Health and Social Care Professionals (Amendment) Bill 2012: Second Stage

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

I welcome the Minister for Health, Deputy Reilly, to the House and invite him to make his contribution.

I am pleased to introduce the Health and Social Care Professionals (Amendment) Bill 2012 for the consideration of the House. The Bill is a relatively short technical Bill, with 20 sections in total that was passed by Dáil Éireann without amendment on 29 November last. The Bill proposes to amend the Health and Social Care Professionals Act 2005 to provide for the enhanced and effective functioning of the Health and Social Care Professionals Council and the registration boards established under the Act. It will also amend the Act to better provide for the assessment and recognition in Ireland of qualifications obtained outside the State and to ensure compliance with the relevant EU instrument.

The 2005 Act provides for the establishment of a system of statutory regulation for designated health and social care professions. The regulatory system comprises a registration board for each of 12 designated professions, a Health and Social Care Professionals Council with overall responsibility for the regulatory system and a committee structure to deal with disciplinary matters. These bodies are collectively known informally as CORU. CORU is responsible for protecting the public by regulating health and social care professionals in Ireland. It promotes high standards of professional conduct and professional education, training and competence among the registrants. The Health and Social Care Professionals Council was established in 2007. Its functions include the governance and co-ordination of registration boards and the provision of administrative support and secretarial assistance to registration boards and their committees. Although the annual cost of running the council is being funded by the Exchequer in the main at present, the intention is that the regulatory system will, in time, be fully self-funding through the annual fees payable by registrants, as is the case with all other health professional regulators, such as the Medical Council, An Bord Altranais, etc.

The following 12 health and social care professions are designated under the Act, namely, clinical biochemists, dietitians, medical scientists, occupational therapists, orthoptists, physiotherapists, podiatrists, psychologists, radiographers, social care workers, social workers and speech and language therapists. In addition, the decision of the previous Government to rationalise the Opticians Board into the Health and Social Care Professionals Council will see another two professions, optometrists and dispensing opticians, being regulated under the Act in 2013. Under the Act, I, as Minister for Health, may designate other health and social care professions if I consider that it is in the public interest to do so and if the specified criteria have been met.

I am aware that some professions, currently not designated, have made a case to be regulated under the Act. While my immediate priority is to proceed with the establishment of the registration boards for the professions currently designated under the 2005 legislation, I have undertaken to commence the necessary steps to bring counsellors and psychotherapists within the ambit of the Act as a matter of urgency. I have given this commitment following the valuable and thoughtful contributions made during the passage of the Bill through Dáil Éireann.

The lack of regulation in the area of counselling in particular is a matter of concern. There are a number of issues still to be clarified however. These include decisions on whether one or two professions are regulated, on the title or titles of the profession or professions, and on the minimum qualifications to be required of counsellors and psychotherapists. A report from Quality and Qualifications Ireland, QQI, is due next year and will establish standards of knowledge, skills and competence to be acquired by students of counselling and psychotherapy. In addition, an examination will be undertaken on the standard of qualifications currently held by counselling and psychotherapy practitioners seeking regulation. The culmination of this work will be a big milestone towards the regulation of counsellors and psychotherapists.

To date, five registration boards have been established. These registration boards are for the professions of social worker, radiographer, dietitian, occupational therapist and speech and language therapist. It is my intention to proceed to establish a further six registration boards in 2013. The Social Workers Registration Board has established its register, has held elections and has made the necessary by-laws on education and training qualifications. The board has also adopted a code of professional conduct and ethics which was subject to public consultation. When the statutory transitional period ends two years after the establishment of the register next May, the profession of social worker will be fully regulated under the Act. The Radiographers Registration Board will soon be in a position to open its register and commence its two-year transitional period. That will also facilitate the commencement of the fitness to practise provisions of the Act.

The Act provides for grandparenting - a transitional period of two years during which existing practitioners must register on the basis of current specified qualifications. After that, only registrants of a registration board, who will be subject to the Act's regulatory regime, will be entitled to use the relevant designated title.

