Health (Miscellaneous Provisions) Bill 2014: Second Stage

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

I am pleased to have an opportunity to address the House on Second Stage of the Health (Miscellaneous Provisions) Bill 2014. This is quite a technical Bill, with a total of 44 sections. It has three main objectives, the first of which is to provide for the subsuming of the Opticians Board into the Health and Social Care Professionals Council. The Bill also makes certain amendments to the Health and Social Care Professionals Act 2005 in the interests of efficiency and to ensure consistency with the legislation governing other health regulators.

The Bill also amends the Health Act 1970 to ensure that statutory contributions are payable by recipients of residential support services who, while maintained, are not directly accommodated by or on behalf of the Health Service Executive.

The first objective and the original main purpose of the Bill, which is to subsume the Opticians Board into the Health and Social Care Professionals Council, is in furtherance of the ongoing programme of State agency rationalisation. The intention is to transfer the regulation of the professions of optometrist and dispensing optician from the Opticians Act 1956 to the Health and Social Care Professionals Act 2005. I would like to pay tribute, at this stage, to the Opticians Board's outgoing president, members, its registrar and their predecessors who have been regulating the optical professions for almost 60 years. The amalgamation of the Opticians Board with a more broad-based, multi-profession regulator will move the regulation of these professions into a modern regulatory regime where the primary and overriding focus will continue to be on the protection of the public. I know that the professional bodies representing optometrists and ophthalmologists have concerns regarding the transition to a new regulatory regime under the Health and Social Care Professionals Act 2005 and, in particular, with the proposed composition of the new optical registration board and I would like to provide some assurances on these points. I note, however, that a statement was issued today welcoming the new regime, for which I am thankful.

The Opticians Act 1956 provides for an eleven-member board comprising five optometrists, one dispensing optician, four medical practitioners and one other person who may also be a medical practitioner. In contrast, the thirteen-member registration boards established under the 2005 Act have a lay majority of one, in line with modern legislation governing other health professionals such as doctors and nurses. The interim optical registration board, whose members will be appointed to the new statutory board when this Bill is enacted, includes four optometrists and two dispensing opticians. It also includes two medical practitioners, one of which is a consultant ophthalmologist, who were appointed to represent the public interest on this occasion. The Act allows a degree of flexibility to cater for the particular skill needs of the board at particular times. Accordingly, the public interest representation of future boards may differ from the current board. Also, on the same basis, the ratio of optometrists to dispensing opticians may be varied in the future, subject to the appointment of at least one member of each profession. The lay-majority model is working well for the other six registration boards and I would urge the professional bodies to work constructively with the new board.

Similarly, the approach to regulating professionals is somewhat different under the amended 2005 Act. It is less prescriptive but, I would argue, more effective than the 1956 Act which currently regulates opticians. The focus is on the protection of the public by confining the use of professional titles solely to registrants who are obliged to comply with their profession's code of professional conduct and ethics. If, as in the 1956 Act, the Bill provided for the inclusion, in primary legislation, of a specific prohibition on the treatment of eye diseases by opticians and an explicit requirement to inform patients of suspected eye diseases or conditions, it would result in optometrists and dispensing opticians being treated differently to the other professions registered under the 2005 Act. These are matters that are more appropriate to the code of professional conduct and ethics that will be adopted by the optical registration board. The code will require registrants to act within the limits of their knowledge, skills, competence and experience in the interest of public protection. Any breach of the code is defined in the Act as professional misconduct which would be liable to investigation and sanctions under the 2005 Act's fitness to practice provisions.

I would now like to provide the House with some background to the Health and Social Care Professionals Act 2005, which will apply to optometrists and dispensing opticians on the enactment of this Bill and with an update on its implementation to date. The Act currently provides for the statutory regulation of 12 other designated health and social care professions, namely the professions of clinical biochemist, dietitian, medical scientist, occupational therapist, orthoptist, physiotherapist, podiatrist, psychologist, radiographer, social care worker, social worker and speech and language therapist. Regulation under the Act is primarily by way of the statutory protection of professional titles by confining their use solely to persons granted registration. The structure of the system of statutory registration comprises registration boards, a committee structure to deal with disciplinary matters and a Health and Social Care Professionals Council with overall responsibility for the regulatory system. These bodies are collectively known as CORU and are responsible for protecting the public by regulating health and social care professionals in Ireland. CORU is also charged with the promotion of high standards of professional conduct and professional education, training and competence among the registrants.

The Act provides for "grand-parenting" which is a transitional period of two years during which existing practitioners must register on the basis of specified qualifications. After this period, only registrants of a registration board, who will be subject to the Act's regulatory regime, will be entitled to use the relevant designated title. As optometrists and dispensing opticians are already regulated under the 1956 Act, no transitional period will apply to them and their transfer to the 2005 Act will be seamless.

To date, the registers of two professions, namely social workers and radiographers, have been established. The Social Workers Registration Board's two-year transitional period ended in May of last year. This means that all persons using the title of social worker are now obliged to be registered and are subject to the provisions of the Act. The transitional period for the profession of radiographer will end in October of next year. Meanwhile, the registers for the professions of speech and language therapist, dietitian and occupational therapist will be established by their registration boards before the end of this year. The remaining professions are following close behind and I expect that the registers of all 12 professions will be open by the end of 2016.

From a public protection viewpoint, a crucial milestone in the regulation of the Act's designated health and social care professions will be the introduction of a robust fitness to practice regime. This will involve the commencement of Part 6 of the Act to allow complaints about the conduct or competence of registrants to be investigated. Disciplinary sanctions, where complaints are substantiated, up to and including cancellation of registration, may be imposed. The regime will be similar to that applicable to medical practitioners, nurses and midwives. CORU is currently putting in place the necessary legal and administrative arrangements to allow the new fitness practice regime to be implemented and I hope to be in a position to make the necessary commencement order before the end of this year.

I would also like to update the House on proposals to regulate the professions of counsellor and psychotherapist which are not currently designated under the Act. This issue has been the subject of many Topical Issues debates in the House in the recent past. The Minister for Health may designate health or social care professions not currently designated if he or she considers that it is in the public interest to do so and if the specified criteria have been met. The previous Minister for Health, Deputy James Reilly, wrote to the Health and Social Care Professionals Council in May of this year advising it of his intention, in the public interest, to designate by regulation the profession or professions of counsellor and psychotherapist under section 4(2) of the Act. The Act provides that the Minister for Health is obliged to consult with the council in the first instance concerning a proposed designation and to give interested persons, organisation and bodies an opportunity to make representations to the Minister. The council has been asked to advise on a number of issues concerning the proposed designation and to take into consideration the recently published report of Quality and Qualifications Ireland, QQI, on the academic standards necessary for the accreditation of courses in counselling and psychotherapy. This is an essential element as it will inform, for the purpose of registration, the assessment by the registration board, when established, of the qualifications of those currently in practice. This is the first stage in the consultation process under the Act and I expect to receive the council's report in the coming weeks. I will proceed to the next stage, which will involve a much wider consultation, when I have fully considered the council's report.

While a number of issues remain to be clarified including decisions on whether one or two professions are to be regulated, on the title or titles of the profession or professions, and on the minimum qualifications to be required of applicants for registration, the proposals to regulate counsellors and psychotherapists are being progressed as a priority. It is hoped the necessary designation regulations can be made early next year. Expressions of interest will then be sought from suitably qualified persons available for appointment to the new registration board that will be established to regulate counsellors and psychotherapists.

