I welcome the Minister of State, Deputy Power, on the first occasion on which I have had an opportunity to do so and congratulate him on his promotion. I wish him every success.
Health and Social Care Professionals Bill 2004: Committee Stage.
It is an old chorus of mine, and a general commentary on our public administration to ask why we cannot have deadlines for the enforcement of legislation. It appears we are expected to write legislation for the convenience of Government rather than the other way around. I do not care if the Minister sets a timeframe of six months, nine months or 12 months, but to insert the standard provision in the legislation with which we deal to the effect that an Act may come into operation on the day the Minister may by order appoint is wrong. Different dates may be appointed. If the Houses of the Oireachtas pass legislation, it is a reasonable expectation that it will come into force at a reasonable time. While I do not care if it is three months or six months, there should be a time limit. We are entitled to expect the same efficiency from Government that Government increasingly expects from the public service generally.
I thank the Senator. Section 2 contains a standard provision on the commencement of the Act.
It is a problem.
Section 2(2) provides the Minister with flexibility on the commencement of different sections of the Act as some may require a longer lead-in time than others. There is no reason the Government would wish to delay the enactment of the Bill. It is not unusual to make the provision outlined.
I do not want to delay the House or make life difficult for Deputy Power who is from the same part of the country as me and is an old acquaintance from many bodies.
I do not know if it is relevant what part of the country the Deputy and Senator are from.
It might be irrelevant, but it is a nice thing to say. This is not a contentious issue. A Government, which rightly tells us about the disciplines of the marketplace and the need for efficiency reserves to itself the right to delay implementation. I do not say there is a conspiracy, but the Government holds up the process and lengthens the timescale of decision, making as it fails to impose on itself the time constraints and efficiency demands it increasingly imposes on everybody else.
Amendments Nos. 1, 2, 3, 6, 23, 24 and 28 are related and may be discussed together, by agreement.
While I do not wish to speak for Senator Henry, I do not especially like the idea of grouping for discussion amendments on entirely different branches of the caring professions. I suggest amendment No. 1——
Is the Senator disagreeing with the grouping?
I do not agree that amendment No. 1 should be discussed with the other amendments in the group.
Is it possible to separate the amendments dealing with podiatry from those dealing with physiotherapy? This is the basis of Senator Ryan's objection. The amendments relate to two different professions and it would be preferable to take them separately as the arguments are not the same on both. I propose we group amendments Nos. 1, 6 and 28 on podiatry.
Amendment No. 24 is composed of two amendments, which I submitted separately and thought would be taken that way. One part of the amendment relates to physiotherapy and the other to podiatry. Can they be separated?
We should take amendment No. 24 separately.
Yes. Can we do that?
Is it agreed to take amendments Nos. 1, 6 and 28 together? Agreed.
I move amendment No. 1:
In page 9, subsection (1)(a), line 3, to delete “chiropodist” and substitute “podiatrist”.
"Podiatrist" is better recognised internationally as the nomenclature for a person who deals with diseases of the foot. While "chiropody" has been in common parlance here, it would be better to use the more internationally recognised term. I did not have the good fortune to learn Greek at school, but I gather that "podiatrist" means physician of the foot whereas the practice of chiropody includes the hand and the foot. While it has been suggested that one could include a reference to "podiatrist-chiropodist" in the Bill, I was reluctant to suggest this usage as I have not seen it used in legislation previously. I do not know what the Parliamentary Counsel would think of that.
We can solve the issue of those who call themselves chiropodists in my amendment No. 24 which,inter alia, states: “In this Act, the titles Podiatrist and Chiropodist are synonymous and both titles use are restricted exclusively to those professionals who are registered as Podiatrists.” The qualification for a person to be on the professional register is bachelor of science in podiatry. We have many problems with this in Ireland as we do not have any school of podiatry that awards a bachelor of science degree and it is difficult to know when one will be set up. That is why some of my later amendments on podiatry have to be taken into account. Given that we want to proceed with the legislation, it would be advisable to ensure that the terminology used is accepted internationally and that chiropodists are included by stating that the title is synonymous if they have the relevant degree.
I support Senator Henry. The term "podiatry" is now more generally used internationally while the term "chiropody" is somewhatpassé. In the University of Ulster the qualification is in podiatry. It is very important to use terms which have the modern valency but also enable the comparable recognition of qualifications obtained in other places. One can deal with the chiropody issue by the definition of the transition arrangements for existing practitioners in that if they are registered as chiropodists they come under the Act. It seems preferable to use the term “podiatry” in this section.
This is an important issue on a number of levels. Senator Henry outlined the change in the title which is the view of the profession and on which we should reflect. In some cases, even the unions do not include the title "chiropodist". Given that the Good Friday Agreement requires us to have parallel legislation North and South, we need to ensure that legislation in the South reflects the situation in Northern Ireland. In Northern Ireland the term "chiropodist" is almost gone. In addition, the amendments in the name of Senator Henry are of an international nature.
On Second Stage I spoke of the importance of mutual recognition of third level qualifications and professional qualifications throughout Europe, which is an EU directive of almost 20 years standing and on which we have made little progress. Part of the reason we have not made progress is that what we are doing in legislation is putting us backwards. There are many instances where this has happened and we are about to do it again. If we do not cover this we make it difficult to get international recognition of qualifications. That is useful in two ways. First, because we do not have enough medical schools for people at various stages of therapy or branches of medicine. This means that people are being drawn in from other jurisdictions who will travel to and from this country.
Second, a compelling case has been made for having both terms covered because, ultimately, we are concerned here with a qualification. The qualification is clear and the work the people are doing is clear. One has only to listen to any of the daily phone-in chat shows where every month there will be an argument about somebody who has put themselves forward. The reason behind the legislation is to stop people putting themselves forward as something they are not and to ensure that members of the public are clear about those with whom they do business and that they are properly qualified in the area in which they are to involve themselves medically. There is no argument against this. I appeal to the Minister of State to accept the amendment and to view it as a progressive and positive step forward.
I am in agreement with the majority of speakers on the amendment. My understanding, which is based on discussions I have had with members of the profession, is that there is a desire to have both titles, chiropodist and podiatrist, included and that the issue arises from the qualifications. I understand that until the mid-1980s the entry requirement to the profession was a diploma in chiropody and since then the entry requirement has been a degree in podiatry. However, a person who qualified with a diploma in chiropody in the mid-1980s and is practising would have the capacity to work for 30 to 40 years in the profession before reaching the standard retirement age. In view of this it would be unfair that the title associated with their profession is not in line with their qualification at the time. The fairest and most reasonable way of dealing with those in the profession would be that both titles be recognised.
It is widely recognised there is a difference in regard to the meaning of the terms. Nowadays there is a greater level of scrutiny of those who deliver a service and understanding, from a consumer point of view, of the service provided by the practitioner. We need to ensure that a person who has a qualification in chiropody is not disenfranchised at a later stage by the use of the word "podiatry" only. As consumers consider the CVs of those they expect to work on their behalf — it is part of the way they operate — both titles should be recognised. While the amendment seeks to change the term from "chiropody" to "podiatry" I am in favour of including the two terms. I am not sure if that is possible but if it cannot be considered in this House perhaps it can be debated in the other House.
I take up Senator Dooley's point. I discussed the matter with Senator Henry this morning. I would prefer an amendment which would retain the two titles, chiropodist and podiatrist. I understand the Senator has tabled a later amendment on that issue.