The Bill has three main purposes. The first is to amend the Act to allow the Minister for Health to continue to appoint professional members to the council until each of the registration boards has been established in respect of the 12 professions designated under the Act, has held elections, and is in a position to nominate one of their elected members. The second is to incorporate the provisions of Directive 2005/3 6/EC on the recognition of professional qualifications into the principal Act and to provide for the assessment and recognition of other non-Irish qualifications which are outside the scope of the directive. Third, and in order to enhance the effective operation of the council and the registration boards, other amendments are proposed which relate to items such as fees payable to members of the council, registration criteria and the updating of fines for offences under the Act.

I wish to briefly explain the technical difficulty that has arisen with the appointment of professional members to the council. The Act provides that the council consists of a chairperson and 24 ordinary members, with each of the 12 registration boards nominating one of their elected members for appointment. As is usual in such cases, for the first term, the Act also empowers the Minister for Health to directly appoint 12 professional representative members since no registration board would have been established. The phased establishment of the 12 registration boards and the resulting lapse of time have meant however that, in the absence of registration boards which can then nominate council members, professional representative members cannot be appointed to the council to fill the vacancies arising from the completion of the terms of office of the original members.

Currently, 12 professional members are attending council meetings in an observer capacity, with my consent, in order that the perspective of the professionals can be maintained. This is an interim measure only and those attending do not have voting powers and cannot fulfil the requirements for a quorum. The Bill therefore proposes an amendment to the Act to allow the Minister for Health to continue to appoint professional members to the council until such time as the registration boards have been established, have held elections and are in a position to nominate elected members for appointment to the council.

The Bill also takes account of the provisions of Directive 2005/36/EC on the recognition of professional qualifications, which was enacted after the enactment of the Health and Social Care Professionals Act 2005. This directive is an Internal Market measure aimed at facilitating the free movement of persons within the European Economic Area, EEA. While health professionals are the largest single professional category availing of its provisions, the directive applies to any regulated profession. The Department of Education and Skills, in light of its role in qualifications, has overall responsibility for the directive in Ireland.

Senators may be aware that discussions are taking place at European Union level to modernise Directive 2005/36/EC. These are expected to conclude during the Irish Presidency. In the meantime, it is necessary to give effect to certain aspects of the current directive in this Bill. The directive makes it easier for qualified professionals, including certain health and social care professionals, to practise their professions in European countries other than their own, while providing appropriate safeguards to ensure public health and safety and consumer protection. This means that applicants' qualifications and post-qualification work experience are assessed to ensure they meet the qualification entry requirements to the profession in question in Ireland. As qualification recognition is the first step in a statutory registration process, it was always the policy intention that the registration boards would assume responsibility for the qualification recognition function under this directive. The Bill, therefore, provides that each registration board will be designated as competent authority under Directive 2005/36/EC for its designated profession.

The Minister for Health is the competent authority for most of the health professions designated under the Act and qualification recognition is for the purpose of eligibility for recruitment to the publicly-funded health sector. The introduction of statutory registration will mean all persons with non-Irish professional qualifications who seek to exercise their profession in Ireland must have their non-Irish qualification recognised under the directive.

The amendments contained in the Bill will also provide a legal basis for the assessment and recognition of qualifications obtained outside the State which are outside the scope of the directive, namely, the non-EEA qualifications of EEA nationals and the qualifications of non-EEA nationals. The Bill provides that the processes for the assessment of these qualifications are the same as provided for in Directive 2005/36/EC, including the provision of explicit appeal mechanisms.

The main provisions of the Bill can be summarised as follows. Section 1 sets out that the Health and Social Care Professionals Act 2005 is the principal Act and section 2 inserts a number of definitions into the principal Act. Section 3 will allow the Minister for Health to continue to appoint representatives of the designated professions to the council until such time as all registration boards are established and in a position to nominate elected members. Section 4 will provide a legal basis, when the council is self-funding, for payments to members of the council and its disciplinary - fitness to practise - committees, subject to the approval of the Minister for Health and with the consent of the Minister for Public Expenditure and Reform.

