Dáil Éireann díospóireacht -
Thursday, 30 Jun 2005

Vol. 605 No. 5

Health and Social Care Professionals Bill 2004 [Seanad]: Second Stage (Resumed).

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

Mr. F. McGrath

It is important to deal with the constructive criticisms put forward by the Irish Society of Chartered Physiotherapists which is very concerned that the protection of patients is not being afforded the paramount importance it deserves by the protection of both titles, "physical therapist" and "physiotherapist". The society has furnished to me a copy of its position statement which outlines the reasons its members believe this Bill must be amended to protect the public and avoid confusion when choosing a health practitioner. To the horror of ISCP members, its original position paper was passed to the Institute of Physical Therapy where it was altered and recirculated to all Deputies as the institute's own document. The ISCP is very concerned that Members are deliberately confused and misled on a very important issue. The ISCP has written to the institute to express its outrage at what has occurred. As a professional body representing health care professionals, the society is most concerned at this underhand way of presenting information.

The impression is given of a battle between the Irish Society of Chartered Physiotherapists, ISCP, and the Institute of Physical Therapy. This could not be further from the truth. When the ISCP refers to physical therapists it is not just referring to those who attended the institute in Stillorgan for lessons but also to all other physical therapists who have completed courses elsewhere.

The National Training Authority, Park House, Cabinteely, runs a home study course in physical therapy consisting of 24 lessons. No hands-on clinical practice is included and all teaching is carried out by means of manuals posted out to students. Having completed the 24 lessons, the newly qualified physical therapist can set up in private practice, without ever sitting an examination or seeing a patient. This is the reason the ISCP is so passionate about protecting the titles of "physical therapist" and "physiotherapist" for those individuals who are eligible for membership of the ISCP and have completed a university degree course. It would be remiss of the society not to care about protecting the patient. Its members are health care professionals with a genuine interest in patient care, safety and well-being and it will do all in its power to ensure patients are not exposed to inferior treatment.

The ISCP has no issue with those calling themselves "physical therapists" but it insists that if the public is to be protected and confusion avoided, the use of the title "physical therapist" must be changed to a title less similar to the title "physiotherapist". I commend the Irish Society of Chartered Physiotherapists for expressing its views and its president, Esther Mary Darcy, for informing Members of the House on this issue.

Section 11 of the Bill provides for the council to appoint a chief executive officer to carry out the management and administration of the council and registration boards and to act as the registrar of each registration board and perform any other duties determined by the council. The chief executive officer holds office under conditions of remuneration and allowances that may be determined by the council with the approval of the Minister given with the consent of the Minister for Finance. I encourage the Minister of State to be flexible and creative in the appointment of the chief executive.

Part 3 of the Bill deals with the establishment of registration boards. The bodies are established on their prospective establishment days to perform the functions and exercise the powers assigned under this Act to the registration board of the designated profession.

Mr. Deenihan

I welcome the opportunity to speak on the Bill. Members have been intensively lobbied by two professions in particular. I will refer to the arguments put forward by both bodies.

This Bill is an Act to provide for the establishment and functions of the Health and Social Care Professionals Council and of registration boards for certain designated health and social care professionals to provide for the registration of persons qualified to use the title of a designated profession and for the determination of complaints relating to their fitness to practise and to provide for related matters.

As the Minister for Health and Children said when introducing the Bill in the other House, statutory registration is best described as a system whereby individual members of a profession are recognised by a specified body as being competent to practise within that profession under a formal mechanism provided by law.

I welcome this development which has been requested for some time. The Bill has been in preparation for a number of years. Unlike systems of voluntary registration, this is a legally binding process with a mechanism for the prosecution of offences. It is integral to the delivery of the commitment in the health strategy to strengthen and expand provisions for the statutory registration of health professionals. This is the first of three Bills to reform the regulatory environment for health professionals, with legislation for medical practitioners and nurses to follow.

The aim is to protect the consumer and provide a reassurance that the professional is competent and qualified and is answerable to a body. In the past those who were not treated properly suffered and the mistakes were buried with them when they died. It was strongly emphasised in the health strategy that gaining people's trust in the health system is achieved by guaranteeing quality.