I am aware of other professions seeking designation under the Act. Creative arts therapists and audiologists, for example, have been making a case for regulation for some time. The immediate priority, however, is to establish the regulatory process for the 12 professions already designated and to come to final decisions, following the detailed consultation process, on the regulation of counsellors and psychotherapists. When all the registers have been established, towards the end of 2016, the Department will ask CORU to prepare a risk assessment, in terms of public protection, of the principal health and social care professions seeking designation, and to make recommendations concerning options for their possible future regulation.

The second objective of the Bill is to make certain amendments to the Health and Social Care Professionals Act 2005 in the interest of the efficient running of the regulatory system and to ensure consistency with the legislation governing other health regulators. In summary, under this objective, the Bill will divide, for the purposes of the Health and Social Care Professionals Act 2005, the designated profession of radiographer into the two designated professions of radiographer and radiation therapist, permit a registration board to regulate two or more designated professions, and introduce uniformity between the Act and certain provisions of other Acts which regulate medical practitioners, nurses and midwives. The division of the designated profession of radiographer into two designated professions of radiographer and radiation therapist, for the purposes of the 2005 Act, is in response to the evolution of the profession into two professions for all practical purposes. Over time, the training, qualifications and scopes of practice of diagnostic radiographers who take images and radiation therapists who apply radiation treatment have continued to diverge. This division for regulatory purposes has been recommended by the Radiographers Registration Board and the Health and Social Care Professionals Council.

The existing 13-member Radiographers Registration Board will regulate the professions of radiographer and radiation therapist and the Optical Registration Board will regulate the professions of optometrist and dispensing optician. This is a new departure as up to now each profession had its own registration board. The Bill also provides that newly designated professions may, in the future, be regulated by an existing registration board. These measures will limit the number of new registration boards to be established as new professions are designated. Registration boards with two or more professions would still have 13 members, the existing balance between the number of lay and professional members would be maintained, and each of the board's professions would have at least one professional member on the board. In time, in order that CORU can operate as efficiently as possible on a cost effective and self-funding basis, it is planned to rationalise the 12 existing registration boards listed in the Act, one for each profession, plus any other boards that may be established for newly designated professions, into a reduced number of inter-disciplinary registration boards. This will require separate primary legislation to be introduced when the registration boards and their registers for the existing designated professions are up and running successfully.

The introduction of uniformity between the Health and Social Care Professionals Act 2005 and certain provisions of other Acts which regulate medical practitioners, nurses and midwives is driven by the desirability to ensure consistency in the various registration regimes. The Bill will amend the Act in a number of respects to bring its provisions into line with those of the Medical Practitioners Act 2007 and the Nursing and Midwives Act 2011.

The final objective of this Bill is to address an unintended lacuna in section 19 of the Health (Amendment) Act 2013, which came to light during the implementation planning phase. That Act modernised the contributions regimes in a wide range of residential settings so as to better reflect current models of residential care service provision in the disability, mental health and care of older people sectors. Under the National Disability Strategy and A Vision for Change, there is an ongoing drive towards community-based living in the disability and mental health sectors. In line with this, the increasing trend, particularly in the disability sector, is for accommodation needs to be met by the agencies of the State, such as local authorities, responsible for addressing the accommodation needs of citizens generally. However, the 2013 Act unintentionally omitted situations where service users are maintained, although not accommodated, in specified settings by or on behalf of the HSE. The primary purpose of Part 3 is therefore to ensure that affordable contributions towards ongoing daily living costs will apply to those maintained in such settings, subject to appropriate safeguards. For example, the level of contribution will be reduced to reflect the extent to which service users meet their accommodation and-or maintenance costs themselves.

I now propose to outline the main provisions of the Bill. The Bill is divided into 3 Parts. Part 1 has three sections which provide for the repeal of the Opticians Act 1956 and for the standard provisions relating to Short Title, commencement and expenses.

Part 2 contains 37 sections relating to the amendment of the Health and Social Care Professionals Act 2005. It applies the Act to the professions of optometrist and dispensing optician. The primary sections in this regard are sections 6, 12, 17, 20, 22, 34 and 36. It also amends the Act, in sections 6, 12 and 21 of the Bill, to divide, for the purposes of that Act, the designated profession of radiographer into the two designated professions of radiographer and radiation therapist. Sections 6, 12, 13 and 16 will permit a registration board to regulate two or more designated professions.

Amendments to provide for the introduction of uniformity between the Health and Social Care Professionals Act 2005 and the Medical Practitioners Act 2007 and the Nursing and Midwives Act 2011, and consequential and other technical amendments, comprise the remaining section of the Bill. The amendments required to align the 2005 Act with the 2007 and 2011 Acts may be broken down into the four main areas of governance, fitness to practice, registration and offences. The principal governance amendments relate to the election of a deputy chairperson of the Health and Social Care Professionals Council, the role of the council's chief executive officer, quorums and the holding of certain meetings of the council and registration boards by video link or the circulation of papers. The Bill amends CORU's fitness to practice regime to allow for: the cancellation of the registration of a registrant convicted of an indictable offence if it is in the public interest to do so, the appointment of persons to assist in investigating complaints against a registrant, the application for immediate suspension of the registration of a registrant on an ex parte basis, and the publication of the transcript of the proceedings of a committee of inquiry. In regard to registration, the Bill provides for the charging of fees for approving education and training programmes and for attaching conditions to the registration of a registrant with a relevant medical disability. Finally, the Bill modernises the Act's provisions relating to the prosecution of offences and provides the Health and Social Care Professionals Council with new investigation powers similar to those of the Medical Council and the Nursing and Midwifery Board of Ireland.

Part 3 has four sections which, under subsection 1(3) of the Bill, will come into operation in tandem with section 19 of the Health (Amendment) Act 2013. The Bill provides, in section 42, for amending section 61A of the Health Act 1970 to define or redefine key terms. The thrust of the amended definitions provision is to ensure that the statutory contributions regime will cover ongoing essential daily living costs such as food and utility bills where these are met by or on behalf of the HSE, irrespective of whether the service user is accommodated by or on behalf of the HSE.

The Bill also provides for a number of amendments to section 67C of the 1970 Act, including provision for reducing contribution amounts automatically for those maintained but not accommodated by or on behalf of the HSE, Health Service Executive; varying contribution amounts based on service users' income levels and-or levels of dependence or independence; and making appropriate transitional arrangements for the new contributions framework if deemed necessary.

This Bill will modernise the regulation of the optical professions, will ensure all those maintained by the HSE and its agents in specified settings contribute within their means towards their daily living expenses while retaining a reasonable amount of income for personal use, and will enable the Health and Social Care Professionals Council to continue to fulfil, in a more effective way, its objective to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions.

I commend the Bill to the House.

I welcome the broad thrust of the first two sections of the Health (Miscellaneous Provisions) Bill 2014. The Government, however, has taken the interpretation of “miscellaneous” to a whole new level in section 3 which covers charges for people who depend on provision of accommodation by the HSE or agents on its behalf. Fianna Fáil has no difficulty in supporting the first two sections but section 3 leaves much to be desired because of the lack of consultation and discussion with the various stakeholders involved.

The Department of Health stated this is not a revenue-raising measure. The Department, however, also told me last year that it would not have a budget deficit of €500 million. I must advocate on behalf of people who have the view that section 3 will put charges on a statutory footing that could be increased at a later stage. The broader issue of this should have been discussed with the Disability Federation of Ireland and other stakeholders who have concerns about these measures. While the measure contained in section 3 tightens up a lacuna in section 19 of the Health (Amendment) Act 2013, it should have been put out for discussion among the stakeholders involved. Not doing so is regrettable. When we talk about giving people with disabilities a voice in society, the very least we should do is listen to them when such a measure that directly impacts on them is brought before the House. Section 3 does impact on people with disabilities.

