Dáil Éireann debate -
Tuesday, 2 Oct 2012

Vol. 776 No. 3

Health and Social Care Professionals (Amendment) Bill 2012: Second Stage

Minister for Health (Deputy James Reilly)

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

I am pleased to have the opportunity to address this House on the Second Stage of the Health and Social Care Professionals (Amendment) Bill 2012. This is a relatively short technical Bill, with 20 sections in total. The Bill proposes to amend the Health and Social Care Professionals Act 2005 to provide for the enhanced and effective functioning of the Health and Social Care Professionals Council and the registration boards established under the Act. It will also amend the Act to better provide for the assessment and recognition in Ireland of qualifications obtained outside the State and to ensure compliance with the relevant EU instrument.

The 2005 Act provides for the establishment of a system of statutory regulation for designated health and social care professions. The regulatory system comprises a registration board for each of 12 designated professions, a Health and Social Care Professionals Council with overall responsibility for the regulatory system, and a committee structure to deal with disciplinary matters. These bodies are collectively known informally as CORU. CORU is responsible for protecting the public by regulating health and social care professionals in Ireland. It promotes high standards of professional conduct and professional education, training and competence among the registrants.

The Health and Social Care Professionals Council was established in 2007. Its functions include the governance and co-ordination of registration boards and the provision of administrative support and secretarial assistance to registration boards and their committees. Although the annual cost of running the council is currently being funded by the Exchequer in the main, the intention is that the regulatory system will, in time, be fully self-funding through the annual fees payable by registrants as is the case with all other health professional regulators.

The following 12 health and social care professions are designated under the Act: clinical biochemists; dietitians; medical scientists; occupational therapists; orthoptists; physiotherapists; podiatrists; psychologists; radiographers; social care workers; social workers; and speech and language therapists. In addition, the decision of the previous Government to rationalise the Opticians Board into the Health and Social Care Professionals Council will see another two professions, optometrists and dispensing opticians, being regulated under the Act in 2013.

Under the Act, I, as Minister for Health, may designate other health and social care professions if I consider it is in the public interest to do so and if the specified criteria have been met. I am conscious that some professions, currently not designated, made a case to be regulated under the Act. However, my immediate priority is to proceed with the establishment of the registration board for the professions designated under the 2005 Act. Then and only then can consideration be given to the registration of other professions. That is not to say that work cannot be ongoing in that regard. To date two registration boards, the Social Workers Registration Board and the Radiographers Registration Board, have been established. The Social Workers Registration Board has established its register, has held elections, and has made the necessary by-laws on education and training qualifications.

The board has also adopted a code of professional conduct and ethics, which was subject to public consultation. When the statutory transition period ends two years after the establishment register next May, the professional social worker will be fully regulated under the Act. The Radiographers Registration Board will soon be in a position to open its register and commence its two-year transition period. This will also facilitate the commencement of the fitness to practice provisions of the Act. The Act provides for grandparenting - a transitionary period of two years during which existing practitioners must register on the basis of current specified qualifications. After this only registrants of a registration board, who will be subject to the Act's regulatory regime will be entitled to use the relevant designated title.

While progress in establishing all 12 registration boards has been slower than expected, this is due in the main to unforeseen legal technical and resourcing issues. However, the learning obtained in establishing these two registration boards has been immense and is informing the work under way on the establishment of a further four registration boards before year end. These are occupational therapists; speech and language therapists; dieticians; and physiotherapists. The remaining boards in respect of those professions designated will be established by 2012.

In line with the Government's decision on transparency in board appointments, my Department sought and received expressions of interest from professionals and laypeople for appointment to these boards over the summer months by public advertisement via the public appointments system. My intention is that these boards will be established in coming weeks with the exception of the physiotherapists registration board which would be closer to year end.

The Bill has three main purposes. The first is to amend the Act to allow the Minister for Health to continue to appoint professional members to the council until each of the registration boards has been established in respect of the 12 professions designated under the Act, has held elections and is in a position to nominate one of its elected members.

The second is to incorporate the provisions of Directive 2005/36/EC on the recognition of professional qualifications into the principal Act and to provide for the assessment and recognition of other non-Irish qualifications which are outside the scope of the directive. Third, in order to enhance the effective operation of the council and registration boards, other amendments are proposed. These relate to items such as fees payable to members of the council, registration criteria and the updating of fines for offences under the Act.

I will now briefly explain the technical difficulty that has arisen with the appointment of professional members to the council. The Act provides that the council consists of a chairperson and 24 ordinary members, with each of the 12 registration boards nominating one of their elected members for appointment. As is usual in such cases, because no registration boards will have been established, the Act empowers the Minister for Health to directly appoint these 12 professional representative members. The phased establishment of the 12 registration boards and the resulting lapse of time have, however, meant that in the absence of registration boards which can then nominate council members, professional representative members cannot be appointed to the council to fill the vacancies arising from the completion of the terms of office of the original members. Currently, 12 professional members are attending council meetings in an observer capacity with my consent so that the perspective of the professionals can be maintained. This is an interim measure. Those attending do not have voting powers and cannot fulfil the requirements of a quorum. The Bill, therefore, proposes an amendment to the Act to allow the Minister for Health to continue to appoint professional members to the council until such time as the registration boards have been established, have held elections and are in a position to nominate elected members for appointment to the council.

The Bill also takes account of the provisions of Directive 2005/36/EC on the recognition of professional qualifications, which was enacted following enactment of the Health and Social Care Professionals Act 2005. This directive is an internal market measure aimed at facilitating the free movement of persons within the European Economic Area, EEA, space. While health professionals are the largest single professional category availing of its provisions, the directive applies to any regulated profession. The Department of Education and Skills, in light of its role in qualifications, has overall responsibility for the directive in Ireland.

Deputies may be aware that discussions are currently taking place at EU level to modernise the directive. These are expected to conclude during the Irish Presidency of the EU. It is necessary, in the meantime, to give effect to certain aspects of the current directive in this Bill. The directive makes it easier for qualified professionals, including certain health and social care professionals, to practise their professions in European countries other than their own, while providing appropriate safeguards to ensure public health and safety and consumer protection. This means that applicants' qualifications and post-qualification work experience are assessed to ensure that they meet the qualification entry requirements to that profession in Ireland.

As qualification recognition is the first step in a statutory registration process, it was always the policy intention that the registration boards would assume responsibility for the qualification recognition function under the directive. The Bill, therefore, provides that each registration board will be designated as a competent authority under Directive 2005/36/EC for its designated profession. Currently, the Minister for Health is the competent authority for most of the health professions designated under the Act and qualification recognition currently is for the purpose of eligibility for recruitment to the publicly-funded health sector. The introduction of statutory registration will mean that all persons with non-Irish professional qualifications who seek to exercise their profession in Ireland must have their non-Irish qualification recognised under the directive. The amendments contained in the Bill will also provide a legal basis for the assessment and recognition of qualifications obtained outside the State, which are outside the scope of the directive, namely, the non-EEA qualifications of EEA nationals and the qualifications of non-EEA nationals. The Bill provides that the processes for the assessment of these qualifications are the same as provided for under Directive 2005/36/EC, including the provision of explicit appeal mechanisms.

