Health and Social Care Professionals Bill 2004 [Seanad]: Second Stage.

I move: "That the Bill be now read a Second Time."

I am pleased to have the opportunity to address the House on Second Stage of the Health and Social Care Professionals Bill 2004. This Bill provides for the establishment of a system of statutory registration for certain health and social care professionals.

Statutory registration is a system underpinned by law whereby each member of a profession may be recognised by a specified body as competent to practice within that profession. As a legally binding process, with a mechanism for the prosecution of offences, it ensures a robust system that serves the dual function of protecting the public while ensuring that the good reputation of a profession is not called into question by the poor practices of an individual member.

Although a number of professions have informal or voluntary systems of registration organised by their respective professional bodies, only five health professions are currently subject to statutory registration in Ireland: doctors, dentists, nurses, opticians and pharmacists. The health strategy, Quality and Fairness — a Health System for You, gave a firm commitment to strengthen and expand provisions for the statutory registration of health professionals. The Health and Social Care Professionals Bill therefore represents an important step forward in strengthening the regulatory environment and is the first of three Bills intended to improve and develop the regulatory environment for health professions. Further legislation will follow for medical practitioners and the nursing profession.

Equity, a people-centred approach, quality and accountability are the four tenets of the health strategy. The health strategy is clear on strengthening and clarifying accountability systems. It is clear on the value of building on quality initiatives. It is also clear on the importance of good human resources management. The system of statutory registration put forward in the Health and Social Care Professionals Bill helps deliver these essential objectives. It will ensure that members of the public are guided, protected and informed, so that they can be confident that health and social care professionals providing services are properly qualified, competent and fit to practice. The system proposed will also ensure professional conduct and the maintenance of high standards of professional education and training among health and social care professionals.

The principles underlying effective regulation of health professionals as set out in the health strategy and the various initiatives on regulatory reform, including the OECD report on regulatory reform in Ireland and the White Paper, Regulating Better, have been key considerations in the development of the proposed system. The most important consideration is that the interests of service users head the policy agenda. We all share the view that the present system of voluntary self-regulation can operate well and the professions themselves must be commended on the development of these voluntary systems. However, in well developed and established professions, even better protection to the public can be achieved through statutory registration. It allows the consumer to be confident that the person providing a service is properly qualified, of good standing and competent to practice in his or her profession. Statutory registration has long been advocated by many of the professions.

The health and social care professions have been to the forefront in setting and maintaining standards of patient care and professionalism. They have been proactive in working towards a statutory system of registration and are supportive of the general principles underpinning the system. A consultation process with the relevant professional bodies took place throughout 2000 with a discussion document, prepared by my Department, forming the basis for the process. A series of one-day facilitated workshops followed at which all of the major issues raised by the discussion document, and others raised by the professional bodies, were considered in some detail. These discussions culminated in the publication in October 2000 of a document titled, Statutory Registration for Health and Social Care Professionals — Proposals for the Way Forward, in which the practical arrangements for a system of statutory registration for health and social care professionals was set out in some detail. The proposals set out in this document emerged from a very positive spirit of co-operation and openness from all parties, without which it would not have been possible to devise the outline scheme.

There are fundamental reasons for the proposals put forward in the Bill. Most importantly, we need to ensure the delivery of the best possible service to patients and service users. This is our primary concern when developing a system of registration for health and social care professionals in Ireland. We are living in an age where we enjoy more personal control with regard to our own health as individuals. We have more choice in health care than previous generations.

As users of professional services we need to be assured that the service providers meet accepted standards. We must know there is a proper forum to bring justified complaints that will deal fairly with those complaints. The system of registration proposed allows for investigation of any allegations of incompetence or misconduct and for the taking of disciplinary action. It also provides a mechanism whereby practitioners compromised by ill-health or addiction can be appropriately dealt with. The Bill also provides for a mediation process and other informal means for less serious complaints by agreement of both parties.

The system proposed provides a legislative framework for the appraisal and approval of education and training courses and the proper development of education and training across the professions. It will provide a more widely informed and participative forum for the administration and implementation of the EU directives on the mutual recognition of qualifications in EU member states. It will also lead to greater consistency in the application of these directives.

As with other systems of statutory registration in Ireland, the system proposed for health and social care professions will be self-financing, that is funded from the contributions of registered members. This proposed system of statutory registration will apply, in the first instance, to 12 health and social care professions: chiropodists, clinical biochemists, dietitians, medical scientists, occupational therapists, orthoptists, physiotherapists, psychologists, radiographers, social care workers, social workers, and speech and language therapists, regardless of whether they work in the public or private sector or are self-employed. It is estimated that 14,000 practitioners will be subject to regulation, approximately 15% of whom are employed in the private sector. These initial 12 professions are long established providers of health and social care within the health service and in some instances have a long history of self-regulation. In addition, the qualifications of the majority of these professions are already regulated within the public health service.

While the proposed system of statutory registration set out in the Bill will apply in the first instance to the 12 health and social care professions I have outlined, the legislation empowers the Minister for Health and Children to include, by regulation, additional health and social care professions in the proposed statutory system as appropriate, on the basis of specific criteria.

Given the number of professionals involved it was considered inappropriate to establish a separate registration system for any individual profession. It was considered vital to develop an integrated, mutually supportive system of registration across the professions. The regulatory structure proposed in the Bill therefore comprises a registration board for each of the professions to be registered, a health and social care professionals council with overall responsibility for the regulatory system and a committee structure to deal with disciplinary matters. A chief executive officer and staff will administer the system.

Each registration board will comprise 13 members, six being registrants of the designated profession with seven members appointed by the Minister for Health and Children representing management in the public and private-voluntary health sector, the public interest and the education sector. Each registration board will determine criteria for registration and will establish and maintain a register of professionals who meet these criteria and will also approve and monitor education and training programmes for the relevant profession.

The health and social care professionals council will comprise 25 members. Membership provisions ensure an appropriate balance with public accountability and provide for representation by the registered professions — 12 members; consumers — nine members; management in the public and private or voluntary health sector — two members; the third level education sector — one member; and an independent chairperson. The health and social care professionals council will, through appropriate co-ordination and oversight, ensure the consistency and coherence of the system as a whole and will promote uniformity of practice among registration boards. The council's co-ordinating role in procedures is particularly relevant in respect of disciplinary matters where a substantial legal and administrative burdenmay perhaps occur and central expertise indealing with complex legal issues can be developed.

To deal effectively with complaints and other disciplinary matters, there will be three statutory committees common to all the registered professions within the system. A preliminary proceedings committee will, following notification of a complaint, give an opinion on whether there is sufficient cause to warrant the taking of further action regarding the complaint. A health committee will deal with cases where a registered practitioner's ability to practise is impaired by reason of a physical or mental ailment, an emotional disturbance or an addiction to alcohol or drugs. A professional conduct committee will investigate complaints against registered practitioners in respect of professional misconduct or poor professional performance.

If a preliminary proceedings committee considers that a complaint should be investigated further, it is referred to a committee of inquiry — either a professional conduct committee or a health committee — for hearing unless, with the consent of the complainant and the practitioner concerned, the complaint is referred for mediation or other forms of dispute resolution.

Hearings of a committee of inquiry will generally be heard in public. In the course of a hearing, a committee of inquiry will be empowered to receive evidence, enforce the attendance of witnesses, examine witnesses and compel the production of records. If considered appropriate, a professional conduct committee may transfer the complaint for hearing by a health committee andvice versa.

In extreme and urgent circumstances, the council may apply to the High Court to suspend a practitioner pending completion of an inquiry if it considers it is in the public interest to do so. Following completion of an inquiry, one or more of the following sanctions may be imposed on a registered practitioner: admonishment or censure, attachment of conditions to registration, suspension for a specified period, cancellation of registration or prohibition from applying for a specified period for restoration to the register. No sanction becomes effective until confirmed by the High Court and it may be made public following this confirmation.