People used to spend their money on material possessions such as homes, gardens, kitchens and cars, but now they are spending money on their health. Ireland is a richer country. People are better off. They have all the material possessions and now they are concentrating on their health and that of their families, especially their children. They want to live longer and healthier lives. As a result they expect a greater quality of service from the professionals they attend when they are sick or have concerns about their health.

People want to know that the service they receive is based on best practice and meets approved and certified standards. Improving quality in the health care system requires implementation of internationally recognised evidence-based guidelines and protocols and ongoing education and commitment from health care institutions and professionals. Trust requires that deficiencies in the system be identified, corrective action taken and future progress monitored. The principle of people-centredness includes ensuring that consumers are given greater control and greater responsibility for their own health and increased involvement of consumers as partners in planning and evaluation. This Bill involves members of the public more in regulating the professionals on whom they depend to ensure they have a long and healthy life.

The legislation on statutory registration of health and social care professionals contains a comprehensive legal process for the investigation of complaints against individual professionals and that is to be welcomed. In light of the recent experience in Mayo and other experiences in different parts of the country, we all know that there will be a number of health therapists and others who will not come under the ambit of this Bill. Freelance operators in the health care industry must be answerable in some way for their activities. The professionals are answerable but the freelance health therapists are not. That is a contradiction in the Bill. This Bill is only the beginning of a process that must be continued in terms of dealing with people who advise on people's health on a daily basis.

Some such operators are neither qualified nor hold the necessary education qualifications and in the end the patient suffers except in some instances where by a stroke of luck the operators are successful in administering medicine that happens to work. How does the Minister or the Department propose to deal with that group of people, many of whom have no qualifications other than some cure was handed down to them or they may have attended a course for a few months and subsequently described themselves as professionals and set up in business? I would like the Minister of State, when replying, to refer to such freelance operators in health care.

Strengthening and clarifying accountability and measurement mechanisms is a priority. Professionals now practise in a more demanding environment. Evidence-based guidelines tied to professional standards, the requirements of health care organisations and patients' rights and expectations all add to these demands. That is another aspect of accountability strengthened by these legislative proposals. The establishment of a system of statutory registration for certain health and social care professionals is therefore considered essential to the delivery of the quality and accountability objectives of the health strategy. It will ensure that members of the public are guided, protected and informed so that they can be confident that health and social care professions providing services are properly qualified, competent and fit to practise. These are all welcome developments, but they will only apply to the people in whom we normally have trust. The legislation does not have a broader application.

Section 4 designates the health and social care professions to be subject to the provisions of the Act, and they have been mentioned by a number of speakers. Members of a number of the professions were referred to with whom we would come in contact on a regular basis, such as chiropractors, acupuncturists and several more people who describe themselves as professionals. Some of these people would be described as a doctor of acupuncture. Many genuine members of different nationalities who have emigrated here practise in this field.

Regulations covering the qualifications of such practitioners should be in place. Many practitioners, for example, a doctor of acupuncture, may be genuine but there should be a system whereby people could ask such practitioners dealing with the important issue of people's health to specify their qualifications and where they obtained them, and such qualifications should be checked. There should be some way of tracking where these people are from, where they got their qualifications and if their qualifications are recognised. There might be a European dimension to this aspect in terms of people who emigrate to member states of the Union. The EU might have a role in such regulation.

I wish to return to the matter of the concern of physiotherapists regarding this Bill. They were anxious that the title of physical therapist would attached to the physiotherapists and be protected. There is provision in the Bill whereby the Minister may in future designate other professions. That will be an ongoing process. Physiotherapists are concerned that people who describe themselves as physical therapists can continue to operate, and that is a genuine concern. They have briefed us comprehensively regarding their concerns and they have been read into the record by a number of speakers.

Physiotherapists have been practising here for 100 years. The first Irish school of physiotherapy was founded in 1905. Physiotherapy is a full four-year honours degree course. The Irish Society of Chartered Physiotherapists has 2,000 members. Some 1,500 physiotherapists are employed by the Health Service Executive. Therefore, there are numerous physiotherapists and their organisation is influential.