The main provisions of the Bill can be summarised as follows. Section 1 sets out that the Health and Social Care Professionals Act 2005 is the principal Act. Section 2 inserts a number of definitions into the principal Act. Section 3 provides that the Minister for Health will continue to appoint representatives of the designated professions to the council until such time as all registration boards are established and are in a position to nominate elected members. Section 4 provides a legal basis, when the council is self-funding, for payments to members of the council and its disciplinary-fitness to practise committees, subject to the approval of the Minister for Health and with the consent of the Minister for Public Expenditure and Reform. Section 6 permits each registration board to prescribe certain practise and training requirements for professionals who have not practised for a designated period of time.

Sections 11 and 13 increase the maximum fines for offences committed under the principal Act. Sections 15 and 16 provide for some changes in relation to "grand parenting" and in respect of the use of professional titles during the transitional period in which practising professionals may apply for registration. Sections 17 and 18 give the Minister the power to appoint members of the council and registration boards for a period of up to four years rather than the current fixed term of four years.

Amendments are also proposed to the principal Act in sections 5 to 12, inclusive, and 14 and 15 to provide for the assessment and recognition in Ireland of qualifications obtained outside the State. Section 5 inserts a new section 27A to provide that, when their registers have been established, registration boards will be designated as competent authorities under Directive 2005/36/EC, empowered to act as competent authorities for their designated professions under Directive 2005/36/EC and empowered to assess qualifications obtained outside the State, which are outside the scope of this directive. This section also provides for necessary transition arrangements in relation to applications under the directive.

Section 6 amends section 31 to provide that a registration board may make by-laws relating to procedures for the assessment of professional qualifications, training, experience, aptitude tests or adaptation periods of applicants for registration whose professional qualifications have been obtained outside the State and are outside the scope of the directive. Section 7 amends section 38 to update and simplify the approved qualifications criteria in section 38(2) so that there are three categories: Irish qualifications; qualifications approved under Directive 2005/36/EC; and other qualifications, and to insert new definitions and remove others no longer necessary.

Sections 8 to 10, inclusive, relate to procedures and appeals for non-Irish qualifications. Section 12 relates to the use of title in the provision of services on a temporary and occasional basis. Sections 14 and 15 amend the registration process for existing practitioners to comply with the processes of Directive 2005/36/EC, which provide for the assessment of formal professional training and post-qualification professional experience. Section 19 provides a minor clarifying amendment to the list of optional qualifications required by an existing practitioner-radiographer in order to register during the transitional period.

This Bill will enable the Health and Social Care Professionals Council to continue to fulfil, in a more effective way, its objective, namely, to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions. I commend the Bill to the House.

Deputy Billy Kelleher

I thank the Minister for his comprehensive outline of the Bill before us. The Fianna Fáil Party welcomes the introduction of this legislation, the details of which we can go through on Committee Stage. There is an obligation on us at this time to ensure regulation and oversight of health and social care professionals, as provided for in the 2005 Act and in this amending legislation which seeks to address some of the technical issues outlined by the Minister.

The Minister, wearing two opposite hats, will be aware of the importance of protecting the integrity of professionals, in particular professionals in the health and social care areas, which are two key areas wherein breaches of trust and the guidelines can have serious consequences for individuals, the professionals and the integrity of that profession. It is important we maintain the highest standards in these areas.

As a pro-European and someone who welcomes free movement of goods and services and the transfer of qualifications between the States, I welcome the transposition of Directive 2005/36/EC.

However, in ensuring the free movement of goods, services and people and the transfer of qualifications between member states, it is critical to have in place some form of governance at EU level to monitor oversight in all member states, because in challenging times of economic difficulties and political upheaval, it could happen that oversight in a particular member state ceases to be sound and robust. However, one would be obligated to recognise the qualifications of medical and care professionals of that state even though one's ability to check out the individuals may be somewhat diminished. In such a situation it is very important to have oversight and monitoring at EU level of directives passed by the Council and European Parliament and transposed by member states. I am not necessarily concerned about this with regard to the Bill but it may arise in future.

Previously, we spoke about Indian and Pakistani doctors coming here. It is important we welcome them and that they are treated with dignity and respect. Unfortunately, this has not always happened. In certain cases they were put up in boarding houses and given less than what I would consider appropriate accommodation. It took some time to assess their qualifications and competencies and in the meantime they were left in limbo. We wanted and welcomed them, but when they arrived we were unable to deal with them in the manner to which they were entitled.

If oversight in any member state or country is questioned or diminished in any way, it brings into question the integrity of everyone who comes from there. We must ensure, therefore, that any country, inside and outside the EU, which provides excellent professionals who come here to dig us out of a hole, so to speak, engages in monitoring to ensure the continued integrity of those who are welcome here and that people cannot question the suitability of individuals. This can happen if the robustness of oversight, training, education, qualifications and standards is diminished. For all these reasons, this is a critical aspect of the directive, the broader internationalisation of medical professionals, and the transfer and freer of movement of people and services throughout the European Union.

Not necessarily related to the Bill is the issue of the PIP implants. Who is responsible for medical devices? The Irish Medicines Board is not responsible. We are told the European Union has an oversight role. At the same time, women throughout Europe who had received the PIP implants which were made of low-grade industrial silicone-----

Deputy James Reilly

I apologise for interrupting the Deputy but the Irish Medicines Board is responsible for medical devices in this country. The incident referred to by the Deputy was a case of fraudulent use of a synthetic industrial implant material.

Deputy Billy Kelleher

I thank the Minister. The point I am making is that people are entitled to protection against fraudulent use of material which is then put into a person's body. The difficulty is that while the Irish Medicines Board may have oversight within the State, if something happens outside the State, people may have difficulty seeking redress afterwards. In fairness, the Minister and the Department responded in a very humane and passionate way when the issue arose to address the concerns of the many women who received the implants. However, there is no form of redress for the many people who were implanted with industrial grade silicone. The implants were approved in Germany or somewhere else at some stage - the company was in France but I believe the patent was German - after which they arrived in Ireland. The Minister, the chief medical officer and others moved swiftly to try to address the concerns of these women, but we cannot pursue anyone and it will be very difficult to seek redress for the fraudulent use of silicone.

With European integration comes obligations for the European Union. It is fine to agree a directive and for member states to transpose it into national law, but oversight is very important and it must be supported at European level in terms of resources and cost. It is unacceptable that a situation such as the PIP implants can arise or that a member state could have diminished ability to oversee the domestic competency of qualifications, training and education.