Certain titles will be protected under the legislation and the Minister is empowered to protect additional titles. It will be an offence for an unregistered practitioner to use a protected title or to represent himself or herself falsely as being a registered practitioner. The Bill was amended and its accountability and transparency provisions were strengthened during its passage through Seanad Éireann.

Let us consider the main provisions of the Bill as passed by the Seanad. Section 4 designates the 12 health and social care professions I specified to be subject to the provisions of the Act, regardless of whether they work in the public or private sectors, and provides for the designation of additional health and social care professions by regulation in the future as appropriate and in line with specific criteria.

Sections 6, 7 and 8 establish the health and social care professionals council, define the object of the council as being to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions, provide that the council must exercise its powers and perform its functions in the public interest and set out the functions of the council.

Section 9 lays down the membership of the council as comprising 25 members, 12 being members of the registered professions with 13 members representing the management of the public and voluntary health or social care sector, third level educational establishments and the interests of the public to ensure an appropriate balance with public accountability. Sections 11 and 12 provide for the council to appoint a chief executive officer and staff to manage the administration and business of the council and the registration boards. The chief executive officer also acts as registrar of each registration board. Section 17, in keeping with the principle of the council's being a self-financing body, provides that the council must meet, out of funds at its disposal, expenses incurred by the council, the registration boards and any committees established.

Section 22 enables the council to make rules providing for such matters as the form and manner in which registration boards are to maintain registers, the details relating to registrants that, in addition to their names, are to be entered in registers and the receiving and recording of evidence by committees of inquiry. It also requires the council to publish a draft of any rule and invite comments on the draft before a date specified in the invitation.

Sections 26 and 27 provide for the establishment of a registration board for each of the 12 professions to be registered, define the object of each registration board as being to protect the public by fostering high standards of professional conduct and professional education, training and competence among registrants of that profession and set out the functions of each registration board. Section 28 lays down the membership of each registration board as being 13 persons, including six persons from the particular profession elected by members of that profession and seven from outside the profession representative of the management of the public and private health or social care sector, third level educational establishments and the interests of the public.

Section 31 enables each registration board, with the council's approval, to make by-laws regarding such matters as qualifications attesting to the standard of proficiency required for registration; procedures for assessing qualifications awarded, training or professional experience acquired outside the State; education, training and continuing professional development of registrants; and adoption and revision of a code of professional conduct and ethics. Where a proposed by-law might result in an additional burden being imposed on the Exchequer, both the council and the Minister must approve the draft by-law. Section 32 requires a registration board to publish a draft of any by-laws it proposes to make and to invite comment on the draft. It also requires a registration board to submit certain draft by-laws to the Competition Authority for its opinion.

Sections 36 to 38 provide that each registration board must establish and maintain a register of members of that profession and the procedure to be followed by a person seeking registration. Sections 43 and 44 provide that a registrant may appeal a decision of a registration board to refuse to grant or restore registration to the council and subsequently to the High Court. Section 46 requires each registration board to make the register available for inspection by members of the public at all reasonable times and also requires each registration board to publish the register, by electronic means or otherwise, at least once a year.

Section 48 enables each registration board to approve or withdraw approval for education and training programmes for the education and training of candidates for registration. Section 49 requires a registration board to monitor the ongoing suitability of education and training programmes approved by the board, including any clinical training and experience being provided, at least once in every five years. Section 50 sets out the definitions to be used in regard to complaints, inquiries and discipline.

Section 51 requires the council to establish a preliminary proceedings committee, a professional conduct committee and a health committee to perform functions and exercise powers in regard to complaints, inquiries and discipline and sets out the membership of these committees.

Section 52 enables any person to make a complaint to the council concerning a registrant on the following grounds: professional misconduct; poor professional performance; impairment of the registrant's ability to practise by reason of a physical or mental ailment, an emotional disturbance or an addiction to alcohol or drugs; a failure to comply with a term or condition of registration imposed under fitness to practise procedures; a failure to comply with an undertaking or any action specified in a consent given under section 61; a contravention of this legislation, the rules or by-laws; and a conviction in the State for an offence triable on indictment or a conviction outside the State for an offence consisting of acts or omissions that, if done or made in the State, would constitute an offence triable on indictment.

A complaint may also be made on the grounds of professional misconduct or poor professional performance even though the matter to which the complaint relates occurred outside the State. Section 53 provides that the council must refer each complaint to a preliminary proceedings committee for its opinion on whether there is sufficient cause to warrant further action being taken regarding the complaint.

Section 56 provides that where there is sufficient cause to warrant further action being taken on foot of a complaint, the preliminary proceedings committee must refer the complaint either for resolution by mediation or other informal means or to a professional conduct committee or a health committee. If a preliminary proceedings committee is informed that a complaint referred to mediation cannot be resolved, the committee must refer the complaint to a committee of inquiry.

Section 58 provides that the conduct of a hearing and a hearing before a professional conduct committee will generally be held in public. A hearing before a health committee generally will be held in private. At the hearing, the registrar presents evidence in support of the complaint, testimony of witnesses is given on oath and there is a full right to cross-examine witnesses and to call evidence in defence and reply. This section provides that a committee to which a complaint is referred may transfer the complaint to another committee of inquiry but only if it is satisfied that it is appropriate to do so and that the legal rights of the registrant will not be prejudiced.

Section 60 enables the council to apply to the High Court for an order directing a registration board to suspend a registrant's registration pending completion of an inquiry, if it considers that the action is necessary to protect the public.

Section 63 requires that on completion of an inquiry a committee of inquiry must submit its findings in writing to the council, and specifies the items that must be included in the report. Section 64 provides that on receiving the report of a committee of inquiry concerning a complaint, the council shall, if allegations have not been substantiated, dismiss the complaint or, if allegations have been substantiated, request the registration board concerned to recommend one or more than one disciplinary sanction to be imposed on the registrant.

Section 65 provides that the registration board concerned must recommend that one or more than one of the following disciplinary sanctions be imposed on the registrant: an admonishment or a censure; the attachment of conditions to his or her registration, including restrictions on the practice of the designated profession by the registrant; the suspension of his or her registration for a specified period; the cancellation of his or her registration; and a prohibition from applying for a specified period for restoration to the register.

Section 66 provides that following consideration of the registration board's recommendation, the council may direct the board concerned to impose on the registrant one or more than one of the disciplinary sanctions referred to in that section.

Section 68 provides that a direction given by the council to a registration board to impose a disciplinary sanction, other than an admonishment or censure, does not take effect unless the direction is confirmed by the High Court. Section 69 provides that a registrant to whom a direction to impose a disciplinary sanction, other than an admonishment or censure, relates may apply to the High Court within 30 days for an order cancelling the direction.

Section 70 provides that if the registrant does not, within the time allowed, apply to the court for an order cancelling the direction, the council may apply to the High Court for an order confirming a direction to a registration board to impose a disciplinary sanction, other than an admonishment or censure, on a registrant.

Section 73 provides that the council may direct a registration board to restore to its register the name of any person whose registration has been cancelled and may attach to the registration any conditions it considers appropriate. Section 76 provides that the council shall notify the Minister and employer, if known, as soon as practicable after any sanction imposed on a registered professional takes effect. This section provides that the council must also notify the Minister and employer, if known, if it comes to its attention that, under the law of another country, the above actions have been taken in relation to a registrant.

Section 77 provides that the council may, if it is satisfied that it is in the public interest to do so, advise the public when a sanction imposed on a registered practitioner takes effect. Section 79 makes it an offence to use the title of any registered practitioner as set out in section 4 or prescribed by the Minister by regulation, unless entitled to do so. Sections 82 to 89, inclusive, provide for the dissolution of the National Social Work Qualifications Board.

Section 91 sets out grandparenting arrangements for those practitioners who have been in practice at any time during the five years ending on the day the register for the particular profession is opened.

