John Lahart (Dublin South West, Fianna Fail)
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943. To ask the Minister for Health the reason physiotherapists are not allowed to order X-rays in view of the fact that in other parts of Europe and Australia this is not the case, provided a physiotherapist has undergone the appropriate training (details supplied); and if he will make a statement on the matter. [18208/20]

John Lahart (Dublin South West, Fianna Fail)
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944. To ask the Minister for Health the reason physiotherapists now registered with CORU cannot order X-rays in view of the fact that the lack of registration previously precluded them from ordering X-rays. [18209/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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I propose to take Questions Nos. 943 and 944 together.

The European Union (Basic Safety Standards for Protection Against Dangers Arising from Medical Exposure to Ionising Radiation) Regulations 2018 (S.I. 256 of 2018) transposed the Basic Safety Standards Directive (BSSD), the purpose of which is to protect the public, patients, workers and others from all forms of ionising radiation. 

The regulations designate those who may refer for radiological tests, those who may carry them out and other functions; nurses, doctors, dentists and radiographers are designated as appropriate. Physiotherapists are not designated in the regulations. Physiotherapists were not designated as referrers under the previous regulations.

It should be noted that not all statutorily regulated professions are designated for the purposes of the BSSD.

In November 2017, my colleague Minister Harris launched Working Together for Health: A National Strategic Framework for Health and Social Care Workforce Planning . Underpinned by a core set of principles, the framework is intended to support the recruitment and retention of the right mix of health workers across the health system to meet planned and projected service need.

John Lahart (Dublin South West, Fianna Fail)
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945. To ask the Minister for Health his views on whether the inability of physiotherapists to order X-rays is seriously hampering their ability to work in an advanced practice role in view of the fact they must interrupt the doctors from doing their jobs to request orders for imaging (details supplied). [18210/20]

John Lahart (Dublin South West, Fianna Fail)
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946. To ask the Minister for Health the reason physiotherapists in a service (details supplied) are hampered by an inability to order X-ray and MRI imaging in view of the potential benefits to the service in reducing the wait times for patients referred to orthopaedics nationally. [18212/20]

John Lahart (Dublin South West, Fianna Fail)
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947. To ask the Minister for Health his views on whether advanced practice physios have the ability to improve waiting times for many patients with musculoskeletal complaints (details supplied). [18213/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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I propose to take Questions Nos. 945 to 947, inclusive, together.

International evidence demonstrates access to appropriate health services for patients is maximised through multidisciplinary team (MDT) working and integration of services. Sláintecare, underpinned by these principles for reform has also identified waiting list management as a key priority. 

 Physiotherapists, as part of the MDT with expert knowledge of rehabilitation and injury management can make a positive contribution towards improving waiting times for some patients. It is documented that there are selected caseloads of patients particularly in the area of musculoskeletal (MSK) disorders that have gained more timely access to care where clinical teams include specialist or Advanced Practice Physiotherapists. There is also evidence that re referral rates are low and comparable to International rates avoiding system over burden. Longitudinal research of patient outcomes is required in the Irish context to determine the appropriateness of care delivered by Advanced Practice.

Physiotherapists and the impact on waiting lists.  

 Advanced Practice Physiotherapist in Ireland is a role title rather than a regulated professional role which is governed by legislation. In other professions legislation protects the title of Advanced Practitioner and requires certain extended standards of practice.  In physiotherapy, such  legislative changes would require definition of the role from the professional perspective and the development of appropriate standards and an education programme to support the change in the level of practice.

Registered Advanced Practitioners are well established in the Nursing and Midwifery professions for example. Advanced Practice in these professions developed over a number of years and followed a recommendation from the Commission on Nursing (1998). The basis of advanced practice is the high degree of knowledge, skill and experience that is applied within the nurse-patient/client relationship to achieve optimal outcomes through critical analysis, problem solving and accurate decision making. The outer limits to advanced practice are set by legislation, policy and guidelines that were developed through an extensive process.