The Minister stated four councils will be established by the end of the year and that others will be rolled out. Considering the medical and care professionals included in the scope of the Bill, it is important we have oversight and that the councils are established to ensure proper training, education, qualification assessment and continual monitoring. The Bill deals with high level qualifications including clinical biochemist, dietician, medical scientist, occupational therapist, podiatrist, physiotherapist, psychologist, radiologist, social care worker, social worker and speech and language therapist. The difficulty we have had in recent years is recruitment and attracting highly qualified people in the various professional categories outlined in the Bill to work in Ireland. Now our highly trained professionals are beginning to drift abroad to seek opportunities in other countries. This is a disturbing development. We all say the fees, salaries and remuneration of general practitioners and consultants should be addressed, but we must be conscious of encouraging people to enter these professions and keeping a percentage of them in the country after they are trained for our own health and social care services.

We welcome the experience that people gain and bring back when they go abroad, and high-end professionals will always move in and out of the country. However, we have a difficulty if there is only one-way traffic and everyone is moving out. The Department of Health, the HSE and the various professional bodies which oversee their membership must be very conscious of this and monitor it to ensure the people who go abroad and gain experience bring it back to this country. During the 1980s the most able people drifted away and it caused difficulties. They returned in the 1990s and the first decade of this century and had a major impact through bringing new ideas and procedures, especially in medicine.

I will not delay the House much longer. The establishment of the various oversight councils is to be rolled out and I would like the Minister to make a commitment that this will happen.

People will always have concerns about the conflict of interest in respect of self-funding, self-regulation and discipline and what flows from that in the event of a fitness to practise meeting or professional misconduct hearing. People may sometimes have a view that there could be a conflict of interest in self-assessment, self-regulation and self-monitoring. I believe the legislation is robust enough in terms of ensuring that is not the case and that, in general, there is no major conflict.

The Health and Social Care Professionals (Amendment) Bill before us is a follow-on from the 2002 report entitled Statutory Registration for Health and Social Professionals: Proposals for the Way Forward and the 2005 Act that flowed from it. In bringing this legislation to the Dáil, which is an obligation, we continually upgrade the oversight of health and social care professionals in every way to ensure it is flexible in dealing with the changing environment that exists. We should ensure there is flexibility, opportunity, oversight and strong regulatory powers in terms of sanction if there are breaches of professional conduct or what can flow from an internal inquiry which may find a person to be in breach of professional conduct. That is critical but what is as important is that if there is a view held by the State or individuals that there is no proper oversight or disciplinary procedures by one of the quora, there is a mechanism in place for the State to step in and have a fully independent inquiry if there is a serious breach by a individual professional under the Health and Social Care Professionals Act 2005 and the amending legislation.

It is important to do this to give people confidence and belief in the quality of the people providing health and social care. Deputy Ó Caoláin has raised this issue numerous times, such as, for example, the Dr. Neary case and many others that have flowed from that. That, in itself, is an issue of concern. We had the debate in this House on symphysiotomy and there was all-party agreement. People will debate the rights and wrongs of symphysiotomy but there are many whose lives have been destroyed because of this barbaric act. We heard at first hand stories that were very emotionally told and felt by those who listened to the impact it had on their lives. I am not saying that the people who carried out symphysiotomy were doing something that was illegal at the time. However, when there is clearly an evolving technology and change of practice, it is important there is continual training and re-evaluation of what is considered the norm in medicine and social care. Let us be quite clear, many practices carried out in psychiatry for a number of years would now be considered almost barbaric. There has been a changing and evolving ethos about how we deal with people with mental health and psychiatric issues and in general medicine itself.

It is for those reasons that there is an obligation on the various quora under this legislation to ensure that, as the Minister referred to, there would be training, continuing evaluation, upskillling and professional development. We see it in many other areas and I believe it should be in the medical and care profession as well. What can very often happen is that individual professionals are very competent and eminently qualified but may not continue to evolve and train themselves in the most up-to-date techniques, procedures and thinking in whatever profession they are involved in. That can have disturbing effects for people down the road. I have cited a number of cases, with symphysiotomy being the very obvious one. This was practised in this country up to the 1970s, after which it was considered to be a procedure that should not be visited on anyone except in the most exceptional circumstances. Even at that, there was a strong body of medical evidence in this country, across Europe and especially in the UK that it should never be used and that a caesarean was the way to deliver a child if there were huge difficulties in delivery. We have had discussions on this issue and I am not sure whether the individuals said this was the right procedure based on the ethos of the hospital or a religious ethos or whether they just did not continually upskill in the most modern techniques and changes in practice in the medical profession. The same is true of social care and psychiatry, with the move from institutionalisation to dealing with and treating people in their immediate home and community environment. That is very welcome but there are still people within the professional community who would say that perhaps we might look at that again. Continually training and upskilling and continuing personal development are very important in the quora overseeing the qualifications of people.

Those are my thoughts with regard to this Bill before us and the 2005 Act. In other fora over the years, I have raised the issue of how oversight and governance at European level should be resourced at European level and the need for a centralised system to ensure all countries play by the same rules in respect of scrutiny of professionals' training and qualification. This is something about which I feel very strongly because all we need is for one or two people from other countries to be found not to be eminently qualified or to have done something wrong in their professional conduct and straight away it will be used by bigoted people and racists to undermine people who are here for a good reason, namely, to assist us in the delivery of our health care. This is why I have always said, as I did at the Oireachtas Committee on Health and Children, that people who have come from abroad are welcome and must be welcomed with open arms and that we must insist on the highest standards, not just for ourselves but for their integrity in order that people would have absolute confidence in them. If not, the sinister element in society could jump on a particular incident and use it to further their own narrow-minded, bigoted agenda.

I welcome the Bill and hope the Minister moves expeditiously in establishing the various councils of the professions and that we would continually upgrade and monitor things to ensure there are additions and the ability to add quora to oversee varying professions.

Deputy Caoimhghín Ó Caoláin

I wish to record my objection to the fact that the Minister has, for whatever reason, chosen not to stay for opening statements in response to a Bill he has just put before the House.

Deputy Mattie McGrath

I wonder where that is from.

Deputy Caoimhghín Ó Caoláin

This is a technical Bill amending the Health and Social Care Professionals Act 2005. It is uncontroversial, seeking to ensure the continuing and effective functioning of the structures established under the 2005 Act - the Health and Social Care Professionals Council and the registration bodies for the 12 designated health and social care professions.

