I have enjoyed listening to a number of the contributions. Senator Ulick Burke mentioned bone-setters. I am not sure what the opposite of a bone-setter is but in footballing terms we would always consider the Meath footballers in that category.
Senator O'Toole was very concerned about the exclusion of Members of the Oireachtas from the council. That is something we will have to examine. We will revert to him on it. It reminds me of a former colleague of mine who retired some years ago. He was looking back and acknowledging the changes that had taken place since he became a Member of the House. He said that when he was first elected, if the position of a postman became vacant in one's area it was only a matter of nominating his replacement. That is the way he put it; I do not want Members to take me up the wrong way. He said that things have changed so much now that if the position became vacant and 100 people applied for it, the only way one could guarantee one's person would get the job would be to recommend the other 99. Members of the Oireachtas have been excluded from this aspect of the legislation. It appears to be a regular provision in a number of legislative measures recently. It reflects poorly on Members and it is something we will examine and come back to at a later stage.
I thank the Senators for their participation in the debate. I note the broad support for the introduction of this legislation, the need for which has been identified for some time, not least by the professionals themselves. The point was made by several Senators that the Bill supports patients and clients in taking greater control and responsibility for their own treatment and becoming empowered in terms of their own health status.
As emphasised by Senator O'Rourke, the Bill is a milestone in the updating of regulatory structures for health and social professionals generally, as identified in the health strategy, including medical practitioners and the nursing profession. Several Senators alluded to the fact that the professionals themselves fully realise the limitations of self-regulation in certain circumstances and that voluntary codes of practice and professional ethics have no legal force. As referred to by Senator Ryan, in establishing any new regulatory structures it is important to get the balance right in terms of competing objectives and interests and the overall benefits and costs.
I would like to respond to some of the points raised by Senators. The issue of protection of additional titles is an important one raised by Senator Henry in respect of chiropodists and podiatrists. It is not envisaged that additional titles will be protected in the primary legislation, rather the Minister is empowered under the Bill to protect additional titles by regulation. It is believed this is the most flexible mechanism for addressing that issue.
In this context, a number of Senators raised the question of the protection of the title of physical therapist. This is a complex issue, given such factors as the inter-changeability of the title internationally, the scope for confusion among the public and the significant number of practitioners currently earning a livelihood as physical therapists and competition aspects. It will require a practical solution that respects the rights of both parties in the best interests of the public.
The operation of grandparenting provisions will be critical to the effective establishment of the system of statutory registration. It is envisaged that registration boards will adopt an inclusive approach to bring practitioners under the supervision of a registration board. An assessment of basic professional competence ensuring safety will be required. If a registered practitioner does not demonstrate the standard of proficiency, competence and professional conduct expected of registered professionals, this will be grounds for a complaint and investigated under fitness to practise procedures.
Senators Browne, Ryan and Cummins emphasised the need for the Bill to promote appropriate competition. The level of lay representation on both the council and the individual registration boards is intended to ensure effective oversight and scrutiny of the work of the council and boards of any practices that might restrict competition, such as barriers to entry. In addition, each registration board is obliged to register every practitioner who meets its criteria for registration, including recognition of qualifications obtained within or outside the European Union, as raised by Senators Brian and Maurice Hayes, Burke and O'Toole. The issue is addressed under section 37.
Both Senators Henry and Ryan raised the level of lay representation on boards and the council. The proposed level of public interest representation should be regarded as underpinning the authority, credibility and public acceptability of decisions and recommendations made by the regulatory structure. It safeguards against any perception that the regulatory system is putting the interests of registrants ahead of the public as a whole.
The restriction contained in section 14 relating to Members of the Oireachtas is, I understand, a standard provision. In view of Senator O'Toole's comments, we will review the legal basis for that inclusion. My own view is that it reflects poorly on Members.
In considering the extension of the Bill to additional professions, the key guiding principle will be risk to the public and that legal regulation is proportionate to the risk posed. A set of criteria is included in section 4 to inform the inclusion of additional professions under the council by the Minister.
The Bill provides that registration boards should develop criteria for restoration to the register. The updating and maintenance of skills and knowledge required for registration would be expected to be included in such criteria. This should allay the concerns raised by both Senators Henry and Feeney regarding those practitioners who may remove themselves from a register for a period of time.
As emphasised by several Senators, the accountability of the council is critical to its success and will be secured in several ways. For example, the Minister is empowered to direct the council or a board to perform its functions. In addition, the council must submit an annual report to the Minister within three months of the end of its financial year and the Minister is obliged to lay this report before the Houses of the Oireachtas.
As several Senators remarked, the Bill embodies a contemporary and, in important respects, flexible fitness to practise system. As far as the investigation of complaints is concerned, it will be a priority for the council that fitness to practise investigations be processed thoroughly, efficiently and in a timely fashion, while fully respecting the requirements of due process. This requirement will be a standard demand by the High Court in confirming decisions by the council.
Several Senators highlighted the provision of alternative medical treatment for serious and life-threatening illnesses. As Senator Henry stated, it is difficulty to prevent the public from availing of such services, particularly in circumstances in which conventional treatments have not succeeded and where they are regarded as a last resort. The strengthening of the regulatory environment by such measures as the establishment of a health and social care professionals council will place the public in a better position to determine whether a practitioner is suitably qualified.
The broader issue can be addressed by better communication of public information, such as the Medical Council's recent warning concerning cosmetic surgery clinics which do not have recognised surgeons in residence, and strengthening an appropriate expansion of the regulatory system. As regards the contribution of the Bill to this issue, it will prevent unqualified occupational therapists, social workers, etc., from using professional titles and will open registered practitioners to investigation if they contravene their code of professional ethics. Contraventions would be expected to include agreeing on the scope of the practice in which a professional is trained and qualified.
A national working group on the regulation of complementary therapists was established in May last year to advise on appropriate regulation of complementary therapists. The working group is expected to submit its report by the end of next year.
I thank Senators for their interesting contributions. I look forward to the further Stages of the Bill, during which the views expressed in this debate can be considered in greater detail. I commend the Bill to the House.