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

Question again proposed: "That the Bill be now read a Second Time."

I welcome this technical Bill, which is quite comprehensive in respect of the 2005 legislation. Difficulties were identified early on and it is surprising that it has taken seven years for it to be corrected. The Minister for Health and Children at the time, Mary Harney, informed me about this in 2006 or 2007.

I will address a proposal that psychotherapy and counselling be included as designated professions. At present, there is no regulation in Ireland for the registration of psychotherapists and counsellors and no State control over the qualifications held by those practising in the area. It is dangerous for untrained and unskilled people to probe a person's unconscious. They are dealing with human vulnerability and serious damage can be done to such delicate people. The Act provides for the registration of persons qualifying under the title of a designated profession for the determination of complaints relating to their fitness to practise. Some 12 professions are listed as designated professions under the Act. The professions of psychotherapy and counselling are not included. When I challenged the former Minister of State, Tim O'Malley, who dealt with the Bill in 2004, he stated that the professions included in the legislation had become so regulated by a process of discussion and consensus. However, the psychotherapists and counsellors group failed at that time to agree an approach to such registration. The Minister of State stated that statutory regulation in such circumstances would have serious legal implications. He accepted the principle that all psychotherapists and councillors should be properly qualified and pointed out that, in consultation with the professional groups involved, he was unable to obtain agreement on the criteria.

In response to the position of the Minister of State, 22 organisations established a psychological therapies forum for counselling and psychotherapy. The forum accepted that it was imperative that the public is protected by the promotion of high standards of conduct, education, training and competence among the professionals of counselling and psychotherapy. The forum pointed out that all bodies involved in the forum provided a code of ethics by which their members must abide. The forum stated that while this form of self-regulation provides protection to clients of these organisations, if falls short of optimal protection as, under our common law system, it is possible for any person to take the title of councillor or psychotherapist and practise accordingly, without training or competence. Any person can put up a sign to say that he or she is a counsellor or psychotherapist and charge €80 an hour to perform psychotherapy and counselling. It is extremely dangerous for such untrained people do so.

I am also aware of courses being provided. One course ran for eight weekends leading to a diploma in eating disorders. One should be a professional to deal with that but I tested the system a number of years ago. A secretary, who had no qualifications or interest in any clinical, medical or psychological area, applied and was immediately welcomed on to the course and provided with a handwritten note inviting her to commence the course on the following Saturday. A course covering a number of weekends also led to a higher diploma in suicide studies. It is highly dangerous for people to counsel those who have suicidal ideations after such a short course, when they are not fully trained. My objective is to include psychotherapy and counselling in this Bill.

The current position does not lend itself to good clinical governance and the maintenance of high standards of patient care. The Health and Social Care Professionals Act provides a mechanism to drive forward the clinical governance agenda. It creates a framework through which practitioners are accountable for continually improving the quality of their service and safeguarding high standards of care by creating an environment in which excellence will flourish and optimal protection is offered to members of the public who access psychotherapy and counselling. The psychological therapies forum made a proposal for statutory regulation of councillors and psychotherapists. We have been informed that the 12 organisations already designated must have full recognition of designation before counsellors and psychotherapists are included in the Act. This is critical to vulnerable people in crisis, who will be damaged by councillors and psychotherapists who are not properly trained and qualified, some of whom are mavericks. The issue of their designation should be given priority.

I do not have confidence of an early introduction of this point. On 17 November 2009, the former Minister for Health and Children, Mary Harney, informed me:

While the proposed system of statutory registration applies, in the first instance to twelve health and social care professions, the legislation empowers the Minister for Health and Children to include, on the basis of specific criteria, additional health and social care professions in the regulatory system by regulation over time, as appropriate. However, the priority for the Health and Social Care Professionals Council is to establish statutory registration for the 12 designated health and social care professions in the first instance. It is not envisaged that additional structures will be considered for inclusion within the scope of the system until the registration boards for the existing 12 professions are established. The issue of inclusion of other grades, such as Psychotherapists and Counsellors, within the scope of statutory registration will be considered after the initial designated 12 professional grades have been dealt with.

After seven years, only two of the 12 bodies are close to registration. How long must we wait until the 12 bodies are registered so that they can make additions?

On 24 May 2010, Mary Harney informed me:

The Council has undertaken an enormous amount of preparatory work to date in readiness for the establishment for the first 13 person Registration Board, The Social Work Registration Board, by the end of this month [in May 2010] It has done excellent work on developing governance arrangements, financial management systems, fitness to practise procedures, ICT requirements and other such issues that will be needed to support the establishment and functioning of all registration boards. As you will appreciate, it is essential that the first registration board, later this month, is established with great care as it will serve as a model for all 13 registration boards to follow.

More than two years later, nothing has happened. The Bill will facilitate this.

Yesterday, the Minister confirmed that we will have to wait a considerable time before action is taken on the registration of psychotherapists and counsellors. The Minister said:

Under the Act, I, as the Minister for Health, may designate other social care professions if I consider that 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, have made a case to be regulated under the Act. My immediate priority, however, is to proceed with the establishment of the registration boards for the professions designated under the 2005 legislation. Then and only then, can consideration be given to the registration of other professions.

Yesterday, the Minister confirmed that nothing will be done about psychotherapy and counselling until all the other professions have been registered.

The Minister then said:

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 their elected members.

The Minister said nothing about the Act catering for further nominations to the board. For that reason, I ask the Minister to add psychotherapy and counselling to the 12 designated professions, and make it the thirteenth.

I note from the Minister's speech that the professions are not being taken in rotation. In fact, the second last one is being worked on at present. Psychotherapy and counselling could be prioritised under the Act.

I draw the Minister of State's attention to some of the debates that have taken place on this issue. I refer to Report Stage of the 2005 Bill, on 2 November 2005. Former Deputy Liz McManus proposed an amendment to insert the following words: "and in particular shall, within the period of 12 months from the passing of this Act, so designated the profession of counsellor and therapist". Former Deputy McManus stated:

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 and 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 types of counsellors people go to.

She asked what guarantee have we, and I quote:

...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, with 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 in this area.

Former Deputy McManus continued:

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.

I supported former Deputy McManus's amendment. I referred to the 400 different named therapies that 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. I pointed out that in other medical professions there is a requirement for a basic qualification in medicine and professionals continue to specialise.

I asked the rhetorical question, 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 community and private practice do not warrant professional recognition. One does not need a recognised qualification or skill base to call oneself a psychotherapist or counsellor. All that is required are premises, a gold plate outside the door and the neck to charge a fee.

The Minister of State at the Department of Health and Children, Deputy Tim O'Malley, replied to the amendment on behalf of the Government. He said:

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 are agreed on the need for people to be confident that a counsellor or psychotherapist is qualified, competent and fit to practise.

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. The section also sets out the criteria to which the Minister shall have regard in considering the designation of further professions. 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 practice, and the existence of defined rules.

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 voluntary regulations.

When the 2005 Bill was debated in the Seanad, former Senator Brendan Ryan made a strong case for registration. He said:

Many people are concerned that some may claim to be psychotherapists who only have a six month diploma while others claim to be counsellors who have a diploma obtained following a 12 month part-time course. Many of these professionals probe deeply into vulnerable areas of people's emotions and their personal lives. It is a profession that desperately needs to be regulated through the formal recognition of proper professional qualifications.

Former Senator Ryan said 12 designated professions were listed for the resolution, through guidance counselling or otherwise, of personal, social and psychological problems but there were only two of the professions to which that could currently apply. He said much of what one might call the resolution, through guidance counselling or otherwise, of personal, social or psychological problems goes outside the profession of psychology and is practised by people who are not qualified as psychologists. The Minister of State, Deputy O'Malley, said he wanted to do what the Senator suggested but that it would be extremely difficult to do so at that time. He said one could end up with numerous court cases because many of the people involved had qualifications.