It continues:

5.46 It is recognised that both populations would benefit from flexible working arrangements which would enable staff to work in another jurisdiction, for example, practitioners with scarce clinical skills might reasonably offer a service to both populations. However, there are some obstacles to workforce mobility, which can be effectively dealt with provided there is a clear focus on tackling such issues. These aspects include indemnity for staff working out of jurisdiction and mutual recognition of qualifications between professional bodies in both jurisdictions as well as registration and pension issues associated with working in both jurisdictions.

5.47 While great progress has been made, further work needs to be undertaken to extend the facilitation of cross-border working for health and social care staff. Furthermore access to an effective resource, which sets out procedures and protocols, to facilitate work across jurisdictions, would be advantageous.

These recommendations are not from a Sinn Féin election manifesto, nor are they taken directly from the health policy that I anchored and published with colleagues in 2005 for my party. I have just cited a jointly commissioned report. For all the same and practical benefits that it recounts, I again commend to the Minister of State, Deputy Kathleen Lynch, to impact with her senior Minister, if that is at all possible, and to acknowledge this as an area of neglect. There is little evidence of focused endeavour, North or South, to bring about the promise of such an agreed report. However, a willingness clearly exists. It is a significant step forward and should be seized in the interests of ordinary people the length and breadth of this island. All that holds us back is a nervousness of a new step forward and a sense of ownership over whatever part of the island on which we live.

At the end of the day, if the Minister and the Department do not take the initiative to give life to the promise of that particular report, including the section I have just cited on the record, it will be lost again and the report will be left to gather dust on a shelf. I urge the Minister of State not to allow that to happen and to help ensure health professionals on this island can provide the best possible service to patients, which is what they are trained to do and is what the overwhelming number of them want to do. It is the reward of their lives' choice that they get the opportunity to deliver their skills on a continuous basis and have the prospect of development within their chosen career paths. I commend the report strongly to the Minister of State and I am happy to record that I will support the Bill.

The main purpose of the Bill is to allow the Minister for Health to continue to appoint professional members to the council until such time as the 12 registration boards are established under the Act and are in a position to nominate elected members. We are told in the explanatory memorandum that the Minister has been unable to appoint professional members to the council on the completion of the terms of office of the 12 members appointed when the council was first constituted. We are told this was due to "unforeseen circumstances". In the interest of clarity, I ask that the Minister explain those circumstances. We should have a detailed explanation of the reason he has not been able to proceed as initially intended.

This Bill is being introduced in very different times from those that saw the principal Act introduced. In 2004 and 2005, the years in which the Health and Social Care Professionals legislation was processed in the Oireachtas, there were unprecedented opportunities to transform health services and create a truly equitable and efficient system. Instead of availing of them, there was bureaucratic change, with the establishment of the HSE. The two tier system remained firmly in place and was reinforced by the privatisation policy of the former Minister, Ms Mary Harney, and the rest of the then Government. We are now in dire economic straits. Cruel cuts are being imposed by this Government on public services and the privatisation policy remains in place. What does this mean in practice? It means that a system that should be wholly designed to allow patients to receive the best care and to allow health and social care professionals to provide that care is instead built around the HSE bureaucracy and the private profit motive.

The system values professional expertise more for the profit it can generate than for the good health outcomes it can help to bring about. As a result, our public health services are short in all of the 12 professions listed in the Bill. Public patients struggle to gain access to the expertise that is readily available. It would be readily available only if access were assured. The recruitment embargo denies patients access to timely care and qualified young people the opportunity to work.

The speech and language therapy profession is one of those listed in the Bill. Let me quote from a letter, dated 29 May 2012, from the Irish Association of Speech & Language Therapists to the Irish Examiner, a paper I am sure the Minister of State, Deputy Kathleen Lynch, reads given her roots in a certain part of the island.

There is huge demand for speech and language therapy for adults and children in services across Ireland. There are significant numbers of unemployed fully qualified therapists. The recruitment embargo has meant that services cannot recruit for vacant posts and few new posts are being created.

Some graduates are working in volunteer positions and these can vary in terms of content. These can provide excellent opportunities for skills maintenance and professional development. However, they are not equivalent to working as an autonomous speech and language therapist under professional supervision and are not considered under the competencies framework for full membership of the professional body.

[T]here is both a supply of qualified, highly skilled therapists and a demand for their services, but in the current situation there is a gap between the two, such that children and adults wait unacceptable durations for access to the fundamental human right to communicate.

That is a very measured, thoughtful and accurate description of the reality faced by health professionals and patients today. This reality is not peculiar to speech and language therapists. We can all relate to it because I am sure every Deputy in this House knows of examples of children and adults with special needs who have not received the professional speech and language therapy they need. It is shameful, especially in the case of children. Children's most vital language learning years pass so rapidly that the system put in place by successive Governments fails to match patient need with professional service provision. The same could be said of the other listed professions, including that of social workers. We are very conscious of this in the context of the referendum Bill we passed in this House last week.

I wish to raise the issue of cross-jurisdictional recognition of qualifications and cross-jurisdictional working of professionals. That is addressed in sections 11 to 15 of the Bill which implement EU directives and are especially relevant to Ireland given the continuing existence of partition. The North-South feasibility study on cross-Border co-operation in health care provision, which was carried out jointly by the two Departments, North and South, and on whose publication and content we had to wait for such a long period, addresses this issue. I wish to cite the report extensively because I believe absolutely that there are powerful gains to be made and real progress to be achieved by turning around two back-to-back health delivery systems on this small island and having them face each other and work together in the common interest and good. The study states:

5.19 Both jurisdictions face significant challenges in terms of sustaining high quality, highly specialist tertiary services normally only provided in centres servicing large populations. The availability of appropriately qualified and skilled staff for such specialist areas is key and for populations of either jurisdiction, the small number of hospital consultants providing care in these areas inevitably means that services are inherently vulnerable.

5.20 In a number of service areas, increased sub-specialisation is evident and in newly developing services it is inevitable that the expertise will reside among a small clinical team. For such highly specialised services the population based in either jurisdiction may not be sufficient to sustain a team of appropriately trained skilled clinicians and the longer term sustainability of a high quality service may only be possible if considered on an all-island basis. Where patients have to leave both jurisdictions for treatment, the impact on individuals and their families is very significant in terms of patient well-being and accessibility for the family in sometimes very traumatic circumstances. Combining resources for the provision of such services on a North-South basis makes sense.

5.21 The development of new highly specialist acute and certain other services and the changing pattern of increased specialisation in existing acute services provides a unique opportunity for both jurisdictions to work together. In principle, both jurisdictions should consider developing these services in a collaborative manner, particularly where low patient throughput makes it difficult to sustain highly specialised services and for health professionals to maintain their skills.

An Ceann Comhairle

I understand that Deputy Catherine Murphy wishes to share time with Deputy Mattie McGrath. Is that agreed? Agreed.