Section 6 will permit each registration board to prescribe certain practice and training requirements for professionals who have not practised for a designated period. Sections 11 and 13 will increase the maximum fines for offences committed under the principal Act. Sections 15 and 16 will provide for some changes in relation to "grandparenting" and in respect of the use of professional titles during the transitional period in which practising professionals may apply for registration. Sections 17 and 18 will allow the Minister to have the power to appoint members of the council and registration boards for a period of up to four years, rather than the current fixed term of four years.

Amendments are also proposed to sections 5 to 10, inclusive, and 14 and 15, of the principal Act to provide for the assessment and recognition in Ireland of qualifications obtained outside the State. Section 5 inserts a new section 27A to provide that when their registers have been established registration boards will be designated as competent authorities under Directive 2005/36/EC, empowered to act as competent authorities for their designated professions under Directive 2005/36/EC and empowered to assess qualifications obtained outside the State which are outside the scope of the directive. This section also provides for necessary transition arrangements for applications under the directive.

Section 6 amends section 31 to provide that a registration board may make by-laws relating to procedures for the assessment of professional qualifications, training, experience, aptitude tests or adaptation periods of applicants for registration whose professional qualifications have been obtained outside the State and are outside the scope of the directive.

Section 7 amends section 38 to update and simplify the approved qualifications criteria in section 38(2) so that there are three categories - Irish qualifications, qualifications approved under Directive 2005/36/EC and other qualifications - and to insert new definitions and remove others no longer necessary. Sections 8, 9 and 10 relate to procedures and appeals for non-Irish qualifications. Section 12 relates to the use of title in the provision of services on a temporary and occasional basis. Sections 14 and 15 amend the registration process for existing practitioners to comply with the processes of Directive 2005/36/EC which provide for the assessment of formal professional training and post-qualification professional experience. Section 19 provides a minor clarifying amendment to the list of optional qualifications required by an existing practitioner radiographer in order to register during the transitional period.

The Bill will enable the Health and Social Care Professionals Council to continue to fulfil in a more effective way its object to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions. I thank the House for its attention and commend the Bill to it.

I apologise for missing most of the Minister's speech. I was on my way to another meeting and was delayed.

I welcome the opportunity to make a few points about this legislation. We could have the Minister in the House all the time. The Minister knows that every day on the Order of Business, we are always looking to have a chat with him about various things. In contrast to the normal adversarial approach I take, we very much support this Bill. The Minister knows that its origins go back to the current Leader of the Opposition, Deputy Martin, in 2000 in respect of the report entitled, Statutory Registration for

Health and Social Professionals: Proposals for the Way Forward. The 2005 Act came about as a result of that report and we then saw the commitment to introduce statutory registration for health and social care professionals. According to that report, approximately 35 grades in the health service come under the overall term of health and social care. The rationale for the introduction of such registration is that we all require confidence in our health care professionals and to know that if we are seeking therapy or medical help and assistance, we can be confident that the prescribed treatment or therapy does what it says on the tin, for want of a better expression. Various disciplines have voiced concerns during the years about people's qualifications.

The legislation, which the Minister went through piece by piece, is technical in nature. Its main implications are the inclusion of additional professions in the system of statutory regulation in the future and the granting of power to the Minister to do that. For example, the Minister may look at including counselling and psychotherapy after the original 12 areas are included. What are the Minister's intentions with regard to herbalists? There are some very well-qualified people who are offering herbal remedies and treatments and many people have considerable confidence in them. There are varying degrees of expertise among these people. Some have done basic courses while I gather that others have completed degrees and doctorates in this area and so are very well qualified and competent in prescribing various remedies and treatments. We should try to include this area as soon as possible so that we can ensure that those worthy of registration are registered and those who are not worthy of registration are not registered so that the public can have confidence in that area also.

