Health and Social Care Professionals Bill 2004: Second Stage.

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

The Order of Business in the Seanad did not last for as long as I had anticipated.

They were good today.

I am not as fit as some at running from my office to the Seanad.

I am pleased to have the opportunity to address the House today on Second Stage of the Health and Social Care Professionals Bill 2004, which provides for the establishment of a system of statutory registration for certain health and social care professionals. Statutory registration is best described as a system whereby individual members of a profession are recognised by a specified body as being competent to practise within that profession under a formal mechanism provided for by law.

Unlike systems of voluntary registration, it is a legally binding process with a mechanism for the prosecution of offences. The Bill is integral to the delivery of the commitment in the health strategy to strengthen and expand provisions for the statutory registration of health professionals. This is the first of three Bills to reform the regulatory environment for health professionals, with legislation for medical practitioners and nurses to follow.

The 2001 health strategy was based on four key principles, namely, equity, people-centredness, quality and accountability. As outlined in the health strategy, gaining people's trust in a health system is about guaranteeing quality. People want to know that the service they are receiving is based on best-practice evidence and meets approved and certified standards. Improving quality in the health care system requires implementation of internationally recognised evidence-based guidelines and protocols and ongoing education and commitment from health care institutions and professionals. Trust requires that deficiencies in the system be identified, corrective actions taken and future progress monitored. The principle of people-centredness includes ensuring that consumers are given greater control and greater responsibility for their own health and increased involvement of consumers as partners in planning and evaluation.

The vision adopted in the health strategy for the future health system places great store on treating people with dignity and respect. The health strategy envisaged that action would be taken to strengthen the customer focus of service providers. While acknowledging the need for freedom in exercising clinical judgment, the Government also accepts the need for a stronger framework for questioning and investigating clinical decisions in specific circumstances. Accordingly, the legislation on statutory registration of health and social care professionals contains a comprehensive legal process for the investigation of complaints against individual professionals.

The health strategy also stated that measuring the costs and quality of services and managing human resources have become increasingly complex at all levels in modern health care organisations. Strengthening and clarifying accountability and measurement mechanisms is a priority. Professionals now practise in a more demanding environment. Evidence-based guidelines, tighter professional standards, the requirements of health care organisations, and patient rights and expectations all add to those demands. That is another aspect of accountability strengthened by these legislative proposals. The establishment of a system of statutory registration for certain health and social care professionals is therefore considered essential to the delivery of the quality and accountability objectives of the health strategy. It will ensure that members of the public are guided, protected and informed so they can be confident that health and social care professionals providing services are properly qualified, competent and fit to practise.

The proposed system will ensure professional conduct and the maintenance of high standards of professional education and training among those professionals. It is estimated that 14,000 health and social care professionals will be subject to regulation from the outset, some 15% of whom are employed in the private sector. The 12 professions to be subject to the provisions of the Bill in the first instance were selected because they are long-established providers of health and social care within the health service and in most instances have experience of self-regulation. In addition, the qualifications of the majority of those professions are currently regulated within the public health service.

While the proposed system of statutory registration applies in the first instance to 12 health and social care professions, the legislation empowers the Minister for Health and Children to include additional health and social care professions in the regulatory system by regulation on the basis of specific criteria. Such criteria include, in particular, the potential for harm to the public, as well as the existence of a defined scope of practice, the degree to which the profession has established itself, has defined routes of entry and is committed to continuous professional development.

Legal registration constitutes a demanding standard of competence for each registered practitioner, including comprehensive fitness to practise structures. A central feature of the Bill is, therefore, the adoption of a contemporary approach to fitness to practise issues. In that context, the Bill provides for a mediation process and other informal means of resolution for less serious complaints by agreement of both parties concerned. It also includes a mechanism for a practitioner to accept a complaint and the sanction proposed to pre-empt the requirement for a full hearing where the complaint is considered to be less serious. A health committee is also being established to investigate, with appropriate input from a medical practitioner, complaints which arise from the health status of a registered practitioner.

The design of the proposed regulatory system was strongly informed by the principle that regulation in the health and social care sphere involves the balancing of a range of objectives and interests. These relate primarily to quality standards of service provision, protection of the public against harm, accountability and economic impacts.

While all regulation imposes economic costs, these costs will be offset in the case of the proposed system of statutory registration by such benefits as quality assuring the competence of practitioners; addressing information deficits for the public; bridging shortfalls in education and training levels; maintaining an incentive to invest in education and training; and the introduction of a statutory disciplinary process and strong consumer representation.

In developing the system of statutory registration for health and social care professionals, there was regard to the principles underlying effective regulation as set out in the various initiatives on regulatory reform, including the OECD report on regulatory reform in Ireland and the White Paper, Regulating Better, which highlighted the requirement that consumers should be placed at the top of the policy agenda. In this regard, while the present system of voluntary self-regulation is operating efficiently in many instances, it is considered that it does not provide adequate protection to the public who have a right to be confident that the person providing a service is properly qualified, of good standing and competent to practise in his or her profession.