Deputy Catherine Murphy

As the Minister stated, this is a technical Bill to facilitate his nomination of people to the Health and Social Care Professionals Council. Ten of the disciplines have not been properly established on the council, yet the Minister has no power to extend the terms of the council's appointees. Given the fact that the Health and Social Care Professionals Act was enacted in 2005, why have these disciplines not been properly constituted yet? Not all of the period in question was a time of financial stress or cutbacks. Since 2005, everyone has learned what can occur when there are regulatory failures. The idea behind the council is to put proper regulation in place. It is not just in terms of finance that we need regulation. We need systems that can anticipate developments and work in co-operation with and deliver services to the public.

The explanation of "efforts have been made" offered by the Minister and the Bill's digest is anodyne. What efforts have been made? Has an onerous obligation that cannot be met been placed on the individuals coming forward? Is there a campaign of not co-operating? Why have the other disciplines not been established? Do they view the council as unnecessary? What dialogue has been held to determine why the council has not been properly constituted, something that has made it necessary for the Minister to intervene and introduce this legislation?

The disciplines in question, including occupational therapy, physiotherapy, psychology, social work and speech and language therapy, are the primary care areas with which we have been engaged for the past two weeks. In many cases, the quality of the service they deliver, especially in the public system, depends on one's address. Some parts of the country might have no waiting lists while other parts could have two year waiting lists. Deputy Ó Caoláin referred to speech and language therapy. There is a world of difference between diagnosing a three year old, delivering the therapy then and sending him or her to school at five years of age and making him or her wait two years for that therapy.

The option of a multidisciplinary approach is being missed because the council has not been properly constituted. The commitment of the specialties must be questioned.

Although Deputy Ó Caoláin was referring to Northern Ireland and the Republic when he spoke of cross-jurisdictional matters, county boundaries being crossed is also an issue. Children attending a special school in west County Dublin will receive speech and language therapy if they are from the area, but not if their addresses are in, for example, north County Kildare. This is despite the fact that the same organisation is involved. The systems failures have progressed past being regulatory. They have to do with people's locations, the numbers involved and the architecture of the HSE itself.

The Bill is a modest measure to plug a gap, but it will not deliver a vastly improved service to those who need it, which is what is urgently required. We cannot say that often enough. The stupidity of the situation is that the five year old who starts school without having received therapy must be picked up by the education bill if he or she fails in school later.

We also pick them up by way of underperformance in ability to work and so on. There is a certain element of economic stupidity about how this is handled and seen within a so-called silo philosophy.

I also wish to speak to the elements that are not included. Perhaps they are not appropriate to this Bill but I should highlight them anyway. For example, medical devices and the practitioners using them are not covered. There was a significant failure in regulation with the PIP implant case, and in the US in 2000, a failure in the licensing system in France was identified with regard to the company in question. The process involved the company being regulated by a German-licensed organisation. The problem could have been identified much earlier if the published material had been picked up by the professions. We can see how that played out for people.

The private clinic area, including those dealing with cosmetic surgery, is not taken in with these regulations. Where there is a failure and no one to pick up the problems, the State ends up picking up the issue through the public health care system. Regulation of areas not included in this measure is required urgently. I understand the European regulatory system is being considered, although individual member states have been warned that this may take some time to flow through by means of directive and legislation. It will be necessary to act on an interim basis in order that we can learn from those mistakes and ensure they are not repeated. There is a similar case with invasive implants like DePuy's hip replacements, which have also failed. These failures have caused individuals to have to endure pain and concern arising from another big operation. This is one of a range of other areas that must be tackled through regulation.

I would like to hear the Minister's thoughts on this when he wraps up the debate. I share the concerns of Deputy Ó Caoláin about the Minister not being present. I respect the Minister of State, Deputy Lynch, who will give a report to the senior Minister. Nevertheless, the Minister should have stayed in the Chamber to deal with this legislation and at least listen to the opening statements. It is very important for the Minister to revert to us on these issues. Not all of the problems occurred under his watch and the legislation dates from 2005. It is important to understand what is going on and why there is disengagement by these professions. The only person who can tell us is the Minister because he has been having the dialogue for the past 18 months. It is vital that he tells us about the dialogue and why there has been a failure that prevented a board being set up without this sort of intervention.

Deputy Mattie McGrath

I am delighted to be able to contribute to the debate on the Health and Social Care Professionals (Amendment) Bill 2012. Although I mean no disrespect to the Minister of State, Deputy Lynch, I am also disappointed that the Minister, Deputy Reilly, left the Chamber so swiftly after making his opening speech on this Bill. The Act has been in force since 2005 but the Minister has only been in power 18 months. Nevertheless, we should have a proper debate and there are questions to answer. The Minister should try to explain some of these issues.

The Minister indicated that the Act provides for grandparenting, or a transitional period of two years during which existing practitioners must register on the basis of current qualified specifications. The Taoiseach, if he has the chance to appoint his next Cabinet, might insert a grandparenting clause to keep the likes of the Minister for Health, Deputy Reilly, under control so as not to allow what we read about every day in the Department to happen.

I compliment the new Minister of State, Deputy White, at the Department of Health but I also pay tribute to the former Minister of State, Deputy Shortall. I served with her on the last Oireachtas committee dealing with social welfare and know her to be a tireless worker and advocate of the underprivileged. She is a champion for fairness and equity. She was forced into a position where she had to resign from office, which is both scary and disappointing. The Taoiseach has already lost two Ministers of State in 18 months, which is a concern. Nevertheless it is not my business but a matter for the Taoiseach to run his Government. While I would not dare to lecture him on how to do it, a small bit of common sense and mutual respect would go a long way.

As I noted, this legislation is originally from 2005, when a system of statutory regulation was designated for health and social care professions. We all know this to be badly needed. The regulatory system comprises a registration board of 12 designated professions and also allows the Minister to make 12 appointments. This begs the question as to why there has been a delay in getting these bodies up and running. There is plenty of expertise and legal advice around so we should have been able to foresee whatever problems may have been down the road with this legislation, which is less than seven years old. I know the Minister is only in office 18 months but the fact remains that the legislation has not worked, so I must ask why there is a delay.

Does this arise because it is part of the dysfunctional organisation of the HSE? There are many thousands of excellent staff in the HSE, both office and front-line workers, including all kinds of health care professionals. Nevertheless, there is a significant deficit and much baggage and administration, red tape and bureaucracy. We must tackle that problem.

The bodies involved in this issue are collectively and informally known as CORU, and they are responsible for protecting and regulating health and social care professionals in Ireland. CORU promotes high standards of professional conduct, education, training and competence among registrants. That is something everyone in this House and the wider country wants and demands.

