Health and Social Care Professionals (Amendment) Bill 2017: Report and Final Stages

I move amendment No. 1:

In page 3, between lines 14 and 15, to insert the following:

Amendment of section 4 of Principal Act

2. Section 4(1) of the Principal Act is amended by the insertion of the following after paragraph (l):

“(m) counsellors, that is to say, a person or organisation who engages in, and holds himself, herself or itself out as having experience or expertise to engage in, the activity of giving information, advice and counselling (including giving information, advice and counselling to pregnant women in relation to crisis pregnancies),

(n) psychotherapists, that is to say, a person or organisation who engages in, and holds himself, herself or itself out as having experience or expertise to engage in, the activity of giving information, advice, counselling, and psychotherapy (including giving information, advice and counselling to pregnant women in relation to crisis pregnancies).”.”.

I tabled this amendment in the interest of highlighting the problem at crisis pregnancy agencies and in the hope that progress would be made. I absolutely welcome the Minister's announcement. It was never more clear to me how necessary it was than when I received the lovely documentation advising me that in fact my information was incorrect and apparently someone somewhere has designated "scientific" evidence of the link between breast cancers and abortion. It would be remiss of me not to acknowledge the work done by the journalists and the media in this area, in particular Ellen Coyne who has worked tirelessly to highlight this. On the basis of the announcement made by the Minister, I will withdraw the amendment. We look forward to the regulation of misinformation and its eradication.

I feel I have to take issue with the Minister and some of his comments. The Oireachtas Joint Committee on the Eighth Amendment of the Constitution met today and dealt with this issue at length. At that meeting I was able to elicit from the HSE - the names of the witnesses elude me - information about the so-called investigation that I called for many times in this House when the Minister was in the last Government, whereby undercover ladies attended so-called regulated clinics. The Minister supports, and is now regulating, these clinics. The advice the ladies got was that if they had an abortion and had complications when they came back to Ireland, they should lie to their general practitioners and say they had a miscarriage. I raised this with the Minister's predecessors and the former Taoiseach and I was told it was an investigation, then I was told it was downgraded to an examination, and today I was told that the file went to An Garda Síochána. The HSE official told me today that a desktop analysis of 16 of the HSE-funded agencies was done and there was a deeper investigation and audit of six agencies. Practices were changed, thankfully, as a result. The Office of the Director of Public Prosecutions, DPP, decided in its wisdom not to prosecute.

In its presentation at today's meeting the Irish Family Planning Association, IFPA, said that gardaí were embarrassed carrying out the investigation. I questioned the official to understand how he could know the gardaí were embarrassed. I have been a member of Community Alert since 1986 and every day of the week the Garda Síochána's crime prevention officer and others are always encouraging the public to report any issues of concern, no matter how trivial. It will be investigated in total anonymity. If it is a figment of someone's imagination or a report of a strange vehicle or whatever it is, there is no issue if it is legitimate. I do not know why they would not have a cosy relationship with An Garda Síochána when they have the imprimatur of the former Minister for Health, and now the current one, with gusto, to let them do what they want to do. I do not like undercover activity, but the IFPA went undercover once on the rogue agencies that the Deputy has described and elicited the wrong information that was being given out.

Such information should not be given out, especially to a woman who is pregnant. I wholeheartedly support this.

Deputy Howlin was in government and he has since introduced a Bill to regulate one aspect. That investigation was swept under the carpet and it went from being an investigation to an examination. I discovered earlier that six groups were brought in and they had to change their practices. A number of the women who went undercover had been in when they became pregnant and got the advice. How much more honest or real could we get. They were in for advice and they did not get the options or advice on adoption, on continuing with the pregnancy or on perinatal hospice or supports. That is a fact. They were there. There is wrongdoing on both sides and we will legislate here for those the Minister believes are rogue and the other people can give out information and are paid for doing so. They are connected with organisations all over the world that are trying to push to repeal the eighth amendment and are providing funding. We discovered all of this at the committee earlier. It was one of the better days of the committee. We got good information.