Section 95 confers power on the Minister to make regulations for matters prescribed in the Act and provides that such regulations must be laid before each House of the Oireachtas and that either House may annul such regulations by a resolution passed within 21 sitting days after the making of the regulation. This section provides that the Minister may make regulations to prescribe additional titles to be protected for use by registrants only if a draft of the proposed regulation has been laid before the Houses of the Oireachtas and a resolution approving the draft has been passed by each House.

Schedule 1 sets out miscellaneous provisions for the council. Schedule 2 sets out miscellaneous provisions for each registration board. Schedule 3 lays down the qualifications required by existing practitioners to be granted registration under Part 9 — the grandparenting provisions.

This Bill is a significant step in meeting the task set by the health strategy as regards the regulatory environment for the health professions. As I have stressed, members of the public are entitled to guidance and protection so that they are confident that the professional providing the service is properly qualified and competent and that unqualified or insufficiently qualified persons are excluded from professional activity. For their part, the professions require protection, including that through a mechanism for sanctioning professional misconduct, so that the good name and reputation of the majority are not damaged by the actions of a very tiny minority.

I commend this Bill to the House and look forward to hearing the views of Deputies.

A great injustice was bestowed on the Minister of State to have to read through all that. I read through the legislation's memorandum as well as the Tánaiste's speech on the Bill in the Seanad and I had a sense ofdéjà vu every few minutes while listening to the Minister of State’s speech. I am sure it must have been just as painful for him to read through 30 minutes of that as it was for me to listen to it.

As regards the Tánaiste's speech in the Seanad, she made a few important points. She said that this was the first of three Bills to reform the regulatory environment for health professionals, with legislation for medical practitioners and nurses to follow. It was pointed out that we have been waiting for this legislation for almost 20 years. I hope that, when the Tánaiste stated that this would be followed soon by new medical practitioners legislation and nurses legislation, it will be in our lifetime as politicians rather than in the lifetime of the Government.

It was pointed out that the 2001 health strategy was based on four key principles, namely, equality, people-centredness, quality and accountability. We must constantly focus on points such as those when talking about legislation. Legislation can often look very good on paper but, as happened recently, it can go badly wrong when tested in the High Court or the Supreme Court. The Tánaiste said that the vision adopted in the strategy for the future health system set great store on treating people with dignity and respect. She said the health strategy envisaged that action would be taken to strengthen the customer focus of service providers.

It is important to reiterate these points because there is an element of fine words having been spoken as regards the health service over the past couple of years, and the health strategy was very much the basis for many of these fine words. However, it is delivery and ensuring that people benefit from this so-called patient-centred approach from the health service that is important. I will expand more on that later. For the moment I am just putting forward the themes I intend to deal with.

My last quotation from the Tánaiste's Seanad speech is that strengthening and clarifying, accountability and measurement of excellence are the priorities. That basically is what this Bill is all about. It is about protecting the consumer or the patient using the legislation we pass in this House as legislators. Before we talk too much about this legislation, we should look at what is already in existence. The setting up of the council will be a dramatic initiative. We abolished 250 health board positions last December and we are establishing 186 regulatory bodies and councils under this legislation. It is not a case of self-regulation, as with the Medical Council. It is to be a statutory body, and obviously the Government will keep control of the regulations and the regulation of people in these professions.

There are some parallels, however, with the Medical Council. Many fine ideas are proposed, for example, about training, regulation and registration of people. Over the next couple of weeks a report will be published on one medical practitioner. It will focus very much on Dr. Michael Neary and what happened in Drogheda hospital. The report will be extremely critical of the medical profession and the Medical Council, the self-regulatory body of doctors. I do not seek to scapegoat the council but to make the point that, irrespective of good intentions, systems can dramatically fail patients. Although I have not read the report, having been involved in much of the debate on Dr. Neary, I know in my heart it will be extremely critical of the Medical Council and doctors, including many consultants outside Drogheda who were involved in dealing with the events at the hospital.

Whether one is a medical director or consultant colleague of a bad consultant, doctors are slow to report each other. The Garda Síochána is often accused of protecting its own out of self-interest. This accusation will also be levelled against doctors and there is no doubt a certain element of self-interest is evident in all professions with politicians being no exception. Deputy McManus will agree that this trait has been much in evidence in recent months in the Joint Committee on Health and Children at which certain Government Members have engaged in protecting their own, rather than pursuing responsibility and accountability to the House.

Sometimes the reason doctors refuse to make a complaint against a colleague is not to cover up issues but because no genuine protection is afforded to those who wish to do so. The Dr. Neary affair is a case in point. It exploded into the public arena because two student midwives who, to the best of my knowledge received much of their training in Northern Ireland where matters of this nature are dealt with under a different legislative framework, were horrified by what they saw taking place in Our Lady of Lourdes Hospital, Drogheda, and complained to their supervisor. The matter came to light when the supervisor took their complaints further.

Why are consultants, powerful individuals in the hospital system in their own right, afraid to report colleagues, even to the Medical Council? One of the main reasons is the fear of litigation. If one cannot prove an accusation one makes about a colleague, one may well find oneself in the High Court, even if the allegation is true. Hearsay and circumstantial evidence are not sufficient as one must be in a position to demonstrate that problems exist. If, for any reason, one is proved wrong, the accused person can sue one for defamation.

A further problem is the lack of political and, in some respects, administrative support. A case in point, which may not be crystal clear but with which the Minister of State, as a matter of interest, should familiarise himself, involves an orthopaedic surgeon in Cork, Mr. Maha Lingham, who has found himself without a job. Mr. Maha Lingham, who worked as a temporary consultant in Cork University Hospital for 12 years, was one of the most successful orthopaedic surgeons in the region and had a tremendous workload. He was also one of a few people carrying out extremely specialised orthopaedic surgery. I do not understand why he is without a job.

The Minister must address the absence of political and administrative support for consultants who wish to make a complaint and the fact that they may find themselves out on a limb as colleagues close ranks. Legislation on the medical profession, including this Bill, does not protect patients or doctors because it is ineffective when those at the top show weakness or lack of leadership. Fundamental changes are needed to make this type of legislation work. In this respect, I fully support my constituency colleague, Deputy Howlin, who has repeatedly called for the introduction of whistleblower legislation. The Bill is too reliant on people being genuine and well intentioned. We must bear in mind that if someone wishes to play the legal system or has ulterior motives or other agendas, the legislation will fail those it is meant to protect. For this reason, the Government should consider the introduction of whistleblower legislation.

It may transpire that a complaint made against a person is not completely true and many such cases have come before the Medical Council, which receives a large number of complaints about medical practitioners. Patients, for instance, complain about the manner in which they have been treated by a doctor. I have every sympathy for the doctors in question, many of whom I know to be caring and considerate and have been badly affected by complaints made against them. Such complaints are not all malicious as patients genuinely believe they have been badly treated. Even if it is shown by the Medical Council that a doctor was not negligent or incompetent and is declared innocent after 12 months or two years, he or she may still feel wronged.

We need whistleblower legislation to encourage people in senior positions, doctors and professionals, to act if they see bad practice. In the course of 12 years — 18 if one includes my medical training, a period when I had ample opportunity to see how other consultants work — I have seen a number of things I would not encourage. As junior doctors, we were under severe pressure not to take action and, as a result, we did nothing.

There is nothing in place to protect consultants who make a complaint, even if it is not substantiated in the long term. This is the case throughout the public service, including in the Garda Síochána, the teaching profession and the medical profession, from physiotherapists to chiropodists and all the professions to which the Minister of State referred, as well as those which, I hope, will seek registration on the new body. If we do not have a proper mechanism to enable people to make their views and concerns known without having to worry that if they put a concern in writing or make a complaint, a lily-white or weak-hearted administrator will release the information.

The Deputy could use a better term than "lily-white".