The Minister stated the Bill’s main objective is “to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions”. We welcome this streamlining and the advances being made in the regulation of professional medical bodies, as well as them being open to the need for the public to have full confidence in such regulation. There is also the need to ensure continual training and education in these professions, as well as sanction in the event of codes of conduct being breached.

For a long time, some of our professions may seem to have had a vaulted position in society and been considered above the law. Critically, as people take more ownership of their health needs, the quid pro quo is that the medical professions must be obligated to respond in ensuring adequate safeguards are in place to ensure the appropriate conduct of their members. This also applies to education and continual learning because of the advances taking place in medicine in general.

As we are dealing with miscellaneous provisions in this Bill, I want to raise another broader issue, one to which we have referred on several occasions as did the former Minister for Health, of medical professionals who have been declared bankrupt such as pharmacists, for example. A commitment had been given that this issue would be addressed. I cannot understand why a pharmacist, if deemed bankrupt, cannot practise. I can understand the pharmacist being debarred from the business aspect but not from practising. Discussions were meant to have taken place to address this particular issue in the short term. Will the Minister inform me how the Department is dealing with this matter? The professionals involved are highly qualified and are meant to be used more in the provision of community-based medical care. This is an area that needs to be examined and the former Minister for Health said he was of like mind with others who raised this issue.

This Bill highlights the complexity of our health services and the number of health care professionals delivering care in our communities. This leads to challenges, particularly for administration managers and policymakers. As we see health care evolve and become more complex in many ways, equally we need to ensure there are simple and transparent ways for people to bring about complaints and not to be afraid to do so. Organisations overseeing the medical professions must also not be afraid to be seen to acting on complaints. Most people who have a concern or complaint about a medical professional will want it ventilated and investigated. For many years, many health professions swept complaints under the carpet which has led us down some unfortunate pathways in some incidents. I hope the norm will be the investigation of people’s complaints. This will enhance the integrity of health professionals as they will stand up to scrutiny and adjudication by their peers. This will ensure the public has full confidence in all health care professions.

Returning to section 3, the Bill provides that statutory contributions are payable by recipients of residential support services who, while maintained, are not directly accommodated by or on behalf of the HSE. Being maintained by the HSE means the cost of food, utility bills and other household essentials are met by the executive or its agents. However, the Department has no estimates available of the numbers likely to be affected by this measure. I find that a little strange. The Minister claims no extra costs or no extra charges will be incurred but it will still affect people involved as this provision will be placed on a statutory footing when this legislation passes. It would be nice to know how many people could be affected. The people most likely to be impacted are older people and those with physical, mental or intellectual disabilities or care needs who are living in accommodation provided by housing authorities or local authorities and who receive residential support services from the HSE or its agents.

That is a critically important point because moving services into the community will become more prevalent in future. I have genuine concerns that increased charges will arise. In some nursing homes people did not receive the full range of treatments they required such as physiotherapy and other supports. The Department of Health, the HSE, HIQA and others must monitor the situation to ensure people receive their entitlements and the necessary supports to address their health needs. In some cases there is no clear oversight or lines of obligation for the provision of ancillary care services.

I recently spoke to a person in a nursing home who informed me that consultant geriatricians seldom visit nursing homes. We still have a long way to go to develop proper community services where the care professionals go into the community and meet their patients in their home as opposed to the reverse always being the case, which requires people to traipse in and out of hospitals continually. I accept such an approach requires resources but it would also free up resources if people did not have to visit hospitals continually. We should change the traffic flow and get health care professionals into communities. That should be easily done in the context of nursing home care as patients are in a defined place. I heard recently that it is very difficult to get a GP to visit a nursing home out of hours. I accept that is a challenge but we must put a strong emphasis on addressing the situation as such cases turn into emergencies requiring an ambulance and a visit to an accident and emergency department. That is not good for the individual or for the system as it ties up scarce resources in an already challenging environment. That is an area about which I have concerns.

People could be discouraged from opting for care in the community rather than in a residential setting. The financial contribution required could discourage some people from moving from a residential setting to a community setting. The Disability Federation of Ireland is concerned that the situation could adversely impact on those accessing respite care services for a period, which would place an extra strain on carers. It is estimated that family carers provide vital, unpaid support to people with disabilities in their homes every day, thus saving the Exchequer considerable sums of money. Periods of rest and time to oneself can be rare occurrences for family carers but it is essential for many family carers to maintain their health and well-being, therefore enabling them to continue to provide care to a loved one at home. The amounts that could be charged could push people with disabilities further into deprivation or back into institutions, as they would no longer be able to afford to live or socialise in the community. The view was expressed to me by disability advocacy groups. It would have been preferable to have allowed time in advance of the Bill coming to the Dáil for discussion between stakeholders and the relevant sections in the Department, the HSE and others on their concerns about the impact of the proposed changes. Their concerns could well have been alleviated or in some way addressed in the legislation.

The national disability strategy and the Disability Act established a new framework for disability services with the aim of supporting equal participation in society for people with disabilities. If they are paying higher charges, however, they will not be able to afford to participate. What I say is not a reflection on the Minister of State, Deputy Lynch, or the office she holds, but we all know what will happen once a charge is introduced. There is an inevitable creep in the system which continually creeps in only one direction. Charges are seldom reduced. It is a concern for many that once a charge is statutorily introduced, the contributions sought could increase incrementally over a period. Most people with disabilities face considerable challenges in terms of personal development, job opportunities and financially. In the context of the Bill, we would oppose anything that would place further burdens on them. The miscellaneous provisions outlined are varied and disparate and it would be remiss of me to allow the Bill to be introduced without highlighting the issues of concern.

On the broader issue of health and the challenges facing it, the Minister of State is aware of the recent figures on waiting lists for outpatient appointments. Those who are on waiting lists for urgent procedures are being told they will be seen within 22 to 24 months for knee replacements and hip replacements. The challenges are considerable. Budgets are set at the start of the year. The Chamber is known for its latitude in many ways and the Acting Chairman, Deputy Catherine Byrne, is particularly known for her generosity in that regard. We must be honest about the health service. We cannot pretend we can give everything to everyone in the State and that it will not cost them anything. It is probably time for political parties and people in general together to come up with an honest approach to the health service. The proposed model for universal health insurance was not workable. Even those who drafted it must have known deep down that it was merely designed to get the Government over a particular hurdle. We have gone past that stage and we now face a situation where the health service is unsure of the funding model that underpins it. The notion that we can have a health service that will limp along, unsure of which direction to take, which funding model will underpin it or the principles that govern it in terms of who can access it, who will pay for it and who can get it are key components of an honest and timely debate on the direction of the health service. We cannot have a situation whereby this time next year we will have another budget deficit of €500 million and pressure on care professionals, especially at the coalface of the health service.

Nurses protested about patient safety outside a hospital in Galway recently and there was another protest in Limerick. Nurses elsewhere have expressed considerable concern at the impact of the cuts on patient safety. Nurses are health professionals whose obligation is to provide care in a safe, meaningful and efficient manner. We must listen to them when they say they are unable to do that. All the governance and structures in place stand for nothing if the Government does not support them in terms of resourcing them to ensure they can comply with their own high standards, the high standards expected of them by others, and the high standards the public deserve. The key issue is to ensure front-line services, in the context of some of the people proposed to be governed under the Bill, can operate in a safe environment. The Minister of State, Deputy Lynch, referred to oversight by HIQA and others. From time to time HIQA must observe the pressure on front-line staff in emergency departments. Nurses in Galway are being given assistance to cope with work related stress. That is how difficult health care professionals find the situation on the front line. In the context of best practice, continuing professional development and oversight, we must ensure professionals operate within clear defined guidelines and maintain very high standards.