I am surprised about the dishonesty relating to this debate. It is all one way. I condemn any misinformation from any side or from anywhere when a vulnerable person is pregnant and needs, above all, proper advice, rather than advice from a State-funded organisation to, in the first instance, go and have an abortion and be given assistance with that and with travel when the Constitution bans such activity. We have to deal with that. The Minister has a duty to preserve the Constitution. There is a full-time, relentless attack on the eighth amendment. We can change the eighth amendment when the public decides so but we need a reasonable and balanced debate, which we are not having. I do not for the life of me know why the Attorney General or his agents are not at the committee defending what the people voted for and what was put into the Constitution so long ago. There is total inadequacy and failure on the part of the Minister and the Government to have this going on with no one defending the status quo, which is what is contained in the Constitution. It is not something that I or anybody else dreamed up. It is in the Constitution and it has saved countless thousands of lives, thankfully. We talk about human life as if it was just confetti.

That is outrageous.

It saved them. It is the Government's duty as I see it to defend the Constitution until a constitutional issue is debated and voted on and a change is made to the Constitution, passed in this House and approved by the President. We can then certainly change the law. We are putting cart before horse with our desire and efforts to denigrate good agencies out there. Most of them are volunteers and not funded by anybody. As I said, I will not accept wrongdoing from any side. The wrongdoing was very much more so on the part of the official agencies paid for by taxpayers. As I said, I was thankful to find out that 16 different parts of the organisation had a desktop examination, whatever that entails. That is what I was told. Six were the subject of a more in-depth audit and wrongdoing was discovered and corrections were made. I could never elicit this information here. I asked four, five or six times of the previous Government to know where the investigation stood but it did not suit anyone to tell me. When it comes from another direction, all hell must break loose. I point out to the Minister again that it is his duty to protect the Constitution until the people decide otherwise.

I want to put on the record the fact the regulations have now been laid before the Houses of the Oireachtas to be passed. That particular issue was raised on Committee Stage and during earlier debates on the Bill. When we speak about people masquerading as counsellors or masquerading in general on this particular issue there must be an honest, upfront assessment of what is involved in terms of the advice being given and the motivations behind it. The reason I say this is we have to accept that people should only get the best clinical advice available from counsellors based on what is acceptable in the profession. We cannot have a situation where women in a crisis pregnancy are being told barefaced untruths because of political agendas-----

-----from any side and every side. Women in crisis pregnancy must be afforded the most up-to-date information based on best clinical evidence and advice from the governing bodies of the various professions. This is why I welcome the fact the Minister has announced the regulations. I hope they will quickly address some of the concerns highlighted in the programme by other people.

I thank Deputies O'Reilly and Kelleher for their support for the laying of the regulations before the House, which I hope Deputy Mattie McGrath will support when it comes to the debate in due course, probably at a joint committee. What we are trying to do is very straightforward. We are basically saying that if people want to be counsellors or psychotherapists, they must obtain suitable qualifications and then provide women with factual advice. There should not be a situation where people can put their names up above shop fronts and tell women that if they have abortions, they are more likely to suffer from breast cancer later in life. This is what has happened in this country and we will not stand for it.

This is what we are doing, and parties on all sides asked me to do it. This is what we are working on together. That is why we are laying the regulations before the House.

The first step is to regulate counsellors and psychotherapists. That is what the regulations before the House involve. We will then set up the registration board. We will populate that through the Public Appointments Service, which will set the minimum qualifications. Once counsellors are regulated under the 2005 Act, one option available to me, which is quite appealing, would be to review the Regulation of Information (Services Outside the State For Termination of Pregnancies) Act to amend the 2005 Act in order to prevent professionals who are not regulated by the State from providing crisis pregnancy counselling services. There are ways in which we can deal with this effectively and legally. The challenge we have all been trying to deal with is to work out a way in which we can bring about an end to a practice I certainly thought all of us wanted to end. Today is the first step on that road. We should try to pass the regulations as quickly as possible in order that we can move to setting up the necessary infrastructure.

I understand Deputy O'Reilly will withdraw the amendment.

Is it agreed that the amendment be withdrawn?

Question put: "That the amendment be withdrawn."

Will the Deputies claiming a division please rise?

Deputies Michael Collins, Danny Healy-Rae and Mattie McGrath rose.

As fewer than ten Members have risen, I declare the question carried. The names of the Deputies dissenting will be recorded in the Journal of the Proceedings of the Dáil.

Amendment, by leave, withdrawn.

Amendments Nos. 2 to 4, inclusive, are related and may be discussed together.

I move amendment No. 2:

In page 4, to delete lines 18 and 19 and substitute the following:

“5. Section 31 of the Principal Act is amended—

(a) in subsection (1), by the substitution of the following paragraph for paragraph (fa) (inserted by section 6(b) of the Act of 2012):".