We cannot trust that information will not be leaked. We have seen how a junior Minister released information which, in some respects, should have been considered confidential. We need to protect people from this kind of practice by offering substantial support and protection.

The legislation is the way forward and is, therefore, welcome. There is far too muchad hoc regulation of the health care professions. Nevertheless, two major concerns arise. Some professionals believe they have been left out of the legislation, for example, some titles are not specifically mentioned. One of the most important issues to arise since the introduction of the legislation — the Minister of State will have heard about it — is the title of “physical therapists”. Every Member of the House has received correspondence from physiotherapists and physical therapists on the matter. This issue must be addressed on Committee Stage. If it is not resolved before the legislation is enacted, the title of “physical therapist” will remain outside its scope, thus creating more problems in the future. The Government should take the bull by the horns and deal with the issue now as it will crop up in future.

A number of other organisations have been omitted from the scope of the Bill. With the complexity of medicine and the many qualifications available, we will see many other bodies seeking to be included under this legislation. In the same way the Medical Council has given status to the medical profession, patients will want to see all health care providers covered by governing councils. The public will think those who are not included under the legislation are alternative or unqualified practitioners. That will have a detrimental effect on many people who hold qualifications who feel they should be included under the legislation. Eventually someone will take a test case to the High Court on the issue. To serve the public interest we must reduce ambiguity and at some stage a Government will have to legislate for alternative practitioners. It is becoming so complex that people do not know where they are going.

Psychologists are included in the legislation but some people call themselves both psychologists and counsellors. We must make the qualifications needed crystal clear. People qualify as psychologists having studied for a long time at a third level institution that is not a university. They may well be left out under the legislation even though we would currently consider them to be psychotherapists. Others who do not have a qualification will also be left out — perhaps the legislation could make that differentiation because patients and doctors do not know how qualified many of those described as counsellors and psychotherapists are.

If a profession other than the 12 mentioned in the legislation feels it should be included, are there any means to consider that? If it established itself and fulfilled the rules and regulations, could the Minister issue a regulation to include such a group in the legislation? It would have to set up a regulatory body with 13 members. Where would that fit in with the council? Would it be difficult to nominate a member to the council?

The majority of the 12 organisations mentioned participate in the public service so perhaps the Minister is thinking that once they are covered, the public service remit has been fulfilled. Does he intend to look after the other bodies that might not have a role in the public service?

What is a medical scientist? Is someone working in a pharmaceutical company, in a laboratory in a hospital or a science graduate doing research at university, perhaps controversially on embryos, a medical scientist? We have not teased this out. We must always keep in mind factors external to those we are addressing. If someone is carrying out stem cell or embryo research, would he or she come under this legislation and would he or she break the law if doing something that this House had not approved?

Has the Minister named the representative bodies for the 12 professions mentioned in the legislation? Physiotherapists are represented by two organisations. Which will be nominated as responsible for looking after physiotherapists? Many of the bodies have at least two representative organisations and there could be conflict if one is chosen above another. We should examine this on Committee stage because the Bill is unclear at present on the matter.

All of the organisations named in the Minister of State's speech are involved in either the health or social welfare services. Why, then, are the ministerial nominees for these bodies named by the Minister for Enterprise, Trade and Employment? That is strange. Why is the Minister for Health and Children not nominating them? Perhaps I have a problem with the Minister for Enterprise, Trade and Employment, Deputy Martin, nominating people because his nominations to the board of the Irish Blood Transfusion Service left lingering problems that the Tánaiste might still have to address before the next election.

The sections on registration, education and training, complaints, inquiries and disciplinary procedures are mostly fine; they follow the criteria used by the Irish Medical Council on making complaints. The council, however, is moving towards all professional conduct committee hearings being heard in public. That has created anxiety for members of the medical profession because if there is a committee hearing in public, it can be reported in the media. If the committee finds all charges baseless, however, the media is not concerned about reporting that. Many of the professions will find themselves in a unique position when complaints are made about them. It is difficult for patients to get a hearing and many of the professionals will be in for a surprise when this legislation is enacted. At least the health committees will be held in private because they cover emotional subjects for everyone involved.

Under section 58, there is provision that each committee of inquiry has the powers, rights and privilege vested in the High Court or a judge of the High Court relating to enforcing the attendance of witnesses, examining witnesses on oath and compelling the production of records. In the discussions by the Joint Committee on Health and Children on illegal nursing home charges, attempts were made to ascertain Deputy Martin's responsibilities as Minister for Health and Children and those of the Ministers of State and special advisers. We hit a stone wall as nothing had been committed in writing. When we sought legal opinion during the course of our inquiries, we were referred to the case of the Abbeylara incident sub-committee and whether Members can make judgments on people that have a negative outcome.

Has this been explored in how the Medical Council works or how this committee will work given that it is not part of the Judiciary? Are there aspects of the Abbeylara incident sub-committee case where negative findings cannot be made on an individual? Has this been cleared with the Attorney General? The Medical Council is the only one that functions to any significant degree. However, the Bill will see the establishment of 12 more similar bodies. Has legal opinion been sought as to whether these committees can operate on this basis and make negative findings?

Section 61 states: "A committee of inquiry may, at any time after a complaint is referred to it, request the registrant concerned to do one or more of the following ... consent to being admonished or censured by the Council." I will ask for this provision to be clarified on Committee Stage. It is almost saying that one must consent to whatever punishment is meted out by the committee before the opportunity is given to hear what the complaint is or make a defence case. An individual should be allowed to wait to hear the full facts of the case against him or her before consenting to being censured by the council looking after his or her professional interests.

While my points are to ensure the legislation works, it is welcome. There is no point in going through all this rigmarole, establishing one council and 12 regulatory bodies with 189 people being taken on in the administrative set-up, if it will not work properly. The Government must examine whistleblowers legislation as it will make this Bill work in protecting patients in the legal environment. While much of the legislation passed by the House never finds its way into public discussion, it is still our role to ensure legislation protects people.

Many people will be surprised to learn that many disciplines in the health sector are not already regulated by law. This Bill has taken a long time to come before the House. It has been mirrored in the long wait for the medical practitioners Bill, sought for many years. I only hope we are not going to have the same drawn-out process for legislation to establish an inspectorate of institutions caring for the elderly. Unfortunately, the track record indicates these matters take some time.

The Bill presents an elaborate structure with 180 appointments to be made. The Health Service Executive does not have a role in this, although it was established to manage the health service, implement Government policy and ensure services ran in a streamlined way. Instead, the Minister for Health and Children will make the bulk of appointments and, in some cases, with the consent of the Minister for Enterprise, Trade and Employment. This type of structure provides rich and fertile ground for Fianna Fáil and the Progressive Democrats to extend their patronage far and wide.

We need to be conscious of this when ensuring best practice is followed. The record is not very reassuring, particularly when the Minister has total power in making appointments across a whole swathe of disciplines. In recent times, we saw the former Minister for Health and Children, Deputy Martin, refuse to accept any responsibility for duties he should have discharged and clearly did not. It does not augur well, not because the legislation is wrong but because we have bad government in good times. This presents the possibility of extending that bad government into new areas.

The complaints procedures set out in the Bill have been carefully thought out. However, it shows up that, for some time, there has been a lacuna whereby there is no complaints authority. Legislation was promised but was absorbed into the Health Service Executive. It is difficult for people to see where and how they can make a complaint against any treatment or care they have received.

Already the Bill's terms will have to be extended because so many disciplines have developed at community and primary care level for which provision must be made. We all recognise this is a process that must be continued. One example is the role psychotherapy plays in health care. It is being widely availed of where people can afford it. It plays a significant part in providing therapy for people and it needs to be recognised in a statutory way.

