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

I move amendment No.1:

In page 9, between lines 5 and 6, to insert the following:

"(a) chiropractor;”.

This amendment seeks to amend section 4 on page 9 of the Bill as presented by inserting in the alphabetical list of designated health or social care professions chiropractor, immediately before clinical biochemist, dietitian and medical scientist. Professions following chiropractor would be designated by the following letter so that, for example, speech and language therapist would become designated profession (m).

In making the case for the inclusion of chiropracty as a designated profession I have to inform the House that I visited a chiropractor in the early years of my election to this House and acknowledge the professional service and advice I was given. It is important that chiropracty is properly regulated in this jurisdiction. The situation on the island of Ireland whereby chiropracty is regulated north of the Border, as it is in the neighbouring island, but not south of the Border is unacceptable. We may be the only country in western Europe that has not moved to have chiropracty registered as a profession in the sense and context of this legislation. As this legislation is primarily geared toward public protection, it is important that chiropracty is included. Open borders in Europe allow people to practice here as chiropractors without the qualifications required in another jurisdiction. I have been informed, as other Deputies have, that there is concern within the profession that those struck off in other jurisdictions where registration is a requirement, find no difficulty setting up in this jurisdiction and advertising as practising chiropractors, leaving the public vulnerable to people with dubious records. In order to protect our communities and citizens it is incumbent on us to ensure that the highest standards not only apply but are enforceable. If the Bill passes without the inclusion of chiropracty we will have failed in the fundamental objective of the legislation.

We must aim for best practice and the highest standards. The only way to achieve that is to give those involved in chiropracty the recognition and public confidence that a common standard provides by adopting this amendment. I note from correspondence that there are some 150,000 registered chiropractors globally. I do not know the number practising in Ireland but it is growing. In small rural locations such as my own there are now practitioners in the high street. It is important to ensure this large number of practitioners is recognised. There is a duty on Government, on the Minister of State and the Minister for Health and Children to adopt the amendment.

The wider issues raised by the Deputy are hugely important. The Bill shows the way forward by establishing a framework for the statutory registration of health and social care professionals. However, the 12 professions listed in section 4 (1) were selected because they are long-established providers of health and social care within the health service and have in most cases experience of self-regulation. In addition the qualifications of the majority of these professions are currently regulated within the public health service by being declared by the Minister under the Health Act 1970. This is not the case for chiropractors as they are not a public health service grade.

As Deputies are aware section 4 also provides for the inclusion, by regulation, of additional professions in the proposed system of statutory registration. This section sets out the criteria to which the Minister shall have regard in considering the designation of further professions under this legislation. These include the degree of risk to health, safety or welfare from the incompetent, mythical or impaired practice of the professions. They also include the extent to which a profession has a defined scope of practice and applies a distinct body of knowledge, and the extent to which the profession has established itself, requiring at least one professional body representing a significant proportion of the profession's practitioners. In addition, it includes the existence of defined routes of entry into the profession and of independently assessed entry qualifications. The future inclusion of any profession is dependent on its meeting these criteria.

The framework established by this Bill offers greatly enhanced protection for the public. The Tánaiste has made it clear she favours the programmed and orderly inclusion of additional health and social care professionals in the new statutory framework and she will consider the case for chiropractors in this light. I cannot accept this amendment.

I am disappointed the Minister of State cannot do so. I speak not only as somebody who has been lobbied by people personally interested but as somebody who has used the services of a chiropractor and who knows many others who have done so. The numbers who gravitate to the services of chiropractors in Ireland must be significant because chiropractors are mushrooming all over the country. I welcome that fact but they must be encouraged to develop in an environment of best regulation and highest standards. Public confidence is hugely important and it is not satisfactory that the public must base its judgment as to the appropriateness of a service on the latest report, be it a good report or, God forbid, a damaging report. We must ensure those who present themselves as chiropractors offer the highest standards of qualification applying within the profession in terms of the services provided.

I have noted section 4(2) of the legislation which was referred to by the Minister of State. It states: "After consulting the Council, the Minister may, by regulation, designate for the purposes of this Act any health or social care profession not already designated undersubsection (1)”. This is the area that has been specified by the Minister of State.

I am a resident living close to the Border which in reality is open to me and my fellow community members who traverse back and forth for commerce, social life and cultural activities and a variety of services, including chiropractic services. Perhaps people will not travel greater distances, but this is unfair and unacceptable for residents in Border communities. To us, the Border is not so much an impediment in going back and forth but a reality in many other ways. Those who choose to go to a chiropractor north of the Border do so with greater guarantees and assurance in respect of the service received, as opposed to those of us who may choose to avail of the service offered by a practitioner on this side of the Border, simply because of the registration requirement, the due recognition given and the setting of the highest possible standards for a health or social care profession.

Health is one of the areas designated for co-operation. There is already in place a raft of co-operative initiatives on health care delivery with the six Northern counties. Surely anomalies such as this should not continue. One would expect this issue to be addressed more effectively. While I have heard the Minister of State's comments, I press him to confirm that chiropracty will come under section 4(2) of the Bill. The House deserves this assurance at least, but I still urge the Minister of State to reconsider the inclusion of chiropractors in the list of designated professions in section 4(1).

I take on board Deputy Ó Caoláin's comments. It is unfortunate that he represents a constituency adjacent to the northern section of the country. We must, however, be mindful of the position in the whole country. We considered all professions and the 12 to be included initially are the ones it is agreed should be registered. The Deputy will realise from what I have stated that there will be an opportunity for chiropractors to be included under section 4(2) of the Bill. I remind him that many chiropractors are already registered doctors in the State, although I do not know the percentage or actual number. These registered medical practitioners specialise in chiropracty. I am aware of what the Deputy described, that is, that chiropractors are registered in the United Kingdom. This causes a dilemma but I hope the matter will be sorted out in the near future when the legislation is passed.

I do not view myself as unfortunate in representing the people of Cavan and Monaghan.