In a matter such as this we cannot attempt to lay down the rules. The profession is the one that should know best. I and other Members have been contacted by the Society of Chiropodists and Podiatrists. We should not drop the word "chiropodist" because it is well understood by many people. The word "podiatrist" is beginning to be understood in a more general sense but, I presume, those involved in both have their qualifications. I do not know why we cannot us the term "chiropodist-podiatrist" and I ask to Minister of State to consider that aspect.
I agree with the previous speakers. I wonder whether section 90 could be brought into play here in the grandparenting section where if we change the name to "podiatrist", could chiropody be brought into line by upgrading the qualification? Having listened to my colleague, Senator Dooley, I can understand that those who have been practising for many years may not want to do that and I do not know how they would fit in. Younger chiropodists might welcome an opportunity to come in under a different umbrella of podiatry by upgrading their skills. The grandparenting provisions under section 90 might just come into play in that regard, bearing in mind that the Minister stated the following in the House last week:
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.
I find myself agreeing with the Opposition on this issue. I accept the points made by Senators Henry and O'Toole but I believe it would be best to keep both titles for thereasons outlined. My amendment concerning "physiotherapists-physical therapists" highlights exactly the same point as that made by Senator O'Rourke. I imagine that something similar could be done for chiropodists and podiatrists. Perhaps the Minister of State will enlighten us on whether it is technically possible.
The grandparenting section is very useful. It would be covered by the second part of amendment No. 24 which states, "In this Act, the titles Podiatrist and Chiropodist are synonymous and both titles use are restricted exclusively to those professionals who are registered as Podiatrists." If all of those people who have been in practice for a long time come forward and are considered to be suitably qualified and trained, they will of course be in a position to be registered.
These proposed amendments have significant implications for an important general principle underlying the design of the regulatory system proposed in the Bill. The approach adopted in the Bill is to specify a single primary title under this section by which members of the registration board of each designated profession will be known. The primary title shows a generic name by which each of the professionals concerned is most commonly known to members of the public.
For the professions currently included in the Bill there would in each case be a number of alternative or variant titles reflecting specialties within the professions. For example, the title "radiographer" would encompass diagnostic radiographer, radiation therapist and radiotherapist, whereas a "psychologist" would be a health, education, counselling or clinical psychologist. Variants would also encompass titles used in other countries. For example, "speech and language pathologist" would be used rather than "speech and language therapist", and "clinical nutritionist" rather than "dietician". In the health service, several of the professions would be known primarily by their grade titles. For example, the titles "child care worker" and "child care leader" would be used for social care professionals. In addition, abbreviations of the titles are in common use in the health and social care areas generally. Examples include physiotherapist and occupational therapist. The same would be true in the case of chiropodists and podiatrists.
To avoid the specification in the legislation of several different titles for individual professions, which undoubtedly would be very confusing for everyone, not least the public, the issue of multiple titles is tackled by empowering the Minister, under section 94(3), to protect variants of the primary title by which those practitioners registered with the registration board of a designated profession are known. The intention in protecting variant or alternative titles is to guard against a wilful attempt by non-registered persons to convey the impression that they are members of a profession regulated under the Bill.
An important feature of this process is set out in section 94(7), which provides a safeguard against misuse of the power to protect additional titles in that a draft of a regulation made by the Minister protecting additional titles must be laid before the Houses of the Oireachtas and a resolution approving the draft must be passed by each House. This allows each case to be examined on its merits, balancing such factors as the protection of the public and the promotion of competition.
While I understand the specific issue that arises in this context in regard to the chiropody profession, as raised by several Senators, the adoption of an exceptional approach in this instance would put the chiropody registration board at odds with other registration boards and would serve to obscure rather than enhance public understanding of the health and social care professions.
On the qualifications of chiropodists, the Department has undertaken a comprehensive assessment of the competence of chiropodists who wish to practise in the public health service to deal with the differing levels of formal educational qualifications that exist among practitioners. While I appreciate the concerns of the Senators, the professional bodies representing chiropodists have not advised my Department that they would prefer the term "podiatrist". Therefore, I do not accept the proposed amendments.
I do not know with which registration board with which the word "podiatry" would be at odds. Senator O'Toole stated the importance of making sure that international registrations are similar. The degree people are required to have to be registered by a board is a BSc in podiatry. Senator Maurice Hayes explained the circumstances in Queen's University in this regard. Obviously, the profession has contacted many Senators saying that it would like "chiropody" changed to "podiatry". If we do not make the change we are just bringing things backwards, as Senator O'Toole explained.
How many Members of this House have been contacted by members of the profession to say they would like the terminology changed? I discussed with the Clerk the possibility of including "podiatry-chiropody". It is up to the parliamentary draftspersons to decide what they would do with this. I am totally unconvinced by the Minister of State's argument. It is extraordinary that members of the profession of all the various councils have been asking for this change.
The Minister of State obviously outlined fairly detailed circumstances regarding the concerns about other professions. To agree with Senator Henry and others, no representatives of the other professions referred to in the Bill have made contact with me but the professionals involved in chiropody certainly have done so. They have made a fairly genuine case, particularly regarding the transition from one educational qualification to the other and the difficulty that will arise at a later stage because of the two different standards. Perhaps an exception could be made for chiropodists in light of the fact they represent the only discipline that contacted us on this matter.
The Minister of State said there was no request from the professional body to change from "chiropodist" to "podiatrist". They have made such a request and the representation made to me was certainly not about changing from "chiropodist" to "podiatrist" but about dual recognition. Perhaps there is some confusion over the representation made to the Department. I ask the Minister of State to consider acknowledging the case being made. Perhaps he cannot do so today because it would require further discussions but he might indicate to us that he is prepared to discuss the matter with the professional organisation in advance of the legislation being considered in the Dáil. I would like to see progress in this matter because it is of considerable concern.
I made a resolution that I would keep quiet about matters that I had not raised myself but, having listened to the argument, I would like to make one point to the Minister of State. If he refuses to accept Senator Henry's amendment, anybody could come into this country and call himself or herself a podiatrist and there would be no regulation to prevent him or her from doing so. If I am wrong, will the Minister of State please tell me? It appears that he is saying that if one wants to be a chiropodist and calls oneself a chiropodist, one will be regulated, and that if one comes into this State and calls oneself a podiatrist, one will not be regulated. People will come here with what is the universally accepted description of the profession outside the State, call themselves podiatrists and we will not regulate them. This appears to be the consequence of the Minister of State's argument. I do not know much about the distinction between chiropodists and podiatrists but, having listened to the debate, it is quite clear what is happening. We will have a situation where the State will not regulate podiatry while virtually every other state in Europe will do so.
The Minister of State said something which bothers me, namely, that he had no such representations from the profession. I understood that I was representing the viewpoint of the profession on this issue. If it is not the viewpoint of the profession, we should think differently on the matter. I notice the Ministers of State have changed positions and I get the impression they are not in a position to accept the change because the argument against it is clear. We need to make this change, and I believe that if the Tánaiste were here she would accept it.
I agree with what Senator Dooley said. I would be happy if the Minister of State gave an indication that he would discuss the matter with the profession before Report Stage. If it is the case that we are misrepresenting the profession, I will back off straightaway. I do not think that is the case or else we have been seriously misled. Perhaps the scenario outlined by Senator Ryan can be dealt with in the Bill if people are purporting to pass themselves off as chiropodists while calling themselves something else or having a different qualification.
The real issue is that if we represent the viewpoint of the profession, we need to have some element of recognition. The easiest way to deal with the matter is to recognise both titles within the Bill. I cannot understand how that would create confusion or difficulty. In fact, it would bring us into line with international best practice, the international usage of titles and what is required under the Good Friday Agreement and the European directive on mutual recognition of professional qualifications. The only compelling argument that might be raised against us is that we are proposing something the profession does not require. I understand we are proposing something the profession requires, and in that case it should be considered.