The points made about a whistleblowers Bill are valid but have not been answered. Recently, the Minister of State at the Department of Finance, Deputy Parlon, said that a whistleblowers Bill was proceeding when he rejected an amendment to the Civil Service Regulation (Amendment) Bill. On the other hand, both the Tánaiste and the Minister for Finance said on the Order of Business that the Government had determined there would be no whistleblowers Bill. Instead it will be done on a sectorial basis. The Government cannot have it both ways. By trying to do so, it is simply looking foolish. That is not to reduce the importance of the issue. The Labour Party presented the Government with an opportunity to provide a much-needed whistleblowers Bill. However, it is regrettable that this state of affairs continues. When one examines health care provision, we have terrible examples of where whistleblowing would have saved people from suffering and, in some cases, death. However, this did not happen because people felt unprotected and unsure about their rights.

In general, I welcome this legislation which seeks to introduce a system of statutory registration for health and social care in Ireland. The stated purpose of this Bill is to establish a system to ensure that members of the public are protected and informed so that they may be confident that the professional providing the service is properly qualified, competent and of good standing. It is vital that the legitimate concerns of members of the public are addressed and legislated for in this way. The proposed system rightly seeks to ensure professional conduct and the promotion of a high standard of professional education and training among health and social care professionals. A health and social care professionals council will be established to facilitate this.

No one would argue with the stated aim of this council, which is "to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions".

All this is to be welcomed by both the public it seeks to protect and the professions it targets as it will help to ensure the protection of their name and reputation and offers a new level of transparency and accountability. The Labour Party's health policies and documents have long advocated a health service that delivers the best quality of care efficiently to all citizens as a right.

However, there are issues of quantity as well as quality which the Government must address and which are not covered by this Bill such as the delays caused by a shortage of occupational therapists at health board level and the costs levied, at times unfairly, on medical card patients for scarce chiropody services. It is not acceptable that there is a wide variation in the level of services available in different parts of the country. While there are instances — this requires further clarification — where medical card holders are entitled to community care services, it is not always possible to get the required services. Community care services include the public health nursing service, home help, day care, respite care and so on. These are the services which one would normally consider to be community care. The rules about which community care services must be provided differ in accordance with the different services. In some cases, health boards are obliged to provide services, while in others, they have discretion about whether to make the service available. This entire area must be clarified and clear guidelines must be published.

There is a lack of clarity about eligibility and entitlement to the services. Health boards were established to provide certain services, set out in statute. That function now belongs to the HSE. The omnibus term "health and personal social services" is undefined but is used to cover all services provided under previous legislation.

On the one hand, Members are familiar with the issue of health services to which there is statutory entitlement but which are not provided, while on the other hand, the statutory basis of some services which are provided by the HSE is uncertain, to put it mildly.

The Department of Health and Children appears to be aware of the problem and there are hopes it will address it in a comprehensive way, in the context of a general updating and clarification of the health service framework. My concerns are, first, that chronic structural problems, which are left unresolved, are prone to explode in an acute manner. The nursing homes debacle must have taught us that. Second, the programme of health service reform seems to have concentrated on assessing what services need to be delivered and what mechanism should be adopted for their delivery, to the complete exclusion of the question as to what services must be delivered by statutory mandate and the need to review and update that mandate.

I do not argue that unauthorised personal social services should be immediately cancelled. On the contrary, these are vital services and are provided for people with the highest degrees of dependency. My point is that the failure to legislate properly can only result inad hoc, non-statutory service provision that is piecemeal, disjointed and entirely inadequate to satisfy widespread unmet needs.

I wish to conclude this point by quoting from the famous legal opinion on nursing home charges provided to the South Eastern Health Board in October 2002: "It is a remarkable feature of the health services in Ireland that such vast sums of money are expended on a system, the statutory basis for which is so confused and haphazard and where practice seems so dislocated from statutory theory."

I will now address some other outstanding issues concerning this Bill, which it is important to put on the record. The Irish Society of Chartered Physiotherapists, the professional body representing physiotherapists in Ireland, has expressed its concerns to me regarding the issue of protection of title. Since the early 1980s the ISCP has worked with successive Ministers and departmental officials regarding statutory registration for the profession and hence for the protection of the public. However, due to the slow progress of this work, the present difficulties have arisen, which essentially pertain to the use or lack of use of the term "physical therapist".

There are grave concerns about the issue of title as it appears in the present Bill and there may be serious implications to the detriment of the public which it does not address. These must be considered further and the Government must address it when we deal with this legislation on Committee Stage.

Within Great Britain and Northern Ireland and possibly some other countries, the titles "physical therapist" and "physiotherapist" apply to the same profession with the same professional qualifications. The titles are interchangeable and the professional qualifications and requirements are the same for both titles. This possible area of confusion must be addressed.

In Ireland in recent years a group of practitioners has begun to use the title "physical therapist". In the absence of relevant legislation protecting title up to now, Irish physiotherapists could not prevent this perceived misuse of their associated title. The use of the title "physical therapist" in Ireland by a group with less education and training standards has led to confusion among the public. Members of the public have, it is claimed, contacted the office of the Irish Society of Chartered Physiotherapists to find out why their physical therapy fees had not been reimbursed by VHI or BUPA, only to discover that the practitioner they attended was not a physiotherapist. This is a possible area of confusion in the public eye concerning the two practices.

The ISCP commissioned Millward Brown IMS to carry out a survey of public opinion on this issue. The results showed that only one person in every three surveyed stated that he or she knew the difference between a physiotherapist and a physical therapist, the latter title being that used incorrectly in Ireland at present. The results also showed that more than one in four believe that a physical therapist requires a university qualification, which is not the case. When representatives of the older population were asked how similar or different they thought a physiotherapist and a physical therapist might be, half of those aged 65 and over answered that they did not know.

This demonstrates an even greater degree of confusion among a potentially more vulnerable, older population. The ISCP believes that the best way to protect the public would be to protect both titles for the profession of physiotherapy in Ireland in the Bill.

There are differences between the two bodies currently practising in Ireland, both in terms of the level of education requirements and the extent of involvement and interaction with the medical profession and other allied health professions.

While the ISCP states that it respects the rights of the groups currently calling themselves "physical therapists" to practise and to their livelihood, the issue is not about livelihood or practice but the use of title and the confusion it causes.

The practitioners who have adopted the title "physical therapist" could continue to carry out their practice, possibly under a different title, because they also have legitimate concerns which no one would disregard. However, confusion of this type does not benefit the person availing of the services and it is important that this is not disregarded by the Minister. Various arguments have been put forward about using different titles such as "State registered physiotherapists" or "certified physical therapists". This is an area that we must address.

Senator Henry raised an issue highlighted by the Society of Chiropodists and Podiatrists in Ireland. While an amendment to delete the word "chiropodist" and substitute the word "podiatrist" was not accepted by the Minister of State at the Department of Health and Children, there was some confusion over the issue. The reason for the proposed amendment from the Society of Chiropodists and Podiatrists is as follows:

The reason we seek to have this amended is that professionals wishing to register are required to have a Bachelor of Science in Podiatry — qualifications required by existing practitioners, thus it would be anomalous to retain the name "Chiropodist" only. Both titles have been in use for over 20 years now. This degree qualification has succeeded the Diploma since the early eighties. If the name Podiatry is not so well known in Ireland this is because we do not yet have a School of Podiatry in Ireland and those wishing to study Podiatry do so at one of the Universities in the UK. Recent legislation in the UK has protected both titles "Chiropodist" and Podiatrist". Indeed we risk losing Irish graduates in Podiatry to the UK.

I would have thought such a Bill would have provided an opportunity to deal with that type of practical issue of title.