I did not mean it in that fashion.

As the Minister of State's own colleague, Deputy Devins, might state, I am very proud to represent the Border constituency of Cavan and Monaghan.

The Deputy is taking my statement out of context.

I wanted to reassure the Minister of State should the Official Report be read out of context.

The Minister of State commented that one had to be mindful of the entire jurisdiction. As a Border resident, I argue that our reality must therefore be taken into account. I made a point about the special circumstances in which we live, but in taking the interests of everyone in this jurisdiction into account one must point to the need for greater regulation and the official designation of chiropracty which is in the interests of every citizen. If the Minister of State is not in the position to accede to my request today, I hope the arguments will be taken on board and that chiropracty will be designated under section 4(2) of the Bill following the Government's acceptance of the sound arguments for why it should be so.

I support Deputy Ó Caoláin's comments.

Amendment put and declared lost.

I move amendment No. 2:

In page 9, line 11, after "physiotherapist" to insert "or physical therapist".

With regard to the previous amendment, will the Minister of State and the Department prepare packs in plain English for those professions which wish to be included under this legislation? The required criteria under section 4 might be outlined. This is a matter for the future and need not be dealt with now.

Amendment No. 2 deals with the issue of physiotherapists and physical therapists. When it was discussed on Committee Stage, we were made aware towards the end of our deliberations that there had been ongoing contacts between the Department of Health and Children and organisations representing physiotherapists and physical therapists. We were told at the time that the issue would be resolved by the time the Bill was taken on Report Stage in the Dáil. Rather than revisiting the arguments made on Committee Stage, I give the Minister of State the opportunity to tell us how the negotiations have fared and if the issue can now be dealt with before further remarks are made.

I ask the Minister of State what has occurred with regard to this knotty issue. I have much sympathy with physical therapists whose concerns are valid. Nonetheless, there is a difficulty in terms of the international nomenclature of physical therapists. This matter could have been dealt with before the Bill was published rather than at this late stage, but I see no indication that it has been resolved. Will the Minister of State clear up the mystery?

With regard to resolving the issue between physiotherapists and physical therapists, it was thought that there was a possibility of a resolution. Discussions have taken place between the Department and both professional bodies. My understanding is that it is highly unlikely there will be agreement between both parties.

I spoke to Deputy Twomey earlier about this matter. I have been a Member of this House longer than him but he appears to have adopted a wiser approach on this issue. He did not meet either side. It appears to be an intractable problem or a zero sum game.

On Committee Stage the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, stated negotiations would take place and a compromise could be reached. It appears to me, from discussions with physiotherapists, that they are not trying to play down physical therapists. The great loser could be the school of physical therapy. If negotiations continue, I hope a solution can be found because clearly the terms "physiotherapy" and "physical therapy" are interchangeable in other countries. However, there is a distinction in this country. I hope the Minister of State will continue to seek a solution, although I do not know whether that is possible. I had hoped one would have been reached before this evening's debate. While I understand the Minister of State's position and I am quite sympathetic, given that these difficulties continue, I will support the Opposition amendment. At this point it would probably be the clearest way to proceed.

I support amendment No. 2 in the names of Deputies Twomey and McManus. In the absence of a resolution of this long-standing dispute in respect of descriptions, the difficulties are only deepened by not recognising physical therapists and only making reference to physiotherapists. I appreciate the difference. In the absence of a resolution it is imperative not to proceed with legislation which excludes one group. I support the amendment as it would offer, at least for now, a position where both would be recorded. I hope this would allow for a level playing field in the further and future redress of the outstanding difficulties which clearly must be resolved, preferably sooner rather than later.

I find it unusual that this legislation has found its way back before the House because this was the most significant issue with which I was obliged to deal in the lead up to its passage. A massive amount of correspondence arose from it and I am sure it was the same for every other Member. I am surprised the Bill has returned to the House on Report Stage as on Committee Stage it was made quite clear that the Department would do all in its power to try to resolve this issue before it reached this point. We will be left with a situation where no side will be happy with the outcome. This is unusual.

When we come to the next amendment, Members will find this is not the only section of which this is true. As far as physical therapists and physiotherapists are concerned, Members will be aware that the issue which has consistently attracted attention during the passage of the Bill through the Oireachtas is that of the protection of title "physical therapist". The Bill specifies a single primary title by which each designated profession will be known under the Bill. This is in line with the drafting advice received. In view of the debate on Committee Stage, it will be helpful to elaborate on the reasons this approach has been taken.

There is more than one sound reason for avoiding the use of alternative expressions in the Bill for the same profession. For example, certain presumptions apply when courts interpret legislation, one of which is the presumption of consistent expression whereby the Legislature is presumed to have avoided stylistic variation, that is, the same words have the same meaning and different words have different meaning. The courts also presume that the Legislature avoids superfluous or meaningless words and does not repeat itself. Every word is presumed to have a specific role to play in advancing the purpose of a statute. Superfluous words can lead to problems of interpretation and to courts striving, in unforeseen circumstances, to give a meaning that was never anticipated when a statute was enacted.

A third reason for avoiding the use of more than one term for any profession is consistency of approach, or parallelism with the treatment of other professions designated under the Bill. If more than one title was to be protected under the primary legislation for any profession, it would be necessary to take the same approach with every other profession. As far as the professions included in the Bill are concerned, there are a number of alternative or variant titles reflecting, for example, specialisms within them. Thus, the title "radiographer" encompasses both diagnostic radiographers and radiation therapists. Variants also encompass titles used in other countries such as speech and language pathologist rather than speech and language therapist or clinical nutritionist rather than dietician. The word "dietician" can be spelled in two ways. Undoubtedly, it would be confusing for everyone if the primary legislation was used to specify several titles for individual professions, not least the public. That is why the issue of multiple titles is tackled in the legislation through empowering the Minister to protect by regulation variants of the primary title by which those practitioners registered with a registration board of a designated profession are known. As Members are aware, it will be an offence for an unregistered practitioner to use a title protected either under the primary legislation or by regulation.