The Psychological Therapies Forum was formed by various organisations, which I do not have time to name. The forum includes Accord, the Catholic Marriage Care Service; the Association of Psychoanalysis and Psychotherapy in Ireland; the Association of Cognitive Analytic Therapy; the Irish Council for Psychotherapy; the Irish Association for Counselling and Psychotherapy; the Irish Association of Christian Counsellors; the Irish Gestalt Society; the Irish Institute of Counselling and Hypnotherapy; Marriage and Relationship Counselling; and the National Association of Pastoral Counsellors.

In a report entitled Public Protection, the forum made a recommendation to the Minister that psychological therapists be added to the list of registered professions. The forum proposed that there would be two grades: psychotherapist and counsellor.

That was the proposal. I believe we should regulate it. I ask the Minister to consider this seriously in light of the debate that took place and the commitment of the previous Government. Commitments which are necessary are honoured in most areas and the commitment given at that time should be honoured now. The statements from former Deputy Mary Harney and from the Minister for Health, Deputy James Reilly, yesterday that nothing will be done about any other profession until the 12 professions are designated will delay this for years. It has taken seven years for two to come near registration so how long will it take for those after the 12?

I welcome the Minister. It is fascinating that between 11.15 a.m. and 11.45 a.m. it is very difficult to contact council officials. It is obvious that the same applies in this House with Members of the Opposition. They must all have left for tea. I do not know the rules but we could obviously conclude the Bill if we wished. However, some of my colleagues have important points to raise.

I welcome this Bill as it is very necessary for patient care. It is also very important that the existing council can run efficiently until the board members from the various registration boards are put in place. However, I have a problem with the fact that it has taken so long, as Deputy Neville said, for this process to reach fruition. In 2000 the need for registration boards for the various medical organisations was first identified. The Act was only passed in 2005, possibly as a result of legislation from the EU. The council was only established in 2007 and it was 2010 when the first registration board, the social carers registration board, was established. That is a very important board, particularly when one considers that we will shortly have a referendum on the rights of children. It was important to have that board in place.

In 2011 the second board, the radiotherapy board, was established. However, there has been no progress on ten more boards. There are probably legal and technical issues associated with those, but does the slow pace in establishing the boards give confidence to the public? It is mystifying that it is taking so long and that we move so slowly on many operations within government. We are talking about 12 boards but I agree with Deputy Neville with regard to psychotherapists and counsellors. Those are important boards that should be established under this legislation.

We must convey to the public that these are not quangos and that we are not re-establishing quangos when it is Government policy to remove them. The role of the registration board is to maintain and establish a register for the designated professions, issue certificates of registration, give guidance on ethical conduct and approve education and training programmes. When one considers the functions of the board one can see how vital it is that all these professions are registered.

It is worrying that Part 6 of the 2005 Act was never commenced. Part 6 is a huge section of the Act, taking up 15 pages, but it has not been commenced to date. Could the Minister of State talk to the Minister about commencing Part 6? It is a vital part of the Act. If it was commenced, it would give more confidence to the public.

In conclusion, I welcome the Bill. The fact that the social workers' board is already established gives more credence to the children's referendum that is due to be held. I strongly support Deputy Neville's comments about psychotherapists and counsellors. They must be registered with some type of registration board. That could be taken on board through an amendment. There are many problems, particularly the incidence of suicide among young men. They need people to talk to and the people they talk to must be competent, well qualified and have proper training to deal with the problems of young people nowadays, who have both mental and physical issues, such as bulimia and so forth. When the Minister tables amendments on Committee Stage, I urge him to consider adding those two boards in view of the crisis situation we are dealing with at present with the number of people taking their own lives and self harming. I would appreciate if that could be dealt with now.

I welcome the Minister and this Health and Social Care Professionals (Amendment) Bill. The 2005 Act was very important legislation for ensuring the highest standards in certain professions and protecting the public by regulating certain health care providers. We have seen in other sectors of society what happens when there is a lack of regulation. This Bill, while technical in nature, augments that important work.

The Act sets out the details on membership, fees, fines and other criteria. It also transposes provisions contained in an EU directive which facilitates the mutual recognition of qualifications across member states. The reference to the EU is significant. Over the last two decades we have seen the consolidation of the Single Market and experience has shown that creating a single market for professions is more difficult than for goods and services due to the different standards of training, educational qualifications and regulations in the member states. As a result, the regulatory role of member states has increased in significance as each state works to uphold consistent safety and professional standards across the Union.

Our membership of the EU and the dynamics of health care mean that many of the providers and practitioners are from outside the European Union. Section 9, therefore, is of particular importance as it has become imperative that a mechanism for measuring and recognising qualifications outside the EU be implemented. In Ireland, the Health and Social Care Professionals Act ensured that only professionals who have met a minimum standard and who have registered with the council established by the Act could use the relevant titles. The Act has had a number of positive consequences in ensuring fairness by permitting all practitioners to register under the same system and, perhaps more importantly, in facilitating greater confidence among the public.

This Bill will complement the earlier Act by ensuring that only genuine, qualified professionals can use the titles of the 12 professions listed. Given that these professions concern health care, this is most reassuring. The Bill will also help to achieve the objective of providing a single body to regulate. It also demonstrates the work of the Department of Health, so often criticised by some, in technical and administrative areas, which ensures that the HSE can concentrate on health care provision. Critics might say that such legislation introduces barriers and makes it more difficult for practitioners to enter the professions, but I believe that no genuine practitioner who has worked hard to achieve a qualification will object to such legislation. The Bill not only protects the public but also the honest dedicated practitioners who have worked so hard to achieve their qualification.

The Minister for Health is empowered with other functions, however, and I urge him to explore the powers set out in section 4 of the original Act. It is entirely understandable that it takes time to bring 12 significant professions under the regulation of a single council but there are other professions which would benefit from inclusion, as other Deputies have mentioned. One such profession is the creative arts therapist, whose practitioners work in such areas as mental health care, special education and so forth in communities throughout the country. Despite the fact that many of the practitioners in this area graduated from the University of Limerick, NUI Maynooth and Cork Institute of Technology and are accredited to the Irish Association of Creative Arts Therapists, there is no State recognition. In reality, anybody can use the title of creative arts therapist and work with some of the most vulnerable people in our society.

Like many other Members, I have been contacted by the Irish Association of Creative Arts Therapists. It states in its correspondence that what is of most concern is that by failing to recognise and regulate its profession, the Government puts some of the most vulnerable client groups at risk when anybody can use the title of music, dance, art or drama therapist without ever having completed the high standard of professional training that is correctly required to be deemed a qualified practitioner.

This is worrying for the majority of the work lies in areas such as mental health, special education, intellectual disability and end of life care. A dangerous situation prevails at present, the letter continues, whereby the state and welfare of some of our most vulnerable client groups is not protected through lack of action by the Government for the past 20 years. Taking those points on board, it is important we explore this profession because it would benefit significantly from a further amendment to the Health and Social Care Professions Act.

There are other professions; Deputy Neville mentioned psychotherapists and I support the calls for their inclusion, and there are other professions that could be added to the list. By doing so, we are not only protecting the public by ensuring high standards of health care, but that there are genuine, qualified practitioners working in health care professions across the country. They would like to see this type of inclusion. It protects them and recognises their work, training and qualifications.

I also wish to be associated with my colleagues' comments, especially those of Deputy Dan Neville, who has vast experience in the mental health area, particularly suicide. The Minister of State, Deputy Lynch, also has a deep interest in ensuring those who are vulnerable are protected as far as possible.

This legislation is to ensure adequate accreditation of professionals dealing with and treating the public. Health and social care is more important than any other sector due to the nature of the business and the Bill is needed to ensure the effective functioning of the health and social care professionals council. While the Bill is technical in nature, it will play an important part in ensuring those professionals are trained to the appropriate standard in their fields.