I recognise the Minister of State has just arrived and he is just picking up on the issue. I would like to know whether there was consultation with the profession and that the professionals did not make this suggestion to the Department. Let us put that on the record so that we will know whether we are receiving clear lines of information.
In light of what Senator Ryan said, could a podiatrist come here, set up a practice and not be registered or recognised even if he or she has a university qualification? Perhaps the civil servants thought podiatry would be included in the next phase because there are just 12 professions included in the Bill. If the profession was not catered for, as Senator O'Rourke, Senator Dooley and Senator Browne said, what is wrong with including "chiropodist-podiatrist" or "podiatrist-chiropodist"?
I apologise to the Minister of State for leaving but I thought I had an appointment with his Minister. I thought this amendment would go through on a nod. I do not understand why we are fighting the Battle of the Somme over the difference between chiropody and podiatry, because there is no difference. There is no need to include podiatry because these practitioners are already included. This is what the profession calls itself universally, therefore, the modern title should be included in the beginning. The Minister's reply earlier was a load of old gobbledygook. One might as well use the phrase "bone-setter" for any form of orthopaedic surgery. If people want to include "chiropody" let them do so, but it should read "chiropody-podiatry".
Like Senator O'Toole, I am amazed to hear that the profession has been in contact with the Department urging it to keep the name "chiropodist". I have received information from them throughout the years because, as president of the Diabetes Federation of Ireland, I have been involved with the profession. The Minister of State will be aware that foot care is important. This business about podiatry has come up in the past. All of us on these benches must take some note of university degrees — after all a BSc in podiatry is the qualification.
It is regrettable that during the Second Stage debate the Minister did not remain until the spokespersons had finished their contributions. Today the Ministers of State switched places, and after an argument being made for half an hour, we now have another Minister of State in place making a fresh argument. The Tánaiste told me that the Bill, which is long overdue, has been bandied about in Government for 20 years. If the Bill is enacted, the Minister has the option of including these other groups in the future. Why not do so now? We have waited 20 years so we should include these groups and do a good job now. It makes common sense.
I apologise for coming here but the Minister of State, Deputy Power, had a prior engagement in a Dublin hospital. He is speaking at a function at 4 p.m. so he could not be here.
I understand that four professional bodies represent chiropodists in Ireland, none of which approached the Department to change the title to podiatrist. However, I will contact the professional bodies concerned to ascertain their formal views on the matter. It is intended to regulate both chiropodists and podiatrists under the aegis of the chiropody registration board by including one title in the legislation and dealing with the other later by way of regulation under section 94(3).
While 12 professions are included in the Bill, several other professions have also endeavoured to be regulated. It is the intention of the Department to regulate the professions later.
We can only act on what we are told. I received calls from a registered chiropodist who said that we could include in the Bill "chiropody-podiatry" which would mean that each title would have the same significance. Perhaps the Minister of State will contact the registered bodies concerned before Report Stage and find out what they want. We do not know enough about the issue so we can only act on what the professionals tells us. I am always pleased to be lobbied by professionals. When I received a telephone call yesterday I said that I would speak on the matter today. If the Minister of State cannot do so, perhaps his officials will meet the registered body of chiropodists to ascertain its members wishes in this regard.
I agree with the Leader who is speaking sense, as always. My understanding of section 95 is that if the Minister wants to do this at a later stage it will still require the laying of a draft of the proposed legislation before both Houses of the Oireachtas and each House will have to pass a resolution approving the draft. That means going through the whole procedure again. Why not do it now? Perhaps Senator Henry would agree to withdraw her amendment now so it can be validly moved on Report Stage and the Minister will have sufficient time to check with the relevant people.
I agree with Senator O'Rourke and the individual from the profession who contacted me. It is not about one versus the other. It is about dual recognition. The person in question is a qualified chiropodist with a pre-1986 diploma who has upskilled to a degree in podiatry. The Minister said, as did the Minister of State at the Department of Health and Children, Deputy Power, that he had had no contact from the professional bodies regarding the change of name from chiropodist to podiatrist. Notwithstanding the wording of the amendment, the issue is clearly that of dual recognition. Perhaps the Minister can tell the House whether there has been any discussion or a request for dual recognition. That might simplify the issue. As Senator O'Toole has indicated, we are acting in good faith having had numerous discussions with members of the profession and are trying to the best of our ability to highlight the issues as we understand them based on representations from the profession. The arguments put forward seem exceptionally reasonable to me and to other Senators and they require further consideration.
I would be happy to conclude on this matter today with an assurance from the Minister that he will discuss the issue of dual recognition with the four groups from the profession and allow some discussion on it here on Report Stage.
It is crucial that we have clarity on the issue of dual recognition and that there is no attempt to abolish it. Senator Ryan referred to what could happen. It is clear that as the legislation is currently drafted people could not misrepresent themselves as being chiropodists. However, people could misrepresent themselves as being podiatrists. That is the difficulty. That leaves a gaping hole in the Bill. Knowing that to be the case, we are about to pass legislation to legislate for a loophole we know exists and are trying to address. It would be very foolish of us not to take that on board.
We have put forward a very persuasive argument, which I will not rehearse. I do not believe either Minister disagreed with the points made, but he tried to pinpoint some technical problems. I do not see any technical problems. This is a matter of protecting the public, protecting a title and giving due recognition to people who are duly and properly qualified.
I suggest that we park this issue until Report Stage and that in the meantime the Minister's officials make contact with the professional bodies and return with a revised proposal on Report Stage. We all have the same objective. There is nothing political about it and nobody is trying to undermine anybody. On that basis I would be happy to move forward.
That is a helpful suggestion, as was the Leader's. I would ask that the Minister's officials make one additional telephone call to establish the position in Northern Ireland so that there is total fluidity around the country.
I have a procedural point. We have spent 45 minutes discussing something Senator Maurice Hayes, who is as experienced a public servant as I have ever met, said he thought would go through on the nod. There is a message to be learned from that by the Minister, namely that the Members of this House and the Dáil put down amendments for a reason and expect a reasonable response. We did not get a reasonable response — we got gobbledygook, a classic parliamentary draftsman's reply to the effect that because we did not put it in, it should not be in and that it should not be in because we did not put it in. We regularly get such a response. Members of the Oireachtas are entitled to serious responses to their amendments.
This Bill is timely. We should not sacrifice accuracy for speed. The point made by the Leader, by Senator Maurice Hayes and others is that we should wait for absolute clarification. We are talking about two different things although they are related. There should be clarification and we should proceed accordingly. If a Government amendment is necessary, let us get it right. It is as simple as that.
I am becoming more and more alarmed. The Minister of State stated that 12 boards are being set up. Is he signifying that we might set up a podiatrists' board as well?
I did not signal that.
It is suggested that the wording regarding "podiatrist" could be left until later. I would hate to see the profession divided up into chiropody and podiatry.
What I said is that none of the four professional bodies has been in contact with the Department of Health and Children and that we will now contact them as well as acting upon the suggestion of Senator Maurice Hayes regarding the situation in Northern Ireland. We will then be better briefed to come back to the issue.
I agree with the suggestion that we postpone this until Report Stage while the officials telephone people in Northern Ireland and all sorts of exciting things happen.
We now come to amendment No. 2 in the name of Senator Brendan Ryan. Is it agreed to take amendments Nos. 2, 3, 23 and 24 together?
I understood we had decided to take amendment No. 24 on its own, but it is a matter for Senator Henry.