Under section 95(3), the Minister can protect variants of the primary title for all of the professions following consultation with the relevant registration board and any organisations that he or she considers appropriate. An important feature of this process is set out in section 95(7) which provides that a draft of a regulation to be made by the Minister protecting additional titles must be laid before the Houses of the Oireachtas and that a resolution approving the draft must be passed by each House. This allows each case to be examined on its merits, balancing such factors as protection of the public and the promotion of competition. This is the best and most appropriate way to protect any title that warrants protection.

As far as the physiotherapy profession is concerned, the title protected under the Bill is "physiotherapist". However, the Irish Society of Chartered Physiotherapists also wishes to have the title "physical therapist" protected for the exclusive use of those professionals registered with the physiotherapists registration board to be established under the Bill. The society considers both titles to be interchangeable in an international context and believes there is a risk of confusion among the public if the title "physical therapist" is not protected for use by physiotherapists. However, members of the Irish Association of Physical Therapists who currently use the title in this country have argued against such protection and wish to retain the title for their own use.

Clearly, this is a complex issue to which Members have given considerable attention. The Tánaiste and Minister for Health and Children is of the view that matters must be resolved in a timely way. The way forward is to deal with protection of title issues by regulation as provided for in the Bill. In line with the provisions of section 95(3), the Tánaiste intends to consult the proposed physiotherapists registration board on its establishment and any organisations she considers appropriate on prescribing the title "physical therapist" for use by registrants of the physiotherapy profession. She expects to make an early decision in the matter. Therefore, I do not propose to accept the amendment.

I welcome the Minister of State's statement. As previous speakers noted, this issue was discussedad nauseam on Committee Stage and obviously there are many strongly held views on the matter. It is most important that the public is protected. What timespan after the Bill’s passage does the Minister of State envisage before the Tánaiste will be in a position to make a decision on this important issue?

I do not have——

The Minister of State has already spoken twice on this amendment.

Amendment put and declared lost.

I move amendment No. 3:

In page 9, line 20, after "(1),” to insert the following:

"and in particular shall, within the period of 12 months from the passing of this Act, so designate the profession of counsellor or therapist,".

Will the Minister of State accept this amendment? I am sure he is aware that thousands of people attend counsellors, therapists and psychotherapists for a range of issues and needs. Some people have been in therapy for many years. Many are vulnerable, perhaps going through crises in their lives and need expert and professional support, for which they turn to counsellors or therapists. Regrettably, it is easy for a person to set up as a counsellor in Ireland. There is a wide range of standards in terms of the type of counsellors people go to.

When the Ferns report was published, I was struck by the fact that one of the criticisms made of the health board was that it did not provide counselling for the little girls of Monageer national school. The board should have provided it but the question in the context of this Bill is what guarantee have we that counselling to such a vulnerable group of children is of the proper standard if there is no formal regulation? This question must be answered. People may have degrees in psychology, which is at least some level of professional standard, but not every psychologist is a good or appropriate therapist while there are many excellent therapists who are not psychologists. We need regulation of this area.

We could argue about people with bad feet or bunions getting professional treatment, which should be the case, but we have a duty to protect an abuse victim with a damaged psyche from meddling by people who guide and direct in a way they believe is appropriate simply because they have set themselves up as counsellors and therapists, done courses or may have strange ideas about what a counsellor or therapist is. It is a central and essential discipline. If we ignore it, we are leaving many people at risk. I would have believed that the Minister of State, who is not listening to a word I am saying, would consider this a primary duty.

It is interesting that the Minister for State at the Department of Education and Science with special responsibility for children, Deputy Brian Lenihan, is also here tonight, for is this not a matter for him? I will not start all over again. In terms of counselling and therapy for young people and adults and when we are dealing with emotional needs as opposed to physical needs, do we not need to ensure standards are set and regulations are in place for this area of treatment and professionalism or absent professionalism?

I second the amendment and echo Deputy McManus's comments. The amendment recognises the difficulties surrounding the area of regulating counsellors and therapists in that it allows a period of 12 months to elapse before the present and totally unacceptable situation is regularised. It gives space to do so and does not insist the situation should be corrected as of now. I have been of the opinion for some time that there is a need to establish a national competent authority to regulate the area of psychotherapy and counselling. The State must ensure that those who offer a service for a fee and have the trust of service users have recognised competencies coming from approved training programmes. I further believe that those who do not have such training should not be allowed to operate.

Psychotherapy and counselling have important roles to play in many areas of life. In respect of mental illness, it is repeatedly highlighted that multidisciplinary community based psychiatric teams, including psychoanalysts and counsellors, is the accepted formula for delivering services but such teams are sadly lacking. There is ignorance and not a little confusion among the general public as to what psychotherapy and counselling are and what the difference is. This is compounded by the fact that there are over an estimated 400 different named therapies, which are used to tackle many medical and social problems, including marriage and family difficulties, anxiety, depression, addiction, sexual abuse, rape, psycho-sexual difficulties, eating disorders, bereavement, adolescent difficulties, AIDS, HIV and many more. In other medical professions, there is a requirement for a basic qualification in medicine and professionals continue to specialise.

A rhetorical question is are there 400 specialist qualifications in psychotherapy or counselling? The absence of clear roles and dedicated skills for those roles fuels confusion and the absence of regulation allows for a situation where many calling themselves counsellors in the community and private practice do not warrant professional recognition. One does not need a recognised qualification or skill base to call oneself a psychoanalyst or counsellor. All that is required are premises, a gold plaque outside the door and the neck to charge a fee.