The system of statutory registration proposed in the Bill is open and transparent, with strong public interest representation which will serve to enhance the quality of service to patients. Strong emphasis is placed on ensuring quality and safety while facilitating appropriate competition. Representative bodies of the professions concerned have long advocated the introduction of a system of statutory registration. The key features of the system reflect the outcome of consultations undertaken with relevant professional bodies and these bodies have been kept abreast of the development of the proposals. In order to ensure quality and safety while facilitating appropriate competition, consultations also took place between my Department and the Competition Authority.

I will outline the key elements of the proposed system of statutory registration for health and social care professionals. Section 4 designates the 12 health and social care professions subject to the provisions of the Act, regardless of whether they work in the public or private sector or are self-employed. They are chiropodists, clinical biochemists, dieticians, medical scientists, occupational therapists, orthoptists, physiotherapists, psychologists, radiographers, social care workers, social workers and speech and language therapists. This section also provides for the designation of additional health and social care professions by regulation in the future.

Sections 6, 7 and 8 establish the health and social care professionals council; define the object of the council as being to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions; provide that the council must exercise its powers and perform its functions in the public interest; and set out the functions of the council. The health and social care professionals council will, through appropriate co-ordination and oversight, ensure the consistency and coherence of the system as a whole and promote uniformity of practice among registration boards.

The locus of control and direction in terms of the operation of the system of statutory registration lies firmly with the health and social care professionals council. The council will have a co-ordinating role ensuring there is uniformity of procedures throughout the system, particularly regarding disciplinary matters where a substantial legal and administrative burden is anticipated in line with current experience in the medical and nursing professions. It is considered that the individual registration boards would not have the capacity required to deal with the complex legal issues likely to arise on an ongoing basis or would not benefit from the expertise the council would build up handling these issues on a regular basis.

Section 9 lays down the membership of the council as comprising 25 members, 12 being members of the registered professions and 13 from outside the professions, representing the management of the public and voluntary health or social care sector, third level educational establishments and the interests of the general public to ensure an appropriate balance with public accountability.

In keeping with the regulatory system for other health professions, section 17 provides that the council must meet its expenses out of funds at its disposal, that is from fees paid by registrants. Section 22 enables the council to make rules providing for such matters as registration and the receiving and recording of evidence by committees of inquiry. Sections 26 and 27 provide for the establishment of a registration board for each of the 12 professions to be registered; define the object of each registration board as being to protect the public by fostering high standards of professional conduct and professional education, training and competence among registrants of that profession; and set out the functions of each registration board.

Section 28 lays down the membership of each registration board as being 13 persons, six from the particular profession elected by members of that profession and seven persons from outside the profession, representative of the management of the public and private health or social care sector, third level educational establishments and the interests of the general public.

Section 31 enables each registration board to make by-laws regarding such matters as qualifications attesting to the standard of proficiency required for registration. Where a proposed by-law might result in an additional burden being imposed on the Exchequer, both the council and the Minister must approve the draft by-law. Sections 35 to 37 provide for the establishment and maintenance of a register of members of that profession and the procedure to be followed by a person seeking registration. Section 45 requires each registration board to make the register available for inspection by members of the public. Sections 47 and 48 enable each registration board to approve or withdraw approval for education and training programmes for the education and training of candidates for registration and require a registration board to monitor the ongoing suitability of education and training programmes approved by the board.

Section 50 requires the council to establish a preliminary proceedings committee, a professional conduct committee and a health committee to perform functions and exercise powers in regard to complaints, inquiries and discipline and sets out the membership of these committees. Section 51 sets out the grounds under which a person may make a complaint to the council concerning a registrant, including professional misconduct, poor professional performance or where a registrant's ability to practise is impaired by his or her health status, including an addiction to alcohol or drugs. A complaint may also be made on the grounds of professional misconduct or poor professional performance even though the matter to which the complaint relates occurred outside the State.

Section 55 provides that where there is sufficient cause to warrant further action being taken regarding a complaint, the preliminary proceedings committee must refer the complaint either for resolution by mediation or other informal means or to a professional conduct committee or a health committee. Section 57 provides that a hearing before a professional conduct committee will generally be held in public while a hearing before a health committee will generally be held in private.

Section 59 enables the council to apply to the High Court for an order directing a registration board to suspend a registrant's registration pending the completion of an inquiry, if it considers that the action is necessary to protect the public. Sections 62 to 64 provide that if allegations have been substantiated the council must impose a disciplinary sanction on a registered practitioner, such as the attachment of conditions to registration, suspension or erasure from the register. Sections 67 to 69 provide that the imposition of a disciplinary sanction other than an admonishment or censure does not take effect unless it is confirmed by the High Court.