There are 12 professionals the Minister of State mentioned. They are all core professionals within the primary community care sector and are employed in the acute hospital sector. They have been selected for registration in this Bill because they are long-established providers of health and social care. In most instances, they have a system of self-regulation. However, it leaves scope for concern about the newer and increasingly popular disciplines of which people are availing, whether counselling or therapy. We need to discuss how standards are to be maintained in those areas which are relatively new, but which are growing and can be of benefit to many people who seek them out. However, people need some type of safeguard that the service of which they avail meets best practice and is regulated in a way that will protect the patient in terms of care. One hears stories of counsellors who are not properly trained and who in some cases do more damage than good. There are enough examples in the area of complementary medicine, of serious misdemeanours and damage being done which is not good for complementary medical practitioners and people in the area of complementary health who are trying to maintain good standards, to provide a service and who are seeking registration and regulation to protect their particular discipline.

The university providers of the State's four professional social work education and training programmes have also raised concerns. Again, while they welcome the registration and public protection aspects of the Bill, they have raised concerns about the implications of the Bill for social work education and accreditation. Social workers represent one of the largest groups among the 12 professionals covered by this Bill and is the only group to have an established statutory qualifications board as opposed to self-regulation.

The National Social Work Qualification Board has developed highly respected standards, procedures and expertise in the monitoring and regulation of professional education prior to awarding professional qualification. It has also developed its other functions of assessment of non-national qualifications, strategic manpower planning, research into the education and training of social workers, facilitating cross-border mobility, provision of induction training and the collection and publication of statistical information. There are concerns that the proposed social work registration board could have significantly reduced functions, capacity and resources in comparison with the NSWQB and that this change could have a detrimental effect on social work education and, therefore, ultimately on the quality of social work services. Disruption or delays in strategic manpower planning and accreditation of non-national qualifications may also generate considerable costs for public bodies and employers. This is an important point.

The area of social work has expanded enormously and, generally speaking, people will recognise the universities have performed an important role in developing that sector and in ensuring good standards, research and planning. It would be most regrettable if the impact of any change in the law was to downgrade standards. When statutory change is being made, there is always the possibility of an impact where a highly developed sector is being regulated or registered for the first time.

There are many examples of people who have, or who have tried to come here from abroad to work but who have faced all kinds of obstacles. Nurses, doctors and other health professionals from abroad, who we desperately need, cannot get registration to practise here for one reason or another. Most of us will have had the experience of a highly qualified health professional coming to our clinics to say he or she cannot get over a particular hurdle even though he or she has something to contribute. It may not be the fault of the Medical Council — there may be other reasons. It is an aspect of the registration of health professionals that we need to keep in mind now that we are living in this new Ireland with the new Irish. The multi cultural basis of much of our health and social care service is something of which we need to be aware. Generally speaking, it is something I welcome. It is wonderful to see people coming here providing us with the expertise. Irish people, particularly in the nursing profession, return the compliment. However, we need to ensure standards are maintained, registration is in place and people are not disadvantaged or exploited because they were not born and reared here.

This is a good, practical step forward. It is certainly a slow step in that we have been waiting a long time for it. However, generally speaking, there is support in this House for this type of regulation and registration. However, it places a responsibility on this Government. I go back to the point I made earlier about Government appointments. We need to see a serious commitment to ensuring best practice and the highest standards and that applies to Ministers, how they make appointments and how they live up to their obligations. Regrettably in the Department of Health and Children in particular there are serious questions about Ministers' lack of responsibilities and the resultant cost to the taxpayer, which was of enormous proportions. I hope in this instance, we will see legislation that will be of benefit not only to taxpayers but, specifically, to people who avail of services. People should be confident that they will get a good service from a competent, registered practitioner and that if something goes wrong — inevitably things go wrong but I hope they will go wrong with less frequency when this legislation is in place — proper recourse and safeguards are in place.

I wish to share time with Deputy Catherine Murphy. I welcome the publication of this legislation of which there are a number of aspects I wish to address. We have waited for this Bill for some time. We also await similar legislation in other branches, such as the medical practitioners Bill for which the Oireachtas Joint Committee on Health and Children has asked repeatedly and which has been called for in this House. Legislation for which I have called repeatedly concerns the area of complementary and alternative medicine. Unfortunately, there is a number of charlatans operating in this area who have given the area of complementary and alternative medicine a bad name. Some tragic cases have emerged where people have been robbed of their money. These were people suffering from terminal cancer who were looking for a cure and were only too happy to dispense with their money. They were ripped off and treated in an appalling way. I will not mention the specific cases; we know them.

People practising in this area have asked again and again for regulation. A committee has met in this regard, of which the Tánaiste is aware. Under the then Minister, Deputy Martin, a group was set up under Terry Garvey to examine this area to enable it to be properly regulated. Practitioners operating in this area want and have sought regulation to enable members of the public to have confidence in their work. We are talking of therapies ranging from aromatherapy to shiatsu and others which have been recognised as having enormous benefits. The benefits of holistic medicine are there to be seen but it requires legislation. People need to know they have some redress.

In this legislation we are giving the client some means of redress. However, like the previous speaker, I have concerns about appointments to a plethora of boards that will now emerge. The Opposition has concerns about perceived patronage in terms of the way these appointments can be handed out. I am not sure what remuneration applies to these positions. I suppose it is a nice way of assisting the party faithful in many cases and such appointments are handed out. There must be greater transparency and accountability in the way these appointments are made.

Much of the discussion on this Bill in the Seanad and in this House centred on the distinction, or lack of it, between physical therapists and physiotherapists. I listened to what Deputy McManus said on this. It must be acknowledged on the floor of the House that we have been lobbied by physiotherapists and physical therapists. It seems to be a case of claim and counter claim. It is important to record all the available information.

This Bill proposes to register by statute 12 named health care professions, including physiotherapy. Physiotherapists are asking to be allowed to protect for their exclusive use the title "physical therapy" in addition to "physiotherapy". The Institute of Physical Therapy and the Irish Association of Physical Therapists are resisting this because they believe it will undermine their existence as a competitor in the provision of physio-therapeutic health care. Physiotherapy and physical therapy have operated successfully here for the past 15 years as distinct entities with distinct training courses, professional representative associations, treatment approaches, functions, scopes of practice and opportunities for employment. Legislation restricting practise might conflict with the constitutional rights of physical therapists to earn a living. This is their concern as the Minister of State is probably aware. The effective loss of the entire physical therapy profession would eliminate competition and restrict the choice of patients without offering them any guarantee of an improved quality of service.

The Bacon report of 2001 advocates the recruitment of physical therapists to hospitals to alleviate an agreed and existing shortage. The removal of up to 350 physical therapists from the health service would worsen this situation for many decades according to the physical therapists.

Irish physiotherapists claim the titles "physiotherapists" and "physical therapist" are interchangeable, yet there has been a clear differentiation between the two separate groups here for the past 15 years. "Physical therapy" and "physiotherapy" are generic titles and should not both be available to one group to own. Appropriation of two titles by one group facilitates regulatory capture. Although physiotherapists argue that internationally physiotherapy is exactly the same as physical therapy, they do not recognise physical therapists from many English speaking countries such as the United States and the Philippines.

The qualification awarded by the Institute of Physical Therapy in Ireland is recognised at home and abroad for the purposes of academic progression and access to master programmes.

The Competition Authority argues that auxiliary professions, such as physical therapy, should be free to emerge which, it says, would not happen in the event of such regulation.

Deputy McManus quoted from what was stated by the Irish Society of Chartered Physiotherapists in its position paper. It stated:

Members of the public often contact the ISCP office to find out why their physical therapy fees have not been reimbursed by VHI or BUPA only to discover that the practitioner they attended was not a physiotherapist. The confusion in the public eye surrounding the two practices is constantly being reinforced to our members through their contact with members of the public.

There is a rebuttal to that by the physical therapists. They state:

This is nothing more than hearsay. Both VHI and BUPA have officially confirmed ... [this was in November 2004] that they have no record of any such claims for reimbursement being made — proof that physical therapists explain the nature of the care and profession fully to their patients.