Will the Minister clarify why section 6 of the 2005 Act, relating to fitness to practise complaints, inquiries and the discipline that might be handed down, has not yet commenced? Why is this issue not dealt with in the Bill? Obviously, it is very important in the regulation of health care professionals and is meant to be a key function of the Health and Social Care Professionals Council. Only two of the professions are registered and up and running so far. Will the Minister indicate how quickly the entire 12-----

I dealt with that issue.

Very good, I will be able to check the record. That is very useful.

The addition of other professions might have been dealt with early in the Minister's speech also, but if it was not, will the Minister indicate some of the additional professions that he intends to bring on board? If members of the public at large feel that a particular area needs to be examined or registered, who do they ask to do that or what is the process in that regard?

We support the Bill. There is the issue surrounding section 6 of the 2005 Act but like the Minister, I commend the legislation to the House. I look forward to hearing further elaboration on some of the points I raised. As far as the public is concerned, the sooner this Bill is passed, the better, in order that we can have more confidence in the professions that are being put forward and prescribing treatments across the various disciplines.

I apologise to Senator MacSharry for the noise during the initial part of his contribution. There appears to be a difficulty with the broadcasting camera opposite him.

I welcome the Minister and this Bill. It is important to have proper registration for people who are offering such services. When the review was carried out in 2000 there were only five professional groups subject to statutory registration - doctors, dentists, nurses, opticians and pharmacists. The 2005 Act expanded that to 12 other groups, including clinical biochemists, dieticians, medical scientists, occupational therapists, physiotherapists, psychologists, radiographers, social care workers, social workers and speech and language therapists.

We are dealing with a very big area. In the health and medical care sector, there are more than 18,000 registered medical practitioners and I understand that more than 4,500 of them are people who did not graduate in Ireland. There is a huge movement of professionals in all areas. An advantage of the EU is that people can move freely within the 27 member states and over the years more people are moving from one state to another. As a large number of professional practitioners have moved to Ireland, it is important that we have a proper procedure in place for registration. I welcome the Bill for that reason.

It is important that the Health and Social Care Professionals Council is fully operational, with all the various sectoral boards registered as well. The Minister said that five are already up and running and another six are due to be established during 2013. This is technical legislation and it is important that it is passed. The registration board is not just about registration but also about ensuring that set standards are reached in respect of education and training and that a set procedure is in place for dealing with complaints, inquiries, discipline and the protection of professional titles.

The EU documentation refers to more than 800 professional qualifications. As more and more people are moving between member states, it is important that we move towards harmonising and recognising qualifications. We are attached to the UK health education system, in that we are more likely to recognise a qualification from a non-European country, for example, India, Pakistan or Nigeria, than we are to recognise qualifications from European countries. Our tendency has been to look towards the UK's education and training process. As we progress further in Europe, there will be greater sharing of information and training and expertise will become more available in Ireland as opposed to the Irish just offering that expertise to other European countries. In this light, it is important that a set of rules apply across the 27 member states.

Not only does the Bill before us deal with the Health and Social Care Professionals Council and the establishment of the registration boards, it also deals with the 2005 directive on same. That directive was a consolidation of 15 other directives and is concerned with the recognition of qualifications. Since it is currently being reviewed, we need to move with the times. I welcome the Minister's work in introducing the Bill and in ensuring that all of the registration boards are set up in a timely manner. Although the legislation has been in place since 2005, we have been slow in putting all of the procedures in place. We need to move faster. I note the Minister's confirmation to the effect that the 12 boards will be up and running within the not too distant future.

Given the work that must be done by the boards and the council, it is important that backup administrative services be in place. The Bill sets out strict timelines for response times to applications and for dealing with appeals and complaints. If the timelines are to work properly, there must be a proper administrative structure.

I welcome this development overall. It is important that the public has a fair protection mechanism that ensures that the quality of service it receives is of the standard expected and required in Ireland and the other 26 member states. I welcome the Bill and look forward to its passage through the House and its enactment at an early date.