We had decided to take amendment No. 24 on its own. Amendment No. 24 includes physical therapists and physiotherapists, and podiatrists and chiropodists, and I thought we had agreed to omit physiotherapists for the moment.
Is it agreed to take amendments Nos. 2, 3 and 23 together? Agreed.
I move amendment No. 2:
In page 9, line 9 to delete paragraph (g) and substitute the following paragraph:
"(g) physiotherapist or physical therapist”.
On a procedural matter let me suggest gently, as I have often done in this House, that it would be no harm to consult Members regarding grouping.
The Senator should speak to the amendments. I am not enforcing anything. I am taking amendments as agreed by the House.
I agree, although it took me 20 years to discover that I could disagree with the grouping of amendments.
A Leinster man is always a bit slow. If the Senator had been born in Cork he would have picked it up quickly enough.
The Senators should address the amendment.
In deference to the Chair, I will not respond to Senator O'Toole.
We have all had representations made to us regarding the confusion between the terms "physiotherapist" and "physical therapist". Listening to the language, it is easy to understand the confusion. Apparently, in terms of health insurance, if one goes to a physical therapist one may not get payment under one's health insurance but if one goes to a physiotherapist one does. There is considerable uncertainty. The request received by all of us in the House was that the term "physical therapist" be introduced as well.
Having heard the response to the last amendment, I could probably write the response of the Minister of State to this one because it will be identical except the words "physical therapist" will be substituted for "podiatrist". The same issues will be raised and we will hear about occupational therapy and other peripheral matters. I understand that all 60 Members of the Seanad received representations about only two terms, "podiatrist" and "physical therapist". This demolishes all the arguments about terminology because no other terminology is sought. In terms of the 12 designated professions, of all the bodies involved, there were quibbles about only two words. In both cases, reasonable suggestions for alternatives or extra wording were used. There is no open-ended request for a variety of vocabularies, therefore. After something of a pause, one of the disputed terms has been sensibly disposed of. I suggest to the Minister of State that there is a perfectly reasonable response with regard to the definition of "physical therapist" unless he has a compelling reason that this term is problematic.
We should be careful about this issue. On the face of it, it may seem that a physiotherapist and a physical therapist are the same but I understand that the work undertaken by each is different. A physical therapist is more concerned with sports injuries, rather than the more regular work undertaken by the physiotherapist. I am swayed by the opinion of the Minister of State and his Department because I am sure they have undertaken careful research into this matter. It is a question of getting it right.
Again, I am afraid I can anticipate the reply I will receive. There are approximately 2,000 physiotherapists and I have been told for years by their international body that the term "physical therapist" is internationally interchangeable with "physiotherapist". The two titles are synonymous and Irish physiotherapists would like those titles to be protected together. Over the past ten or 15 years, people with training in physical therapy but not physiotherapy, and who have been known only as "physical therapists", have arrived in Ireland. Nobody is saying that these people do not do good in the field in which they work, which I understand is mainly massage and which many patients seem to find helpful. There is no denigration of these people, therefore, but it is important to recognise they do not have the same training as physiotherapists.
We must ask these physical therapists to bring forward their qualifications so we can ascertain the most suitable title for their profession. It is important that Ireland keeps in line with the practice of various international boards. Physiotherapists and physical therapists are interchangeable internationally because they have the same training. We should try to follow the international standards in this legislation.
I agree with previous speakers that we must protect the title for one profession, namely, physical therapist-physiotherapist. Physiotherapists have told me they want to work hand in hand with physical therapists, but wish the latter to operate under a unique title, separate from their own. As Senator Henry observed, the world professional body wants the title protected for one profession, which is the physiotherapist. Physical therapists, as we know them, deal more often with massage therapies than sprains and breaks. One will always find a physiotherapist working in a hospital setting, but this is not the case with physical therapists, as we know them. I have used the term "as we know them" more than once because in the United Kingdom, Northern Ireland, Europe and the United States, a physiotherapist is called a physical therapist but there is a significant difference between the two professions in this jurisdiction.
As we pointed out in the House last week, we do not wish to do damage to any profession, nor do we want to deprive any professionals of work. This Bill is vital for the protection of the public, however, in ensuring there is no confusion regarding the two professions. I will be pushing for the protection of both titles for one profession.
Senators Henry and Feeney have expressed exactly my own views on this issue. This discussion appears to be different from the last one we had on the issue. I understand that 92 countries use the term "physical therapist" to mean "physiotherapist" in their various languages. It is not sufficient, therefore, for us to effect a change in this regard by regulation under section 94. There is no choice in this matter. Senator Maurice Hayes spoke earlier about the situation in Northern Ireland, where the terms "physiotherapist" and "physical therapist" are interchangeable in law. We must include these two terms, both denoting the same profession. The terms were interchangeable in this jurisdiction up to ten or 15 years ago until the term "physical therapist" began to acquire a different meaning.
I apologise to physical therapists for my statement of last week that the "title of physical therapist applies to those practitioners who do not have professional qualifications". I should have said "who do not have the same professional qualifications" because I am sure these practitioners have such qualifications. However, as Senator Feeney observed, they are not the same qualifications as those possessed by physiotherapists. Physical therapists do not generally operate in hospitals but in a different capacity.
The temptation is for the Minister to decide that this issue will be regulated under section 94 but this not the correct approach. In 92 countries, the two terms are understood to be interchangeable. This issue is easily resolved by including the terms "physiotherapist" and "physical therapist" as interchangeable in the Bill and regulating this interchangeability to ensure that both terms apply to the same profession. If such an approach is established as afait accompli, those practitioners who use the term “physical therapist” will have to find another title for their profession. They are currently using many different terms to describe the work they do.
The most important task in the context of this issue is to protect the public. We are all aware that it is commonplace for people to consult practitioners who call themselves "physical therapists" in the mistaken belief that such practitioners are physiotherapists. Patients in these circumstances have found that such treatment is not covered under the terms of their contracts with BUPA and VHI. We must protect the public and there is a simple solution to ensure this objective is achieved.
Members have been contacted by both physical therapists and physiotherapists and our objective is to recognise that they both do important work. However, we acknowledge that they do slightly different jobs and have slightly different backgrounds and qualifications. An MBIMS Catibus survey carried out in September last year indicated that nine out of ten Irish adults were aware of physiotherapists, while only three in ten were aware of physical therapists. A further one in three of those surveyed considered physical therapists and physiotherapists to be the same or similar, while half of those aged over 65 did not know the difference. It is important that this matter is clarified. That is the purpose of the amendments under discussion, which I hope will receive the backing of the House.
If we proceed to lump physiotherapists with physical therapists in the Bill, a situation may arise where physical therapists may treat patients on a basis that is not inconsistent with their qualifications. All hell would break loose in such a scenario and we must be careful to avoid that. There seems to be a strong similarity between the two qualifications but there is a difference. We must be careful not to put something into law that might not stand up in the fullness of time.
I agree with Senator Glynn on this issue. The inclusion of the term "physiotherapist-physical therapist" suggests that these professions are the same, which is not the case.
The international terminology which identifies physiotherapists as physical therapists is one that we have to get to grips with to ensure that people's qualifications in these fields are recognised. We must also recognise that people in Ireland who describe themselves as physical therapists do not have the qualification or provide the full range of service of that held and provided by a physiotherapist.
There are possibly two ways of dealing with this issue. One is to offer physical therapists who wish to do so under the transitional arrangements the opportunity to bring themselves up to the standard to provide the broad range of physiotherapy services. The other option is to encourage them to come under such a title as may be agreed, under subsection (2), which provides for designation of other bodies. The Minister of State might also consider the designation of chiropractors. As Senator Glynn said, it is quite dangerous to suggest that these two kinds of therapists are exactly the same.