There are no means to monitor the present unregulated situation and the opportunity for untrained people acting as psychotherapists or counsellors to do damage is frightening. Vulnerable people in crises who need professional help can be destroyed. This situation has been exposed by some practising alternative medicines where people have been duped out of life savings. Is the same happening in the area of psychotherapy and counselling? It is not alarmist to assume there are instances of it. How much is there and what damage is being done? The stigma that persists in respect of mental, emotional and personal problems prevent the exposure of these issues. Those damaged in such a way may not be in a position to recognise their abuse. Do those who are severely damaged die by suicide? There are no psychological autopsies on those who die by suicide. I am convinced of the need to do such autopsies to determine the psychological difficulties and where the services failed. Such information made available without identifying the victim is vital for research into why so many take their lives and is invaluable in formulating suicide prevention programmes.

Clients, often in severe distress, make major investments in therapy and have a right to know that the therapy they are engaged in is safe and effective. For this reason, the development of practice standards for accreditation and training is essential. The recent report of the working group on the role of psychotherapy within the health service states the requirements of the various accrediting bodies can differ significantly. The situation is problematic as, given the lack of clarity regarding agreed criteria for training and qualifications, both the health service as an employer and the general public have difficulty in making judgments as to the equivalence of one qualification against another. This is why confusion arises and Deputy McManus's amendment, which would give 12 months and space to all those concerned, including the Government, aims to correct the situation. The professional group strengthened its regulation arrangements. The Government's position, through not accepting this amendment, is to stay on the fence until the various professional groups strengthen their regulation arrangements. I accept they have an onus to do so as a matter of urgency and appreciate that is the Minister of State's difficulty. However, they should have 12 months to do so. If there is no will to do so within that time, the Government must move towards statutory regulation. Only five professions are subject to this, medicine, dentistry, nursing, optometry and pharmacy. As the Minister of State pointed out, there can be only one registration board per professional grouping. A difficulty arises in conferring powers of statutory registration on a professional body where more than one body represents the profession, as is the position in the case of counselling and therapy.

We should strongly urge the groups to come to a consensus, which is lacking, on basic definitions, training and accreditation. The professional bodies have a responsibility to ensure the public can have the same confidence in the professionalism of psychotherapists and counsellors as they do in doctors, dentists and pharmacists. This would enable them to supervise the delivery of a safe, high quality service to clients. The role of supervision is becoming increasingly valuable as it enables professionals to maintain good standards of practice and to develop responsive services to meet the needs of clients. Supervision also has a key function in fulfilling an employer's duty of care to staff under the Safety, Health and Welfare at Work Act 1989, as employers may not be covered under the Act if employees are not qualified.

By accepting Deputy McManus's amendment the Minister of State would accept that there is a difficulty and challenge for the four bodies to come to an agreement within the next 12 months on the criteria for membership of their organisations. The ideal way to do so would be through amalgamating the organisations. If that cannot occur, the organisations should come to an understanding on the criteria, training and qualifications required to ensure those who provide counselling and psychotherapy services have the necessary skills and qualifications. That would also ensure those whom we and medical professionals advise to go to counsellors and those whom psychiatric professionals advise to go to psychotherapists can be confident that persons calling themselves psychotherapists and counsellors are at a level and standard to meet the criteria acceptable under the Bill.

I listened intently to what Deputies McManus and Neville stated. I met organisations representing counsellors and psychotherapists. Four groups are involved and they hope to meet in the near future to see if they can come to a general consensus on entry criteria. I do not know whether they will be able to do so. The concern of Deputies for the inclusion of counsellors and psychotherapists in the system of statutory registration being established has been made clear throughout the passage of the Bill. We are all conscious that the provision of counselling and psychotherapy services has increased in recent years and agreed on the need for people to be confident that a counsellor or psychotherapist is qualified, competent and fit to practice.

I have already mentioned that section 4 of the Bill provides for the inclusion by regulation of additional professions in the proposed system of statutory registration. This section also sets out the criteria to which the Minister shall have regard in considering the designation of further professions under the legislation. These criteria include the extent to which the profession has a defined scope of practice and applies a distinct body of knowledge; the extent to which the profession is established, including whether at least one professional body represents a significant proportion of the profession's practitioners; and the existence of defined routes of entry into the profession and of independently assessed entry qualifications. The various professional groups representing psychotherapists and counsellors have been encouraged to prepare for statutory registration by working to explore a common understanding on baseline qualifications and scope of practice. I also hope to see a further strengthening of their voluntary regulation arrangements.

As indicated on Committee Stage, a working group was established to examine the role of psychotherapy in the health service in order to assess requirements for the future. The working group's report has been finalised and I expect the next step will be to put in place an action plan for progressing the issues. This will include a further exploration of issues relating to the development of an appropriate model of service. The outcome of this work, together with the work that must be done by the representative professional groups, will form part of the formal process required in line with the provisions for the designation of further professions as set out under section 4. For the reasons outlined, I cannot accept the amendment.

It is clear there is no disagreement between the Government and ourselves on the principle. What is at issue is the timeframe which the Minister of State must consider further. Seven or eight years, or perhaps longer, have passed since the proposal was made to designate these professions. That length of time should inform us of the need to set down a certain framework. Deputy Neville expressed more comprehensively than I the concerns about the influence counsellors and therapists have. Many have a benign influence and it is beneficial and healthy. However, there is great concern about the fact that the influence of poorly trained individuals or persons with an agenda can be malign. I do not want to exaggerate in any way. One must consider that those seeking this help are often extremely vulnerable. They have emotional needs, trauma and distress in their lives and are seeking help. At the very least, the Government owes a duty of care to recognise the mushrooming in the provision of therapy services and ensure certain accreditation and standards apply. However, it should not be left open-ended.

If I have a sore neck and go to somebody who is not good at his or her job, all that will happen is that I will continue to have a sore neck. Going with a damaged psyche to somebody who is not good at his or her job can have a far more problematic outcome in terms of trust and dealing with the client's problems in a way that is healthy and appropriate. I am not at all comforted by the approach of the Government which involves stating there is a problem, not putting in place a timeframe, hoping the hundreds of people of varying standards and training will come forward with the solution and leaving the matter open-ended. Of course, we must consult them and ensure they play a role. However, I ask the Minister of State to accept that he is required to set a timeframe as otherwise it may take another eight or ten years to do so. At least, there is a professional body for psychotherapy, although it took this length of time to reach that point.