I welcome the Minister to the House and add my support to the Bill. I welcome the Minister's comments to the effect that his priority is to proceed with the establishment of the registration boards for the professions designated under the 2005 legislation. I will reiterate Senator Burke's comments, in that this work must be done in a timely and efficient manner. I look forward to it.

In particular, I welcome the Minister's statement that he has started taking the steps necessary to include counselling and psychotherapy among the professions to be recognised.

It is alarming as we have all heard of cases where people can put a plaque on the door and call themselves a counsellor or psychotherapist and provide counselling in areas like suicide or eating disorders, which are very serious complaints that require proper and effective training. I welcome this change, which is vital, and I urge the Minister to hurry it through as quickly as possible.

Another point related to qualifications. I welcome that freedom will be given for people to have qualifications recognised within the EU. What about qualifications from America or Canada? In the past year I have heard the case of a radiographer who has tried to take up a position having been sought for the job. He had to gain the appropriate qualifications but was left for nine or ten months, which is a major delay in looking at his qualifications. I understand there was a problem with the registration board and waiting for it to meet so as to carry out the official process. If somebody is to relocate or return to this country, there should be procedures where registration can occur in a timely manner.

I add my support to the Minister and particularly to his words today indicating that steps will be put in place for counselling and psychotherapy processes. It is vital that they are included.

Cuirim céad fáilte roimh an Aire. Tá mé cinnte go mbeidh áthas air a chloisteáil go bhfuil muid i Sinn Féin ag tacú leis an mBille. Is breá an rud go bhfuil muid ag aontú faoi chúrsaí. Cuireann muid failte roimh an reachtaíocht áirithe seo mar síleann muid go bhfuil sé fíor-thábhachtach go mbeadh na daoine atá ag plé leis na cleachtais éagsúla leighis seo cláraithe mar is ceart.

Sinn Féin will support the legislation and the Health and Social Care Professionals (Amendment) Bill is a welcome technical measure. It has a number of key purposes, as the Minister outlined, and we hope it will add to the effective functioning of the Health and Social Care Professionals Council, which represents 12 disciplines, including clinical biochemists, dieticians, medical scientists, occupational therapists, orthoptists, physiotherapists, podiatrists, psychologists, radiographers, social care workers, social workers and speech and language therapists, with optometrists and dispensing opticians to be added in 2013.

The registration boards for each of these professions have yet to be established. One of the purposes of the Bill, as outlined, is to allow the Minister to continue to appoint professional members to the council until each of the registration boards has been established in respect of the 12 professions designated under the Act, elections are to be held and there is the chance to nominate an elected member. We support this process, which is a reasonable step to ensure various disciplines are represented.

The second key purpose is to incorporate the provisions of Directive 2005/36/EC into Irish law, which relates to the recognition of professional qualifications into the principal Act and to provide for the assessment and recognition of other non-Irish qualifications outside the scope of the directive. This is again perfectly sensible and there is a need to ensure skills are transferable, particularly as there is often a need to bring people with particular skills into this country's health care service.

Although it is vital to ensure there is co-operation, integration and transferability in a European context, we should also consider how to better bring about integration in an all-Ireland context, and it is not just Sinn Féin which sees value in this. As my colleague, Deputy Ó Caoláin, noted in the other House, the North-South feasibility study of cross-Border co-operation in health care provision, carried out by the two Departments in the North and South, made clear the benefits of cross-Border operation. He noted there are significant difficulties, as there are two jurisdictions on this small island, for both sets of authorities in sustaining high quality and specialist services normally only provided in centres servicing large populations.

Steps can be taken to overcome such challenges if a cross-Border approach is taken. The report noted that where patients must leave both jurisdictions for treatment, the impact on individuals and families is significant in terms of patient well-being and accessibility for families in what can sometimes be traumatic circumstances.

Combining resources for the provision of such services on a North-South basis makes sense. It is particularly relevant to the legislation that the report notes, "it is recognised that both populations would benefit from flexible working arrangements which would enable staff to work in another jurisdiction. For example, practitioners with scarce clinical skills might reasonably offer a service to both populations".