I never said that.
I agree with what the Senator said.
On a point of order, no Member is making that claim.
That is not a point of order.
It is a point of information.
As I understand it, it has not been suggested that practitioners describing themselves as "physical therapists" are seeking to mislead the public. Rather a situation has arisen over a long period whereby a significant number of persons are currently practising in this State and earning a livelihood providing services to the public using the title "physical therapist", which in other countries would appear to be synonymous with the title "physiotherapist".
The imposition of a solution by means of a legislative amendment does not constitute a sustainable long-term solution to this issue. The range of possible solutions must be explored thoroughly between the relevant parties through a process of real engagement and focused consultation on a partnership basis. I am not convinced that there is sufficient evidence at this point to justify the strong legal measure that the proposed amendments would represent. It would pre-empt the resolution of a long-standing and complex issue that requires careful consideration of the rights and obligations of all parties involved.
The provisions of the Bill allow for protection of the titles in the future following further detailed examination of all relevant issues, allowing time for the representative bodies to come to a practical solution on a mutually agreed basis. The rights of existing practitioners must be respected. Reservation of the title "physical therapist" to physiotherapists could impact significantly on the livelihood of many physical therapists. There are several hundred people practising as physical therapists. A sustainable long-term solution is required which acknowledges this fact and protects the public.
I thought the main objective we were trying to achieve was to set up registers for the protection of the public. Of course I am sympathetic about people and their livelihoods but the protection of the public is important. I have a vested interest in this area. As a medical practitioner, I must be sure of the qualifications of those to whom I refer people. Under the legislation we are allowing for a situation which does not represent an improvement on the current position. Therefore, why bother with what we are doing? There is confusion about this issue.
I recognise that those people who have recently arrived in the State and call themselves "physical therapists" do a useful job, but members of the public believe they are physiotherapists. We know that because during the Second Stage debate many Members pointed out that it is only when members of the public apply to have their fees reimbursed from the VHI or BUPA that they find out that people they were attending were not physiotherapists. I do not believe they are trying to defraud people or do anything awful, but some people with little training, and Senator Glynn in particular has spoken about the charlatans, will take thousands of euro from people. We are perpetuating the opportunity for people to do that by the way we are dealing with this legislation and by saying that in years to come we will introduce some regulation. We should settle matters now.
This debate is turning into a farce. The purpose of the Bill and the reason we all welcomed it was that it would afford protection to members of the public whereby if a person had an illness or an injury he or she would be able to attend the right person, so to speak. It would also afford regulation to the professions which would be beneficial for them. In addition, as Senator Henry pointed out, if a medical practitioner refers a patient to another person, the medical practitioner would have some guarantee at least that that person is properly qualified.
Nobody is saying that the two kinds of therapists are the same, but our amendments are clear. We acknowledge there are two major bodies, namely, physiotherapists and physical therapists. They do different work and have a different educational background. I will pose the same question Senator Ryan posed during the debate on an earlier amendment. If this amendment is not accepted and the title "physiotherapist" applies as it currently stands, does that mean that a person can come into the country tomorrow, start practising as a physical therapist and not be regulated? Surely that is in nobody's interest, certainly not that of the patient, the physiotherapist or the physical therapist.
I agree with other speakers on this issue. The Minister of State said there are 700 physical therapists here and Senator Henry pointed out there are 2,000 physiotherapists. The school of physical therapy has been in existence for ten or 15 years.
Where is it?
In Dublin. We all acknowledge that physical therapists have their own scope of practice and no Member wants to do them any damage. However, in the interest of members of the public, we as legislators must take a stand and point out that in every other jurisdiction except the Twenty-six Counties, a physiotherapist is also known as a physical therapist. We cannot let members of the public believe they are one and the same. We should take a stand on this and something must be done now to protect that title.
Since I was elected to this House two and a half years ago, I have received letters from physiotherapists requesting the protection of the title "physical therapist" in regard to their profession. In that respect, I must say shame on me in that all I did about this was make inquiries, obtain information and send it out to them but nobody was doing anything to address the issue. This probably happened for two and a half years before I was elected to this House. Now we are pushing the issue further aside again.
During the debate on Second Stage I said that in the 1960s some people, who did not have the appropriate qualifications, called themselves "chemists". I do not know how that was solved but I am sure it was by an Act of the Oireachtas. In the 1970s I came across an architect who had no qualifications but put the title "architect" on the door, and I am sure that issue was solved internally or by legislation.
I accept it will be unfortunate for people who call themselves "physical therapist" if they are no longer allowed to do so unless they have the qualifications of a physiotherapist. However, given that in 92 countries the titles are interchangeable, we do not have the freedom to leave the title in doubt in the minds of members of the public. Therefore, if the purpose of the Bill is to protect the public, we have no choice but to grasp this opportunity and state forthrightly, as the position will be for people who call themselves "physical therapists", we cannot leave the public open to the danger of misunderstanding in this regard. The Minister of State must grasp this opportunity and provide that people may not call themselves "physical therapists" unless they are physiotherapists.
What Senator Quinn said is the nub of the issue. One of the wonderful things about dealing with legislation is that one learns a great deal. Given that the citizens of 92 countries accept that physiotherapy and physical therapy are the same profession, when a person sets up a school of physical therapy or calls himself or herself a "physical therapist" and practises as one, that is misleading, although I accept nobody set out to be deliberately so. Nevertheless, it is misleading and it is our job to protect the public from things, which are either deliberately or accidentally misleading. If Senator Quinn, in his other profession, were to carry an advertisement, which suggested something, which was not true, even if it were not his intention to do so he would probably be reprimanded by the Director of Consumer Affairs. In this State alone, the term "physical therapy" is claimed to apply to a different profession while everywhere else the term means the same as "physiotherapy".
I am concerned about the livelihoods of physical therapy practitioners but I am more concerned about the common citizen who needs physiotherapy and mistakenly ends up with a physical therapist. The sensible thing is to describe the profession by its two terms used throughout the world, invite those who commonly describe themselves as physical therapists to find another appropriate and non-misleading title for their profession and let them continue to practise. If they are doing a different job from physiotherapists their profession will not be affected by the name they give themselves because the people who know they are different will be those who consult them. If they have clients who think they are going to a physiotherapist they are, whether deliberately or otherwise, misleading those people. The best thing to do, both for the profession and its clients, is to have a new name, which is not open to misunderstanding.
There are only two issues here. My colleagues and I could have submitted 40,000 amendments about aromatherapy, ki-massage therapy and so on. We did not do that because we understand what is involved. There are two words about which there is some debate. The reasonable thing would have been to listen to the consensus across the House, agree to consider the amendment again on Report Stage and attempt to address a legitimate concern regarding the confusion between two terms which, if rushed, sound identical and which in 92 countries are accepted to be identical.
I appeal to the Minister of State to listen to the arguments put forward and agree to think about the matter. The amendments can be reintroduced on Report Stage when the Minister has had time to consider them. We are, after all, somewhat rushed. The Bill was first debated only last week. It is complicated legislation containing many technical terms. A little time would do no harm.
I do not believe there is any attempt by physical therapists deliberately to mislead or to abuse any term.
We did not say that.
Physical therapists also do postgraduate courses and are accepted into Trinity College and other colleges of medicine. In almost 15 years, no negligence case has been brought against a physical therapist. No one, certainly not on this side of the House, is casting aspersions on physical therapists.
Were talks held with physiotherapists' representatives and was this point raised by them? Are they willing to have the titles separated in order to avoid confusion? It is unfortunate that the term "physical therapist" is recognised throughout the world as meaning the same as "physiotherapist". Can the Minister of State clarify this point?