It is critical that we support them when we ask them to do this. When we ask them to do so in legislation they are under an obligation so they should be helped with resources and supports. That is a debate for another day but it seems to me that everyone in this Chamber pretends he or she has the solutions to the challenges that face us in the area of health. We do not have all the solutions but we need a collective observation on the health system we seek, how it will be funded and the services it will provide. Who pays for health care and who receives it? Will everyone be entitled to universality or will contributions vary depending on a person's resources and needs? Will we encourage private health insurance? Is private health insurance integral to the public system or is it separate?

Nobody has all the solutions but producing a document prior to an election is merely pretence - and that applies to all parties. Five-point plans, seven-point plans and key lines throw health services into upheaval yet we expect a service to be delivered. This is not good enough as 100,000 people work in the health sector and 4.3 million people depend on it in various ways. We cannot simply lead the health service into a cul-de-sac and reverse out when we find it is blocked because that is not a sustainable way to deliver health care in this country. Even the best will of the professionals governed by this legislation, other legislation and various overseeing bodies does not allow them to operate properly in this environment.

GPs and nurses are under pressure to deliver in the community primary care setting, as are front-line staff in the emergency services. These are all key areas and we must respond quickly and collectively to the cries for support and help. Many nurses already need help to deal with work pressure and GPs are leaving the country in droves. I am not exaggerating - this is the reality of what is happening outside Leinster House. I know the Minister of State is not immune to this observation as she sees this every day. This matter must be addressed quickly.

The budget will be published on 15 October and it will outline some form of funding until the end of this year. I hope it will give us a chance of making it to the end of 2015 with a reasonable financial package that is realistic, achievable and sustainable, as opposed to the pretence that was offered last year and in previous years. I could go back further but such arguments are for another day.

We can speak of statutory registration, regulation, oversight and insisting on the appropriate behaviour of health care professionals but this must be done in the presumption that such professionals will be supported in their duties with proper and fair resources.

This is the first health-related Bill of the new session and I welcome the Minister of State but I wonder when the Minister for Health will make his opening contribution. I welcome the opportunity to speak on the Bill. The explanatory memorandum indicates the Bill's main purpose is to subsume Bord na Radharcmhastóirí, the Opticians Board, into the Health and Social Care Professionals Council, CORU, divide the designated profession of radiographer into two designated professions of radiographer and radiation therapist and ensure that statutory contributions are payable by recipients of residential support services who are maintained, though not directly accommodated, by or on behalf of the Health Service Executive.

I have been contacted by the Association of Optometrists Ireland - I am sure this applies to everyone here - and it is in broad support of the section dealing with eye care. That this Bill will facilitate increased care at primary level is to be welcomed. The fact that all parties to this proposed change have been consulted is also to be welcomed. I note also that the Department of Health patient safety committee has acknowledged that there is no risk to patient safety if Bord na Radharcmhastóirí is subsumed into the Health and Social Care Professionals Council.

I have also received correspondence from the Federation of (Ophthalmic and Dispensing) Opticians Ireland, which represents eye care providers and registered opticians in business in Ireland. While they are supportive of an update to the Act of 1956 they are concerned about sections 81A and 81B of the draft Bill. These sections state that spectacles may only be dispensed or sold by a registered medical practitioner or a registrant of the designated profession of optometrist of dispensing optician. The members of the federation inform me that currently, while optometrists conduct eye examinations and prescriptions are dispensed by dispensing opticians, they are often assisted by other trained members of staff with tasks such as the selection of frames and the processing of payments. I have been through the process a number of times in my life. They say that the result of these sections is that current practice would be prohibited. The members of the federation see current practice as both safe and an efficient use of skilled time. They are also concerned that if these sections remain in the Bill they could lead to restrictions on access to eye care, including sight tests, an increase in costs for members and the taxpayer and an increase in prices for the patient. I raise these matters on Second Stage because I believe they need to be addressed by the Minister and the Department. I hope my points receive responses when the Minister of State responds to this debate.

To require an optometrist or a dispensing optician to conduct the entire sale, they say, would be a poor use of the time of a clinically skilled professional. They also say that this very specific requirement is not something that is specified in the cases of other clinical professions regulated by CORU. I therefore seek clarification as to whether the Bill allows registered optometrists or dispensing opticians to delegate certain non-clinical functions of the dispense, for example the selection of frames, and the sale of spectacles to suitably qualified staff working under their supervision. Some people buy non-prescription spectacles off the shelf so there is a need to clarify the impact and intent of the sections mentioned.

This is the first Bill to be brought forward in the new Minister's term. I had intended stating "by the new Minister" but this apparently is not the case. Much has changed, it appears, in Government policy since his arrival. Gone are some of the core objectives of the former Minister and in their place we have but guarantees of a continuing - with respect - unfair two-tier health system. I note that to date six registration boards have been established for social workers, radiographers, dietitians, speech and language therapists, occupational therapists and physiotherapists. It is a great pity that these are among the very same services the Government has targeted for cutbacks. Sadly, it is the most vulnerable in society who are most affected by the cuts introduced in the years of austerity under the former Fianna Fáil Government, and continued and deepened by the Fine Gael and Labour Party coalition. The very young and those who have lived longer lives, those with disabilities and those in under-resourced and deprived areas already at a disadvantage see supports continually chipped away.

I further note that no mention is made of the remaining professions of the 12 that had previously been designated under the Health and Social Care Professionals Act 2005, specifically the roles of clinical biochemist, medical scientist, orthoptist, podiatrist, and psychologist. I ask the Minister of State for an update on the development of a framework for the regulation of these professions. If she put it on the record in her opening contribution, I apologise. The debate started way ahead of the signalled time on my schedule-----

It took me by surprise also.

-----and I missed what she had to say. I have the text of her contribution and I will take the time to study it afterwards. If any of the points I have made were not covered in it, I ask that they be addressed in the closing contribution on Second Stage.

The second part of the Bill divides the designated profession of radiographer into two separate professions of radiographer and radiation therapist. There is an important difference and I welcome this development as something that will be to the benefit of patients and also to what will be the two stand-alone recognised professions of radiographer and radiation therapist. These roles have different focuses and I believe that such a division will aid in ensuring the roles keep up with developments internationally along with aiding transparency, and will further improve patient care.

That the Bill will allow the cancellation of registration of a registrant convicted of an indictable offence if it is in the public interest is to be welcomed. Indeed, it is unfortunate that this has not been a part of legislation to date. I also welcome the provision for the appointment of persons to aid investigations and immediate suspension on an ex parte basis. The publication of the transcript of the proceedings of a committee of inquiry, a new departure, will add to transparency and will help to increase the public's trust in CORU and in the provision of multidisciplinary health care. It is to be hoped this will avoid the lack of transparency and omerta that was seen in representative bodies in the past and will not lead us into future health care scandals in which the public is kept in the dark following an injury to one or more of our number. The horrors of the Michael Neary scandal or the symphysiotomy scandal come to my mind, and they must press us to demand a better standard of care and more speedy access to redress in the health sphere.

The Health and Social Care Professionals Council will be given new investigative powers similar to those of the Medical Council and the Nursing and Midwifery Board of Ireland. While the vast majority of those represented by Health and Social Care Professionals Council are, without question, diligent, hard-working and caring individuals, the public must, nevertheless, be protected from rogue practitioners and those whose standard of care is not up to scratch, or even in some cases dangerous to the general population.