How much longer will it take to arrive at the point where anyone attending a therapist or a counsellor can be secure in the knowledge that the State has ensured the standard of that person's training is appropriate to a client's needs, at the very least?

I do not wish to delay the House but I understand exactly what Ms McManus means. I will meet all the groups. The expert group examining the whole mental health area will also have a view on this issue. I share the concerns expressed by both Deputies about the lack of standardisation of qualifications. I assure the House that as the Minister of State with responsibility for mental health I foresee a significantly enhanced role for both counsellors and psychotherapists in the area of mental health. I assure the Deputies it will not take years but it would be preferable if base line criteria could be assembled on a voluntary basis by those involved. If voluntary agreement among the various organisations is not possible, I assure the House that the Tánaiste and I will expedite this process.

Amendment put and declared lost.

I move amendment No. 4:

In page 11, after line 40, to insert the following:

"(e) make professional awards at certificate level of qualifications for health and social care professionals,”.

This issue was raised by the body being abolished under this Act. The university social work education providers have pointed out that with the abolition of the NSWQB under Part 8 of the Bill there is no provision to continue the existing power to award the national social work qualification award.

The amendment tabled by Deputy McManus proposes to allow the council to make professional awards at certificate level of qualifications for health and social care professionals. I believe the Deputy is referring to the awards currently granted by the National Social Work Qualifications Board. Deputies will be aware that this board is being subsumed into the council under the legislation. It should be noted that under the Bill the registration boards generally will have the responsibility for education and training issues and will accredit courses appropriately. Accordingly, the matter is already dealt with in the legislation.

The continuity of the work and contribution of the National Social Work and Qualifications Board to professional development will be maintained and the experience and knowledge of the board in addressing many of the responsibilities that will in future fall to the council will be fully transferred.

I am very impressed that the Minister of State has such intimate knowledge of this board but I cannot say I share it. I will withdraw my amendment.

Amendment, by leave, withdrawn.

Amendments Nos. 5, 6 and 22, are related and may be discussed together.

I move amendment No. 5:

In page 12, lines 27 and 28, to delete all words from and including "all" in line 27 down to and including "section" in line 28 and substitute the following:

"not less than 40 per cent of whom shall be women and not less than 40 per cent men, appointed by the Minister following a process of public advertisement for the positions, assessment of candidates based on published criteria of qualification and interviews".

I calculate from the text of the legislation as presented that the council will have 24 or 25 members. It is unclear to me whether the Chair will be one of the 24 members to be appointed, 12 from the designated professions and 12 from a variety of other sources, three of whom will represent management of the public health sector, management of a voluntary or private sector organisation and representative of third level educational establishments involved in the education and training of persons in the practice of the designated professions. Nine others will be appointed by the Minister. Representatives of the interests of the general public are to be appointed with the consent of the Minister for Enterprise, Trade and Employment.

In 1991, Government guidelines were put in place to implement the recommendations of the Second Commission on the Status of Women. These guidelines require that Ministers and Departments ensure that 40% of those nominated to State boards and State-appointed bodies should be women.

My amendment seeks to ensure this is lived up to or at least, worked towards. Women are clearly under-represented on State bodies. The Taoiseach and other members of the current Government have acknowledged this on many occasions. Nothing will ever be done about it unless the intent is enshrined in the specific legislation regarding these bodies. The health and social care professionals council provides another opportunity. My appeal to the Minister of State is to recognise that women are under-represented on State bodies. I ask him to accept this amendment and ensure at least 40% participation by women on this important council. I would wish to see more women than that number involved but as that is the position already agreed to by Government in 1991 as the guideline to be met, I hope the Minister of State will accede to its inclusion in the Bill.

Women are even less well represented on private boards and bodies and in senior management. The responsibility on the State to give the lead and to demonstrate what society wishes to see is therefore all the greater. This is one area in which Government can impact and facilitate.

The second part of my amendment deals with the method of appointment of the members to the health and social care professions council. The basis of this argument is to ensure greater transparency in the appointment. I have raised this matter with the Taoiseach many times and I cannot explain the reluctance to open up access to State boards and other State-appointed bodies to the wider public. Why must it be that somebody must know somebody else which leaves the Government open to accusation of jobs for the boys and fewer jobs for the girls? We want every citizen to have a right of access if they have the required expertise, experience and that they meet the criteria and have the qualifications laid down.

This is exactly what the Government is doing. The Deputy has walked into this one.

If the Minister of State can prove to me ——

The single transferable speech does not work on this one. The Deputy should read the Bill.

Order, please. The Minister of State will have an opportunity to reply.

——that what I have argued for in amendment No. 5 is provided for in the Bill, I will be most happy. However, this does not appear to be the case. In order to ensure it is open to every citizen, the position should be publicly advertised so that the most suitable people can compete and be considered. There should be a clear understanding of the requirements regarding qualification. This is a very reasonable proposition. I look forward to the Minister of State's response because he is biting at the bit to get going like a greyhound at Shelbourne Park. I will listen to what he has to say in reply and if he satisfies what I am trying to achieve, I will be the first to welcome it.

On behalf of Deputy McManus, I express support for Deputy Ó Caoláin's position on gender balance, a concept the Labour Party also proposes to introduce in amendments Nos. 6 and 22, one of which relates to the registration boards while the other relates to the council. My party's position on gender balance has been well known for a long time.

I hope the Minister of State will accept the amendments, particularly given that other Ministers have accepted similar amendments seeking gender balance in other legislation. It is particularly important that we ensure an appropriate balance between men and women on the registration boards. I note from section 9(3)(b)(iv) that nine members of the board will be representative of the interests of the general public, while the other three members will represent other interests. Ensuring that at least 40% of members will be women and 40% men should, therefore, present no logistical difficulties.