The first letter we got from them was dated 28 June. Deputy Paul McGrath referred to that and more or less read their concerns into the record of the House, so I will not repeat them. Have the Minister and his officials studied their concerns and given any commitments to the Irish Society of Chartered Physiotherapists to the effect that in future physical therapists will be included in this Bill and that title would be protected? As a sportsman I have been in contact with a number of physiotherapists over the years and they are very professional. I have the highest regard for them. The fact that they spend four years studying the discipline of physiotherapy is significant. In one sense it is a broad area, but in another sense it can be very specific. I spoke to a young woman recently who is currently studying physiotherapy in the University of Limerick. She advised me that she has spent the whole year studying anatomy alone. That must be very intensive, and obviously these people have an in-depth knowledge of how the body works, and how it is affected by various treatments. Treatment is becoming more complicated as we know. Interferential therapy and ultrasonic treatment was introduced some years ago and there are other types of treatment that require deep medical knowledge. Otherwise damage could be done, especially where bones are concerned.

We have received a briefing from the Institute of Physical Therapy. I met a representative of the institute, whom I found to be very genuine. There are about 350 physical therapists in the country at the moment, although that figure varies. The Institute of Physical Therapy was established in 1989, unlike the Irish Society of Chartered Physiotherapists whose first school was established 100 years ago. The institute was established in 1989 to pioneer a course in physical therapy in Ireland. Physical therapy is a holistic natural approach to the prevention and treatment of musculo-skeletal conditions. It is worth pointing out that unlike the physiotherapists, the physical therapists utilise a range of gentle hands-on techniques, including stretching and mobilisation, that have proven to be safe and effective in the treatment of most muscular related disorders. The physiotherapists use interferential therapy, ultrasonic treatment and other means for treating injuries. Generally speaking, the physical therapists use their hands more and just work on muscles and tendons, without going any further. The physiotherapists obviously give more advice as regards the internal workings of the body and how other parts of the body affect the muscular system as well. They have expertise in the area of diet and other disciplines, too. We have both of those disciplines at this stage.

It is worth noting that the Institute of Physical Therapy offers a three year course designed for mature students. It is probably on at weekends and of its nature this could be regarded as part-time. However, most of the people who come through the institute have degrees already. Most of them are graduates, I understand, based on the submission we received. They are also very professional. I have come into contact with a few physical therapists, most of whom work with inter-county teams and generally speaking, they are very professional. They would not work with inter-county teams if they were not. If nothing else, this Bill has highlighted the conflict between the physiotherapists, on the one hand, and the physical therapists on the other.

It is very important at this stage that the Minister should offer some view on the concerns of both professional bodies. Normally in the lead up to a Bill we, as Deputies, are lobbied by various groups. However, the only people who have lobbied me are these two groups. It is important, therefore, that some clarity is given, based on the submissions of both of these groups, and it would be very helpful. It is more or less implied in the Bill that when people attend a certain therapist all the relevant documentation as regards qualifications, education and experience of the professional should be available. It is not just good enough to have letters after a person's name. Each professional should have a curriculum vitae setting out qualifications and the body of which he or she is a member.

I welcome this Bill and the debate on it. One major issue of contention is the distinction between physiotherapists and physical therapists. I would like if the Minister could give the House a direction as to the future position of both these professional bodies.

Mr. S. Ryan

I welcome the opportunity to make a brief contribution on the Health and Social Care Professionals Bill 2004. It is long overdue and in that context it is appropriate that it is being debated in the House before the summer recess.

Before I forget or run out of time, I ask the Minister to respond to the following question, when he is summing up. In view of the fact that a BSc in podiatry is listed under the Third Schedule as the minimum qualification required for registration and there is no school of podiatry attached to any university in the State, is it proposed to establish such a school at one of the universities and will the call for tenders go out before the end of this year? The Minister will be aware that at present students must go to the University of Ulster at Jordanstown or to one of 12 universities providing the course in Britain. In the context of that being referred to in the Bill it is important that the Minister clarifies the situation as regards access to that professional qualification.