To return to what Deputy McManus said on this matter, the ISCP commissioned a Millward Brown IMS poll. The idea was to find out whether people knew the difference between a physiotherapist and a physical therapist. The results showed that only one in three people surveyed knew that difference. The point was made as to whether people know the difference between a certified accountant and a chartered accountant or a podiatrist and chiropodist. I confess that in many cases I do not know the difference between all these professionals. Such confusion exists which I fully recognise.

With these differences having emerged over the past 15 years, we face the problem of how we should deal with this issue. We could consider a number of means. I do not know if changing names is possible. The potential for confusion could be minimised by the Irish Association of Physical Therapists and the Irish Society for Chartered Physiotherapists obliging their members to explain their agreed differences between physical therapy and physiotherapy to potential clients at their first consultation. It should be part of the legislation that the differences are made clear. This is what both branches of the professions would like to happen. It is clear that the professional qualifications required for physiotherapy are much higher than for physical therapy. I understand why physiotherapists might feel aggrieved that practitioners are coming in from the side and taking some of their business and that confusion has grown because they have acquired the name physical therapists. It is up to us for the sake of the patient to ensure the differences are clarified. It would not help to have one title for both therapies because there is no question but they are different. An amendment to this effect will be tabled on Committee Stage by Green Party.

As to the fees that can be claimed and reclaimed, members of the public can reclaim physiotherapy fees from the VHI and BUPA has said the position is under review.

Generally I welcome the Bill. Much discussion has taken place in the public arena about regulation and the term "nanny State" has been used. Clearly that has to do with regulation of personal behaviour. If anything there has been under-regulation of professions, organisations and institutions. There is much catching up to be done and this Bill attempts to do that.

I have been contacted about this matter by physiotherapists. While I do not wish to repeat the points made by previous speakers, there is a substantial difference between the two disciplines. It is obvious they have co-existed, albeit in different areas of specialty. A four-year degree course is required for one discipline while for the other discipline, according to the documentation, the course ranges from a part-time 40 weekend course to short distance learning without any clinical practice. Clearly there is a difference in the level of qualification required and what they do is quite different.

The Bill is intended to protect the public. The area about which I would be concerned is the confusion among the public in regard to the service they are getting. One in two in the over 65 age group said they did not know the difference between the two disciplines. That is a gigantic level of confusion and it cannot be ignored. In the younger age group the level of confusion is one in three. Very often these are people who are vulnerable. Often those over 55 take a professional qualification as an absolute guarantee of the service in which they are engaging. It is important the Bill regulates that area. That issue needs to be addressed during other Stages of the Bill.

The Bill draws attention to the fact that this is not the only area that requires regulation. Some ten or 12 areas are listed as requiring regulation while others are not listed — almost everyone can think of areas that are not listed. Given that it has taken a long time for the Bill to get to this stage it is fair to say the list is not complete. The longer the timeframe without regulation the more professions appear to emerge.

It is in the interest of the profession to maintain good professional standards but I am not certain that self-enforcement achieves that aim. One would imagine there would be a vested interest in maintaining good standards. There are plenty of examples where good standards have not resulted from self-enforcement. I will be interested to see what happens on Committee Stage in terms of adding to the Bill.

There are others who operate in the social care area who are not included in the Bill but should be included. The public is entitled to and has an expectation that it will be protected. There is much in the Bill that is good from that point of view. For example, the Bill makes it an offence to use the title of any registered practitioner as set out in the Act or as prescribed by regulation, and that is worthwhile. The problem is that if some professions are excluded it almost makes it worse for them. That is the reason the list needs to be complete as it provides some comfort and protection to the public. It is important also that standards are not just set but maintained. I would welcome the inclusion of education and training and discipline, albeit with the proviso that I am not an absolute fan of the mechanism of self-enforcement.

A plethora of people practise in the health care area in complementary and alternative medicine, some of whom provide services which people swear by and consider them wonderful. There are others who are chancers and prey on the vulnerable. It is important that issue is addressed and obviously regulation and legislation is needed. Sometimes people turn to complementary medicine and they need protection.

I am concerned about the perception of legislation such as this, worthwhile as it is. There is a perception that if one regulates for something, the service is there to be regulated. In many of the areas that will be regulated there will be those who will work in private practice. Similarly, there will be those who work for agencies such as the Health Service Executive. The expectation is that if one regulates for speech therapists, there are speech therapists. I can speak only of the experience in Kildare and I am fortunate that it will be readily understood by the Minister of State at the Department of Health and Children, Deputy Seán Power, who is present, given that we share the same region in terms of the Health Service Executive. The reality is that there are no speech therapists in the Kildare area, particularly for people with intellectual disabilities, even though that area was part of the old Eastern Regional Health Authority. The position is different in Dublin which is within the same Health Service Executive region.

It is fair for the public to ask if this regulation is an academic exercise and what use are regulations if a person has a child who requires speech therapy at a critical time and the service is not available, irrespective of whether it is regulated. A number of other professions are listed which fall within the same category. While the Bill is important it will create a perception that there will be movement on the services provided. There could be disappointment that this is an academic exercise for many who cannot avail of those services that are being regulated. I avail of this opportunity to make that point and use Kildare as the example.

I am grateful for the opportunity to speak on this Bill. There must be proper availability of professionals in the health service no matter what kind of register is in place. The ruination of the health service has been the lack of professionals needed to do the job adequately. The capacity in hospitals must be improved and there must be proper development of primary health care to ensure the people of this island have a proper health service. The news today is that Professor Drumm has finally agreed to take on the job. I wish him well. As someone working in the health service, I have no doubt Professor Drumm will have a very good indepth knowledge of the situation.

The Medical Council registers medical practitioners. As a GP I am registered with the council and I pay my subscription and health insurance. However, this Bill does not take into account the alternative medicine practitioners. I have spoken in the House on a number of occasions about the disgraceful situation in my locality. A lady whom I call a killer continues to practice unfettered. If I do something wrong I am liable to be struck off the medical register and I am insured so that my patients can sue me. This practitioner whom I call a killer as I did before, is still carrying out her trade and already two people have died through her utter negligence of their situation and the utter failure of the system to protect vulnerable people. This Bill does nothing to address this situation.

The Government has considered this for several years by means of a working group but I do not know what they are working at. It is clear there needs to be a proper recognition of the problems. Certain people are not subject to the laws of the land and not even subject to the Coroner's Court. They have been summoned on two occasions to the Coroner's Court. The coroner investigated the case of the death of a young man who left a wife and family. This woman is practising in my area, seeing children with various illnesses and giving them placebo drugs which are useless, homoeopathic type drugs, which after analysis by the State chemical laboratory have been proved to be just sugar. This continues and I regret the Bill does not address this disgraceful situation.

Nor will this Bill do anything for the people waiting for speech therapy and different types of services because the professionals are not available. This Bill will do nothing about the embargo the Government will deny exists. That embargo exists. The people who are needed such as the speech therapists, nurses and the consultants will not be hired because of the ceiling on recruitment.

I am familiar with the case of a man awaiting urology services who would be well capable of doing a day's work, but he cannot do anything because he must put up with the discomfort of a tube that he must carry with him day and night. That man must wait in the queue for urology services and compete with people who have been waiting since 1998 because such is the waiting time for urology services. The national treatment purchase fund is of no use to him because his problem had an acute onset. A 20-minute operation would sort this man's problem. He needs professional help but this Bill has nothing to offer him.

When will this man receive treatment? If I make inquiries I will be told he will be waiting for five years. Must this man carry a bag around with him for five years? Chemical analysis shows that he is pre-cancerous and if he is to wait any longer he will probably develop cancer. He may well not survive the cancer. I have seen many men who will not survive, whose life expectancy has been shortened and who will die an early death purely because they have been left on this urology list.