When my Limerick East constituency colleague, the Minister for Defence, Deputy O'Dea, served as Minister of State with responsibility for equality, he suggested that gender balance on boards could be made a statutory requirement if it was not achieved voluntarily by Government Ministers and Departments. Unfortunately, he did not implement this suggestion even though the statistics show that a large majority of members of boards and councils established by Ministers do not have a reasonable gender balance. I assume the Minister will have no difficulty providing for gender balance in the legislation given that it is supposed to be Government policy.

I support the amendments. The Minister of State indicated that the provisions of the Bill, as drafted, are satisfactory in this regard. Since I entered the House, the need for gender balance has been discussedad nauseam but progress on the issue has been minimal. The Minister of State has an opportunity to make his mark. I hope his indication that the Bill includes positive provisions which would satisfy the requirement for gender balance will be borne out when he responds.

The Government fully supports the thinking behind the amendments which are consistent with its general policy. While it is desirable that membership of both the council and the different registration boards be gender balanced, the Minister cannot accept the amendments. Deputy Ó Caoláin walked into the trap when he made the single transferable part of his speech concerning jobs for the boys because there is no question of jobs for the boys or girls under the legislation which envisages appointment by the Minister following election by members of individual professions.

The amendments purport to require the Minister to direct the course of an election and individual voters' preferences. Perhaps this issue should be addressed in the House but we would first have to give a good example by requiring that two seats in every four seat constituency, one seat in every three seat constituency or two or three seats in every five seat constituency be reserved for females. If the Deputy were willing to advance that proposition, the House could lead by example, after which it could legislate accordingly for the various professions covered by this Bill.

As Deputies are well aware, the Fianna Fáil Party has taken an initiative on gender balance by providing in its internal constitution at the recent Ard-Fheis that there be full balance. No doubt, having given the lead, other parties will follow Fianna Fáil.

The Green Party introduced gender balance years ago. Fianna Fáil is 15 years behind the times.

I appeal to Deputies to examine the precise terms of section 9 which provides that the council will comprise a chairperson and ordinary members appointed by the Minister. The concept of appointment by the Minister which the amendments tabled by Deputies Ó Caoláin and McManus seek to change is highly qualified by the subsequent provisions of the section. For example, subsection (3) provides that in the case of the council one person is to be appointed for each designated profession and he or she must be "an elected member of the registration board of the designated profession" and be "nominated by that board for appointment to the Council". The Minister cannot direct the registration boards to appoint a particular person or prescribe gender quotas for them, as the Deputies opposite have urged. This would be a far-reaching intervention by the Minister into the proceedings of a board which will enjoy some measure of autonomy as well as statutory guidance under this legislation.

It is true, however, that a further 12 persons must be appointed by the Minister under subsection (3)(b). Again, however, great care is taken in the legislation to designate exactly the qualification of the persons in question. Deputy Ó Caoláin referred to jobs for the boys and argued that every citizen should have the right to be considered for such appointment. Under the legislation, it is the right of every qualified citizen to be considered for appointment to the council.

The council contains the representatives of the boards as well as the other appointees of the Minister appointed under exact statutory standards. Section 28 includes basic provisions on the registration boards which will perform a fundamental role with regard to each profession. The section also provides that the Minister shall appoint members to the boards. Deputy McManus has been consistent and tabled an amendment seeking to amend the provisions on membership of the registration boards, whereas Deputy Ó Caoláin has not tabled such an amendment. Deputy McManus, in the spirit of amendments Nos. 5 and 6, is procedurally correct to table an amendment to section 28. Her amendment proposes to prescribe a female quota of 40% for ministerial appointees. However, as an examination of the section reveals, the Minister's discretion is quickly exhausted by the detailed provisions regarding the appointment. Six persons are appointed by the Minister on their election by the registrants of the professions. For the House to amend the section in the manner proposed by Deputy McManus would empower the Minister to direct voters, described in the legislation as registrants or members of the profession, to elect a 40% female quota, irrespective of their preferences. Deputies on the other side are advancing a far-reaching proposition, as is their right, but this Bill is not the context in which this question should be raised. If an example is to be given in a matter of this nature, it must be done through the Constitution.

With regard to the board, although seven particular appointments are left to the Minister, again these are carefully designated. Four of them are to be representative of the public interest, while the other three are to be representative of particular disciplines and possess particular expertise. Again, there is no question that these provisions amount to some kind of charter for discretionary ministerial appointments and, in fact, the legislation is carefully circumscribed. It should be noted that many of the professions to be regulated under the Bill are predominately female. It could be argued, therefore, that the composition of the council and registration boards must reflect to some extent the gender composition of the professions represented. An issue may arise regarding male representation in the context of several of the registration boards.

I assure the House that in the general making of appointments to bodies the Tánaiste and Minister for Health and Children will have close cognisance of Government policy in regard to the need for gender balance. On the issue of appointing persons to the council it should be noted that 12 members of the council will be elected representatives of the respective registration boards who have been nominated by the board for appointment. The Minister's power of appointment is, therefore, purely a formality in this context and cannot be burdened with a statutory duty to insist upon a particular gender qualification.

The Minister of State has hardly satisfied his earlier claim by interruption. If anything, he has spent his time telling us why the Minister cannot accede to the thrust of the amendment. With all respect to the Minister of State, if you had paid a little more attention to the detail of the legislation before being deputised this evening, you would have known that the Minister is in charge of 12 further appointments, nine of which are drawn from the general public. They will be picked as the Minister decides. My point is absolutely valid.

I am sorry, but you did not seek to amend that provision, so I do not need to take that kind of cheek from you.

I beg your pardon, but——

Order, please. Members should direct their comments through the Chair.

The reason was clearly his facility to espouse——

You did not——

I did not interrupt you once, and you should at least have the manners to be quiet——

You need not patronise me in this House.