Few of us can disagree with the main objectives of the Bill to provide for the establishment of the health and social care professionals council as well as registration boards for certain health and social care professions. It also provides for the registration of persons qualifying to use the title of a designated profession and for determination of complaints relating to their fitness to practise, and related matters. How can these objectives be best realised, initially in this legislation and thereafter through its practical implementation? I am not convinced the Bill meets these objectives or addresses many of the outstanding issues.

On reading the Bill, I was struck first by its elaborate structure. It provides for at least 180 appointments to be made to various councils and committees. Who will make these appointments? According to the Bill, this task will fall, by and large, to the Minister for Health and Children. The notion of jobs for the boys and girls is the first thought to come to mind. Unfortunately, the record of such appointments over the years has been less than reassuring and this must be a concern for the public.

Section 4 designates the 12 professions provided for in the Bill. It is appropriate at this stage to refer not only to the objective of having high standards in the professions, to which we all aspire, but also to the level of service being provided — or not provided — to the public. Many of the designated professions, for example, chiropodists, occupational therapists, physiotherapists, social care workers, social workers and speech and language therapists, are vital to the community care service. In reality, however, the idea that community care is available is essentially a fallacy, particularly for older people. Surveys and reports have clearly shown that the vast majority of older people want to be cared for in their homes with minimum health service involvement. It is shameful that community care is totally inadequate and is not being delivered as envisaged.

The availability and willingness of family members to care for their elderly relatives make the major difference in terms of keeping elderly people at home. Notwithstanding its many promises, the Government has failed to adequately acknowledge the role of community carers. Any debate on health and social care must include an acknowledgement of their role. The Labour Party has put this issue at the top of its agenda and will continue to vigorously pursue it. If the Minister fails to deal effectively with carers, the Government will feel the wrath of voters at the next election.

The community care system must be developed to ensure older people receive the support they need and families providing care do not become isolated. Community care services are essential to achieving the aim of keeping at least 90% of people aged 75 years or over in their own homes. It is obvious to political representatives that insufficient finance has been provided to develop these services.

The key community care services urgently required for older people and their carers are domiciliary nursing, general practitioner and home help services, respite and day care centres, meals and transport services, paramedic services and several of the services specifically referred to in the Bill, including occupational therapy, physical therapy, chiropody, speech therapy and social work. It is a scandal that, at a time when health and social care services are being put on a statutory footing, the availability of such services is restricted in the community. For example, medical card holders are obliged to make a contribution towards the cost of chiropody. In addition, according to the most recent figures available to me, the home help service, which is essential if we are to ensure people are cared for at home rather than in acute beds in hospital, was cut back by 300,000 hours in 2003 as compared to 2002. Is it not a scandal that while medical card holders are being deprived of the home help service to which they are entitled, Minister after Minister has been returning departmental moneys to the Department of Finance?

If we are to implement a comprehensive community care service that would reduce dependency on acute hospital beds, emphasis must be placed on the shortage of occupational therapists and chiropodists at Health Service Executive level. The delay in providing these services means costs of providing scarce services are being unfairly levelled on medical card holders. Furthermore, we must address geographical variations in service levels, which a number of delegations visiting the Houses have described. Surely a basic, uniform service should be available throughout the country.

Representations received from the Irish Society of Chartered Physiotherapists and the Institute of Physical Therapy made particular reference to the protection of title. Time and again, Deputies have highlighted the case expressed in the position paper submitted by the Irish Society of Chartered Physiotherapists, which I have read.

It is also important, however, to place on record the views of members of the Institute of Physical Therapy. During my sporting days I suffered major back problems and often sought treatment from experienced physiotherapists, and I have always found them to be highly professional. I must also acknowledge that physical therapists, who treat clients from sporting and general backgrounds, have built up 350 practices throughout the country. Clients come from both sporting and general backgrounds and are largely referred by existing clients.