The Bill deals with membership and registration criteria of professionals and the recognition of professional competence and qualifications. We should pay attention to Deputy Neville's assertions, and I ask the Minister of State and the Department of Health to do so because some people are vulnerable to those who claim to be counsellors and psychotherapists and they must be protected from such people. If someone operates in the public space and claims professional competence, he or she must be properly accredited by a council such as the medical professional council.

I commend all health and social care professionals on the manner in which they continue to work on the front line and care for patients in the community and in hospitals, despite fairly harsh budget cutbacks and the resources available to them being more scarce. Health professionals in this country are stepping up to the mark and caring for patients in these difficult times.

As a Deputy from the south east, I want to highlight a recent report from the south-east hospital working group. The report was compiled by health professionals in the south-east hospitals of Wexford, Waterford, south Tipperary and Kilkenny. It contains proactive proposals for a reconfigured and more efficient network of hospitals in the south east, delivering services and putting the patient first. I have forwarded the report to the Minister and the CEO of the HSE and I urge them to consider the proposals in it. These hospitals are working in collaboration with the Royal College of Surgeons of Ireland and Waterford Institute of Technology. They have identified operations in the south east that are hard to understand. Cardiac patients in Kilkenny who are treated in St. Luke's hospital are being transferred for further specialist treatment in St. James's Hospital in Dublin, when there is a modern, fully functioning cardiac laboratory in Waterford Regional Hospital, where two consultants, health professionals of the highest standard, operate only half an hour's ambulance drive away. These patients, however, are referred to Dublin for some reason. This does not do patient services or efficiency within the health service any good. I urge the Minister, the HSE and the Department of Health to address these inefficiencies in the best interests of patients.

I also welcome the opportunity to speak on the Bill. Although it is technical in nature, it has generated an interesting discussion on the regulation of health professionals working in the primary care services and acute services.

Only five professions were registered just 12 years ago: doctors, dentists, nurses, opticians and pharmacists. No one will disagree there is a huge need to regulate the increase in other allied health professionals in the health care services, including social workers, physiotherapists, radiographers and so on. I also concur with a lot of the debate about psychotherapists and counselling services. There is a significant need for the Government to step in and regulate this industry. I have met many people with masters' and PhD qualifications and they are outraged to think someone could do a course on the Internet and then set up a private practice. It does a serious disservice to the profession and it puts very vulnerable people into unprofessional hands. Often when people are vulnerable and seeking help, they might be embarrassed to talk to a GP so they might use a search engine to look for a counsellor and there is no regulation of whom they will encounter as a result. Anecdotally, I have been told of organisations that are writing reports for courts on children who have been sexually abused and the reports are being written by people with no qualifications at all. These are the most vulnerable children in Ireland and I will follow up on this with the Minister and those who are dealing with this in the HSE, particularly Gordon Jeyes, because it is alarming to think someone is masquerading as a qualified therapist and engaging in serious intervention with very vulnerable children.

The other issue I wanted to raise is that of rogue crisis pregnancy agencies and their proliferation in the telephone book and on the Internet. Again, a vulnerable group of women who are looking for help might not always be afforded the information they deserve and might find themselves talking to people in a completely unregulated sector in the social care field. There is a great deal of work to be done but it could all be tackled if psychotherapy and counselling services were to go ahead at a further stage.

It is regrettable there are only two professional councils at the moment but this Bill will give the enforcement powers over someone's fitness to practise, which is hugely important, but it also has a major role in education and ongoing professional development, which is vital when we live in a world where things are changing. We want our health professionals to be guided by the best evidence-based practice that is readily available but we must ensure these professionals engage in the educational process so they do not just decide a basic qualification is enough. We must move with the current trends in research to ensure people get the best services they deserve.

Referring to Deputy Coffey's remarks about the more efficient use of services by the HSE, the south east, particularly Waterford Regional Hospital, is a prime example of how allied health professionals are working together to conquer the difficulties in the health services. There are nurse-led clinics and physiotherapy clinics for orthopaedic patients where there are long waiting lists but we are now using the huge educational and professional resources of allied health professionals to assess those on the waiting list to ensure consultant hours are maximised.

These are the kinds of stories one never hears about within the health service. These are the kinds of measures the Croke Park agreement is delivering for people and when such issues are debated, people should remember that.

I will conclude on that note, while reiterating this legislation is welcome, as it moves matters forward. However, a serious conversation is needed on the regulation of psychotherapy and counselling services because some highly vulnerable people access such services, perhaps online or from telephone books. It is very difficult to police them and ensure such people get the service they so badly need and the quality of service they so badly deserve.

I now call on Deputy Buttimer, who I understand is sharing his time with Deputies O'Donovan and Donohoe.

Yes, if that is agreeable to the House.

Is that agreed? Agreed.

Despite being technical in nature, this Bill is very important. The thrust of the point I wanted to make in respect of the issue of psychotherapists and counsellors has been made by Deputy Neville. The Government should introduce an amendment to the Bill on Committee Stage because, speaking as someone who has been a director of adult education, who himself has gone through the process of engaging with health care professionals in terms of counselling and who meets people every week in the most vulnerable and critical stages of life, it is imperative that such professions be included as a matter of urgency to protect both the person attending for service and the professional person concerned. This sector, which has been addressed in all the contributions thus far, should come under the regulation of the Act because in the modern era, statistics show there has been an explosion in people's use of psychotherapists and counsellors. This is the reason it is important to regulate the sector. As the Minister of State, Deputy Kathleen Lynch, is aware, and as many speakers have indicated, it is those who are most vulnerable and who are in need of service who are engaging with the professional services. Consequently, those who are practising and holding themselves out as counsellors and psychotherapists must be regulated. They should be properly qualified and trained and, equally, they should be held to account to the very highest of professional standards. This is the reason I believe they should be included. I understand the reason they could not be included in the original provisions of the Bill because, regrettably, agreement had not been reached between the professional organisations. However, I understand agreement has been reached since publication of the Bill and Members must now proceed, as a matter of urgency, with the inclusion of such people in the statutory registration scheme as so doing would allow for continuity of service and would give people a sense that a professional service is being delivered, as is the case.

This legislation is very important. It is about reform and driving home that the Government is taking a different type of approach in respect of health care and health care professions. The Bill includes a list of health and social care professionals and it is important to consider which occupations have been so included. The list includes biochemists, dieticians, podiatrists, psychologists, radiographers, social care workers, social workers, speech and language therapists, occupational therapists, medical scientists and clinical biochemists, all of which are professions that bring a standard of professionalism to the delivery of care. These professions provide services in the health model to those who require a service. The reason the Bill is so important is because it is about the people who interact and those who engage with and use the service. Again, one must consider those who work in the health care service and I join Deputy Coffey in congratulating and complimenting those health and social care professionals who work in our service. As Chairman of the Oireachtas Joint Committee on Health and Children and someone who has been involved in the HSE's southern regional health forum for many years, I see at first hand the huge volume of work being done each week. Those who criticise people who work in the health sector must pause for a moment to consider what has been done, the continuum of care and the quality of service. Moreover, those who criticise the Croke Park agreement fail to recognise that as a consequence of it, there has been a change in the nature of work and in the work practices to the betterment of those who use and need the service. This is the reason this legislation must be viewed as a protection of both the health and social care professional and of the user, that is, of the person who requires the service. This is the reason the issue of competence and qualification is so important. I have witnessed people setting up practice as pseudo-psychotherapists and pseudo-counsellors. Such people are not regulated and lack the same degree of competence and qualification as others. This practice must be examined, reviewed and changed because those who come into contact with them do so because they need to be given a sense of hope and a sense of being listened to. Such people need to have their lives changed in terms of what they do and the engagement they have.