The answer is not to put services into the bigger hospitals and I hope Professor Drumm gets my message. The answer is to support the local services. When people criticise the Hanly report and its recommendation for centralisation, which is just the Fitzgerald report under another name, the Government asks if they have an alternative. The alternative is to support the local services and hospitals. Where there are consultants in Mayo General Hospital there are little or no waiting lists. Where there are no consultants the lists stretch back to 1998, which is a scandal. A urologist in Mayo General Hospital would enable that man to be treated and he would not have to endure many years of discomfort. He has to get up seven or eight times at night. This is something that happens to older men in particular but this is a younger man who should not be in this position.

There are many actions the Government could take to provide services at local level. Twelve trolleys are in use in Mayo General Hospital today because there are no available beds. Some people have been waiting up to five days on trolleys. I visited the accident and emergency department in Castlebar the other day. A 90-year old man was on a trolley with tears in his eyes. I asked him what the matter was. He said he was not feeling at all well and that it was his birthday that day. A young man had chest pains and should probably be treated in the intensive care unit but he was also on a trolley. Trolleys and people were everywhere. How could the staff do their work properly when there was not sufficient room even for them to move around, never mind treat a patient? The resuscitation room for use following serious traffic accidents is jammed full of people. I wonder what would happen in an emergency. The staff would not be able to cope. I am all in favour of the registration of professionals but the professionals should be there in the first place to allow them to be registered. I hope the Government will examine this situation in Mayo General Hospital, which is like Dante's "Inferno", pure hell, pure terror, pure chaos for people who have to deal with it. I pay tribute to the nurses and doctors working under very difficult conditions. I hope the Government gives them the support they need.

How is it possible to support people at home if the facilities are not provided? I refer to centres and homes for older people. When people need to convalesce they cannot return to their area because there is no place for them to go. I know of one situation in Ballinrobe where the land has been bought for many years. In County Mayo we are waiting for completion of the design stage of a home for older people in Ballinrobe, which would cost approximately €200,000. This is not a great deal of money but the centre would give people hope for the future.

Many current difficult situations could be easily sorted out. Proof that health apartheid exists is demonstrated in that people have been forced to march to Dublin to lobby for BreastCheck services for the south and west. There is much in this Bill but it should contain much more.

With the permission of the House, I wish to share time with my colleague, Deputy Devins.

I welcome the opportunity to speak on this Bill. The statutory registration of health care professionals is a necessary and welcome development from all points of view. It will benefit practitioners and the general public alike. I wish to respond to a point made by Deputy Catherine Murphy in her contribution with which I agree. The registration is but one aspect of this matter and I had intended returning to it during my remarks and I hope to do so.

Apart from registration, which is acutely important, yesterday's High Court judgment regarding autism highlights the need for ceilings to be lifted in the numbers of occupational and speech therapists being trained. Even more urgent is the need for relevant sectors to talk to each other. Independently the education and health sectors do significant work. However, Deputy Catherine Murphy has outlined the situation in Kildare and the same applies in my area. While there is considerable goodwill to provide services for children with autism it is proving quite intractable to get coherence in the provision of services between the Departments of Education and Science and Health and Children. Even with the enactment of the Bill we urgently need protocols so that what happened in the High Court yesterday does not continue to occur. Significant numbers of children with conditions across the autism spectrum are in need of support and the sooner those protocols are put in place the better.

The statutory registration will give recognition by an authorised body to all members of the relevant sectors and pronounce them as competent to practise within that line of work. By placing registration of the listed professions on a statutory footing, the Bill will give these professions the commendation they deserve. At present, only a handful of health care staff are subject to statutory regulation, including doctors, nurses, dentists, opticians and pharmacists. This new system will regulate the activities of a further 12 separate professions involving more than 11,500 people in the public sector and thousands more in the private sector. While I support the Bill as published, I take this opportunity to show how this may guide and direct us as we tackle some of the more contentious areas of the health care sector.

The legislative framework before us will allow for the appraisal and approval of education and training courses, examinations, qualifications and institutions, and ensuring the proper and timely development of education and training facilities. Improving quality in the health care system requires implementation of internationally recognised and evidence-based guidelines and protocols, and ongoing education and commitment from health care institutions and professionals.

An example of the need for coherence is in the service delivered by chiropodists. At least two organisations represent chiropodists with two avenues for qualification. In Dublin it is proving very difficult for medical card holders, particularly older ones, to get chiropody services. It is now common for chiropodists to charge a top-up fee of up to €15 in addition to the GMS fee paid by the Health Service Executive. Despite my attempts and those of many colleagues in the House to raise the matter in various ways, all I have ascertained from parliamentary questions is that the Department of Health and Children wrote to the HSE in January reminding it of its obligations in this area. While it may be a small and niggling matter in the context of the overall budget and service delivery of the Department of Health and Children, to the recipients of that service it is extremely important.

While I congratulate the Tánaiste and Minister for Health and Children on the proposal, I call on her to consider the number of college and training places compared with demand in these areas. For example, when I see that psychologists, social workers and social care workers are included on this list, the first thing that comes to mind is the dire need for increased staff and services for adolescents, particularly in counselling services, and for families, particularly in family conferencing facilities. When we consider the level of adolescent suicide or the increase in anti-social behaviour, this regulation should aim to improve services in this regard.

I again reiterate the urgency of providing greater numbers of places for those who wish to train as occupational and speech therapists. I also highlight the significant lack of provision of psychiatric services for adolescents, which is completely inadequate and needs to be addressed. We also need to address the issue of psychiatry for older people. The referral procedures are extraordinarily complicated. While I am sure these are appropriate and ethical, I know of a reclusive couple who everybody recognises are in need of psychiatric intervention. However, because no general practitioner referral has been made, the consultant psychiatrist for the HSE is not prepared to intervene in their case. These people live in appalling conditions. I have rarely if ever come across anything like it before. It is incumbent on the HSE to be able to direct professionals to intervene in serious cases of abject neglect such as this one.

I appeal to the Tánaiste the urge these new bodies to increase both the number of courses that give recognition to these professions and the number of courses that are approved to remove the cap on numbers taking these subjects. The legislation also allows for greater consistency in the application of EU directives concerned with the mutual recognition of third level qualifications. I know this has caused disruption in many of these professions and in many more. Therefore, by including it in this legislation, it will inform how best we can go about such recognition in other areas. While the mutual recognition of qualifications has been addressed reasonably well in the education profession, it has been dealt with unsatisfactorily in many others and some significant gaps need to be filled.

As outlined in the 2001 health strategy, gaining people's trust in a health system is about guaranteeing quality. Statutory registration such as this is in line with this goal as it guarantees that people receive proper treatment when they enter a particular practice. People want to know the service they receive meets approved and certified standards. This system will ease their legitimate concerns that they are visiting health professionals who are properly trained and competent to look after their ailments or injuries. Extending this statutory registration to other professions will increase the trust the public has in our health care system.

The Bill is also good for the professionals as regulation will protect their good name and reputation and allow them to stand over their titles. Established professionals are not afraid of being part of a regulatory system whereby they must uphold standards because that is what is meant by being a professional. Many realise that the good name and reputation of the majority can be damaged by the actions of a very small minority and that a profession can be brought into disrepute without a mechanism for sanctioning professional misconduct and misdemeanour. In this way, the Bill gives the professionals and the public protection from those working in specific health areas without any proper qualifications and from those who provide substandard or questionable services.

Extending this system to other areas will provide the same protection. For example, we are all aware of the tragic death of a Limerick woman earlier this year following plastic surgery in New York at the hands of someone who was under investigation for negligence at that time. We all want to ensure that such tragedies are prevented and, by ensuring that all major health care professions are adequately trained and regulated, we can achieve this. I also note what Deputy Cowley said about people in the non-medical area.

A proper registration system gives the public and the professions increased protection because it allows for the investigation of allegations of misconduct or incompetence. Any complaints can be followed up and rectified and in an extreme case a person's name can be erased from the register.

Debate adjourned.