Physiotherapists and physical therapists looking in will be glad to know that we are going to talk about physiotherapists and physical therapists now. As I mentioned in my opening remarks, these amendments, together with the other amendments to the Bill I am proposing, have been drafted by the Office of the Parliamentary Counsel. They address these three main issues that arose on Committee Stage. These three amendments propose to amend section 5 of the Bill to provide that the codes of professional conduct and ethics adopted by registration boards must specify that registrants act within the limits of their knowledge, skills, competence and experience. Regulation under the 2005 Act is primarily by way of registration and protection of professional titles.

The Act currently provides that each profession's code of professional conduct and ethics must specify the standards of conduct, performance and ethics expected of registrants. While the Act does not define scope of professional practice, the codes adopted by registration boards also oblige registrants to act within the limit of their knowledge, skills, competence and experience. Any breach of the code is defined in the Act as professional misconduct and would be liable to investigation and sanctions up to and including cancellation of registration under the Act's fitness to practise provisions. The amendments proposed would impose a statutory requirement on all registration bodies, including the Physiotherapists Registration Board, to include these restrictions in their codes. The amendment would in the interests of public protection underpin in primary legislation the current practice of registration boards.

Amendment agreed to.

I move amendment No. 3:

In page 5, line 4, to delete “public;”.” and substitute the following:

"public;",

and".

Amendment agreed to.

I move amendment No. 4:

In page 5, between lines 4 and 5, to insert the following:

"(b) by the substitution of the following subsection for subsection (2):

"(2) A code of professional conduct and ethics adopted by the registration board of a designated profession must specify—

(a) the standards of conduct, performance and ethics expected of registrants of that profession, and

(b) that registrants of that profession act within the limits of their knowledge, skills, competence and experience.".".

Amendment agreed to.

Amendments Nos. 5 to 9, inclusive, are related and may be discussed together.

I move amendment No. 5:

In page 5, line 10, after "31(1)(fa)" to insert "in respect of persons who hold an approved qualification (within the meaning of section 38)".

These amendments propose to amend section 6 of the Bill. They are drafting amendments to clarify and put beyond any doubt the provision in the Bill that 31 December 2019 is the closing date for applications for Institute of Physical Therapy and Applied Science students and recent graduates.

In respect of Committee Stage amendments and the undertaking given to us by the Minister, is this a result of that discussion with the various representative bodies of physical therapists and physiotherapists?

Yes. I reiterate that the amendments I am bringing forward arise from detailed engagement between my Department and the two professional bodies, which I very much thank for the way in which they engaged. I hope, and my understanding is, that these amendments are satisfactory to both organisations.

Amendment agreed to.

I move amendment No. 6:

In page 5, line 21, to delete "(ca),".

Amendment agreed to.

I move amendment No. 7:

In page 5, line 22, to delete "and".

Amendment agreed to.

I move amendment No. 8:

In page 5, between lines 22 and 23, to insert the following:

"(c) where the Physiotherapists Registration Board has made a bye-law under section 31(1)(fa)(i) in respect of persons who were awarded a Bachelor of Science in Applied Health Science and a Diploma in Physical Therapy by the Institute of Physical Therapy and Applied Science Dublin after 1 January 2013 and a person to whom the byelaw applies satisfies that board that he or she has met the criteria and fulfilled the conditions specified in that bye-law, and".

Amendment agreed to.

I move amendment No. 9:

In page 5, line 23, to delete "(c) was" and substitute "(d) was".

Amendment agreed to.

I move amendment No. 10:

In page 6, to delete lines 20 to 25 and substitute the following:

"(ii) successfully completes an assessment of professional competence set by the Board in accordance with any guidelines issued by the Council that attests to the standard of proficiency in the assessment, treatment and management of musculoskeletal disorders required for registration in the profession.".

This amendment proposes a further amendment to section 6 of the Bill. It would amend the Bill's provisions on the assessment of professional competence to be set by the Physiotherapists Registration Board in the assessment, treatment and management of musculoskeletal disorders. It would remove the reference to qualifications from the Institute of Physical Therapy and Applied Science from these provisions. The assessment of professional competence would be in accordance with any guidelines issued by the Health and Social Care Professionals Council. The amendment would also ensure consistency with section 91 of the Act which applies to all designated professions.

Amendment agreed to.
Bill, as amended, received for final consideration and passed.