——when I am responding to you.

Through the Chair, please.

You can call it"patronising" or whatever you like. Quite frankly, I am not the least bit intimidated by the Minister of State or any of his colleagues.

No one is seeking to intimidate the Deputy.

I use my right to speak here——

He has an absolute right to do so.

——and the Minister of State can either sit there and listen or leave, whichever is his desire. I am sure that it will not matter one way or the other.

Let us return to the amendment.

It does matter.

The Minister of State has already determined his responses in this regard. The fact is that the Minister has the opportunity to appoint nine representatives to represent the interests of the general public, quite apart from the other three, something that I pointed out when I originally moved the amendment. These are the words I used very carefully and clearly in proposing the amendment. This allows the Minister to try to ensure that we achieve a guaranteed quota of 40% women on this council. I would be delighted if it proved the case, as the Minister of State suggests it might, that a greater number of women were appointed; I also stated that when I introduced this amendment. Therefore, we are making the point that at least 40% should be men. It is balanced regarding what can — and, one hopes, will — be achieved.

There is more to the situation than just that, and that is the reason my amendment goes further. Let us make no mistake. I did not make the accusation of jobs for the boys, or girls, regarding State boards. I said that it left the Government open to that accusation, although I have not subscribed to it. However, the guilt complex is there, and it is bound to present itself.

The Minister of State cannot have it both ways. The point is that I wish to see a fair and transparent appointments process. The Taoiseach has said in this House that his greatest difficulty in getting people with the necessary skills, professional experience and so on to come forward is that they are already far too busy to give of their valuable time in serving on State boards and State-appointed bodies. The way to address that is to open the doors to every citizen and not simply the names nominated by those with access to an ear. That has been the practice, but we do society and the State boards a disservice if we cut out ordinary, decent men and women the length and breadth of this country, who, from their experience in their professions or in retirement, can bring expertise and knowledge to bear in the service of the State, which is there to serve every citizen.

The second part of my amendment is as crucial and important as the first.

I remind Deputy Ó Caoláin that this is his second time to speak, so he has only two minutes.

Have I exhausted it?

You have a right to reply.

I suppose the two minutes are over. I thank the Leas-Cheann Comhairle for his patience and the Minister of State for listening at last. If he does not accept the amendment on this occasion, I look forward to his doing so in due course. These arguments will continue to present themselves.

I reiterate what I said before. It is Government policy that there be gender balance on State boards, and I do not know why the Minister of State cannot accept the amendment. I do not see why it cannot be done. Section 28 deals with membership of the individual boards for the various professions. Three are to be engaged in the practice of the profession, two in management services and so on, so there is no reason the Minister of State cannot say that one must choose at least one man and at least one woman in situations where there is to be more than one nomination. I accept that when only one is chosen, one cannot stipulate that one should have a man or a woman. However, where there is more than one, there is no reason that the Minister cannot do so. It has been done before by many Ministers. I do not accept that it cannot be done. There are extras to be appointed by the Minister both to the boards and to the council.

What is sauce for the goose is sauce for the gander, and I have no problem saying that, in the very few cases where men are in the minority and one must discriminate in their favour rather than in favour of women, we should do so. We need gender balance on boards. In the vast majority of cases in Ireland, the discrimination must be in favour of women to ensure that they be properly represented. However, if in the case of certain professions it must benefit men, that is fine, since that is what it is all about. We must ensure that this goes into all legislation and that Government policy and that of all parties in this House is implemented. That will not be done by wishful thinking.

That is why I raised the fact that the Minister for Defence, Deputy O'Dea, threatened to do it but never did so. He said that he would do it within six months of being appointed as Minister if it did not happen automatically. It did not happen, but he did not do that. If this is the attitude of Ministers, it will not happen. Perhaps it must be enshrined in legislation that Ministers do so regarding Government-appointed councils and boards. In this case, I see no reason that it cannot be done, and I urge the Minister of State to accept the amendment.

I have listened carefully to what the Minister of State had to say. He started by stating that his own party had recently introduced a form of gender balance. In my party, we tried to do so many years ago, and I confess that it has not been too successful, even after putting the structures in place. We have six Deputies, all of whom are men. Sinn Féin has five, and all five are men. The Labour Party——

Some 33% of us are female.

Watch Fianna Fáil. We do it.

Good for them. However, the point I was trying to make is that, despite setting up structures, many societal factors militate against female participation. Therefore, a quota system such as this is the best way forward. Deputy Devins was not present, but I recently met Danish parliamentarians. It was quite remarkable, since most were women. There was only one man. They had managed it, and Nordic countries always manage to be far ahead of us when it comes to such issues. To my mind, this amendment makes perfect sense. It is a way of giving legislative effect to the theory, but it must be more than that. It must now become a reality. If we had a list system here, we would have a very different approach. We could have 40% female representation. It is difficult to achieve that with the present system. For many reasons, into which I do not wish to go, there are certain advantages in politics if one is a man; that is the long and the short of it.

I support these amendments. I understand that Deputy Ó Caoláin is vexed enough to put the matter to a vote. We shall see.

I assure Deputy Ó Caoláin that I always listen to his every word with the greatest of care. I was commenting on his amendments since they do not seek — neither do those tabled by Deputy McManus — to prescribe how the Minister should make his own appointments. They purport to describe how all the appointments to the council, which is the overarching body regulating such professions, and the individual registration boards should be made. I reiterate my original point that it is Government policy to secure gender equality in the composition of such boards. However, to provide so in the context of such boards is for the Minister to dictate the consequence of a nomination from a professional body or the course of an election.