Reducing contribution amounts that cover essential daily living costs for those maintained by, or on behalf of, but not accommodated by the HSE, is concerning to me and to many Deputies in the House. I would be worried that this might be an effort to reduce supports in general. The Bill tells us that amounts of contribution would be varied, based on income levels of service users or levels of dependence or independence or both, as the case might be. This passage most certainly needs clarification as it is open to interpretation. It could lead to a Minister - I will not say "the Minister" - deciding that some or many of those receiving support would no longer qualify for it, either in part or in full.

In summary, I support the principal thrust of the Bill, certainly with regard to the Health and Social Care Professionals Act. Much of its substance focuses on the necessary regulation of health care practitioners but, unfortunately, as I have said and intended for the Minister of State's senior colleague if he were here, many of these are among the practices that have been so severely hit by recent years of Government-driven cutbacks. I would have urged him, as I urge the Minister of State, to ensure these are matters of serious and immediate address.

To encapsulate the key points which I believe need clarification, I seek clarification whether the Bill allows registered optometrists or dispensing opticians to delegate certain non-clinical functions of the dispense to suitably qualified staff, as is the case at present. I reflect on the provision for a reduction in contribution supports to cover essential daily living costs for people with physical or intellectual disabilities. If it is, as I fear, it needs to be removed. If it is not as it suggests at first reading, I ask for detailed clarification on how it is to be interpreted and how it will work out in real terms. These points merit the Minister of State's attention and clarification and I look forward to hearing what she has to say.

I am grateful for the opportunity to speak on this new legislation. I welcome the fact the Minister of State is in the Chamber to listen to the views of various Members. We all have one thing in common, despite some political differences, which is that we all want a quality health service with standards and professionalism. We should all unite in the debate on funding for the health services. I strongly welcome any important debate on our health system, in particular on reforming our health service. The Bill is about standards and professionalism. These words jump out at one when one reads the legislation. We must make them real and meaningful and relate them to people's lives. We have a long way to go with regard to standards, professionalism and resources.

The number of people on trolleys in accident and emergency departments increased by 158 in August. This is appalling and not good enough. It is unacceptable. How can we talk about standards and professionalism when this type of activity takes place on the front line in our accident and emergency departments? That is a key part of this debate as well. The Minister of State should not come into the House and say everything is fine, the economy is booming and growth is back in business when there has been an increase of 158 of patients lying on trolleys in hospitals in August. It is time to get real and bring in the resources and reforms we all support.

We need to stuff the tax-cuts brigade until we help the sick, the elderly and the disabled. That is a debate that will go on in coming weeks regarding the budget. In any economy in any civilised society that was ravaged by recession and rampant greed where resources are slim, one must give it to the neediest. That must be a key aspect if one is in here today addressing health issues. That is a tough decision for the Government. It can throw out tax cuts to the wealthy and yet it cannot find the extra resources and finances to look after the sick, the elderly, the disabled and our senior citizens on trolleys in hospitals such as Beaumont. That must be challenged and these are the kinds of tough decisions that need to be made. These are important key elements of this legislation.

The main purpose of the Bill is to subsume the Opticians Board into the Health and Social Care Council. It makes certain amendments to the Health and Social Care Professionals Act 2005 in the interests of efficiency and to ensure consistency with the legislation governing health regulators. It also amends the Health Act 1970 to ensure that statutory contributions are payable by recipients of residential support services, who, while maintained, are not directly accommodated by or on behalf of the HSE. That is what is going on in this legislation. There are positive elements to it and I would also be very constructive regarding the Bill.

The Health and Social Care Council, which I will refer to as the council, is an independent regulator established to protect the public by promoting high standards of professional conduct, education, training and competence among registrants of 12 designated health and social care professions. That is what the council is all about. The objective of the council is a key aspect regarding the build-up and debate on the health service. The objective of the council is to protect the public by promoting high standards of professional conduct, education, training and competence among the registrants of the designated professions.

To date, six registration boards have been established for the professions of social worker, radiographer, dietician, speech and language therapist, occupational therapist and physiotherapist. It is planned to have all these 12 boards and the registers established by 2015. I welcome that six have already been established which is a positive development. I hope we achieve that target by 2015.

When one looks at the details of it, one finds we are talking about professions such as social worker. We now have a crisis with dysfunctional children and children at risk and yet we also have a problem with social workers. We need people to be involved in these front-line services. We all know there are waiting lists but we have to prioritise kids' situations. In particular abused children and children at risk need to be at the top of the political agenda.

The Minister of State should not come in here and tell us the economy is achieving 5% growth if the Government is not going to look after those vulnerable children. If one does not intervene when they are between four and ten years of age, they will all end up in Mountjoy Prison, robbing taxi drivers in Cork or beating people up in the streets because their dysfunction and abuse was neglected when they were between the ages of four and ten. Most sensible people, whether one is a social worker, an education psychologist or a backbench politician, will say that is the reality. Therefore the social workers have to be given priority.

An issue that has come up in recent days is the scandal of the shortage of positions and children on waiting lists for speech and language therapists. This is something we have to deal with. Children should be given these services as a right. If it means more tax, so be it, but one has to pay for the services.

I would like to broaden the debate because I mentioned social workers and speech and language therapists, and there are also occupational therapists. There is also the broader issue, which is the main part of the Minister of State's brief, and that is the issue of disabilities. We need to ensure we have high professional standards for all children and adults with a physical or intellectual disability. We have examples of good practice in the State as I know from first hand from my experience of my family situation. There are some excellent service providers in the State doing an excellent job, but we also need to plug the gaps and give those, who do not have them, an adequate service.

For example, many people do not realise that the census in 2011 recorded 595,355 people as having a disability, equivalent to 13% of the population. At least one in ten adults of working age of 15 to 64 has a disability. Disability increases sharply with age. Just 5.4% of children under 15 have a disability compared with 38% of those over 65 years. This is linked into the debate about the standard and professionalism of this debate on the whole council issue.

Some 68% of people who use disability services are not satisfied with the level of control they have over their own lives. I accept this is about to change and that debate is going on and hopefully it will change. Some 40% are also dissatisfied with the quality of services being provided. The 60% I mentioned earlier are satisfied and, in fairness, they are getting a good service which I commend. However, if we are talking about reform, change and resources, we need to focus on the 40% who are not satisfied.

Some 13,655 applications for disability allowance were turned down last year, which represents a refusal rate of 55%. The Minister of State might say they are trying it on. The reality is that 58% of the appeals were later accepted. My point is that these people should not be punished or penalised for their disability. Almost 4,000 people with disabilities were in need of social housing in 2013.

This goes back to the issue with speech and language service. More than 32,000 children remained on waiting lists for speech and language assessments and interventions at the end of 2013. In 2013, some 15,830 people were waiting for assessment by an occupational therapist, with 2,500 waiting for more than a year, including 1,900 children. I am giving the facts and the reality. We know we cannot do it overnight, but we should prioritise certain issues.

We also have to face the reality that many people with disabilities have also been caught, particularly over the four or five years of austerity and they experience higher rates of poverty, for example. That is a figure that has been ignored - people with disabilities in poverty. Families where the head of the household is not at work due to illness or disability have the lowest average annual disposable income in the region of €21,492 - an 11% drop since 2010. Individuals who are not at work due to illness or disability endure some of the highest levels of consistent poverty at 17.6%. This overshadows the national figure of 7.7%.