If one considers this Bill in the context of its aims, the Minister should indicate the reason it has taken four years to have all this changed. Why have only two boards been established? What was the previous Administration doing since 2000? Why was there no joined-up thinking or progression? As the legislation before Members is about introducing reform, I believe they should be made aware of the reasons reform has been delayed. Was there resistance to reform? Is there resistance to change or has the allocation of resources been sufficient? The other area of importance concerns the issue of fitness to practice and this must be considered in the context of this Bill because there is a need to implement a registration system whereby a fitness to practice regime is in place in which complaints, inquiries and disciplinary proceedings must be commenced. This is linked to reform, accountability and transparency, which, in the professional, modern world now obtain in all aspects of life and which should happen here. As other speakers have noted, health and social care professionals deal directly with people and the errors that are made for whatever reason have a profound and serious impact and profound and serious effects. It is very important to have in place a system to deal with any problems which may arise with regard to such professions and professionals. Moreover, in the interest of those of us who use such professions and professionals, this must be included as part of the Bill. I greatly look forward to amendments to the Bill being introduced on Committee Stage. The Bill is much needed and is long overdue. I welcome its publication and I hope the Minister of State will listen to the contributions made by Members.

It is worth noting there was a great deal of new-found interest in the health services in recent days from supporters of the previous Administration. As per usual in all debates that take place in this Chamber, be they Second Stage, Committee Stage or other Stages, the Opposition benches are completely unmanned. It demonstrates the level of real interest within the Opposition ranks with regard to trying to bring real reform and change to the health services. It states a great deal about the commitment of the Fianna Fáil Party in particular to Oireachtas reform and how the Dáil actually operates, which is regrettable. Since my election, I believe this to be my fourth time speaking in the Chamber to entirely empty Opposition benches. The reality for me and others who speak and spend time examining legislation is that Members come into the Chamber during Leaders' Questions and blow off a great deal of hot air regarding their new-found interest in the health services. However, when they get an opportunity to make a contribution or to listen to some of the contributions being made, which have been constructive in nature, they do not attend. They see no merit in so doing because "Oireachtas Report" may not cover it tonight. Why would it, given this is legislation that is long overdue, makes perfect sense and which everyone supports? However, those who will blow off the most steam and who will run out to the plinth to make statements about the current Minister for Health, the former Minister of State in the Department of Health or the incumbent Minister of State in the Department of Health with responsibility for primary care or whatever, are not present today. This demonstrates the level of real interest those who destroyed the health services have in reforming them.

While it is very welcome that we are debating the Health and Social Care Professionals (Amendment) Bill, I take the opportunity to mention regulation of private home-care providers - an issue I have raised on a number of occasions. While legislation is promised in the area, it is of great concern to me because the people involved are also professional in nature. There has been considerable media speculation recently and many home-care providers are also looking for this. Many Members of this House would know family members and others who are in direct contact with home-care providers. Under the previous Administration we saw what happened when private nursing homes were allowed to operate unregulated. I implore the Minister of State to deal with the Law Reform Commission report, entitled Legal Aspects of Professional Home Care, which was published in 2009 and proposed minimum standards, minimum training requirements, supervision and inspection, a role for HIQA and a clearly defined role for family members in respect of people who are in a key position of trust.

We have rightly debated at length the issue of children and people with intellectual disabilities, but unsupervised and unregulated people are attending to vulnerable old people living on their own. I do not cast aspersion on any person doing that job at the moment. However, as Deputy Buttimer said about psychotherapists, it is just as important for a home-care provider to be working in a statutorily regulated industry as it is for the person in receipt of it. As I said at another meeting yesterday, in light of renegotiation of the contract for consultants' pay, we now have an opportunity to renegotiate some of the home-care packages. Rather than just focusing on the number of hours allocated to people and how they might be reduced, we should investigate how much the person coming in to care for the elderly person gets paid and how much the company employing that person gets paid. There is an enormous differential and considerably more could be done in that area to deliver cost savings without impacting on the needs of the person who is ultimately dependent on the home-care provider. They do very valuable work, but I have difficulty with the area being unregulated with the only role for the HSE to be the paymaster. I will take every opportunity to raise this issue continually in debates on health and social protection. It needs to be done for the people in this industry who have nobody to speak for them.

I believe we need regulation in the area of orthodontics. In 1985 provision was made for the creation of the post of orthodontic therapist. All Deputies will have come across people visiting their clinics whose children are waiting for braces. There is reluctance among some people to regulate the area. When we are discussing reform, shortening waiting lists and doing more work with less money, we need to address orthodontic care. Over a number of years in Pembrokeshire in Wales, orthodontic waiting lists were reduced practically to zero because the Welsh Assembly took an initiative to regulate the area of orthodontic therapists and take it out of the control of people who - for their own reasons - wanted to maintain that element of control. That is the type of reform people now expect. I welcome the suite of professionals to be regulated under this legislation, but there is another cohort of professionals. This legislation will need to be fluid and flexible so that it can be amended on an ongoing basis to allow for further councils and governing authorities.

I welcome the provisions of the Bill, which make perfect sense. I regret that no one from the previous Government bothered to turn up to listen to what we had to say, but that is their problem. There is an opportunity to do more for people about whom we are inclined to forget because they do not make the headlines. I know the Minister of State has a significant interest in this given her responsibility for disability and older people. I urge her to put the regulation of home-care providers on the top of the legislative agenda.

I welcome the opportunity to speak on the Bill and offer my support to it. I thank the Minister of State for being present to hear what my colleagues and I have to say. I will make some points on the Bill and then comment on some of the broader issues raised by Deputy O'Donovan.

Deputy Buttimer touched on some of these points earlier. I express puzzlement at the very low number of regulatory councils that have been established in recent years. Having read the background material on the Bill, I understand the overall body that was established to facilitate setting up regulatory councils was known as the Health and Social Care Professional Council, which was appointed in March 2007. Since then it appears that only two regulatory councils have been put in place - those for radiographers and social workers. Given the consensus in the House and elsewhere on the need for statutory regulation for all kinds of professions, I am puzzled that in five years that have elapsed since then more progress has not been made in setting up new panels and councils to regulate so many of the other professions that are important to the people we represent. While I accept the Bill will play a role in accelerating that, in the years since the initial body was put in place we have made virtually no progress in introducing the right kinds of councils and procedures for other professions that should be covered by this approach. I would welcome a prospective and response from the Minister as to why this has happened.

I wish to speak about the two councils that are in place. I understand that one of the reasons for introducing the Bill is the difficulty Minister has faced in putting in place new people and reappointing people to the councils that have already been established. In particular, I understand there has been a delay in appointments to the social workers' council. Why it was that the case? Was it because of a shortage of people willing to perform the roles? Was it because either the previous Government or this Government felt that the people who put themselves forward did not have the right skill sets to do the job? Why have we felt it necessary to make changes regarding how appointments are made to the existing councils? Why has there been difficulty filling those roles in the past? It appears that only two councils have been established since March 2007 and with those councils there have been delays and difficulties in appointing people to them. Given the focus on and support for statutory regulation of all councils, this is disappointing. I would welcome an answer as to what is driving those two developments.

Part 6 of the Health and Social Care Professionals Act 2005 deals with the determination of fitness to practise, the handling of complaints by the relevant council, etc. From my background reading on this Bill, it appears that Part 6 of that Act has not yet been commenced and I wish to understand why that is the case.

Will the new council which this Bill seeks to put in place play a greater role in terms of addressing issues raised in regard to the work and standards of care of health and social care professionals? This is an important point. The explanatory memorandum to the Bill sets out the procedure for the making of a complaint in regard to the work of a social worker. While I agree with Deputy Buttimer's remarks on the professionalism of our health care workers, regrettably things do not always work out as people would want and they find it necessary to make a complaint. A point made on one of the websites through which a person can make a complaint is that the complaints officer dealing with concerns in regard to social workers might also be the principal social worker for an area, which may give rise to concern on the part of the person wishing to make known his or her concerns in terms of whether the complaint will be dealt with in an impartial manner.