Sections 75 and 76 provide that the council may notify the Minister, employer and public as soon as any sanction imposed on a registered professional takes effect. This includes imposition of a sanction in another jurisdiction. Section 78 makes it an offence for an unregistered practitioner to use a protected title or to falsely represent himself as being a registered practitioner. Section 90 sets out grandparenting arrangements for those practitioners currently in practice. It is intended that all persons currently qualified to work in the public health service will meet the standard required for registration. Where practitioners do not possess the required qualification, they will be given an opportunity to undergo an assessment to demonstrate competence. Where a practitioner does not reach the standard of proficiency required for registration, he or she would not be entitled to continue to use a title that is protected under the legislation but would be entitled to continue working under a different title.

As I said at the outset, this Bill marks a further step in the process of strengthening and expanding provisions for the statutory registration of health professionals as set out in the health strategy. It is further confirmation of the Government's commitment to the delivery of a reformed health service which has as its core objective the maximisation of the level and quality of care provided to patients and clients in the years ahead.

I welcome the Minister to the House. I think this is the first time she has presented a Bill in the Seanad as Minister for Health and Children.

She was here last week.

She was not presenting a Bill. She was speaking on health topics and has certainly been very busy lately.

Fine Gael welcomes this long overdue Bill which the Tánaiste informed me has been circulating for nearly 20 years. The Bill is welcome from everyone's point of view. It is good for the consumers who will get proper treatment when they enter a particular practice. The last thing one needs is someone with a back problem visiting a so-called physiotherapist and emerging with neck and leg problems, later discovering that the practitioner was not fully qualified in the appropriate area. The Bill is also good for the professionals as regulation will protect their good name and reputation and allow them to stand over their titles. Any complaints can be followed up and rectified and in an extreme case a person's name can be erased from the register. Hopefully that will not happen too often.

The Bill will place registration of the listed professions on a statutory footing, giving them the recognition they deserve. The statutory registration gives each member of the profession recognition by a specified body as competent to practise within that profession under formal mechanisms provided for by law. Fine Gael believes that registration of health professionals is necessary in order to ease the legitimate concerns of the general public that they are visiting health professionals who are properly trained and competent to look after their ailments or injuries. The Bill also affords the professionals and the public protection from quacks or those working in specific health areas without any proper qualifications. The Bill will ensure that the good names of professions are protected.

A proper registration system gives the public and the professions protection because it allows for the investigation of allegations of misconduct or incompetence, a welcome step not currently provided for. The legislative framework of statutory regulation also allows for the appraisal and approval of education and training courses, examinations, qualifications and institutions, ensuring the proper development of education and training across the professions. It also allows greater consistency in the application of EU directives concerned with the mutual recognition of third level qualifications in EU member states.

The registration system must ensure that we deliver the best possible service to patients, clients and service users. While the proposed system of self-regulation must be welcomed, I hope that the new structures will have no adverse effect on competition in the various professions. That is a danger when going down the road of regulation. The Tánaiste said she had consulted with the Competition Authority in drawing up this Bill, but we should consider the issue. Unfortunately, we will not find out what might happen for perhaps a few years after the Bill is enacted and in operation. We must be careful that we do not over-regulate and discourage competition in the area. I assume that would not be the aim of the Bill.

I welcome the Tánaiste's reference to people working in areas in which they might not necessarily have the appropriate qualifications. I am aware of one gentleman in Carlow who is quite famous for setting bones, etc.

He is known the world over.

The individual in question has cured many people but he has no medical qualifications whatsoever. The concept of grandparenting rights is, therefore, interesting.

They used to be known as "grandfathering" rights but we have changed the name.

As far as I am aware, the same term is used in respect of slots at Heathrow Airport. Aer Lingus does not own its slots there but it is said to have grandparenting rights in respect of them. This is a good concept because it will allow people who are currently practising and who have a history of doing so to remain in their professions, even though they might not have the necessary qualifications but can clearly demonstrate that they are qualified to work and can cure people.

I am concerned about the holding of hearings in private. The Bill states that hearings can be held in public or private. Why would hearings involving health cases be held in private? I accept there is a need for discretion in certain cases. However, in order that members of the public have confidence in the system we must ensure that deals cannot be done behind closed doors. It is also important to ensure that decisions are reached quickly and that complaints will not take years to resolve.

I understand there are to be 12 registration boards. If I recall correctly, 13 groups were originally to be covered by the Bill. Health and safety officers were included initially and perhaps the Tánaiste will indicate why they were ultimately left out.

Physiotherapists are seeking a clear distinction between themselves and physical therapists. I urge the Tánaiste to rectify the position at this stage. I am aware that, under section 94(3), the Minister may, by regulation, prescribe one or more than one title that is a variant of the title specified in section 4 for the profession and that, in addition to the title specified, may be used by registrants of that profession. However, section 94(7) states that a regulation may be made only if a draft of the proposed regulation has been laid before the Houses of the Oireachtas and if a resolution approving the draft has been passed by each House. I am concerned that on Committee Stage the Tánaiste should cater for the needs of these groups.