The report considers that issues such as indemnity for staff working out of jurisdiction and mutual recognition of qualifications between professional bodies in both jurisdictions, as well as registration and pension issues associated with working in both jurisdictions, need to be resolved for the benefits of that to be fully recognised. I agree with these sentiments. I hope the Minister takes them on board and that we will see action in this regard in the coming weeks and months.

The third major purpose of the legislation is to enhance the effective operation of the council and registration boards, including items such as fees payable to members of the council, registration criteria and the updating of fines for offences under the Act. This is largely technical in nature.

The steps taken are positive in improving regulation and so on. They are, however, modest steps with reference to the substantial reform we require. The Minister commits himself to reform on a substantial scale but we need to see more evidence of this progress.

Given the way the HSE and the health care system are structured, too few people are employed in many of these disciplines, despite many being trained in those fields. The most obvious example is that of speech therapists. Many who have qualifications would love to take on that work full-time and plug a gap in service provision that is clearly there. This was borne out in the Dáil contributions by Deputy Ó Caoláin and several others. The recruitment embargo is a blunt instrument that is not working and is hampering the care of patients.

I urge the Minister to bring this issue back to the Cabinet. Nonetheless, we commend the Minister for bringing the Bill forward and we will be supporting it. Táimid ag tacú leis an mBille mar atá leagtha amach.

While the Bill is short and technical, it is important. It is essential that we have registration boards and regulation for professionals. There must be certainty for professionals working in the various disciplines and members of the public who avail of those services must have certainty and trust in standards. A certain level of educational attainment must be established prior to entering a profession and there must be continuing professional development and training throughout a professional working life. In 2000, only five professions were registered. There are now another 12. Twelve years is a long time but some of these things can take a long time. It is important to give certainty.

I am glad to hear the Minister's comments on counsellors and psychotherapists. This area can be difficult. A person can put a plaque on the wall and offer those services. This can happen in other areas but it is particularly true of these areas. Counsellors and psychotherapists deal with vulnerable people who are crying out for help and depending on these professionals to support them and provide the necessary interventions and supports. In many cases they charge a hefty fee of €60, €70, €80 or more per hour for their services. This area has been crying out for regulation for a long time and we have all heard stories of how the trust of the public has been violated by certain individuals. I welcome the Minister's comments that he will work on this area as a matter of priority. He laid out how he intends to move forward. That is a positive move.

As a member state of the European Union, we want to ensure that there is a standard for all professions across the 27 member states. Those standards should be required of any professional coming to work in this country or in any member state. There should be a means of assessment to ensure professionals meet those standards. This is an important and positive step, from everyone's point of view.

The registration boards will give certainty and confidence to users of the services of these health professionals. This will also give certainty to the professionals themselves who have committed their lives to working in these fields that their professional standards will be recognised, which is also important.

I welcome the Bill. It is important for these professionals to be registered. Many of them were trained via the hospital system while others have gone through the CAO system to acquire their qualifications. I am delighted they can move freely in the EU. What has the registration fee been set at? I presume they only have to pay the fee in one country and can still travel and work in others.

Senator MacSharry referred to the regulation of herbalists. Has the Minister proposals to regulate acupuncturists and reflexologists who also operate freely?

Section 6 permits each registration board "to prescribe certain practices and training requirements for professionals who have not practised for a designated period of time". Will the Minister elaborate on this? How much further training will they have to undergo before being permitted to register? I support the Bill and thank the Minister for coming.

I have two questions. I refer to the registration. It costs public health nurses €90 annually to register with An Bord Altranais but the proposed fee for social workers to register with a board is €295 annually. Who sets the fees? What does someone who registers get in return for that money?

Section 6 permits each registration board "to prescribe certain practices and training requirements for professionals who have not practised for a designated period of time". It is a requirement that these professionals will have to regularly update their skills and training. Who will cover the cost of the training courses? Will it be down to the professionals or the HSE?

I thank Senators for their support for the Bill, their contributions and the questions raised.