A constituent of mine raised with me this morning how he could best have his concern in regard to the handling of an important issue which he had raised addressed, without causing undue worry or difficulties with which he might have to deal in the future. I acknowledge that all of our social work professionals do the best job they can and that the vast majority meet and attain the standards required. However, as I stated earlier, occasionally those standards are not met. It is very important that there be clear guidelines in place in regard to how issues raised by people are to be responded to and dealt with. I would appreciate a response from the Minister of State, Deputy Lynch, on the reason Part 6 of the 2005 Act has not been implemented and whether this Bill, when enacted, will play a role in its commencement.

I wish to raise with the Minister of State my concerns in regard to one of the professions that will come within the remit of this Bill. I am sure other Members have, like me, received representations in regard to the waiting lists for orthodontic and speech and language therapy assessments. I have with me some correspondence in terms of my dealings on this issue on behalf of constituents. While the professionals are doing their best they are finding it hard to deliver the standard of care they would wish to provide to the people in need of this service. One response from the Health Service Executive in regard to orthodontic treatment states: "I regret I cannot be more positive at this stage and wish to reiterate that all children are offered a treatment place as soon as one becomes available". Another letter from the Health Service Executive in regard to speech and language therapy services acknowledges the frustration caused by waiting times and states that all possible will be done to meet the needs of the constituent.

While I support all that is being done in terms of closing the gap between spending and taxation and what needs to be done to ensure we have in place the correct type of reform measures to ensure where possible front line services are protected, I would like to make two suggestions in that vein. The work of the special delivery unit in terms of its addressing the waiting lists for some form of care within our health service has worked and produced results. Perhaps a similar approach could be taken to addressing problems in this area of our health service. If the children waiting for this type of care do not get assessments now they will in the future face greater difficulties and the taxpayer will face greater costs, both of which we want to avoid.

The Minister for Public Expenditure and Reform, Deputy Howlin, has signalled that at some point in the future he will consider selective recruitment into a small number of areas within the public service. I believe two important areas that need to be prioritised are speech and language therapy and orthodontic services, in particular for young people.

The recruitment of a small number of people spread across the country would make a vast difference to the people we serve, who deserve a better service than that currently available. I would urge that these areas be prioritised in our policy for recruitment into the public service into the future.

I welcome the opportunity to contribute to this Second Stage debate on the Health and Social Care Professionals (Amendment) Bill 2012, which is technical legislation to update and amend the 2005 Act. Like other speakers, I would welcome an explanation from the Minister of State, Deputy Kathleen Lynch, as to the reason only two of the proposed 12 registration boards have been established. The Health and Social Care Professionals Bill was enacted in 2005, a time of plenty. It is difficult to understand the reason it has not been implemented to any great extent. It appears little or no priority was given to implementation of the provisions of the 2005 Act.

This Bill, which is basically technical legislation and has the universal support of this House, provides that the Minister may nominate persons to fill vacancies on the registration boards and seeks to ensure the mutual recognition of qualifications between member states is updated. I would welcome urgent implementation of this Bill into the future. I support the suggestions regarding the inclusion of additional professions in the Bill and that we take this opportunity to do that. I believe the professions of counselling and psychotherapy should also be regulated under this Bill. I recently looked into the area of counselling and psychotherapy on behalf of a constituent. There is a huge plethora of people using the title "counsellor" or "psychotherapist", the vast majority of whom I am sure are well qualified to do so. However, this area needs to be regulated in order to ensure protection of the public and persons utilising these services.

Including these professions in the Bill's provisions on registration would also protect the professionals. As it stands, anyone can set up as a counsellor or a psychotherapist. This is an especially sensitive area and we should give priority to such registration because many of those who attend these professionals are in difficult situations and have serious mental health issues. I support the calls made by other Deputies to include these two professions.

We should take this opportunity to commend the various health professionals on the work they do. Exceptionally professional work is done by people throughout the country and a very good one-to-one service is provided by health professionals in very difficult circumstances. We should refer to these difficult circumstances and the Minister should examine the manner in which many of these professional services are funded and resourced at present. I understand and accept that some of these professions are exempt from the moratorium but others are not and swathes of the country do not have certain professional services, such as the lack of a community dietetic service in the Tallaght area. Community occupational therapy and physiotherapy services are seriously depleted. This means additional costs are incurred because more expensive services must be used to deal with patients who could have been cared for at home, which is what they and their families would have preferred, but who are forced to attend general hospitals or private nursing homes. These are very costly compared with the community services which should be provided.

With regard to occupational therapy and the provision of equipment, only those who are fully immobile qualify for motorised wheelchairs or scooter surfaces. This means an individual who is 50% or significantly immobile but not fully immobile becomes housebound, which brings its own difficulties and ensures such a person must use general hospital or private nursing home services at huge additional cost to the health service and the taxpayer.

I am sure the provision of speech and language therapy services is a matter raised regularly with Deputies by parents encountering significant delays in having their young children seen. The earlier that speech and language difficulties are dealt with, the better the outcome. These parents also state the lengthy waiting list for these services undermines various other services and creates other difficulties for young children.

Even in professions not affected by the moratorium, cover is not provided for sick, annual or maternity leave. This creates significant difficulties in the health service, particularly in community care services which, we all agree, should be fully supported because they are very effective and, if at all possible, people want to be looked after in the community. However, many services such as occupational therapy, physiotherapy and dietetic services are not available or have significantly reduced availability. This means those who require the services must use higher cost services in nursing homes or hospitals. I call on the Minister to examine this area and ensure leave, especially maternity leave, is covered. Maternity leave is long and the Minister should ensure replacements are made available. It would be cost effective and good policy.

I welcome the Bill and the opportunity to speak on it.

I call Deputy Derek Keating who is sharing time with Deputies Regina Doherty and Dara Murphy.

I welcome the opportunity to speak on this very important legislation, the purpose of which is to amend the 2005 Act. Although the Bill seeks to take account of the provisions of the 2005 EU directive relating to the recognition of professional qualifications and the assessment and recognition of qualifications obtained outside of the State, I wish to focus my contribution on what is happening in Ireland at present.

For far too long we have had many problems with standards of service provision in our health service. We need a recognised regulation to ensure a minimum standard of service provision for patients, who are the most important people in our health service. The Bill provides for each profession to have its own structures to deal with standards of service provision, standards in professional practice and complaints about service provision. It also provides for a registration board for each designated profession.

Today in Ireland, anyone can put a brass plate over his or her door, proclaim himself or herself a physiotherapist, psychotherapist, care worker, social worker, and so forth, and pluck his or her fees out of the air. That is simply not good enough anymore. Sadly, this week, we saw a medical doctor brought before his peers on the fitness to practice committee to address a charge of poor performance. I use this as an example of what we need to see in other professions.

Over the years and through my involvement in the community as a youth worker and previous to that as a sports and fitness instructor, I have had to refer people for professional help because of depression, self-harm and the threat of suicide. I have often been concerned about the standard of service being provided by the professionals who do not provide a good service and who sometimes hide behind those famous expressions: "I don't discuss individual cases", or "My relationship is a professional matter." Confidentiality is the cornerstone of all professional services provided. However, the reality is that there are many self-appointed professionals who do not have registration and in whose case there is an absence either of qualification or of sufficient qualifications.

I welcome the Department of Health and Children's decision to work closely with the various councils it is establishing. These councils will also contribute to the educational system in respect of the training authorities and postgraduate courses that many professionals are to undertake. Continuous professional development, CPD, is a very important component of professional practice. However, it is not enough to be qualified. The need for continuing upskilling or training is also vital. One of the benefits of having a registration board is that, in my experience and that of many of my colleagues with whom I have discussed this matter, professional accountability is often lacking in some areas of the medical profession. It is probably an aspect of human nature but the reality is that people sometimes become institutionalised. They get into a routine or sometimes rush to make decisions, diagnoses, care plans or therapies without fully validating them with other colleagues or examining new developments or treatment plans and without consulting the person receiving the service. We are all capable of becoming stale in our practice. However, when one is providing services to young people, including those with learning disabilities, or to dependent elderly people, the terminally ill or people with an addiction or physical problem, every profession is required to give the highest standard of service but in a manner and with an attitude that contributes towards respect, the dignity of the person, the right to self-determination and even the right to stay the way he or she is if he or she so chooses.