The Institute of Physical Therapy was established in 1989 to pioneer a course in physical therapy in Ireland. Physical therapy is a holistic, natural approach to the prevention and treatment of musculoskeletal conditions. The therapist uses a range of gentle techniques, including stretching and immobilisation that have proven to be safe and effective in the treatment of most muscle related disorders. These are natural, drug free treatments that are individually tailored, do not conflict with conventional medical treatment and are founded on the principle of health science. It is safe and effective in the treatment of back, muscular and joint problems. In the 15 years since the institute's foundation, no physical therapist has faced a negligence claim.

The Institute of Physical Therapy offers a three year course designated for mature students. The professional association of practitioners, the Irish Association of Physical Therapists, was established in 1992 and regulates the profession in Ireland. Physical therapy presents itself at all times as an alternative to physiotherapy and physical therapists explain to clients unsure of what to expect that the treatment is not available under a medical card.

In its submission, the institute notes the Bacon report on the current and future supply and demand for physiotherapists forecasts a shortage projected to last until 2016. The report recommended the immediate recruitment of physical therapists into the public service to address this. Any restrictions on the work of physical therapists will exacerbate the current shortages for many years and the removal of 350 therapists would have a negative impact on a health service already unable to cope.

Both physiotherapists and physical therapists provide a service and we must ensure the public get the best possible service and have a choice of which they prefer and which will meet their needs. There is room for both professions to complement each other. They have worked together for the last 15 years and, irrespective of this Bill, they can coexist. The Minister can get it right in this Bill and I recommend that the Institute of Physical Therapy's recommendations are taken on board. She should not remove them from practice, which would be a negative step. We can deal with this in detail on Committee Stage.

Page after page of the Bill refers to the establishment of committees and mechanisms to deal with complaints. The Bill does not make it clear, however, how a person would go about initiating a complaint against someone who has been negligent.

Caoimhghín Ó Caoláin

This Bill is welcome but long overdue. It has been recognised for some years that better regulation of a range of health and social care professions is necessary. It is essential for the professions themselves and will ensure that only those who are properly qualified and subject to statutory regulations are allowed to practise the various disciplines outlined in the Bill. The public needs this statutory protection and guidance to be confident that those from whom they receive treatment are fully competent and accountable within their respective professions.

Before addressing the Bill, it is appropriate to say something about the issues surrounding health and social care professionals in Ireland today. It must be recognised that care across a range of areas has improved, primarily as our knowledge has improved and led to a more detailed and specialised approach to all aspects of human health. This is welcome.

The issue of accessibility, however, to the skills, knowledge and care of these professions is central in our health and social services. Access to care for many citizens is very difficult and is often denied for two reasons.

Our two tier public and private health system means the higher a person's income, the more likely he is to avail of the care provided by the professions listed in this Bill. The Bill covers those who work in the public and private sectors and the self-employed but the trend of our times, encouraged by the Tánaiste and Minister for Health and Children, is for more and more of these professions to be sucked into the private sector. At the same time the public sector is starved of the professionals it desperately needs.

The second reason for the inequity in accessibility is due to the shortage of persons practising in many of these professions. This is clear to us across the range of services addressed in the Bill. One only has to look at the desperate need for more speech and language therapists to provide services for children with special educational needs. Not enough speech and language therapists are being trained. For some reason, young people are not choosing it as a career in sufficient numbers, yet the system is crying out for more therapists. There is also a shortage of radiographers which often prevents state-of-the-art hospital facilities from coming on stream. The planned roll-out by the autumn of 2007 of BreastCheck with its static centres in Galway and Cork and mobile units for the rest of the country will require a large intake of trained radiographers and others within the associated professions. Despite this, I do not believe this is achievable or that those positions required will be recruited from within the indigenous complement. As with many other areas of health care, BreastCheck will have to look overseas to fill some of these positions.

It would be interesting to conduct a survey of the professions covered in the Bill to assess the state of play of each regarding supply to learn whether numbers in the professions are inadequate. In areas where they were found to be inadequate, one would find the private system receiving a disproportionate number of those trained in those professions and the public system losing out once again.