Senator MacSharry raised the issue of fitness to practise committees under section 6. We need at least two committees to be in place and these have not commenced yet because the three new registers and the social work register have only recently been added. These committees will commence next year.

A number of Members asked about establishing registers for other health-related fields. They could make submissions to the Department. Many of them mentioned specific areas, some of which I am interested in. For instance, acupuncture is valuable and it works, particularly for pain relief. I would much prefer people to have acupuncture on a weekly basis than to take non-steroidal anti-inflammatories, which can destroy their kidneys and cause gastrointestinal bleeding.

Acupuncture is a safe alternative, particularly in older people, but we do not have any university here that has a prescribed course, therefore, one is at the mercy of the person delivering the service. It is an area I would like examined. I would like to see some of the colleges provide a course on which we could rely to produce suitably qualified individuals to provide these services. The same applies to reflexology, not to the same extent, but it certainly can have a role in respect of relaxation.

Senator Marie Moloney asked about registration costs, an issue also raised by Senator John Kelly. The reason it is more expensive for social workers to register is that they number only in the hundreds whereas there are 60,000 nurses. If one has to support the same superstructure with fewer people it will obviously cost more. As to who set the fee, at the behest of the unions I entered a long discussion with them on the fee because I did not want people to have lots of frills in respect of the register that are unnecessary when those who have to register have to pay the bill.

Senator Mary Moran raised the issue of an individual from the United States. The same processes apply. Obviously it is in our interest and I would like to see a minimalisation of red tape in respect of professionals coming to this country as we need them. As the traffic is often in the other direction, it is good to get some coming this way. The time period allowed is four months. That should be the case unless they have not provided the appropriate documentation which can hold up the process. Clear information is provided on the Department's website but that is not to say that individuals do not run into difficulty from time to time. It is an area that must be kept under active review because we should not do anything to obstruct suitably qualified people coming to the country to deliver care.

Senator Ó Clochartaigh mentioned the recruitment embargo. The reality is that the embargo has to stay in place but we said we would be much more flexible around it; we will be and have been in the past and will be more so next year. However, we face a serious challenge - I do not want to get into that discussion - in the health budget next year. There are 3,500 staff who must go. Considering that there are 37,000 plus nurses in the Health Service Executive manpower, sadly nurses cannot escape, therefore, we have to go back to changing the model of care that I mentioned, that is, ensuring that the right patient is seen by the right person in the right place at the right time. So often, that is not the case in the current system. There are nurses looking after people who health care assistants could look after. There are general practitioners looking after patients who nurses and physiotherapists should be looking after. There are patients being looked after in hospitals who should be looked after in the community. There are consultants looking after patients who others should be looking after. A big job of work is being undertaken through the clinical programmes, the SDU. That is ongoing and we continue to make progress. Obviously we would like if the progress was faster but the reality is that one never gets to where one wants to as quickly as one would wish but that does not mean one should not continue to strive to do so and we certainly will.

The issue of herbalism and herbalists was mentioned. Currently, the product is regulated under the medicines legislation rather than the actual practitioner. One could look at herbalism and traditional medicine. That is a whole area that needs to be explored. Just because I am a doctor does not mean I close my eyes to these issues. My view is very simple, if it works, it works and as long as it can be proved to work and in repeated control trials to be seen to work, why not have it available to one's citizens? There are other jurisdictions we can look to where they have got structured training in these areas and have degrees from universities that ensure that the individual who is practising is competent in the area. We know this can be looked at but the most pressing issue for us, outside of those mentioned, has to be counselling and psychotherapy. Given the high rate of suicide in the country, we have to ensure we have got the professionals suitably qualified to help us deal with the mental health requirements of the people.

I thank all the Members for their contributions and support.

Question put and agreed to.

When is it proposed to take Committee Stage?

On Tuesday, 18 December.

Committee Stage ordered for Tuesday, 18 December 2012.
Sitting suspended at 2.45 p.m. and resumed at 3 p.m.