I wish to inquire about accountability. Each profession will have its own registration board but there will also be a general council. For how long will the council hold office? Will it be possible to reappoint its members and, if so, for how many terms? To whom will the council be accountable? My previous portfolio was transport and whenever I asked a question about roads I was informed that responsibility in that regard lay with the NRA and not the Minister. The position was similar as regards train services. The last thing we need is to create another body which will be completely unaccountable to Members of the Oireachtas or the public. I hope the Minister will accept some responsibility in this area and not simply blame the council for any bad decisions taken or walk away from difficult decisions. The council should be directly linked to the Minister and thereby linked to the Houses of the Oireachtas and members of the public.

I am disappointed the Tánaiste has not remained in the Chamber for the contributions of Opposition spokespersons. I thought it would be common courtesy for her to remain and not leave halfway through. I am sure, however, my views will be passed on to her in due course.

The complaints process should work if it is effective. However, we must ensure it is quick and fair. We must also ensure that decisions are reached fairly and in a manner that stands up to scrutiny. In the case of someone with a genuine complaint against a particular person or body, we do not want it to take years for the complaints process to run its course in order for a resolution to be reached.

In general, Fine Gael welcomes the Bill. However, we will be tabling a number of amendments on Committee Stage. The main issues that arise are the accountability of the general council, the absence of health and safety officers from the legislation and the need to ensure the complaints procedure will be fair, effective and not time consuming.

This is extremely important legislation because it will place a number of professional bodies on a statutory basis. Many of the people involved in the professions to which the Bill relates were treated unfairly for many years. It is only fair that when people undergo the rigours of taking the decision to enter a profession and study to gain competency therein, they should have protection under the law. It may have taken some time for the Bill to reach us but it is extremely important. I have spoken to many members of the relevant professions who welcome the legislation.

The Health and Social Care Professionals Bill provides, as the Tánaiste stated, for the establishment of a system of statutory registration for health and social care professionals. It is a key element in the health strategy, Quality and Fairness — A Health System for You, to expand and strengthen the regulatory environment in the health sector. It is also pivotal to the objective of providing quality and accountable health care for the public. The latter is extremely important because when people attend a practitioner, either one of those to whom the Bill refers or some other practitioner — I have the honour of being registered in a particular profession — they should be able to rest assured that, following treatment, the cure will not be worse than the disease. Patients' rights must be protected.

Before the Bill was brought forward, a series of workshops were held with the professional bodies to try to reach a consensus on how a system of statutory registration might operate in practice. The groups were consulted to ascertain what they felt were the strong points, which might be enshrined in law, and the potential weak points, which might be consigned to the dustbin. In the main, the objectives in this area have been achieved.

The Government has always emphasised the importance of seeking to build consensus by using a highly-consultative process with the professions involved. The purpose of establishing a regulatory system is to ensure that members of the public are guided and, above all, protected and informed in order that they can be confident that health and social care professionals providing services are fully qualified, competent and fit to practise. The system of statutory regulation proposed in the Bill is open and transparent and is characterised by strong public interest representation. The latter will serve to enhance the quality and accountability of health and social care services provided to the public. A system of legal registration for health and social care professionals is essential to the development of the quality and accountability objectives of the health strategy.

Professional people are usually extremely jealous when it comes to their professional standing. They would be quick to disassociate themselves, and rightly so, from any member who brings their profession into disrepute. That is a well-known fact. No one is quicker to blow the whistle on a person who is bringing any given profession into disrepute than one of his or her colleagues. Long may that practice continue.

At present, only a handful of health care staff — doctors, nurses, dentists, opticians and pharmacists — are subject to statutory regulation. The new system will regulate the activities of more than 11,500 professionals working in the public sector and thousands more in the private sector. On the matter of funding of the 12 registration boards, each of which will have 13 members, I trust there will be an annual registration fee as obtains in other professions. If the boards are to have responsibility for ensuring the education of their members is progressed and kept up to date, a certain financial provision will be necessary within the given profession.

The new system will regulate the activities of a large number of people. The titles of various professions will also be protected. It will be an offence for an unregistered person to offer professional services to the public. I have raised this matter in the House on a number of occasions. They may not be covered by the provisions of this Bill but certain people are practising what they call alternative medicine. Registered doctors who have been struck off, and rightly so, are ripping off vulnerable people by telling them cock and bull stories that they will do the devil and all for them when they are doing nothing. They are the modern day Draculas, sucking every last cent out of those people and the inevitable always happens; the person dies and the unfortunate dependants lose whatever funds they have.

Alternative or complementary medicine will not be affected although these areas are likely to face separate regulation in the coming years. I appeal to the Minister of State and to the Tánaiste to ensure that the people to whom I have referred are put out of business and put in jail where they belong. Members on both sides of the House have complained about some outrageous occurrences. I was confronted with a situation in the Mullingar area prior to the local elections. What I heard would make an apt script for a horror film and it is a disgrace. We cannot stand idly by and allow this to happen and it underlines the importance of this legislation. I am very annoyed about this situation. Other Members such as Senator Finucane, have raised this matter. Something must be done about these people. I think there is a clinic called the Killaloe clinic but I am not sure.