I suggest that the Minister of State or his officials meet with the two professional bodies to see if a new name can be agreed for physical therapists. Senator Ryan could then withdraw the amendment and resubmit it on Report Stage when those consultations have been completed. We cannot leave room for confusion.
Amendment No. 23, which I submitted, is similar to Senator Ryan's amendment. I take Senator Feeney's point. If the Minister of State can undertake those consultations before the debate on Report Stage I would be happy to withdraw that part of my amendment.
There is another part to amendment No. 23. It comes to light partly because of what Senator Ryan has just said. He referred to the fact that if I, in my other job, happened to carry an advertisement which misled unintentionally I would still be guilty of the offence.
Section 79 states that a person "is guilty of an offence if, with intent to deceive, he or she contravenes section 78(4)", and so on. Can the Minister of State put my mind at rest on this matter? If someone who uses the wrong term afterwards claims not to have done so with intent it appears that the person would not be guilty of an offence. I am saying that if a person uses the wrong term he or she is guilty of an offence. Before I withdraw the amendment in full I would like to hear the Minister of State's view as to whether there is a need for the second part of amendment No. 23.
I would be willing to consult the representatives of physiotherapists and physical therapists in an effort to come up with another title for physical therapists. I fully understand what everyone has said about the confusion in this country compared with other countries where the two qualifications are synonymous. The titles are not synonymous in Ireland because there are different educational requirements for physiotherapists and physical therapists. With the agreement of the House I will go back to both organisations to see if they can suggest an alternative term. That would solve the problem for everybody. No one is casting aspersions on either profession. A change in wording could get us over this hurdle.
The words "intent to deceive" are required to demonstrate the necessary level of proof required to secure a conviction. I understand what Senator Quinn is saying but I do not think there is any intention by anyone to deceive.
I understand that but we are not saying there is an intention to deceive at present. I am concerned about the future. My amendment states: "In this Act the title "physical therapist" shall be deemed equivalent to the title "physiotherapist" and its use is restricted exclusively to those professionals who are registered as physiotherapists." The second part of the amendment states: "Anyone contravening paragraph (a) is guilty of an offence.” It is not a question of whether a person intended to deceive. If someone calls himself or herself a physiotherapist it would not be an acceptable defence to say he or she did not know an incorrect term was being used.
I do not wish to press the amendment at this stage. The Minister of State has agreed to consult further and the amendment can be resubmitted on Report Stage. It is not simply a question of intent to deceive. If someone uses the incorrect term it should not be a good defence to say he or she did not know.
As you well know, Acting Chairman, my vanity alone leads me to withdraw most amendments on Committee Stage simply so I can resubmit them on Report Stage. I would not have pressed the amendment anyway but I am grateful for the willingness of the Minister of State to consider it on Report Stage. If he sustains the tone he has just demonstrated we will make an enormous amount of progress on the Bill in the 40 minutes remaining. All the Opposition seeks are reasonable responses and this is not a Bill on which we have any intention to waste time. We have spent a great deal of time, however, talking about matters that should have been resolved at an earlier stage. Therefore, while I cannot speak for Senator Browne, I am happy to withdraw my amendment No. 2 with a view to possibly reintroducing it on Report Stage.
I am willing to withdraw amendment No. 3 with a view to resubmitting it on Report Stage. I await the Minister of State's comments at that stage. I appreciate the gesture he has made.
I move amendment No. 4:
In page 9, line 17, subsection (2), after "subsection (1),” to insert “and in particular shall, within the period of 12 months from the passing of this Act, so designate the profession of counsellor or therapist,”.
Every time I refer to this matter I must declare an interest because I am married to a psychiatrist and, consequently, I do not get an unbiased view of the issue. What troubles me is that in the list of professions to be designated there is no mention of therapists or counsellors. Many people are concerned that some may claim to be psychotherapists who only have a six-month diploma, while others claim to be counsellors who may have a diploma obtained following a 12-month part-time course. Many of those professions probe deeply into vulnerable areas of people's emotions and their personal lives. It is a profession that desperately needs to be regulated through the formal recognition of proper professional qualifications.
The 12 designated professions are listed in section 4(1). Section 4(3)(c) refers to “the resolution, through guidance, counselling or otherwise, of personal, social or psychological problems;” but there are only one or two of the professions to which that could currently apply. Much of what one would call “the resolution, through guidance, counselling or otherwise, of personal, social or psychological problems” occurs outside the profession of psychology and is practised by people who are not qualified as psychologists. A huge number of people are practising that sort of stuff but it is dangerous for untrained, unskilled people to probe other people’s subconscious. It is potentially as dangerous as people prescribing limited amounts of medication because one is getting into very dangerous territory. I moved the amendment in order to raise this matter and I appeal to the Minister of State to consider it.
We can discuss on the section some of the criteria that arise later in the Bill concerning how a health or social care professional should be designated. To a degree we are saying that we will follow the market rather than defining it but I am not madly keen on that approach. When dealing with human vulnerability on the one hand, and the designation of professions on the other, one must ask what is good for the public, rather than asking what the public wants. I will raise a number of questions about that when we discuss the section. What proposals does the Minister of State have to regulate counselling and psychotherapy?
Senator Ryan has raised a most important issue concerning an area in which the general public is at its most vulnerable. The Irish Council for Psychotherapists has been in contact with me to say that it has standards in place and is linked to the European Psychotherapy Association. The council has signed up to the EPA's standards and would like to be included within the terms of the Bill. Therefore, I propose to table an amendment on Report Stage to include psychotherapists. As Senator Ryan explained, some people may describe themselves as counsellors or therapists but not all of them are. For that reason, it is most important to put regulations in place for the sake of the general public.
Psychotherapists and counsellors are not mentioned in the list of designated professions in section 4(1). Senator Ryan made a relevant point in his contribution last week when he stated that in the past we turned to priests if we had troubles or worries. As the Senator pointed out, however, priests have six or seven years' training depending on the religious order with which they studied. At least they had some kind of training. There are well qualified counsellors who may have an interest in psychotherapy and will look after a person very well. There are others, to whom my mother would have referred as "fly-by-nights". They cause more harm than good to people seeking help who comes away feeling more confused than ever. The Minister of State should consider provisions to rope in such people when it comes to Report Stage.
During the debate on Second Stage, concern was expressed about rogue practitioners who were doing damage to people who had nobody to pick up the pieces for them. I support other speakers in calling for that aspect to be examined in order to ring-fence such people.
My view on these matters is well known. I support the idea that people delivering professional services should be qualified to do so. Section 4(1) refers to 12 designated professions but the Bill allows the Minister to include other professions in the fullness of time. Apart from focusing on the need to register the 12 designated professions, the Bill also deals with who is entitled to call themselves what in other groups, apart from the 12 aforementioned professions. The debate is welcome and the public will be the winners when it becomes law. When the Bill is enacted and other groups are added, as the Minister of the day may deem appropriate, the public will be getting a service from properly qualified people who have the full approval of the Department of Health and Children.
I cannot disagree with Senator Ryan that a number of other groups need to be included within the provisions of the Bill but I am sure they will come forward in due course.
I thank Senator Ryan and other speakers for drawing attention to this important area, including counsellors and psychotherapists. I agree that many of those who practise as counsellors and therapists do an excellent job but, unfortunately, that cannot be said for all of them. There is a big problem there. Given my responsibility for mental health, I have met many of these groups. I agree that they should all be regulated by the Bill but, unfortunately, there is a dichotomy in that they cannot agree among themselves. Many of them are well qualified but Senator Ryan has been kind in saying that others have completed six-month courses. Some may have attended much shorter courses than that.