The 2005 Act provided for the establishment of statutory registration. This Bill improves on the current legislation and empowers the Minister to appoint professionals to the boards of their professions and to establish a standard that is expected from their peers. The new legislation will also allow the Minister to update fines for offences under the Act and I also welcome this part of the legislation.

We hear a lot about corporate governance in the media, even in the case of charitable organisations. Standards of practice and accountability, including regular accounting to boards and committees, are important in modern Ireland. What I hope comes from this new legislation is that each professional will not only be accountable for his or her actions but will also be responsible for his or her professional opinions and interventions. Indeed, we will, once and for all, continue to improve the services that are so necessary to help the vulnerable people who very often have only two choices - to take it or leave it. This legislation gets rid of that attitude and puts in place not only a legal obligation on professionals to be accountable but also an invitation to and obligation on professionals to take responsibility for their members. It also protects professionals from managers who demand shortcuts. The best regulator for any profession is a professional who knows that service.

I revert to the point I made previously when I said it is almost impossible to regulate attitudes but, thankfully, we are very fortunate because we have a culture of care and a commitment to excellence. As has been stated before, the majority of professionals, who I would group under the umbrella title of allied health professionals, are hard-working and conscientious and committed to standards and the needs of their clients, and that is what they expect of them.

My opening remark was that this Bill is necessary to improve the 2005 Act. I wish to place on the record of the House my gratitude for the many thousands of professionals working in the health service who will never be rewarded in monetary terms for their kind and professional commitment, caring and gentleness. I have experienced it myself and I am sure many other people have experienced it as well when family members are in the care of professionals. That gentleness and recognition for each person in his or her own right are so important in addition to the professional treatment. Today, those working in front-line services will benefit from this legislation. I welcome this legislation because of those who cut corners or occasionally act unprofessionally or who are hard task masters. I welcome the Minister's commitment not only to introduce a new, smarter, more efficient health system but his encouragement and support for the majority of kind, gentle workers who go beyond their contract and give of themselves daily. It is for these reasons I support this Bill.

The Bill makes a number of housekeeping amendments to previous legislation, with the general intent of ensuring medical organisations run as well as they ought to. Key to this is the amendment of the 2005 Act by changing the current provisions regarding professional membership of the Health and Social Care Professionals Council and to make other technical amendments. In 2005, the Department of Health introduced a system of statutory registration for health and social care professionals. This system ensures members of the public are protected and informed in order that they can be confident that the professional providing the service is properly qualified, competent and of good standing. It also ensures professional conduct and the promotion of high standards of professional education and training among health and social care professionals. The system of statutory registration currently applies to the 12 health and social care professions, regardless of whether they work in the public or private sector or are self-employed.

This Bill, which introduces amendments to the Health and Social Care Professionals Act 2005, is necessary to facilitate the effective functioning of the council and the registration boards for those individual professions. The principal amendments relate to the appointment of professional nominees to council; changes in registration criteria, including the power to allow registration boards to put in place a scheme for returners to practice and setting criteria for qualifying as an existing practitioner; and further implementing the EU directive for recognition of professional qualifications. This EU directive is wide ranging, covering workers from architects to nurses, but it has a significant impact on the health service and its revision will need to be monitored closely by all employers in the health service.

There is no doubt that it will be beneficial to the HSE, with overseas EU workers comprising a significant number on the medical register. We have seen the mistakes of the past. The well-being of patients and the quality of health services must be a top priority for member states so specific rules need to apply to health care staff covered by the EU directive.

There has been plenty of talk about the movement of foreign health workers in recent years, particularly in the wake of high-profile cases that have raised concerns about the clinical competence and, in many cases, language skills of some migrants and the methods of assessment by regulators and employers. Against this backdrop, the European Commission has, over the past year, been consulting on changes to the directive on the recognition of professional qualifications. Under the current terms of the directive, health care professions who hold certain qualifications awarded in one member state can register to practise in any other EU member state without having to satisfy further tests or formalities under the directive's automatic recognition procedures.

Automatic recognition of qualifications grants access to professional registration, but it does not determine an individual's suitability to do the job. Importantly, professional registration does not remove any responsibility from the employer to ensure the applicant is competent to perform the role for which he or she is applying. This is why a number of tighter rules are needed to ensure all health professionals coming to work in Ireland are fit to practise.

One important amendment to the directive concerns an alert mechanism between professional regulators that would place an obligation on each regulator to warn other member states of professionals who have been struck off. I would be particularly in favour of such a change being introduced to help prevent dangerous or incompetent practitioners shopping around for jobs in Europe. I would also like to be sure that the legislation ensures registrants to be required to demonstrate continuing professional development in order to maintain registration in their home countries. Many European regulators have no such requirements.

Language is an issue that has been a source of much controversy in the public arena, and welcome change is planned in this area. The new proposal makes it clear that regulators will be able to ask applicants for registration for evidence of language competence.

Another proposal from the Commission concerns the introduction of a portable, Europe-wide electronically transmittable professional card certifying a person's qualifications and professional status. Whatever system of exchange is used, its success will depend upon the quality and trustworthiness of the information it contains.

While the Commission's proposals suggest the sending country will create and validate the card, it is the receiving country whose nationals are potentially at risk of harm so responsibility for checking credentials should remain with it. There is no doubt in my mind that the safety of patients must always come first, and a worker's right to mobility should never be at the expense of safety and quality. Given the mistakes of the past, we have argued for higher standards to be applied to health care professions as the risks are so much higher and patients are vulnerable. Now is the time to act.

I too welcome the opportunity to speak on this Bill. It is described as technical but it goes further than that.

I acknowledge the presence of the new Minister of State in the Department of Health, Deputy Alex White. This is his second time in the hot seat although it is my first time to be in the House in his presence. We were colleagues very briefly; I was a member of the Joint Committee on Finance, Public Expenditure and Reform for only two weeks when he became Minister of State. While he will be a great loss to the committee, I am certain he will be a great servant to the Department of Health and the people.

I am sure the Minister of State is aware that the subject matter of this Bill has been the subject of significant public debate recently. An hour or two ago, members of the Fianna Fáil and Sinn Féin parties were happy to raise the issue of primary care facilities in their areas when members of the media were present. However, now that we are actually debating the professional qualifications and regulations of many of the people who will work in primary care units, there is nobody present from those parties. At least their false anger is consistent and we know what they are about.

Primary care teams and primary care units were mentioned in the manifestos of the Fine Gael and Labour parties and now comprise an important part of the programme for Government. The regulation of staff in primary care teams is vital bearing in mind the people they serve and treat.

On a day when the Government has announced it is seeking further reductions that will affect staff in public services, it is necessary to point out the great work being done in the health service, particularly by health care professionals. The reductions will be targeted and there will be no reduction in front line service provision.

Let me focus on the professional qualifications directive. Over the past 18 months, the Government has tried to improve the ability of people in Ireland to move abroad to work within the European Union. While Ireland has high unemployment at present, as everyone will know, there are large parts of Europe suffering from a shortage of professionally qualified staff. Even in Ireland, there are areas in which we still require professionally qualified staff. This is an important aspect of the legislation.

Some 800 professions are identified throughout the European Union. The directive sets out the rules for mutual recognition of qualifications between member states. This is of benefit to our professionals when going abroad and to our citizens, who can be assured that those staff who come from other countries, particularly those within the European Union, are qualified satisfactorily.

Qualification requirements differ from country to country. A person fully qualified to carry out his profession in one country might not be considered fully qualified in another. The directive of 2005 is a key for professionals to overcome problems resulting from these differences. It enables professionals to take advantage fully of the Single Market when finding a job and developing their career or extending their business.