CORU covers some delicate areas, including biochemists, dieticians, medical scientists, occupational therapists, physiotherapists, psychologists, radiographers, social workers and speech and language therapists. Many of these people have made a career choice arising from career guidance and family or peer advice. They have dedicated time in third level institutions, doing research and masters degrees, ending up in a highly qualified position after a massive cost to the State and the individuals or families, which may have struggled to help the people achieve the qualifications. Deputy Murphy, on the other hand, referred to the people in many disadvantaged areas, waiting for treatment. Every Deputy knows of many cases of people waiting for orthodontic treatment, speech and language treatment and access to many similar such services.

With the embargo on recruitment to the HSE and the health needs that exist, it beggars belief that people are told the special treatments their children need, having waited a year or two years and then going into secondary, are not covered by the State. That is a huge cost on the family and a huge social pressure on the individuals who badly need the treatment. Whether it is speech therapy or dental treatment, they need it. They were recommended by health care professionals to have it and they applied for it. As was mentioned, some people have worked as volunteers. There are many people waiting for such treatment and there is a high demand for it, but many of our highly qualified people are emigrating and we are losing that valuable resource to other countries. Many of those people do not even work their chosen profession in the countries to which they emigrate. It is a disgrace.

I said during the debate on the children's referendum Bill that it is pointless passing laws and amending this legislation if we do not have the wherewithal, the resources and, most importantly, the vision and the passion to follow through on these measures. There is no point in amending Acts, putting them on the Statute Book and filling up the law libraries. We must make sure we are able to provide for what we legislate. I know we are in a deep dark recession but this legislation has been hanging around since 2005 and during the peak boom years of the Celtic tiger, but it is still not up and running.

I was interested to hear the research Deputy Ó Caoláin quoted. On an island the size of Ireland and having regard to the peace process and people coming together, the Administrations in both parts of the island must come together, pool, unite and share expertise for the benefit of all the people. This is still a small island even when one includes the populations of both jurisdictions relative to the size of our neighbours. My late brother could not understand how we had 13, or whatever is the correct number, health boards at the time and Manchester where he was working, which had a population of 3 million had one body looking after this area. When we consider many such cases, we can see where bureaucracy has got a grip. The health boards were disbanded because we wanted openness, transparency and accountability but we got the gigantic monster that is the HSE and no job was lost at the time. I am not blaming the current Minister for that but it happened and it got more unwieldy, entangled and bureaucratic and, worse than that, it operates at arm's length from ordinary people.

On the other hand, there are the private practitioners, some of whom are accounted for in the legislation, who have set up their own systems. I go back to the time of Barry Desmond and I saw him in the Dáil trying to break the grip the consultants had on the public hospitals. I have often said that if one is a veterinary practitioner, one must provide one's own specialist designated research, operating theatre and whatever. Why should consultants have access to public facilities and beds if they are not playing ball? Such access should be removed from them. They should get their own house in order if they do not play ball, cutting out the waiting lists and work longer hours. I cannot understand how there have been so many commitments to change this but it has not been changed. It is the stark naked fact that big powerful lobby groups in this country are the tail wagging the dog and they are refusing to budge. It is a long time since Barry Desmond - I think he is alive and well and I hope he is - stood in this House and as Minister tried to break that cartel and he failed. Successive Ministers have also failed to do so but it must be broken. What we, this Bill and all other legislation are about is service to our people and not to any particular sections or elite group of our people. These people have excellent qualifications and worked hard to gain them and they must be recognised for having done that and paid appropriately but not for having a logjam and a closed shop. We saw what happened with the pharmacists - young pharmacists could not become practitioners. Now there is the issue of the price of generic drugs. We have to deal with this matter. The Minister, Deputy Reilly, and the Labour Party promised that they would deal with it but they have not. It is not easy to do so: they cannot simply wave a magic wand and have it dealt with but they have to deal with it because the public are tired of it. We are all tired of it because it has gone on for too long. In the recession we must examine the pooling of resources North and South on this island.

We must not allow a situation where racism against foreign national practitioners could be encouraged. They were encouraged to come here and we needed them. Unfortunately, most of them were working junior doctors. It was 18 months ago when the Minister, Deputy Reilly, embarked on a crusade abroad to recruit these people, who I am sure were suitably qualified, but we found they were staying in bed and breakfast accommodation and all kinds of places and they could not operate. There were queues for procedures. I would not want anybody who does not have proper qualifications and certification working in our hospitals but they were recruited abroad to a set of standards, must have been interviewed and must have got the nod to come over here at great expense to the State, I might add, and then they were kept here in abeyance as if they were in some kind of quarantine. Then we had to do some kind of a cleansing in respect of them before they could work. It was horrible for those people to have been put in that situation plus the fact that we did not have them working at the front line where we needed them. That was another case of bureaucracy gone mad. I do not know who was keeping the door closed, keeping them out or did not want them here but that is what happened and it was not that long ago. I am sure it will happen again but it should not happen. Those eminently qualified people, regardless of their colour or creed, are entitled to work here and they have worked here. We cannot discriminate against them because some people are anxious, as others have said, to jump on the bandwagon and discriminate and denigrate people because of their colour, race or because of where they come from. That should not be allowed or contemplated anywhere.

Where does health and social care and the HSE fit into all this? It is all about health and social care but that is not being meted out to ordinary people who are trying to access ordinary, simple, basic treatments. In many cases when people get into the system they are very well treated but such access is not made available to many people. It is the preserve of those who are able to go private and access the system. I read in the newspaper today that VHI health cover will increase again. The minute any changes affect these people they pass on the cost to the insurers. We have to question the cost of treatments and bed nights in terms of insurance cover. They are too high. The rackets must be stopped. The cartels must be broken. Health and social care must be delivered to people. It is part of their civil right under the Constitution. That must be recognised and we must set out to deliver that. The delay from 2005 to 2012 in getting this legislation up and running and the need for it to be amended now to enable its unfolding is patent nonsense because that should have been identified at the time the legislation was introduced. I am not saying we are infallible but there are legal people who understand if there are legal pitfalls and blockages in the context of legislation. If there are, there should be a back-up model in order that the blockages can be cleared and dealt with and the legislation, as enacted, can be put into practice. It is all fine to hear pious platitudes but we must be mindful if there are various reasons legislation cannot be implement or is not workable. Do we ever in the Oireachtas test if legislation is fit for purpose before we pass it? That applies to all legislation. One wonders if some legislation passed was ever tested to establish if what it proposed was sane, realistic or achievable or if it was all in deep chapters, which no one could unravel or implement. I thank the Minister for introducing this legislation now but why is there a need for it and why did it take so long to introduce it? Will he answer those questions? I know the Minister of State might attempt to and that the Minister is not present. I think he is one of the 11, like the Flight of the Earls, who will be flying off. It is important to be prepared for taking over the EU Presidency. I remember when I was on the opposite side of the House a few years ago Ministers being criticised for travelling abroad for St. Patrick's Day celebrations.