This new system is a culmination of several years of consultation and discussion between the Department of Health and Children and interest groups along with the research undertaken by the IPA. This is the first of three Bills to reform the regulatory environment for health professionals. Legislation for medical practitioners and nurses will follow and that is to be welcomed. I assume Senator Henry, who is a doctor, will also welcome that proposal. Established professionals are not afraid of being part of a regulatory system whereby they must uphold standards because that is what is meant by being a professional. Any legislation which will ensure a system which will be widespread and across the board will be welcome.

Statutory registration is a system whereby each individual member of a profession is recognised by a specific body as competent to practise within that profession under a formal mechanism provided by law. Unlike systems of voluntary registration, it is a legally binding process. All persons wishing to practise must be registered and can be prosecuted for practising if not registered and that is to be welcomed. Moves to introduce legislation to provide for the registration of certain health and social services professions have been under consideration for some significant time but for various reasons it had not been possible to proceed. Members will know the old saying that it is never too late to do the right thing and at long last, the right thing is being done.

There are several pressing reasons such legislation should now be introduced. Legitimate and genuine concern exists among members of the public. They wish to be guided and protected so they are confident that the professional providing the service is properly qualified and competent to do so. The professions themselves require protection where normal operational procedures and ethical factors make it impossible to exclude those who are unqualified or insufficiently qualified from engaging in professional activity. This is because, among other reasons, the professions can only apply an ethical code to their own members. The good name and reputation of the majority can be damaged by the actions of a very small minority that bring a profession into disrepute unless there is a mechanism for sanctioning professional misconduct and misdemeanour.

Disciplinary procedures are provided for in the Act. The Nurses Act established a fitness to practise committee. Such a procedure is strict. Anyone who has undergone the rigours of such a committee or was stupid enough to put himself or herself in the position of undergoing those rigours, will know what it is about. The word is out that one should keep one's nose clean or else one will be given the boot which is only right and proper.

A proper system of registration can allow for investigation of allegations of incompetence or misconduct and allow for disciplinary action to be taken. It also provides a mechanism whereby practitioners compromised by ill-health or addiction can be appropriately dealt with. This is a very important provision. Registration provides a legislative framework for the evaluation or approval of education and training courses, examinations, qualifications and institutions, thus guaranteeing proper development of education and training across the professions. Some of the professions are already discharging these functions. Registration provides a more widely informed and participative forum for the administration and implementation of EU directives on the mutual recognition of third level qualifications in EU member states. It will also lead to greater consistency in the application of these directives.

Voluntary codes of registration, while very useful in themselves, cannot by definition offer the legal protection afforded by a system of statutory regulation and this is why this legislation is important. Underlying all the considerations must be a strong commitment to ensure that the best possible service is delivered to patients and clients and this must be the primary concern when developing a system of registration for health and social care professionals. It is proposed to establish a system of statutory self-regulation for social care professionals and the other 12 health and social care professions involved. The regime will provide a formal legal framework and administrative infrastructure within which the quality of the service provided to the public and the future development of the professions can be assured.

A registration board will also be provided. We are delighted to "import" professionals, if that is the right word to use. In the past there was great difficulty in recruiting social workers. When I was a member and chairman of a board, we were forced to recruit in South Africa. People from across the water are very welcome in this country. If they have committed a misdemeanour across the water or been guilty of any professional misconduct, that must impact on their employment in this country.

I welcome this Bill and I welcome the Minister of State to the House. I have posed a number of questions and I look forward to Committee Stage. This Bill must be right. It has been a long time in gestation. It is important because we need the type of professionals the public deserves. We must outlaw services such as those provided by the east Clare clinic.

May I share my time with Senator Quinn?

Is that agreed? Agreed.

I welcome the Minister to the House and I welcome the Bill. The Bill has been sought for approximately 20 years and it is good to see it before the House today.

I have taken note of the sensible words of Senators Browne and Glynn but it is important to recognise that we cannot protect the general public from themselves. If they insist on going to unregistered practitioners there is very little we can do but the Bill puts everything in a much better framework because people will now be in a position to look up registers and see if these people have the necessary qualifications. It is important for fellow professionals as well because all health work, as the Minister is well aware, is team work and one would like to think the people one is working with are properly qualified. We have appalling examples of people claiming to have qualifications which they do not have. We have seen people appointed to jobs only to discover afterwards they do not have the qualifications. That is why they are now asked in many cases to send in the original degree certificates. It is good to see this Bill being brought forward.

Senator Glynn brought up the case of a man who was on the medical register but it was well known for many years that he was promoting fraudulent treatments and taking a great deal of money from the unfortunates in the general public who had very serious illnesses. There appears to be no method under this legislation whereby the council could taken action about something which was publicly well known. A complainant has to come forward but people are sometimes reluctant to come forward to denounce someone they have trusted. They sometimes feel very foolish. Might it be possible to examine whether the council can initiate a complaint if something was known to be a public scandal?