We are now focusing on primary care and putting the patient at the centre in this regard. It may allow for more self-employed staff in the health service. That will certainly allow people to have greater flexibility in their workplaces, but it may also give rise to a more efficient health service, particularly at primary care level, which is the level closest to the people on the ground.

There are 12 areas listed in the legislation and there is provision to allow for the addition of other professionals. However, the legislation does not state whether other professions can be added.

Deputy Dan Neville stated he has for many years focused on health services, particularly the mental health service. He referred to many Ministers and Ministers of State of successive Governments with whom he has dealt. I know of nobody in this House with greater expertise in the area of mental health than the Deputy. I ask the Minister of State, Deputy Alex White, to avail of an opportunity to read the suggestions of Deputy Dan Neville, and that the ministerial summary identify whether some of these suggestions can be taken on board in this Bill or another.

I welcome the opportunity to contribute on this important legislation. Each of us has commented on the quality of various professional services, but the standard of health and social services is of particular importance. I have listened with interest to a number of Deputies. We should compliment the dedicated people involved in the provision of health and social services who have given their all and made significant commitments above and beyond the call of duty for many years. They have not received rewards or a great deal of recognition. Unfortunately, when something goes wrong, as is the case in certain circumstances, they all get the blame. I hope that the directive being complied with will address these issues.

All Deputies know of situations that have gone wrong in recent years. Something should have been done to protect patients, people with special needs or other vulnerable people. For years, incidents occurred that should not have been allowed to happen. There was no backup or commitment. There was always a good excuse for things not being done in the right order. Various Deputies have referred to the State's liability in this regard. That liability increases with the passage of time.

It is ironic that we are discussing this issue in the aftermath of the Celtic tiger, when everything was possible and there was an abundance of funding. However, the money did not go where it should have. Emphasis was not placed on addressing the issues we are discussing. Glitches appeared in the system.

In the past ten or 15 years, there have been many professional incidents in the health service, some of which were appalling. While those involved might have had all of the necessary qualifications, some of their practices raised serious questions. I do not want to go into particular details, but some women had operations performed upon them that were debilitating, demeaning and ever lasting in so far as their health and well being were concerned. I will never understand how problems of that nature were not addressed at the time or how a particular procedure was allowed to continue regardless of the questions legitimately raised by other professionals. That other professionals were unwilling to address those questions was a terrible blight. The Minister of State and all other Deputies are fully conversant with the issues.

Incidentally, I congratulate the Minister of State and wish him well. He has a difficult portfolio in difficult times. Like everyone, he is being asked to perform more tasks with less money.

I thank the Deputy.

The operations carried out were appalling and attempting to stand over them professionally only exacerbates the situation.

The individual needs to depend on the professionalism and qualifications of the person providing the service, which were always taken as a given. When one attended a hospital or so on, it was automatically understood that the medical profession was competent and would provide the best advice for the circumstances to put the patient on the right path. Unfortunately, a number of incidents have led us to believe that these criteria were not always met.

Those of us involved in public life have been disadvantaged. As my colleague stated a few moments ago, the response we usually get is to the effect that the issue in question is a professional matter and we are not professionally competent to ask about the procedure or methodology. I have rejected that response all of my political life for a good reason. Public representatives are elected to represent the people, including professionals. Being reluctant or quoting the Data Protection Act and so on to facilitate a refusal is a dangerous route to take. I have always spoken out against it and will continue to do so. It renders the public representative unable to do the job that he or she was elected to do. I am not referring to spurious cases, but to situations in which there is a reason to believe that issues are not being dealt with in an appropriate fashion and the public interest is not being protected. It is the public representative's duty to raise this concern with the relevant individual or agency in the first instance so as to ensure that the information is right. It is not acceptable for any organisation, however professional it might be, to suggest to the representative that an answer cannot be provided because he or she has no professional competence in the area in question. Were that the case, a solicitor could not take a medical court case. A lawyer could only discuss the law and nothing else except in the abstract. If one wanted to pursue an issue, it would be crazy if one needed to be a professional in that field.

I welcome the Bill and its objective and I hope that it brings focus to a series of issues that have come to the public's attention in recent years. It will produce a co-ordinated and integrated approach to addressing issues and ensuring standards of professionalism throughout the health and social services. This is important. Each Deputy has had issues brought to his or her attention. Some agencies respond when we follow up on those issues, but some will always find a reason for not responding. This peculiar situation has developed over the years and endangers public confidence in the State's services.

This is a difficult time. Everyone is expected to take on greater responsibilities and to do more for less. We must do our best. It will not be easy. People's expectations, having been dashed for a variety of reasons, will become more sensitive. People will naturally and understandably want reassurance, which can only come from the cross-EU implementation of a proper code of standards and ethics as well as qualification criteria.

A number of Deputies have raised the question of languages. It is important that the patient can communicate his or her problem. If he or she cannot be understood, it creates a problem.

I agree entirely that there is a need for a clear understanding of the work done at all levels by these professionals, who must be competent.

There is another issue that we have come to recognise over the years. There have been cases in the past where structures have been in place and all the necessary statutory requirements were complied with by various authorities but the system still failed. That should not happen, although I know there will always be individual cases with extenuating circumstances. Notwithstanding that, we must try to aspire to a position where we can be entirely confident in procedures with follow-up so that extraordinary cases do not develop and people will not have to ask why something happened. We must deal with such issues.

I do not want to be critical of individuals. I am sure everybody has had experience, as I do, of reporting a particular incident, which could be life-threatening or threatening in some other way but with nothing happening as a result. We should not have to repeatedly follow up such issues. Having brought a matter to the attention of the powers that be in health, education, security or justice, it should not be necessary to pursue the issue endlessly. It should be possible to rely on the authorities concerned to deal with such issues in a competent fashion and to respond effectively.

Is the Deputy sharing time with Deputy McHugh? The Deputy has eight minutes left in his slot and Deputy McHugh will be next if nobody offers to speak on the other side.

I will take five minutes.

My colleague will take five minutes of the slot.

The Deputy has three minutes remaining.

Psychological services have been referred to by various other speakers and it is very important for us to consider them. I have not had an experience with those people providing psychological services to young adults or children that would suggest any lack of professional competence. Nevertheless, I am sure I and everybody else has experienced the lack of seamless follow-up services in the event of a problem being brought to the attention to the powers that be. There should be an ability or willingness to follow up. There can be a bit of a rejection for the interfering public representative in such matters but when an issue is brought to the attention of relevant individuals, there is usually a satisfactory response. We should not have to go through an altercation in order to resolve such matters.

We hope that as a result of adopting this directive in legislation, there will be an improvement and we will not see questions raised about incidents that should not have happened. Very often, these cases affect vulnerable people, including children, those with special needs and people in the care of professionals, whether they are young, old or middle aged. Such people are vulnerable by virtue of being in that care. The State has a duty of care in such instances and I hope it will recognise that it has a responsibility to protect all citizens - young, old and middle aged - in the course of that duty of care. I hope that as a result it will provide a better society as we proceed.

At the outset I welcome the Minister of State, Deputy White, and congratulate him on his new role. I wish him well and no doubt his good wife will keep him right from a social consciousness perspective. As a former lecturer in sociology in Maynooth, she certainly has an in-depth knowledge of the social needs of the country. Every opportunity for the Minister of State to hear interventions from colleagues will be used. There is no better opportunity than a technical Bill like this for that, as we have the liberty to digress.

With regard to the recognition of qualifications, a parallel could be drawn with the Department of Education and Skills, which oversees the Teaching Council of Ireland. The Department of Health will have a system in place for qualifications outside the jurisdictions to be recognised in this country. I wish the Minister of State well with the process, and it is important for the Department to consult with those involved with the Teaching Council of Ireland to see what they have learned over a number of years. Some 12 months ago in this House I was critical of the teaching council but since then, with a backdrop of fewer resources and considerably fewer human resources in the council, there has been a marked improvement. Its systems took a while to put in place correctly but the council has done remarkably well in the past 12 months. It should be acknowledged when something works well and there should be credit where it is due. I acknowledge the work of the Teaching Council of Ireland.