If it was Hallowe'en, I would say it was something else but this is similar to the Flight of the Earls with high powered Ministers, officials and their entourages. I do not know if that is necessary. If the troika can come over here to tell us what to do, surely the European officials could come here to meet departmental officials and say what they want out of it. I wish the Taoiseach and his Ministers well with the EU Presidency but is this amount of foreign travel needed? Nothing has changed since I sat on the Government benches other than the personalities on the seats and the public is growing weary of it.

Deputy Seán Conlan

I wish to share time with Deputies Paul Connaughton, Peter Fitzpatrick and Mary Mitchell O'Connor.

The Bill is an important legislative instrument, as it seeks to advance the establishment of the State regulatory scheme for professionals, which will regulate the registration of the various professions delivering services within our health system. The delivery of this registration process is central to ensuring those providing services under various professional banners are qualified to do so; the provision of their services is regulated by an appropriate authority, adequately equipped to ensure the patient receives a professional service and delivered by a person appropriately qualified to do so; and the delivery of that service is regulated by a reputable authority, which has the power to inquire into, and adjudicate on, contentious issues arising from the delivery of the service.

A total of 12 health and social care professions are designated under the original Act but only two have established registration boards and this is causing a delay in the delivery of this system, which seeks to safeguard the delivery of professional services from the targeted areas to the patient. This scenario cannot be allowed to prevail and, accordingly, we must ensure this legislation, which empowers the Minister to make the necessary appointments required to bring effect to the system, is passed in the interest of delivering a safe and efficient care to the patients involved.

Registration with whichever of these 12 boards is applicable to the profession they intend to practice is required before the professional persons can use the relevant title and the original Act provided for the establishment of the Health and Social Care Professional Council, which would implement the Act and bear overall responsibility for regulation. The problem has arisen whereby the Minister for Health has no provision to fill vacancies that have arisen in the remaining ten disciplines for which boards have not been established. This is causing the system to stall and it is essential that this legislation be put in place and that there is no further delay in the implementation of this process, as the adequate registration of professionals and the establishment of a regulatory authority authorised to examine the qualifications of professionals offering their services and capable of ensuring those practising are qualified to do so is essential to the confidence of the public in the services offered.

We are becoming a more cosmopolitan society and, with the influx of people from other jurisdictions, it is imperative that we have this process in place in order that professional people who present themselves and offer their services can be appropriately adjudicated regarding their qualifications and their fitness to practise. The Bill addresses the requirements of the professional's qualifications directive, Directive 205/36/EC, establishing rules for the mutual recognition of professional qualifications between EU member states and also provides for the recognition of qualifications obtained outside the EU. This is such an important area that I fail to understand how the original legislation, which resulted in the appointment of the first council in 2007, still remains in limbo in 2012. That is a gap of seven years and this reflects either complacency on behalf of those charged with the implementation of the legislation or an unwillingness on their behalf to implement it. Whichever is the case, any further delay must not be tolerated and I commend the Minister on pushing ahead with this Bill to break the logjam. I urge him to proceed speedily with the establishment of the registration and regulatory authorities provided for in the Bill and ensure that, on this occasion, those involved are not afforded the opportunity to frustrate the implementation of this system and that the safety of the patients is placed before professional sensitivities.

I have no doubt whatsoever that is what the Minister will do because bringing change to a health service that had become dysfunctional and incapable of delivering the service the public wants is a task that was bravely accepted and undertaken by him and he is actively engaged in it. I am becoming weary of listening to those on the Opposition benches complaining every step of the way. These departmental cuts were coming regardless of who occupied the ministerial chair because those on the Opposition benches, who are complaining, left the till open and let everybody help themselves. They blew the money like drunken sailors and left their mess for the Minister to clean up.

Why was this legislation, which was passed in 2005, not brought into effect until the Minister came along? Why is it necessary to introduce a new Bill in order that he be authorised to appoint new members to the ten professions that failed to adhere to the legislation? It was not given effect because the Government that introduced the legislation comprised the same people who are attacking the Minister at every opportunity and who had a blueprint for dealing with the introduction of difficult or unpopular procedures. That blueprint was to ignore them and to let those adversely affected by them ignore them. That appears to be the only reason ten of the 12 identified professions failed to form registration boards. They were simply allowed the indulgence of proceeding on their merry way, totally ignoring the 2005 legislation. The then Minister did absolutely nothing about it. That way of governing has no place in a modern democracy and the Government and the Minister of Health will take the difficult path - the path which wins few friends - that will deliver the change so badly needed in the way we deliver health care to those relying on us.

Deputy Paul J. Connaughton

I am grateful for the opportunity to contribute to the debate. As health and social care becomes increasingly specialised, it is only proper that professionals working in these areas are correctly registered and this is the rationale behind the Bill. A few short years ago, only five professions were subject to statutory registration: doctors, dentists, nurses, opticians and pharmacists. At the time, that was sufficient as that was the extent of specialisation within the profession. However, as scientific knowledge increases, so too does the need for registration and among the health and social care professionals covered by the Bill are dieticians, occupational therapists, physiotherapists, psychologists, social workers and speech and language therapists.

The legislation will have the benefit of giving much-needed clarity to consumers wishing to purchase the services of some of these professionals. For example, a person procuring the services of a speech and language therapist for a child can be assured that if he or she is registered with the necessary board governing that profession, that he or she have the proper qualifications and that those qualifications have been checked and independently verified. Equally, if people let a social worker into their home or are engaging with a psychologist, they deserve to be assured that the person involved has achieved the necessary competence and that this has been independently verified. The registration process will protect the public but will also protect the professionals involved in that proper entry requirements will be established and there will be a proper mechanism to oversee entry into the profession and ensure this is restricted to people who have the necessary qualifications.

At European level, the introduction of the professional qualifications directive set out the rules for recognition of qualifications between member states, an important consideration for the many professionals of Irish origin working abroad, and the Bill also provides for the recognition of qualifications obtained outside the State, which are outside the scope of the directive that was transposed into domestic law in 2009. The fact that the boards established under this Bill will determine fitness to practise complaints for each of the 12 listed professions is another important consideration. This was provided for in the 2005 Act, but had not commenced to date and the passing of this Bill will facilitate the speedy introduction of proper complaints procedures. For students currently in second level education, greater clarity will be provided in terms of career paths as a result of the legislation because one of the functions of the Health and Social Care Professionals Council is the approval of education and training courses.

I am concerned, however, about the slow nature of progress to date in the establishment of the various boards. For example, only two of the 12 registration boards proposed have been established. The first of these, the Social Workers Registration Board, was appointed in August 2010 and the register for social workers opened in May 2011. All practising social workers must be on the register by the end of May 2013. A total of 2,700 social workers are expected to be on the register by the end of May next year and much work relating to this process remains to be done.