These boards are not self-regulatory. The professionals in each board will be outnumbered by the ministerial appointments but there does not appear to be anything which would prevent the Minister appointing people who are fit to be registered on those boards. That would mean that the profession could be in a majority on the boards. The same appears to have happened in the veterinary council Bill where a vet could be put forward by the Food Safety Authority and some of the other nominating bodies. I do not know if the Minister means the registrants are always to be in a minority or if she does not mind whether that is the case. The council will oversee the registration boards and the chief executive officer of the council will be a very busy person. I was glad to see that he or she will be able to delegate some of his or her duties to juniors.

There is confusion among the general public about the qualifications of some persons. Senator Browne highlighted the situation regarding physiotherapists and physical therapists. It is only in the past few years that physical therapists who are not physiotherapists have set up practice here. Some of them do an excellent job but in the United Kingdom and internationally the title "physical therapist" is synonymous with the title "physiotherapist". The titles are interchangeable and the professional qualification requirements are the same. This fact is recognised in 92 countries, all of whom are members of the international organisation of physiotherapists. The main concern of the society in this country is the protection of the public, which it believes can only be done by protecting the titles "physical therapist" and "physiotherapist" in the Bill, and I will table an amendment to that effect.

In recent years, practitioners who were physical therapists have become confused in the public's mind with physiotherapists, and the confusion often arises when they try to get physical therapist fees reimbursed by the Voluntary Health Insurance or BUPA, only to discover that the therapist they attended was not a physiotherapist and they are not entitled to a reimbursement of fees.

The other group about which there could be confusion is chiropodists because they are required to have a bachelor of science in podiatry. It might be as well to call them chiropodists-podiatrists or something like that because there will be enough trouble trying to sort out the grandparenting situation. I understand there are about five different groups which for many years have been in discussion with the Department of Health and Children about the qualifications and criteria that will be allowed in this Bill.

I do not know who will do the assessments but this is an important area because with the dreadful increase in diabetes in this country, foot clinics and the referral of patients by the medical profession and others to properly qualified chiropodists-podiatrists, is vital. One of the great expenses incurred by diabetics is due to the fact that those who get ulcers on their feet are admitted to hospital for about a month, at goodness knows what cost, when they could be properly treated in a foot clinic or by a well-qualified chiropodist-podiatrist.

I was delighted to see an attempt was being made to provide for mediation between the professional and the complainant. That is a very good idea. From experience with medical litigation cases, I am aware that if some attempt had been made at mediation earlier in the proceedings, many court cases might have been stopped.

I was delighted also to see that professional conduct committees and health committees will be established under the Bill. As the Minister will be aware, the problem has frequently been a health issue involving drink and drugs or something like that. These cases are unsuited to being dealt with by professional disciplinary committees. That is a welcome development.

Under the Bill, the professional conduct committee is mainly to be held in public. That is fine for the professional but I hope the complainant is given sufficient warning as to the private details that may be explained in public. Some of it can be held in public, some in private, but I am aware that people who have taken medical cases to court have been horrified by the medical details brought forward. I have no objection to the committees being held in public, which is probably a good idea, but it is not nearly as hard on professionals as it is on complainants and I hope they are given sufficient warning.

Another area which concerns me is the fact that a register will only be published from time to time. It should be published every year. That is essential because people leave and join the register, and it will have to be up to date. I am sure Senator Quinn will mention, as he always does, that reports must be published and laid before the House promptly, not as soon as is practicable.

Another aspect about the registers that concerned me was the restoration of names. For example, if a person decides not to work for a certain number of years and leaves the register because there is a retention fee to be paid, there is nothing in the Bill about continuing professional development. Changes will have taken place in the time the person was not working. This is a major problem and I have had to be tough about continuing medical education. I am sure the Minister has seen that with pharmacies. One could not be out of that profession for two years without having to deal with all the dreadful changes. One would spend all the time looking up MIMS. That is an important aspect because we do not want people sliding back onto the register, so to speak. With the best will in the world, we all think we are keeping up to date with matters by readingThe Irish Times health supplement but there is a little more to it than that if one is practising as a professional. I hope that something could be done to require people to show they have tried to keep up in that regard.

I welcome the Bill. I will table amendments. As the Minister of State's officials will be aware, regardless of how warmly Senators welcome Bills, the House can always improve them. I look forward to energetic debates on Committee and Report Stages.

I welcome the Minister of State and the Bill and thank Senator Henry for allowing me to spend a few minutes discussing a specific issue. As the Senator pointed out, the legislation is long overdue. I recall that in the 1960s anybody could use the title of chemist. I am not sure when legislation changed the position. In the 1980s, while chatting to an architect about qualifications, I discovered that anyone could place an architect's sign on his or her door.

We must ensure that the qualifications of health care professionals, in particular, are regulated. The contributions of Senators Browne and Henry reminded me of the difficulties we face in this area. One of the 12 professions referred to in the Bill is physiotherapy. I, too, have been contacted by the Institute of Chartered Physiotherapists regarding its difficulty with the title of physical therapist — I often use the word "terrorist" in place of "therapist".

There is a difference.