We should add paramedics to the list of professions to be recognised, and I have spoken to a few of them with American qualifications who would be interested in different roles within the Irish system. Their qualifications are not recognised so it is important we check that out.

The patient mobility directive is due to be transposed into law in October 2013. With that in mind there will be great changes, and I would like the Minister of State to intervene so we can get a good understanding of what is coming down the track. This is not just about a cross-Border process between Northern Ireland and the Republic but rather a European directive that will enable patients to get care in different countries throughout the European Union. That will be a historic feature and landmark change to the way we deliver health services within the Union. I note the existing international work that is ongoing between the United Kingdom and Ireland, including lung transplants in London or the Duchenne muscular dystrophy treatment of young boys in Newcastle in the UK.

There has been an historical movement of patients across the UK, Ireland and Europe so it would be important to learn from the experience, including that of the young boys who suffer from Duchenne muscular dystrophy. Currently they are registered through the HSE and in the past they had travel paid for. That has now changed, which puts pressure and cost on the young boys travelling to Newcastle.

However, the more important point is not an economic one. The parents of the boys currently going to Newcastle are of the opinion that the standard of care and service they get in Newcastle would not be provided in this jurisdiction. I ask the Minister of State to familiarise himself with the issue. I realise it is a clinical one and that he is focused on the primary care aspect, but there will be an overlap because there is a degree of primary care at a household level for boys who suffer from Duchenne muscular dystrophy, a disease that shortens considerably the lifespan of these boys. However, on a positive note, the ongoing clinical trials in Newcastle are reassuring to the parents and they have advanced many new treatments. It is important to emphasise the fact that if a service is being provided in the UK or elsewhere in the European Union, people have the choice to access it.

I take this opportunity when the Minister of State is present to raise a primary care issue. There is grave concern about the home help service about which no doubt he will be aware from his Labour Party colleagues. The time of year is a factor as we approach the winter. Many elderly people are used to receiving the assistance of a home help, be it for an hour a day to help them get up in the morning. Any change in respect of this service must be treated delicately and sensitively.

An 87 year old who came to my clinic on Monday told me that she has the assistance of a home help for one hour a day, five days a week, Monday to Friday, and in that way does not incur the extra cost of a double time payment for a home help on a Saturday and Sunday. She would be agreeable to have assistance for half an hour a day and she also proposed she does not need assistance in the summer time. This 87 year old woman has come up with solutions. She can make savings and realises where savings can be made. Any sort of review of decisions in respect of the home help service must be taken on merit and it is important to listen to the voices of the people who receive this service.

A consultant got in touch with me with respect to cross-Border challenges. While we as legislators and politicians talk about the potential for cross-Border collaboration and synergies to provide services rather than incurring duplication in the provision of services, there is a cultural barrier, with which no doubt the Minister of State will be faced in the not too distant future, in that there is resistance to change at all levels within the health service. It will require strong leadership and hard decisions to ensure there is collaboration and positive co-operation at a cross-Border level.

I want to make a point regarding the new politics of Sinn Féin and Fianna Fáil with respect to representations at a political level, not only within the health service but across the board. As a Deputy representing my constituency, having been involved in politics for 12 years at council level and previously as a Member of the Seanad, I am at a loss to know as to how far representation can go. For example, in the case of rural Garda stations, am I allowed to lobby the Minister to retain Garda stations in Donegal or is that a prerogative of the Commissioner? Is it a civil servant diktat list system to which we as politicians in this House must adhere? Are we allowed to make representations? Where does the politics of Government party Deputies such as myself in terms of my constituency come into play?

I wish to cite another example, that of Malin Head Coast Guard station, and I am digressing from health but this is an important example. Prior to the formation of this Government, Deloitte & Touche was commissioned by the Department of Transport seven years ago to prepare a report examining the centralisation of coastguard facilities in the country. When this Government came into office, that Department commissioned another report, the Fisher report, calling for the centralisation of coastguard services. We have to examine where we are at as a political body and whether interventions can be made by politicians to ensure constituencies such as mine get the services the people demand. I have met the Minister, Deputy Varadkar, and will continue to lobby him to ensure the Coast Guard stations remain in Malin Head and Valentia, even though the new politics of Sinn Féin and Fianna Fáil are more or less insisting there should not be interference from politicians in regard to diktats from civil servants or lists that are drawn up. While acknowledging that the world is not perfect, the issue of what powers politicians have to represent their constituencies is a legitimate one that should be explored in this House. Top civil servants remain in office after a Government falls - there was a car crash in terms of the loss of Fianna Fáil politicians in the last general election - and they retain their same doctrines and philosophies. It is our job as politicians, in the interests of the people in our respective constituencies, to challenge whatever diktats or list systems are presented to us.

I thank the Deputies for their contributions to this Second Stage debate and note from what I have heard, and I have heard a great deal, that there is broad support for the Bill before the House. The main purpose of this relatively short Bill is 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 is a relatively short Bill. This type of legislation is often described as technical. Deputy Catherine Murphy suggested it is easy to describe a measure as technical but often technical provisions in legislation have enormous impact and are of great importance and relevance. That applies in this case, for example, to the professions concerned and, ultimately, to the public in terms of the confidence it has in the various professions, the fact they are registered and regulated to a degree, that there is public knowledge of that, that there is transparency and a broad understanding of the standards that apply in the different professions, and that those standards are maintained and, to the extent appropriate, supervised. That is in the interests of the community, society and the professions. There is a common cause on that - I do no think any Member has questioned the necessity for that kind of system.

Some issues were raised in the course of the debate as to the delay or the belief that there has been an inordinate delay in bringing forward additional proposals such as those in this amending legislation. I return to the point that whereas it can be suggested such enactments are technical, they are also often very complex and require careful consideration and drafting. On the issue of the speed at which these things have been done or are done, the question of which professionals are to be dealt with in this legislation was set out in the 2005 Act. There are 12 designated professions and it is those within the parameters of the 2005 Act we are dealing with in the Bill before the House. I heard a good deal of the debate and the contributions, including that of Deputy Neville, which springs from a very long and close involvement in the areas with which he dealt. I am quite sure that when we come to deal with Committee Stage, the issue of the scope of the legislation is something that can be addressed by colleagues.

I thank colleagues for their kind words to me. I look forward very much to my role in the Department of Health dealing with the issue of primary care but other matters also, as I am discovering by the hour. It is a significant challenge that I intend to embrace from the outset.

I also endorse and emphasise the issue raised by many colleagues about all the professions in the health and social care areas. Some terrific, professional, dedicated and committed people work in these professions and they serve their patients and the broader community well. We are currently debating the constitutional amendment proposal for new provisions in respect of children and the role and contribution of social workers features regularly. The social work profession sometimes comes in for grossly unfair and ill-informed criticism and the commitment of the profession, particularly, although not exclusively, in the area of child welfare must be acknowledged. The same goes for each profession that is required to be registered and regulated under the legislation. I acknowledge that colleagues on all sides agree with this.

I refer to the provisions relating to the mutual recognition of professional qualifications throughout the EU and the recognition of qualifications domestically. They will assist us in this State but will also assist Irish health professionals who travel abroad. This model has been developed at European level and the achievement of the best common set of standards is important because there are different histories and contexts in each member state. However, increasingly, the standards required of professionals in the health and social care fields are converging internationally and it would make sense that standards ought not to differ too much in the context of the qualification needed to practise in these professions. It is correct that we should move towards a better regime for the mutual recognition of qualifications.

We should not imagine that because the legislation is technical that it will fail to have an impact. I look forward to the constructive examination of this important Bill on Committee Stage.

I would also like to congratulate the Minister of State on his appointment.

I also join the Leas-Cheann Comhairle in congratulating the Minister of State on his appointment and wishing him well for the future.

Question put and agreed to.