined with real reforms like building up a new community-based healthcare service and giving GPs access to diagnostics. I have just come from a meeting with lead emergency department consultants from all over the country on what support they need to get patients moved through emergency departments. The figures are there to be seen. We now have the highest life expectancy in Europe. The five-year cancer survivorship rates have doubled since the 2000s. There are services in women's healthcare that did not exist two years ago. We have built a new service of 94 primary care teams around the country. I am not shying away from the challenges. The challenges are real, the biggest being access. However, the information we see is clear: waiting lists are falling. We are more than capable of addressing the issues that arise.

On Ukrainian doctors, more exams have been put in place. The clinical observers' role is being finalised. We hope to have it in place shortly. With regard to independent practice, once PRES 3 is passed, clinicians can work independently. There will be another PRES 3 exam later this year, which will bring more of them on stream.

I will take a look at physio registration from the UK. I do not have the details with me.

On CORU and regulated professions, at the moment nine professions are regulated. Three more are being prepared for regulation: counselling and psychotherapy, psychology and social care workers, which is the main purpose here. There are another 22, two of which are designated for regulation and 20 of which are aspiring to regulation. It takes time. We need a different approach from the way CORU operates at the moment. It is not its fault. The way it was set up by us in the Oireachtas is every one of these has its own committee and its own complexities. I do not believe that is the way to go. We need to consolidate how this works and speed it up.

Not all professions need to be regulated. In plenty of professions the potential for patient risk is very small. We do not have to regulate everything. The feedback I have had is there are professions who want to be regulated because they think it is the pathway to employment in the HSE. You do not have to be regulated to be employed by the HSE. Psychology is not regulated yet we hire many psychologists all over the country. We need to change the process for professions to be regulated and then work on a patient-risk basis. Where there is a real potential risk of patient harm, they are the ones that need to be regulated first.

I thank colleagues for their contributions and for the broad support for the Bill. Go raibh maith agaibh.

Mark Daly (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

When is it proposed to take Committee Stage?

Lorraine Clifford-Lee (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Next Tuesday.

Mark Daly (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Is that agreed? Agreed.

Mark Daly (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

When is it proposed to sit again?

Lorraine Clifford-Lee (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Next Tuesday at 1 p.m.

Mark Daly (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Is that agreed? Agreed.