I must be careful, it is a slip of the tongue. I also have difficulty with the word "draft" as I occasionally mistakenly use the word "daft" instead in the House.

Until now, I did not understand the implications of an issue which arises with regard to the physiotherapy profession. As Senator Henry noted, 92 countries have determined that the titles "physiotherapist" and "physical therapist" have the same meaning. This is also the case in Northern Ireland and Britain where regulations have been introduced on the matter.

Section 94(3) provides that the Minister may prescribe one or more than one title as a variant of a title specified in the legislation. The titles of physiotherapist and physical therapist create a specific difficulty in that both have the same meaning in most parts of the world. In Ireland, however, physiotherapists have qualifications and a university degree, whereas the title of physical therapist applies to those practitioners who do not have professional qualifications. This presents difficulties to patients been treated by physical therapists who have found to their surprise that their claims are not accepted by BUPA or VHI. This difficulty will not be easily resolved by the legislation in its current form. The provision of section 94(3) allowing for regulation of the matter at a later stage is insufficient. The Bill should define physiotherapists to include physical therapists because unless the latter title is included in and regulated by legislation the public will continue to be misled.

I was impressed by Senator Glynn's deeply held concerns regarding activities by a person which verge on criminality. The issue I raise is entirely unrelated and arises from confusion. It should be addressed in the Bill rather than by regulation at a later stage. The objective of the Tánaiste and Minster for Health and Children and the Minister of State in her Department, Deputy O'Malley, is to frame good legislation. During the forthcoming debates in the House amendments will be introduced to improve the Bill, including one to address the matter I have discussed.

I welcome the Minister of State at the Department of Health and Children, Deputy Tim O'Malley. As previous speakers have noted, this welcome legislation is long overdue. It is vital that the legitimate concerns of members of the public are protected to ensure they are confident that professionals providing services are properly qualified and competent.

The professions require protection where normal operational and ethical factors make it impossible to exclude unqualified or insufficiently qualified persons from professional activity. The reason, among others, is that the professions can only apply an ethical code to their own members. Unless a mechanism is in place for sanctioning professional misconduct, the good name and reputation of the majority can be damaged by the actions of a few who bring a profession into disrepute.

The Bill will provide for a proper system of registration which allows for investigation of any allegations of incompetence or misconduct and disciplinary action to be taken if deemed necessary. It also provides a mechanism to deal appropriately with practitioners compromised by ill health or addiction. It is vital that a system of statutory registration provides a legislative framework for the appraisal and approval of education and training courses, thus ensuring the proper development of education and training across the professions.

In dealing specifically with one aspect of the Bill, I bring to the attention of the Tánaiste and Minister for Health and Children the legitimate concerns of the Irish Society of Chartered Physiotherapists. I met representatives of the society and listened carefully to their briefing. While the ISCP welcomes the publication of the Bill, it has concerns about the issue of title. It believes that issues which have implications for the general public have not been addressed.

As Senator Henry stated, the title, "physical therapist", as distinct from the "physical terrorists" to which Senator Quinn referred, is synonymous with the title of "physiotherapist". These titles are interchangeable and the professional qualifications and requirements are the same. In recent years, a group of practitioners has adopted the title "physical therapist", which has led to confusion regarding the difference between the two practices. The matter has only come to the attention of members of the public when their claims to VHI or BUPA have been rejected and, on investigation, they have discovered they were not treated by a physiotherapist.

In hospital settings some doctors who trained or practised in other countries refer to chartered physiotherapists as physical therapists. As previous speakers have noted, this leads to confusion which can impact on patients. While the legislation may focus on statutory regulations for professionals, the interests of patients must be to the fore at all times. The differences between the two practices which currently operate here are profound, both in terms of the different level of educational requirements and the extent of involvement and interaction with the medical profession. This is nowhere more evident than in pharmacy in which there is a distinct difference in the qualifications of assistant pharmacists and pharmacy technicians who work alongside pharmacists. It is imperative that the legislation recognise and clearly set out this difference.

The Institute of Physical Therapy awards the qualification of physical therapist. While this is a legitimate qualification and its practitioners provide a specialised service to the public, it is not the same as the qualification or service provided by a physiotherapist. These two qualifications must be recognised and regulated, while also being separated in the eyes of the general public. I hope the Tánaiste and Minister for Health and Children will address these concerns on Committee Stage.

I also hope the Tánaiste will be in a position to give an assurance that she will, through statutory instrument, protect the titles of physiotherapist and physical therapist for the profession of physiotherapy in the legislation and thereby protect the general public from the current confusion engendered by the fact that a separate group of practitioners whose members are not physiotherapists is using the title "physical therapist", which is interchangeable with the title "physiotherapist" elsewhere in the world.

Recent developments in a changing arrangement between general practitioners and pharmacists must be addressed. While I am aware the Tánaiste recently addressed the issue in the Dáil, I re-emphasise it in the hope that she will examine it in the short term in accordance with existing legislation. Lest some may not know this, I declare a conflict of interest in that I own a pharmacy. However, it does not change my view.