Another concern must be the payment of an application fee and, subsequently, of an annual retention fee. This is a cost of going to work and should be recognised as such, perhaps with these fees being offset by tax credits. The procedures involved in the appeals system must be fair and it is only right and proper that applicants for registration who are dissatisfied with the outcome have the right to appeal and the list of grounds for appeal are listed in the Bill. I also welcome the fact that under the current Act, and also under the provisions of this Bill, applicants will have the right to appeal a registration board decision to the High Court to ensure their rights are safeguarded. As medicine and social care becomes increasingly specialised, it is fitting that a proper system be put in place to recognise emerging specialties and ensure all professionals claiming membership of a particular medical or social care profession have their competence independently verified and have complaints against them arbitrated on by a professional and independent body.

I welcome the provisions of the legislation in the context of the clarity they bring to the use of the 12 professional terms listed and the safeguards they provide both to the professionals involved and the users of their services.

Deputy Peter Fitzpatrick

I welcome the opportunity to discuss the Health and Social Care Professionals (Amendment) Bill. The Bill proposes necessary technical amendments to the Health and Social Care Professionals Act 2005, which introduced a State regulatory regime for the designated health and social care professions not previously regulated. The main purpose of the Bill is to amend the Act to allow the Minister for Health to continue to appoint professional members to the council until each of the 12 registration boards established under the Act has held elections and is in a position to nominate one of its elected members. The 12 registration boards were established following the 2005 Act, which provided for the establishment of a system of statutory registration for 12 health and social care professions.

The system comprises a registration board for each of the 12 designated professions, a Health and Social Care Professionals Council with overall responsibility for the regulatory system, and a committee structure to deal with disciplinary matters. In time, as each register completes its transitional period, only a registrant of a registration board will be entitled to use the relevant designated title. The Health and Social Care Professionals Council was established in March 2007. Its mission is to protect the public by promoting high standards of professional conduct and professional education, training and competence through statutory registration of health and social care professionals.

I have witnessed at first hand some of the great work carried out by carers throughout my constituency of Louth and east Meath. Whether it is nursing, midwifery, occupational therapy or radiography, the standard of care provided in Our Lady of Lourdes Hospital in Drogheda or Louth County Hospital in Dundalk is outstanding.

Social care is a profession where people work in partnership with those who experience marginalisation or disadvantage or who have special needs. Social care practitioners work with children and adolescents in residential care, as I have experienced in the setting of St. John of God's, Drumcar, County Louth. Other services include those for people with learning or physical disabilities, like the great work done by St. Brigid's Special School in Dundalk. I have seen support provided to homeless people in Dundalk by the Society of St. Vincent de Paul. I have seen people with alcohol or drug dependency being supported by the Simon Community in Dundalk and Drogheda. Other organisations support families in the community and I have witnessed the support provided for older people by Older and Bolder in Dundalk and Drogheda.

To date, only two registration boards, the Social Workers Registration Board and the Radiographers Registration Board, have been established. This is the difficulty the Bill addresses. The current provisions of the Act do not allow for the Minister to make nominations for vacancies which have arisen subsequently, since the Act specifies that these should be elected members of, and nominated by, registration boards. The Bill, therefore, provides that the Minister may appoint members to the council in various circumstances, including where a registration board has not been established or has not yet held an election. This is one of the key benefits of the Bill and why I have no hesitation in commending it to the House.

Deputy Mary Mitchell O'Connor

New and innovative therapies are being developed and internationally recognised all the time. I wish to draw attention to dance movement therapy, art therapy, drama therapy, music therapy and play therapy. All of these therapies have merit. As a former school principal, I have seen wonderful outcomes for children with emotional needs who have participated in play therapy led by qualified play therapists. Any therapy delivered by professional therapists that cuts down on medication and improves quality of life must be welcome.

I have particular regard for music therapy, which I have seen used in the children's unit of our National Rehabilitation Hospital in Dún Laoghaire. Music therapy is based on the understanding that all human beings are able to respond to music, irrespective of disability or injury. Music has always been a powerful tool of expression. It can touch our emotions deeply and allows for a freedom of communication that needs no words and often no movement. Music therapy is an evidenced-based profession. A growing body of research demonstrates the benefits and importance of music therapy as part of rehabilitation treatment programmes. Music therapy is the planned and intentional use of music-based methods to meet an individual's emotional, social, physical, psychological, behavioural and communication needs. Irish music therapists works closely with other professionals within the interdisciplinary paediatric teams using music-based methods to facilitate the children to achieve their rehabilitation goals. Music therapy is available as a core therapy in many international rehabilitation units and is an established part of interdisciplinary treatment within health, education and social care settings.

On 26 July I tabled a parliamentary question to the Minister for Health asking for statutory registration and recognition of these four therapies. Many Irish people have invested years qualifying in these areas. They have also invested significant amounts of money and they are professionals. However, there are many other rogue traders, such as people presenting themselves as qualified dance movement therapists, art therapists, qualified drama therapists and music therapists. It is confusing for people and leaves vulnerable people in a more vulnerable position. The present position is unsatisfactory for our citizens and for the therapists.

The object of the principal Act associated with this Bill is to protect the public. This will be achieved by promoting high standards of professional conduct and professional education, training and competence among the registrants of the 12 health and social care professions designated under the Act. In the principal Act, 12 professionals are listed and, in time, only registrants will be entitled to use these titles and the public will have confidence in the professions. This must be greatly welcomed. The answer to my parliamentary question of 26 July, which asked for statutory recognition for dance, art, drama and music therapists, indicated that the Minister for Health has power to include them if he considers it appropriate and in the public interest. When the regulatory frameworks in respect of the 12 designated professions are fully in place, I ask the Minister to incorporate these additional therapies - drama, art, dance, music and play therapy.

Deputy Dan Neville

I welcome the Health and Social Care Professionals (Amendment) Bill. It is very important that the designated professions are regulated. I was closely involved in the debate on the original Bill in 2004. My contribution is based on the debate that took place at that time in respect of one profession that was excluded. The profession of psychotherapy and counselling was excluded specifically because the organisations involved in regulating the professions could not agree how it was to be regulated. That was the sole reason for the exclusion and the Minister of State at the time, Tim O'Malley, accepted that they should be included. He hesitated to include them while divisions existed among the various professional organisations on how to regulate. He asked the professions to agree on an approach. In 2008, the professions presented to the Minister a document on public protection entitled Submissions on The Statutory Regulation of Counsellors & Psychotherapists in Ireland. Tomorrow, I will outline and develop the reasons psychotherapy and counselling are not regulated at present. Anyone can practise and charge for psychotherapy or counselling in this country.

Counselling can do great damage to vulnerable people. I will develop that idea when the debate resumes and I will propose that the Bill be amended to include psychotherapy and counselling, as was originally intended.

Debate adjourned.