Some 48.5% of people not at work due to illness or disability are at risk of deprivation, in contrast to the national average of 26.9%. This means that they struggle with the cost of adequate clothing and heating and cannot afford to eat a meal with fish or meat every second day. That is the reality. I am bringing this into the debate because we are talking about standards, professionalism and the work this council will do to upskill and ensure that standards are met.

Just 24.5% of people with disabilities have completed third level education compared with 38.7% of the general population. Some 16.3% of people with disabilities aged between 15 and 49 have completed no higher than their primary education, compared with 5.1% for the general population of the same age.

Included within that figure are people with intellectual disabilities but there also are people with a physical disability who are extremely bright and intelligent. I again refer to my experience as a councillor on Dublin City Council. In 1999, our target was to try to get the figure of staff with disabilities up to 5% and I remember we exceeded that target in one year. It showed that a lot of talented people in IT and in administration who had a physical disability came into work in Dublin City Council and made a massive contribution to the city of Dublin and the development and running of Dublin City Councils services.

My point is that Members must be radical, creative and compassionate and must show leadership. Only 20.7% of people with disabilities aged 15 and over are in employment, while the equivalent figure rises to 50% for the general population of the same age. The unemployment rate for people with disabilities stands at 30.8%, which is significantly greater than the current figure of 11% for the general public. There also of course have been the hits in budget 2014, including a 15% cut to the weekly invalidity pension, a reduction of €5 million in expenditure on the supplementary payments, cuts of €44 per week to jobseeker's allowance, the abolition of the telephone allowance and seeking of €2.1 million in savings through exceptional needs payments. These issues affected people with disabilities and I raise them because they are important and because one must go back to standards and to the work that is set out.

I will return to the detailed provisions of the legislation, which makes reference to amendments to the Health Act 1970 in respect of statutory contributions. The Bill aims to ensure that statutory contributions are payable by recipients of residential support services who are maintained, though not directly accommodated, by or on behalf of, the Health Service Executive, HSE. Being maintained by the HSE means the cost of food, utility bills and other household essentials is met by the HSE or its agents. While there are no estimates available of the numbers affected, this group is likely to comprise older people and people with physical, mental or intellectual disabilities or care needs who are living in accommodation provided by housing authorities or local authorities or who receive residential support services from the HSE and its agents. Residential support services vary greatly, based on client need, and may include care assistance, supervision, house-parenting, psychological and nursing services. I urge the Minister to give priority to these services in the build-up to the budget.

I note the figures for the waiting lists for residential places, day places and respite care are not very big and consequently, they could be targeted and dealt with effectively. A radical Minister for Health could solve this issue pertaining to residential and day care because I read recently that in some places, the numbers were 300 to 340 and while there was a big figure in the region of 1,100, these still are issues we can attempt to solve. I urge the Minister, as well as every party in the Dáil, to prioritise these people. Examples of good practice are available, as are examples of high standards. Moreover, as the Minister of State, Deputy Kathleen Lynch, is aware, there also are examples whereby some of these service providers during the bad times really maintained services against the odds and managed their money sensibly. I have seen some outstanding services and people availing of some of them did not mind paying a contribution for respite in order to pay for the poorer families in respite. Some chief executives of such services took a highly inclusive approach with the parents. I happen to be a parent of a daughter who is in the Prosper Fingal services, which has a young team of staff who, although they are nailed to the wall, are doing a fantastic job against the odds. My point to the Minister of State is that examples of good practice are available. They should be given a leg up and, where possible, there should be a focus on these issues and the delivery of the services. This is an important point.

The Department of Health has stated that the new system is not intended as a revenue-raising measure, which I welcome. It is understood that most of those affected already are contributing towards their maintenance and accommodation costs. Under the Health Act 1970, the daily contribution will not exceed 80% of the maximum daily rate of the State pension (non-contributory). The Bill provides for waivers in certain circumstances, including to avoid undue financial hardship on the person concerned or his or her dependents. These are the positive aspects of this legislation and are the issues about which Members must agree on a commonsense idea and must decide to adopt it. I will support this and make no apologies for so doing. However, as part of my support, I urge the Government and the Minister to focus on the priority issues. They should not come into this Chamber every second day like the comedian who came into the Chamber earlier, namely, the Minister for Finance, Deputy Noonan, who was telling jokes about the economy. The bottom line is if the economy is growing, that is fine but one must focus on providing services. Moreover, the State must prioritise its money and it is easy to jump up and down stating one wishes to give tax cuts to those people and further tax cuts to those who are well off. Any humane, sensitive and compassionate Government must first acknowledge it is aware that people want this and that everybody needs a break. It should accept the point about middle income and low-paid workers who, God knows, have suffered enough in recent years. However, there are certain times in life when one must make tough decisions and they must be to support the weaker sections of society. This must be the entire theme in respect of this legislation today.

I refer to the details in the legislation providing for the dissolution of the Opticians Board. The section looks at the dissolution of the aforementioned board, the transfer of staff, transfer of property and liabilities to the council, preservation of contracts, pending legal proceedings and preparation of accounts. I am a little concerned by the section pertaining to the transfer of staff and a red light has gone on in this regard but perhaps the Minister of State can deal with it later. It provides that every person who, immediately before the relevant day, was a member of the staff of the Opticians Board is, on the relevant day, transferred to, and becomes a member of, the council's staff. I welcome this provision. Moreover, a person transferred under this section is entitled, while in the council’s service, to be employed on conditions of employment no less favourable than those to which that person was entitled immediately before the relevant day. The previous service of a person transferred under this section with the Opticians Board is to be counted as service for the purposes of, but subject to any exceptions or exclusions in, certain Acts, including the Redundancy Payments Acts, the Protection of Employees Acts and the Unfair Dismissals Acts.

As for the number of people affected by these issues, I believe there are no estimates available of the number of people likely to be affected by the changes proposed in the Bill. The Department has stated: "Unfortunately, the HSE does not collate information at present in a manner which facilitates quantification or reliable estimation of the numbers likely to be affected by the amendments in Part 3 of the Bill". This is also an issue Members must watch because this pertains to standards, effectiveness, accountability and reform. Members should remember they all were elected in 2011, when all promised reform following the shenanigans, everything that had gone on and the way in which things happened. On the doorsteps, all Members promised reform. My point to the Minister of State today is that part of reform is about being realistic. Anyone working in the health service will say that one cannot effect reform without money. As for those Members who come into this Chamber and state that expenditure in the health service is out of control, they do not realise but must understand that the health service is a service; it is not a private company or business and things change overnight. For example, last nights "Prime Time" programme highlighted the question of those families affected by hepatitis C. Those concerned need a drug to keep them alive and I believe the figures quoted were for more than €300 million. However, the bottom line is Members must pull back and must ask what, as a country and as a society, are the priorities. The point I make is that when one has limited resources, one must give them to the priority cases. Although this will not be popular with some people, I must state that I was shocked by a recent poll in The Sunday Business Post. I was having a go at the tax-cut brigade and my position was that were a few extra bob available, they should be put into services. I thought I would get hammered but in the aforementioned The Sunday Business Post poll, when asked, 61% of people stated that were an additional few million euro available, the money should be put into services and the resources should be provided. The Minister of State, Deputy Kathleen Lynch, also should focus on this point that support exists in this regard. Everyone accepts she is trying to do this internally and people are aware that in their hearts, those who work in the health services are trying to provide a quality health service.

People are also aware that there must be reform, efficiencies and accountability and that they cannot spend their lives slagging off the medical profession, including doctors and consultants. I acknowledge so doing might sound good in the newspapers.