My understanding is that most professionals have become regulated through a process of discussion with all the groups involved to try to reach a consensus. I have met many counsellors' and psychotherapists' groups and have asked them to come up with proposals which we can consider. I want to do what the Senator has suggested but it would be extremely difficult to do so at the moment. One could end up with a lot of court cases because many of these people have qualifications. We must therefore be extremely careful how we go about matters. The Senator's amendment proposes inserting a timescale of one year. I wish we could do it within a year. However, I am not that optimistic that we would be able to do so. As I look to the future of mental health services, I see the need for properly trained counsellors and psychotherapists, as all psychiatrists would agree. As we have only one opportunity, we must be extremely careful to get this right. I want to consult psychiatrists and everybody in this field. Some of the groups with which I had discussions could not agree among themselves how to define the various therapists and counsellors. I have asked them to come back to me with proposals at which time we will reconsider the matter. Unfortunately, I cannot accept the amendment as worded. I am grateful that we have had the discussion today.
As I said earlier I would not dream of pushing it, as I would be unable to raise the matter again later. I agree we have superb professionals in these areas. I had an unfortunate experience not many years ago when my son was in second year and a classmate of his committed suicide at the age of 14. Within an hour the Southern Health Board provided counsellors advising the teachers how to deal with the matter. The teachers and others told me the quality of service was first-class, professional and very good. Properly-trained and qualified professionals represent a significant asset in a crisis.
The failure of the profession to agree is the problem I want to address. I suggested a timeframe of 12 months as it is time the Tánaiste and Minister for Health and Children advised the group to either agree a framework of qualifications or let the Department write them on its behalf. We would not allow every quack to walk into the country and write prescriptions just because the medical profession could not agree on these matters. It is correct that we properly regulate who can practise medicine because such people are allowed to write prescriptions, which is the main factor that distinguishes medical practice from other areas of care for vulnerable people.
We must recognise that what was the case 50 years ago is quite different now. Many people are opting for other ways to get support for emotional and other distress, which may be better for them than a lifelong dependence on medication. I know of documented stories of poor counsellors creating lifelong dependence. While I do not mention any single individual, this is capable of being very cynically interpreted as it also represents an income stream for life. A misfortunate wretch might feel he or she must see a particular professional every week for the rest of his or her life and pay €40 or €50 each time. A person with 20 or 30 such clients would be on the pig's back for life.
While I may take issue with the Minister of State on this matter, I feel that if within 12 months the groups cannot agree on a format for qualifications, on behalf of the people of Ireland, the Minister should tell them what qualifications will allow people to call themselves therapists and counsellors. Given the disparity, unless we take action, I do not believe large chunks of that profession would take action.
I very much support Senator Ryan's sentiments. As Senator Glynn and the Minister of State will be well aware, spoken therapies have become so much more common in psychiatry than psychotherapeutic drugs that we must try to tackle the issue. More people are consulting such professionals and we will need to make the decision if they cannot do so among themselves. As Senator Feeney will be very aware, we must be very careful regarding the individuals to whom people are being referred by, let us say, our psychiatric colleagues. They must know that a proper standard is in place and ultimately we must make the decision as to what can be considered a proper standard.
I am delighted we have had this discussion. I agree with what has been said and will follow up on what Senator Ryan has said. I agree these people need to be regulated and I will do everything to drive forward the message to them.
I move amendment No. 5:
In page 9, subsection (3)(b), line 32, to delete “or” and substitute “and”.
This is a very simple amendment, which is unlikely to need 25 minutes' debate. One should make a diagnosis of a condition, treat it and care for the person as opposed to the current wording which is "the diagnosis, treatment or care of those who are injured, sick, disabled or infirm".
The Minister of State should accept the amendment.
Changing the words could have the effect of excluding people. Substituting "or" with "and" would inappropriately restrict the definition of a health or social care profession. By leaving the word "or" in place a health or social care profession can be a profession in which a person exercises skill or judgment relating to the diagnosis, treatment or care of those who are injured, sick, disabled or infirm. By replacing "or" with "and" a person would need to exercise skill or judgment relating to the diagnosis, treatment and care of those who are injured, sick, disabled or infirm. In other words, all three would need to be carried out to be considered a health or social care profession. This is considered to preclude a number of professions currently included in the Bill. Therefore, it is not proposed to accept the amendment.
Does this subsection contain a typographical error? Should it not state "the diagnosis, treatment or care of those who are injured, sick, disabled or infirmed"? I believe it should state "infirmed" as opposed to "infirm".
Infirm is a general term. There is no such word as "infirmed".
It is possible to be infirmed in the same way one can be sick.
Whatever about the time we have spent up to now, many questions remain to be asked about section 4. I will go through my questionsseriatim, as I want to ensure they receive answers. The section contains a list of the health and social care professions. When the Bill is enacted two things will happen. First, only those who are properly qualified will be allowed to describe themselves as belonging to one of these professions. Second, only people who are correctly registered will be able to practise these professions. I am concerned about, for example, a medical doctor who could sometimes be a dietician, sometimes a psychologist and sometimes, as many GPs are, a social worker. While I am not being awkward, this is a genuine question. How can we be sure we will not have a series of territorial wars in which the general work of a medical doctor and particularly a general practitioner will be eaten away by exclusive claims of these individual professions?
It would be extremely difficult for me to speak about turf wars down the road in the medical profession. There were turf wars in the past and there will more in the future.
The medical profession is good at defending its patch too.
All professions are. The legislation does not prescribe the regulation of the scope of practice for any profession. It would be open to any designated profession to define the scope of its practice as part of its code of professional conduct and ethics. Endangering the public by operating outside the scope of practice would be grounds for complaint against a registered practitioner. It is considered that any legal protection of scope of practice would inappropriately restrict the development of a profession as professional boundaries expand in line with the development and growth of professional skills and knowledge. Protecting scope of practice would also better constrain skill mixes and the most effective utilisation of scarce professional resources as auxiliary professions, take on tasks and activities that would previously have only been carried out by qualified professionals.
I understand Senator Ryan's point but if what he said happened in the future, it can be legislated for then — now is not the time to do it. The regulation of these professions will not have an adverse impact on the medical and other professions.
Senator Henry might be able to answer this because of her professional background. These used to be profession supplementaries in medicine and they now stand on their own. Now they will be part of a primary care team where people play different roles. It would be ridiculous if a good GP who wanted to tell someone to eat less fat had to first consult the nutritionist. The GP will develop his or her practice in the normal way and when a person needs specialist care from a dietician or a similar profession, it will be dealt with then. The legislation should be as flexible as possible so modern medicine and primary care can develop, leading to enhanced team work.
I take Senator Ryan's point but Senator Maurice Hayes is right. There is much more team work now in hospitals. As for general practitioners feeling their jobs are being taken, there is hardly a general practitioner in the State who is not ready to collapse. There is no GP in Mulhuddart to treat 10,000 people and there is barely one in Ballyfermot. The people of Mulhuddart will be ecstatic, as will any medical practitioner anywhere in the area, if some social workers, psychologists and dieticians turn up. The head of the Mater Hospital blamed the accident and emergency department crisis on the fact that there are not enough GPs and that they are not working late enough. If some of them were open at 2 a.m., it would remove many of the people from accident and emergency departments. I cannot see this causing any crisis in primary care because we are in a dire situation as it is. These people will be welcomed.
I agree with Senator Henry. I oversaw the rewriting of the ethical guide for the Irish Medical Council and the doctors' scope of practice is clearly outlined. I can understand, however, Senator Ryan's point. Doctors would refer to the relevant disciplines rather than take on the work themselves. They are only too glad to know there is a supplementary profession to back them up.