Co-operation between health care professionals is vital in the operation of an effective health care system. However, team working among health care practitioners must have its limitations, for example, in the case of general practitioners coming together to build health centres and putting pharmacies on site, or pharmacists building health centres and inviting general practitioners to relocate their local surgeries to their health centres. Clearly, there should be no business arrangements of this kind between the prescriber and the dispenser as recommended in the pharmacy review group report. This is not in the best interests of either profession or in the best interests of the public. Each profession has its own separate and autonomous role and it is important that this independence should not be, or be perceived to be, compromised in any way.

On the wider issue of health centres generally, I have serious concerns about allowing a pharmacist or a few doctors to control the market in a particular location. Apart from possible ethical considerations, what would this mean for patients in terms of choice, accessibility and quality of care in the long term? I ask the Tánaiste to examine this issue carefully and to set out clearly how she proposes to address the matter.

In conclusion, I welcome the Bill and look forward to examining it in more detail on Committee Stage. The Bill is long overdue and should be welcomed by the professions, as I feel it is. More important, it is in the interests of the patient. All our initiatives and the direction of the health services must be geared towards quality of service for the patient, which should be to the fore in all legislation.

I welcome the Minister of State, Deputy Tim O'Malley, to the House. Like other speakers, I welcome the Bill. It is long overdue and, while I did not examine it in detail, the memorandum makes good reading.

I speak from a unique position as a former member of the Medical Council and An Bord Altranais, which are governed by Acts that mirror the Bill before us. In so far as they mirror it, one can take a sheet out of the Medical Council's book or that of An Bord Altranais and state they are well regulated professions. There are a few problems at the edges — perhaps I am being flippant in putting it that way — but I was glad to hear the Tánaiste state that reform of both professions and the Acts that relate to them is due in the near future. Hopefully, whatever is wrong with those Acts will be put right. In saying that, the 26 year old Medical Practitioners Act 1978 has stood both professions in good stead. I do not see why this Bill will not be just as effective.

The Bill, as pointed out by other speakers, is good for the professions given the ever-changing medical world. During my time with the Medical Council, I discovered that patients now go to their doctors armed with much information. They search the Internet, based on their symptoms, and then they quiz the doctor. However, the medical and nursing professions lend themselves to this. There is a partnership between client and doctor or patient and practitioner. While I am never comfortable with the word "consumer" and prefer the word "patient" when talking about medical matters, patients or consumers increasingly take control and organise their own health care, which is quite new. The Bill gives protection to the practitioner but also allows the patient greater accountability and greater insight into what his or her practitioner might be doing.

I have much experience in the area of fitness to practise. In my six years on both medical bodies, dealing with the issue of fitness to practise was the best education I have had. It opened my eyes and ears to matters one would not believe were going on, some very sad and with dire consequences for practitioners as well as members of the public. I am glad fitness to practise is dealt with in the Bill, supported by the capacity of the High Court to deal with certain cases.

I welcome the establishment of a health committee. While the Medical Council set up its own health committee, An Bord Altranais does not have a health committee, or did not when I left it one year ago. Such a committee is a more humane way of dealing with sick practitioners than subjecting them to a full fitness to practise examination, especially when the issue is one of mental health or addiction. They should be dealt with in a kinder way. I am glad the health committee cases will be held in private before being held in public if the case involves the issue of fitness to practise.

Section 59 of the Bill is essential. It enables the council to apply to the High Court for "a section 59", as I am sure it will become known, to suspend a registrant's registration where the council feels the protection of the public may be interfered with in any way. I agree with Senator Henry that if somebody comes off the register voluntarily and is off it for a number of years, continuing education and training should take place.

While I did not examine all the detail of the Bill, I am interested in the area of competence assurance. It is a hard lesson learned by the Medical Council that the competence of practitioners is now as important as their experience. With regard to competence assurance, perhaps measures dealing with peer review could be included in the Bill.

That the Bill deals with mediation is also welcome. As Senator Henry stated, in most cases if one could bring the complainant and the person complained of together, a simple apology would normally sort out the issue and there would be no need for the lengthy legal costs often inflicted on both sides.

I have a concern about other sub-committees of the 12 boards in question. These are all in the health area and ethics is a significant issue for them, including the matter of the confidentiality of patient records. I do not know how detailed they will be compared to medical records and medical histories but there would have to be a history of some kind. What protection will the public have in regard to their records being maintained in a secure manner rather than being exposed?

Registration takes up much of the Bill from section 35 to section 46. I am interested in having some amendment made to the Bill in this area, a matter I will raise on Report Stage. When a certificate is issued, there should be an onus on the practitioner to display it. This does not often happen and certificates are left in drawers or facing down on desks. How are members of the public to know a practitioner is registered unless they see a certificate displayed? Other medical practitioners have their degrees displayed on the wall. While I do not mean certificates must be displayed in nice frames, they should be displayed in paper frames similar to those of children's first day at school photographs. They should also be displayed on practitioners' desks, visible to members of the public.

Debate adjourned.