A serious examination must be conducted into inequality in access to education. In wide sectors of society, young people do not aspire or have no expectation or possibility of ever being able to practice any of the professions covered in the Bill. We need to see greater activity on the part of the Department of Health and Children and the Government in informing second level schools to equip young people with the information to make informed career choices. I have no doubt many young people, owing to a variety of reasons, some of which I have alluded to, would never think of these real and live options for their career paths. As a result we are deprived of the talent of countless young people who could make an invaluable contribution to the health system.

One great disadvantage of the health system and a barrier to progress within it is the elitism among medical professionals. The former Minister for Health and Children, Deputy Martin, called the hospital consultants kings in their own domain. I absolutely agree. Without diminishing the central role played by consultants and the higher echelons of the health profession in the system and the work most of them do, it must be admitted that for decades they were subject to too little accountability and scrutiny. Only the very privileged minority secured contracts which hospital consultants still enjoy and which the Government has been attempting to renegotiate for years in an effort to ensure greater equity in hospital care for public patients. It appears the process is painfully slow.

To cite one instance, in the Neary case we saw the total inadequacy of the Medical Council as a regulatory body. For years the victims were ignored and when the council was finally forced to take action, its investigation also took years. The victims of this practitioner were vindicated but were alienated from the body supposedly in place to ensure public confidence in the medical profession. Sadly, they have yet to receive justice.

In his summing up, will the Minister of State explain where the medical profession fits into the picture? Where stands the promised medical practitioners Bill and the nursing Bill? These Bills are designed to provide for regulation in the same way as this Bill. Perhaps the Minister of State will elaborate on the promised Bills mirroring this one when Deputy Durkan has finished consulting him.

Mr. Durkan

I was advising him.

Mr. B. Lenihan

Gabh mo leithscéal. Táim ag éisteacht.

Caoimhghín Ó Caoláin

No doubt it is good advice. To what extent has experience with existing and far from satisfactory regulatory bodies such as the Medical Council been taken into account? There is much experience to draw on and I am interested in what the Minister of State will say in this regard.

I will reserve a detailed consideration of the Bill, as we will have an opportunity to do so during subsequent Stages. The general framework is acceptable. However, my major reservation is that all appointees to the health and social care professionals council are to be ministerial choices. Sinn Féin Deputies have repeatedly raised this issue over many Bills. Once again it looms large in this Bill. The 25 members of the health and social care professionals council are all to be appointed by the Minister for Health and Children. The registration boards of the professions concerned will nominate 12 people. The nine to represent the interest of the public will be nominated by no one but the Minister for Health and Children.

It is interesting that the term "the consent of the Minister for Enterprise, Trade and Employment" has been added to this provision. Perhaps the Minister of State will explain that particular addendum. My own suspicion is that it is there because the view prevails in Government that people accessing professional health care are consumers of commercial services rather than citizens with rights to proper health services. Whatever the reason — I look forward to the explanation — the representation for the public is inadequate and should be changed. On Second Stage, I commend a revisitation of that proposed configuration to the Minister of State.

As other Deputies have noted in the course of this debate, I have also been lobbied by bodies representing physiotherapists and physical therapists, and clearly there is a dispute between them about the name and nature of their respective professions. From the material submitted by these groups, it is clear that there is a dispute about basic facts. Only yesterday, I received a further missive from the Irish Society of Chartered Physiotherapists. The dispute is about such critical issues as training and, indeed, the qualification of physical therapists. Perhaps this Bill is not the place to resolve this complex issue. The Bill reflects a recognition of both, which is meritorious, but clearly as there is a serious disputation, I suggest that the Department consider initiating discussions between the groups in pursuit of agreement on how they can work in harmony and for the public benefit. If at the end of that process this Bill requires amendment, in any way reflective of that engagement, let that be done.

Broadly, however, it is in the interests of both sets of professions and in the wider public interest that this disputation is put to rest. Some form of mediation is necessary and the Minister and the Department should consider what role they can play in helping the two sets of protagonists to come to a peaceful and harmonious conclusion to their dispute. I look forward to the opportunity to address some of the detail in later Stages of the debate.