However, I have a major concern in light of the €100,000 or so of taxpayers' money that is given over to training each young doctor in UCC, NUIG, UCD and so on, when, as soon as their training is complete, so many end up going off to Australia or the United States to work. It might not be popular to mention Cuba in this Chamber - colleagues seem to have gone mad lately in their support of the US - but what happens there is instructive. When I visited the country some years ago I met a group of medical students who told me how, after finishing their training, they were obliged to give two years' service to poor communities in the villages and mountains, providing GP, midwifery and a range of other services. On another occasion, in a pub in Havana, I met another gang of medical students who were working, during their summer holidays, with the poorest families and communities.

This is a country that has been hammered by the embargo imposed by the bully boys in the US. I do not know what the Americans are up to, but I wish to God they would leave the Cuban people alone. However, that is another debate. The point of this example is to show what is happening in a very poor country that is being tortured by a US embargo. I attended a disability centre during my visit there and saw the disability provision that operates from cradle to grave. Every child with an intellectual disability is guaranteed a service from day of birth to day of death. We have far more resources than some of the countries already providing the type of modern, accessible and progressive health service our citizens deserve.

I welcome the Bill and the measures it contains. When it comes to health service provision, we should take a cross-party approach. The universal support for the NHS in Scotland was very evident during the campaign leading up to the independence referendum. I am very sorry for the voters for whom the result was a disappointment, but I was pleasantly surprised to see that all parties were committed to protecting the NHS. Some even spoke about how to make a better NHS. I would like to see a united approach in this country which acknowledges that there are certain things in life which we as a society and country must protect, namely, a good-quality health service and a good-quality education service. One can build a country and a society from those foundations. If we look after our sick, elderly and disabled, we will have a better country and a better quality of life for the people who live here. The Minister for Finance and his departmental whizz kids might not agree, but early intervention will, in the long term, see substantial savings in the provision of health services. I referred earlier to children being raised in very dysfunctional and violent families. We must intervene early in such circumstances and prevent their ending up in Mountjoy Prison some years down the road.

I hope the Minister of State takes on board the points we have made today. I urge her to keep fighting in the coming weeks for people with physical and intellectual disabilities. These people deserve services as a right, not as a charitable act. The parents of children with disabilities pay taxes and are entitled to a service. Nobody complains about the cost of sending little Johnny to the local national school, but there is plenty of whinging when parents of children with disabilities are looking for speech therapy and other services. We must break down that mindset. I welcome the legislation, but urge the Minister to give consideration to these issues.

I welcome the opportunity to contribute to the debate on this important Bill, whose aim is to enhance the health protection of the public. I was not around for the debate on the Opticians Act 1956, which this Bill will replace, or the Health Act 1970, which it amends. I was here, however, for both the passing of the Health and Social Care Professionals Act 2005 and the publication of the health strategy in 2001 which was the impetus for that legislation. I recall the importance attached to the passing of that Act in terms of its affording important information and protection to patients and giving them certainty that the health professionals caring for them had participated in recognised training and qualification courses and had reached and maintained a certain standard and fitness to practise, as overseen and enforced by a statutorily specified body. That such statutory safeguards are necessary is beyond question and I very much welcome the amendments and additions proposed in the Bill we are discussing today, which will enhance the safeguards in the original legislation.

Sick people have always been easy prey for charlatans. In fact, that has never been more the case than today, when we, more than any previous generation, are obsessed with health, fitness and diet and the pursuit of a longer and better quality of life. This is not a bad thing, but it does leave people open to the influence of quackery, mountebanks and very dubious medicine in a whole range of areas, from the magic diet that will give one the perfect figure to offers of foolproof cancer cures. Moreover, the Internet, which is now available to everybody, greatly facilitates this. It is understandable that people who are desperately ill or unhappy want to believe there is a cure for their ills. It is not something for which we can comprehensively legislate, because no legislation can protect people entirely or prevent them from accessing such doubtful services.

I am not suggesting that because a service is not regulated it is necessarily bad, but there are some services which are so important they must be regulated. I was appalled recently, in the aftermath of the Y case, to see fly postering all over Dublin advertising a website for the purchase of abortion pills. Abortifacients are not of themselves dangerous, but they can be both dangerous and ineffective if taken without proper supervision and information, if not taken at the right time, or if taken by persons who have no access to after care, if such is necessary. This particular issue is not entirely relevant to the Bill before us this evening, but it is an example of the types of practices to which people who are desperate will resort and which are facilitated by the Internet.

My colleague, Deputy Dan Neville, has frequently raised concerns regarding the lack of regulation of counsellors and psychotherapists offering various services, particularly to people who are at risk of suicide. I have regularly had flyers through my door offering services to both adults and children. The persons advertising these service may well be properly qualified, but it is difficult to know for sure. Before anybody is allowed to go mucking around with the minds of people who are unwell and vulnerable, there should be a way of ascertaining whether they are suitably qualified to do so. People seeking these services should know how to access providers who are competent and whose qualifications are recognised. As I said, it may be that most of these people are qualified, but the point is that we do not know. I understand there are moves afoot which would allow this group to reach agreement on the standards and qualifications necessary to allow members to assign themselves part of a designated group of professionals, so members of the public will know where to go to access these services. The Minister of State might elaborate on that.

On the other hand, there is always a danger when setting standards to regulate any profession or allow access to a profession that such regulation becomes so prescriptive as to create a restrictive practice or anti-competitive situation. In fact, that has been in the case in the health sector in the past, with some professionals acting as gatekeeper to their services or the services of others in the profession. The Minister of State might recall the fight put up by opticians some years ago when pressure was applied to them to end their monopoly on the sale of reading glasses. I assume that monopoly was protected in law at the time, but we can be thankful that the same no longer applies and people can now buy what is essentially a pair of magnifying glasses at a reduced price from a range of outlets.

I am very glad to be able to buy them cheaply. The work opticians do is vital and specific but it is no reason they should be the gatekeeper to buying what is just a magnifying glass. I mention this because there is an onus on the council and on registration boards to be wary of these kinds of practices, even down to the setting of registration fees, lest they also become a barrier to entry. After all, the idea is not to protect the professions but to protect the public. The public interest should be paramount in all the deliberations and determinations of the council and the registration boards.

While the thrust of these provisions and the parent Act is to protect the public, there are two enormous benefits to the professionals themselves whose titles are being protected. They will not, for instance, find their careers being undermined by individuals who have not gone through the same training, who do not have the same qualifications and who have not obtained the same standards as they have. Once their profession is registered, people cannot just come in and set up without registering and having the recognised qualification. This is recognised by the various professionals because they have always been anxious to have statutory backing for their specialty and, indeed, we have had representations for further specialties.

If I remember correctly, this designation of professions facilitates compliance with an EU directive which allows mutual recognition of qualifications of those who are designated. This gives a huge benefit to the professions because it gives them ease of mobility and they can practice across the 28 EU countries. It is a benefit to the HSE in that when there is a shortage in a particular profession, it can go abroad and know that the standard of those it recruits in the EU is of a similar standard.

The 2005 legislation anticipated that further professions would join the registration system, beyond the initial 12 designated. The legislation was flexible enough to facilitate that and what is happening now, that is, the inclusion of opticians, with a single board registering the two branches of the profession. The same split is being accommodated for radiographers, which is right, because clearly they are two very different specialties. I am surprised it was not recognised initially because it is something that requires very different qualifications and it is right they should be registered separately and be subject to different standards.