The role of a GP has changed substantially in recent years, with GPs standing back from carrying out certain procedures in their surgery due to a fear of litigation. Who could blame them, the way people think now? The co-operative system has been a welcome development in the lives of GPs — it works well in the Midland Health Board system.
The attending disciplines referred to would be welcome but Senator Henry is right, there is a shortage of general practitioners, mainly as a result of the rise in population, the retirement of general practitioners and the method by which they are replaced, which is slow. We must get this right. Replacements must be vetted and the health board must ensure that the person taking up the position is suitable. We should not sacrifice accuracy for speed.
I understand Senator Ryan's point. All professions must change and one of the major problems I face is getting people to understand what team work means. That is a major challenge for all of us who want to achieve a better health service.
Senator Glynn mentioned the co-operatives. I was at the Shannondoc co-op in Limerick, where doctors work together on a team basis. Although a small number of GPs still resist the idea, of the thousands of people treated in the mid-west, only 8% were appropriately referred to accident and emergency wards. The remainder, were treated by the general practitioner or nurse through the co-op. That shows that when things are done properly, with the professions working together as a team, the system works. The corresponding referral figure might be as high as 30% of the people in an area where there is no co-operative. I take the point but the Senator should not worry.
I will not be losing any sleep. If the appropriate number of people had medical cards, the figure would be even lower than 8%. Many people feel they cannot afford to visit the GP.
I hope that will change in the next few days.
Ever since the Revenue Commissioners decided that quadriplegics were not covered by the legislation exempting people from excise duty for cars because the legislation stated the exemption applied to those who could not use their hands or their feet, I have always felt an obligation to tease out what legislation really means because, although that was a most peculiar interpretation, the Revenue Commissioners used it to refuse people an exemption.
Elsewhere, section 4 states that if the Minister considers it is appropriate and in the public interest that a health or social care profession be designated, he or she shall have regard to certain factors, such as the extent to which the profession has a defined scope of practice and applies a distinct body of knowledge and the extent to which the profession has established itself, including if there is at least one professional body representing a significant proportion of the profession's practitioners. That is acting after the fact. I am not trying to be awkward, but there is an expectation that all people working in these areas will be of a sufficiently high professional standard to do all these things. The trouble is that some of them are not, as the Minister of State just indicated. They cannot agree. I am worried that this section might restrict the Minister from intervening where people are doing harm and because they are not part of an organised profession with the type of structure outlined in paragraphs (a) to (d), inclusive, the Minister would not have the legal power to intervene. I would question this. For example, if the health or the safety and welfare of the public is threatened, it is not much consolation to learn the Minister cannot do anything about the situation because a particular profession is not well organised. There is a gap there and I merely ask the Minister of State to consider it.
This is a brief and probably malicious question. Section 7 states:
The object of the council is to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions.
Is there a similar primary object in the legislation governing the Law Society or the Bar Council of Ireland, my own professional body — the Institution of Engineers of Ireland or, indeed, the Pharmaceutical Society of Ireland? The provision that the primary objective of the self-regulating body should be to protect the public is admirable and should be in all legislation dealing with the regulation of any profession. I wonder whether similar provisions exist in respect of the bodies I have mentioned. If the Minister of State does not know, it is not a fair question. However, I just want to make the point that it should be the first paragraph of all legislation dealing with the professions.
I do not know the answer to the Senator's question. As I understand it, based on the pharmacy profession, which I know best, the responsibility of the Pharmaceutical Society of Ireland is to protect the public. I cannot speak about the other professions. However, the Senator is right.
I may have missed it, but I cannot find a reference to any qualification the chairperson of the council should have when the Minister selects him or her. It is amazing there is no suggestion that the person to be appointed ought to possess some qualification or degree. I know that under the present Minister this could not happen, but if it were a Labour Party Minister for Health and Children, the person appointed could be a prominent member of the Labour Party. I believe the chairperson of such an important body should have some threshold to get over before taking office. It is a pity, because there is so much prescription right through this section, all of which I agree with. I think, however, the office of chairperson could be better defined.
I hate to disagree with Senator Ryan. I do not believe a Minister should be too constrained in the appointment of a chairperson to a council. I accept that ideally he or she should have the ability to know what is going on, etc. In my experience, however, the best qualification for a chairperson is some horse sense, not necessarily degrees or academic qualifications. The role is essentially one of protecting the public. In my experience the people best able to protect the public are those who know what is going on in public. I accept that a certain level of know-how is needed to deal with issues, but it would be a mistake to try to be too prescriptive.
I would agree with Senator Maurice Hayes and I do not propose to accept the amendment. It could be very restrictive.
There is no amendment involved.
I thought there was an amendment. As regards any stipulation about who should chair a council, the fact that a person might have qualifications does not necessarily mean he or she has common sense. I prefer to leave the situation as it is.
Is section 9 agreed to?
I have a few more comments to make.
This debate will continue next week because, clearly, there are many issues to be discussed. If the professions outlined in the Schedule wish to contact any Member of the House, we will be pleased to hear from them. I would remind the House that the Minister of State, Deputy Tim O'Malley, will be taking Private Members' business as well. I suggest a formal break of ten minutes between 5 p.m. and 5.10 p.m.
Is that agreed? Agreed.
On section 9, I would like to suggest a very small amendment, to deal with the issue I have raised. I am responding to what Senator Maurice Hayes said. Subsection (4) states:
Before appointing a chairperson undersubsection (1) or an ordinary member under subsection (3)(b)(i) or (ii) or subsection (6), the Minister may consult with any organisations he or she considers appropriate.
I would be much happier if that means "shall consult", so the Minister must actually talk to somebody else he or she considers appropriate, before appointing a chairperson. Sensible people will consult, but both in my own party and in others, decisions are sometimes made about appointments to these bodies that, superficially at any rate, may not appear too sensible.
There is another question I may have missed. The Teaching Council, for example, makes some effort at gender balance. In all of the procedures for electing people to the various councils, I do not find, or I may have missed, any suggestion of gender balance. Will the Minister of State say whether this is deliberate policy or an omission and can we think about it between now and Report Stage?
The Senator can do so.
I can what?
He can think.
It is somewhat tongue-in-cheek for me to say this, but I am inclined to leave that word "may" instead of "shall consult", to avoid being overly prescriptive. I say this as someone who represented the public interest on An Bord Altranais and the Medical Council. I worked alongside people who represented the public interest with me and they were the best workers one could find. If one was being prescriptive one could not have picked better people. My only fear is that if we insist that the Minister of the day "shall consult", that is to prescribe. If one of the 12 has a grievance against somebody being put forward, whether male or female, he or she might object and insist on an appointee from a particular organisation. The Minister of the day could never get 12 bodies to agree to one chairperson. There will always be something wrong.
When we consider past appointments, it is possible to be cynical; perhaps they were not all good. By and large, however, people who represent the interests of the general public have a great role to play and the chairperson would, ideally, be representing those interests.
I am not concerned about the consultation issue because if anyone wants to make a go of anything he or she must consult. How else can he or she get the information required? I do not agree with providing for gender proofing in legislation. Whereas one can do a job whether one is man or a woman, the term "gender proofing" is always used to label women who it is claimed would not have got where they are without a quota system. It is very discriminatory.
Why then was the teaching profession deemed to require it? Why was it required in the institute of technology sector when, staff appoint two representatives to each governing body?
It was introduced by the former Minister for Education, Niamh Breathnach.
The issue is that it is in force now. As I said, it is not for me.