Deputy Gormley put it rather well when he said that the problem may lie in the electoral system that we habitually use in Ireland, generally the spot vote or a single transferable vote. For example, if a list system was to be employed in such elections that might be a way of securing a particular outcome. However, that would require a proposal of much greater detail than that before us. What is before the House this evening is a simple direction to the Minister to ensure that 40% of the appointments should belong to a particular gender. Were we to so legislate, the Minister would then, in effect, have to tell a particular professional body that he cannot accept the freely chosen representative of its registration board, as per its electoral mandate and that it must reballot until such time as the necessary number of acceptable appointees of a particular gender is reached. I do not believe that is a tenable proposition.

Equally, in the case of the overall council the nominations come from the individual registration boards representing the particular boards. The Minister would have to give a direction to those boards that he cannot accept their nominations unless they belong to a particular gender. The question would arise as to which particular boards would have to be given such a direction. When all of those issues are looked at one can see the problems which this House may well have to address, though in a different context, as to how gender equality may be ensured. To provide for it in this legislation would require legal architecture of considerably greater sophistication than that which has been put before the House this evening by Deputies Ó Caoláin and McManus, although I accept the spirit in which the amendments were tabled. If I have given Deputy Ó Caoláin the impression otherwise, I am sorry for so doing. I accept it is an issue that must be attended to, but this legislation illustrates very well that it is not as simple a matter as it often seems. Very few Bills, nowadays, provide that a Minister appoints, say, ten persons at his or her discretion, to a particular board. The trend, in statutory draftsmanship, has been towards restricting the scope of the discretion of the Minister and trying to insist that members of particular boards have appropriate qualifications. That is evident in this legislation and it makes the task of gender balance all the more difficult.

Add to this the fact that here we are providing representative machinery for professions and there is very great difficulty. As regards the public interest appointment, in the case of a profession where there is a substantial female or male composition, it can be difficult to identify persons who have the type of public interest knowledge of the given professional activity, as distinct from being a member of the profession, and who meet the gender requirements. These are difficulties that Ministers have to grapple with. I am happy to reiterate what the Tánaiste said, which will certainly warrant what has been said in the House this evening being taken into consideration in the making of any appointments that are at our discretion.

I acknowledge the Minister of State's change of tone. I hope, irrespective of what action is now taken, he will raise this matter with the Tánaiste, as indicated, and the Government will adhere to the spirit of this amendment, at least. I acknowledge, too, the Minister of State's point on the legal architecture necessary in this regard, but it must be started somewhere. I may not have the resources in terms of the exactitude required in drafting legislation, but we have some small experience. I assure the Minister of State that it is experience that we will continue to gain. The spirit of it is strongly held by me and clearly, by other Opposition voices. The Minister of State has reflected good intent in this regard and I acknowledge this. However, I advise the Leas-Cheann Comhairle that I will press my amendment.

Question put: "That the words proposed to be deleted stand."
The Dáil divided: Tá, 69; Níl, 55.

  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Ardagh, Seán.
  • Blaney, Niall.
  • Brady, Johnny.
  • Brady, Martin.
  • Browne, John.
  • Callanan, Joe.
  • Callely, Ivor.
  • Carey, Pat.
  • Carty, John.
  • Cassidy, Donie.
  • Collins, Michael.
  • Coughlan, Mary.
  • Cregan, John.
  • Cullen, Martin.
  • Curran, John.
  • Davern, Noel.
  • de Valera, Síle.
  • Dennehy, John.
  • Devins, Jimmy.
  • Ellis, John.
  • Finneran, Michael.
  • Fitzpatrick, Dermot.
  • Fleming, Seán.
  • Gallagher, Pat The Cope.
  • Glennon, Jim.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Haughey, Seán.
  • Jacob, Joe.
  • Keaveney, Cecilia.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Killeen, Tony.
  • Kirk, Seamus.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McDowell, Michael.
  • McEllistrim, Thomas.
  • McGuinness, John.
  • Moloney, John.
  • Moynihan, Donal.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Connor, Charlie.
  • O’Dea, Willie.
  • O’Donnell, Liz.
  • O’Donovan, Denis.
  • O’Flynn, Noel.
  • O’Keeffe, Batt.
  • O’Keeffe, Ned.
  • O’Malley, Fiona.
  • O’Malley, Tim.
  • Parlon, Tom.
  • Power, Peter.
  • Power, Seán.
  • Sexton, Mae.
  • Smith, Brendan.
  • Smith, Michael.
  • Treacy, Noel.
  • Wallace, Dan.
  • Wallace, Mary.
  • Wilkinson, Ollie.
  • Woods, Michael.


  • Allen, Bernard.
  • Boyle, Dan.
  • Breen, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burton, Joan.
  • Connaughton, Paul.
  • Connolly, Paudge.
  • Costello, Joe.
  • Cowley, Jerry.
  • Crawford, Seymour.
  • Crowe, Seán.
  • Deenihan, Jimmy.
  • Durkan, Bernard J.
  • Enright, Olwyn.
  • Ferris, Martin.
  • Gilmore, Eamon.
  • Gormley, John.
  • Gregory, Tony.
  • Hayes, Tom.
  • Healy, Seamus.
  • Higgins, Joe.
  • Higgins, Michael D.
  • Howlin, Brendan.
  • Lynch, Kathleen.
  • McCormack, Padraic.
  • McEntee, Shane.
  • McGinley, Dinny.
  • McGrath, Finian.
  • McGrath, Paul.
  • McManus, Liz.
  • Mitchell, Gay.
  • Morgan, Arthur.
  • Murphy, Catherine.
  • Murphy, Gerard.
  • Naughten, Denis.
  • Neville, Dan.
  • Noonan, Michael.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Keeffe, Jim.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Pattison, Seamus.
  • Penrose, Willie.
  • Rabbitte, Pat.
  • Ryan, Seán.
  • Sargent, Trevor.
  • Sherlock, Joe.
  • Stagg, Emmet.
  • Timmins, Billy.
  • Twomey, Liam.
  • Upton, Mary.
  • Wall, Jack.
Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Ó Snodaigh and Stagg.
Question declared carried.
Amendment declared lost.
Debate adjourned.