There are other aspects of the legislation which give new powers to the registration boards - for instance, to suspend members of the profession when they are under investigation, if it is in the public interest to do so, and to cancel registration if they have been indicted of particular offences, again if it is in the public interest to do so. That is essential. One must be able to enforce standards. There is no point having standards if one cannot enforce them, so they are welcome additions to the powers of the registration boards.

There is a new power to add conditions to certain professionals if, for instance, they are suffering from a mental or physical disability of some sort. That is reasonable. It should not be black and white where one is struck off if one has a disability. People can do a job to a certain standard. I am glad that flexibility is included.

If I have a criticism it is the inordinately long time it has taken to implement the 2005 Act. I am not laying this at the Minister's door because it goes back over several Governments. This Bill is the second legislative change to the Act. For all intents and purposes, the Act has not yet been implemented. It took a while to get the boards in place but at this stage, we should be looking at a situation where all the boards should be at least registering the professions. As long as this goes on, the potential of the Act to protect the public is unrealised and there can be no mechanism in place to deal with fitness to practice complaints. The key to this kind of legislation is that the standards set are enforced. If that is not possible, there is no point setting standards at all. It is time for this legislation to be implemented and to be up and running. I hope this additional legislation will act as a spur to action, so that at least we can get all of the professionals registered and operating.

I refer to the section on statutory contributions because this is a miscellaneous provisions Bill. Like Deputy Finian McGrath, who spoke before me, I have a child - a son - in residential care. I can also say people have suffered over the years of cutbacks. There are different providers but I can only speak for the provider for my son which is Cheeverstown House. It has done an enormous amount of cutting back and has created enormous efficiencies. It is now at a stage where there is very little room for manoeuvre and services are definitely suffering. Like Deputy Finian McGrath, I hope its hardship can be eased as times get better and that it is prioritised.

The reason I mention it at all is that I fully support the whole notion of contributions. There was a bit of an outcry when statutory contributions were first introduced. The contribution made is only a fraction of the cost of the service. I would be delighted to make the contribution required, as I think most people would be, given the huge contribution taxpayers make towards the services. This measure in the Bill is a belt and braces provision to ensure persons who are supported or maintained by the HSE or its agents are liable for charges for that support although they are not actually accommodated by the HSE. The purpose is to give legal backing, even though I presume, in most cases, they are already paying.

I understand the need to include the whole new range of accommodation types because there has been a proliferation of different types of services in recent years. As well as the kind of sheltered accommodation provided by local authorities, there are many new living arrangements for people with disabilities. I am sure the Minister will agree that as the recession bit, the provision of new residential care places virtually came to a standstill and families with people with disabilities had to become ever more involved and had to find more innovative ways to find housing solutions, including buying homes, sharing homes and lending homes. Sometimes a number of families have come together to provide a home. They are more than happy to pay for the services with a certain percentage remaining with the clients as pocket money. Indeed, that arrangement is not dissimilar to the direct provision system for asylum seekers which has received much comment recently, but it is the system which pertains for many people in residential care. We should welcome the fact the HSE is flexible enough to look at these new models of housing for people with disabilities. The recession has forced us all to be a bit more imaginative in the way we provide services, whatever they may be.

I agree with previous speakers that it is a little bit worrying to read that the HSE does not know how many people this legislation will apply to or how much it is currently collecting from them.

If the system is to work fairly, it has to be flexible and recognise the different circumstances in which people might get supports from the HSE. The HSE and local authorities have to be able to respond flexibly. I recently dealt with a case involving a married couple who rented from their local authority. The husband had to enter a mental health facility for several months. He paid the charge in the mental health facility, which meant his wife did not have that income, but she was charged by the local authority based on the benefits accruing to a married couple. Local authorities and the health service need to co-operate so that people are not disadvantaged. That is an aside, however, and I welcome the legislation overall. I am delighted to have the opportunity to speak on it and I look forward to seeing it being implemented at the earliest opportunity so that it can provide the safeguards it envisages.

I thank the Technical Group for allowing me time to speak on this important Bill. I welcome that the Minister of State, Deputy Kathleen Lynch, is in the Chamber for this debate. Given that she is a very practical person, I am sure she wants to hear about practical things that are happening on the ground with regard to our health service. St. Columbanus Community Hospital in Killarney is an excellent facility with which the Minister of State is familiar and which is run by an excellent management team and by nurses and staff who are stretched to the limit. Yesterday evening, I received a message from the hospital that a resident, who was not very elderly, wanted to see me. When I visited the ward on which he was staying, he was not expecting me because he did not have a mobile telephone through which I could contact him to make an appointment. He was sitting on a chair beside his bed with a towel covering his face. When I said "hello" to him he perked up and pulled the towel off his head. He explained that he had covered his head with the towel because he has cataracts and has been waiting two years to have them removed. The Minister of State will be aware this is usually a successful operation and that the distorted vision caused by cataracts can be very upsetting. This man is only in his early 60s but he is condemned to sit on that chair with a towel over his head because the only way he can get comfort is by seeing blackness in front of his eyes. If he removes the towel he is upset by the lights and strobes he sees because of the cataracts.

These operations have been moved to the South Infirmary in Cork, which is inundated to the point where it cannot manage. Earlier today I listened to the Minister for Finance as he clapped the Government on the back. I know the Minister of State would not act likewise because she is aware of the issues arising in her Department. She knows too many stories like that of the nice man I met yesterday to clap herself on the back. When these issues are addressed, I will be the first person to clap her on the back but I will not do so while we cannot look after people in that position or we condemn those who worked hard and paid their taxes to that type of existence. I cannot get the experience out of my head because it was an upsetting encounter.

As a constituency Deputy, I am sure the Minister of State is dealing with similar issues on a daily basis. We need an honest and open debate about the stress and pressure facing front-line nurses and staff in our community and general hospitals, whether in accident and emergency departments or on the wards, because nurses are at breaking point. That is not an exaggeration. Over the summer I had reason to visit Kerry General Hospital and Killarney Community Hospital, as well as other community hospitals, on a daily basis. I have also been down to Cahirciveen. Everywhere I go, nurses and other staff tell me they are breaking point. They are working harder than they ever worked before because they are not given adequate resources to deal with the workload. It is a dangerous situation saved only by their resilience and the fact they go beyond the call of duty every day. People who knew I was visiting the aforementioned individual in St. Columbanus home told me that what was happening was a disgrace. Something has to be done. I know the Government has to be prudent with money and budgets but there is a difference between being prudent and not providing a service. When it comes to simple matters, such as waiting lists for cataract or hip operations, it is disgraceful that people continue to suffer. They do not have sufficient resources by themselves and rely on the health service to ensure they do not have to wait in discomfort, misery or agony. That is unfortunately the situation.

The management of our community and general hospitals are excellent. They provide an excellent service with what they have but they do not have enough. Kerry General Hospital has not received any structural investment other than the additional work done on the accident and emergency department, which was welcome. The wards of those hospitals need a huge investment to upgrade them. I ask the Minister to fight for the necessary resources. There is Cabinet responsibility for providing proper health care to people who desperately need our help.

Tomorrow the general practitioners of Ireland will take an unusual action by protesting outside the Dáil. They do not want to be here because they would prefer to do their work as general practitioners who provide an excellent service. Unfortunately, when young doctors entering the workforce see the contracts and obstacles this Government is putting in their way, they are bailing out and leaving the country. Doctors who are growing elderly are saying to themselves they have had enough and are retiring rather than signing up to what is put before them. We will lose a wealth of experience and will be left with another crisis in terms of a scarcity of good general practitioners willing to work in communities the length and breadth of the country. It is unprecedented that the doctors are coming here tomorrow.

Debate adjourned.