Mr. Glennon

I also welcome this legislation. In a country where the provision of health care is such an important issue for the vast majority of its people, any legislation which deals with the provision of health care services is to be welcomed. By the nature of health care, it is essential that there is adequate regulation of the provision of services. I will not rehearse most of the arguments that have been made previously. I came to the Chamber specifically to deal with the issue to which I believe every speaker has referred in this debate thus far. Like other Members, I have received representations from both sides of the therapy issue, if one might so describe it. I felt that I should contribute to the debate as a user, at times a frequent user, as both patient and employer, of the services of both professions.

My experience of both professions has been extremely positive, both as patient and as employer. I am speaking of my experience in the sporting arena, particularly during the past 15 years, when I was heavily involved with professional athletes who had a day-to-day requirement for the services provided by both physiotherapists and what are referred to as physical therapists. In general, my experience has been that as with any profession, the vast majority are expert practitioners and a few are not so expert. Obviously, the forthcoming regulation will affect the not so expert end of either sector. However, my impression was that the crucial factor for any patient of either arm of the profession is the confidence of the patient in the professional administering the service, particularly in the area of sports injury, to which my experience is confined. The confidence of the athlete in the ability of the professional to rehabilitate the injury and get the athlete back into the sporting arena at the earliest possible opportunity was a vital component in the choice by the patient of the type of treatment and the individual by whom they wished to be treated.

Unfortunately, sports injury and the recovery from such injuries are topical at present. However, the manner in which our attention has been focused on the issue in the past week by the unfortunate injury to Brian O'Driscoll in New Zealand tends to make us overlook the ordinary day-to-day bumps and bruises experienced and suffered by individual athletes in the daily practice of their craft and earning of their livelihoods. While such spectacular events receive wall-to-wall and angle-to-angle coverage across our television screens, for the athletes who train and engage in what by any standards is extremely rigorous physical activity, injury is part and parcel of their lives. It is an occupational hazard and the ability to recover quickly is a vital element of their day-to-day lives. In particular, the ability to recover more quickly than their opponents, or in this case the replacement, is vital. This ability can only be provided by a practitioner who is able to identify and treat the injury but also — this is particularly important — restore the individual's confidence that he or she is capable of returning to the arena and performing again to his or her maximum ability at the earliest possible opportunity. In my experience of both professions I found little if any difference. Probably the country's highest-profile practitioner in either craft in the sports area describes himself as a physical therapist. Jokingly he will describe himself as "therapist to the stars". I have no intention of mentioning names, which would breach confidentiality. However, the list of names represents a "who's who" across the Irish sporting spectrum, including footballers, hurlers, rugby players and athletes both male and female. They attend that practitioner because of their confidence in him to deliver the service and their confidence when returning to the sporting arena that they are not putting themselves at unnecessary risk of aggravating the injury and thereby putting themselves to even greater discomfort and risking reducing their earnings.

I understand from where the physiotherapists and the therapists are coming. In its letter dated 28 June, the Irish Society of Chartered Physiotherapists states:

This is why the ISCP is so passionate about protecting the titles of "physical therapist" and "physiotherapist" for those individuals who are eligible for membership of the ISCP and having completed a university degree course... The ISCP has no issue with those currently calling themselves "physical therapists" continuing to practise but the ISCP insists that if the public are to be protected and confusion to be avoided anyone using the title "physical therapist" must change their title to something that is less similar to the title "physiotherapist".

I agree with some of the earlier speakers who regard this as an unseemly spat between two groups of professionals. The first few paragraphs of the letter from the Irish Society of Chartered Physiotherapists does not do any service to the debate or to either group of professionals. Any efforts to try to bring the parties together to resolve matters would be worthwhile.

I believe a clear distinction exists and in due course that distinction would emerge in the eye of the public were the word "chartered" to be always used with the word "physiotherapist" resulting in a clear distinction between a "chartered physiotherapist" and a "physical therapist". From my understanding of both submissions one of the major difficulties is in the similarity of the names "physiotherapist" and a "physical therapist", particularly when they are spoken quickly. Using the word "chartered" would immediately remove the similarity and would draw a clear distinction between both. Its consideration is worth pursuing. It is somewhat ironic that the bottom of the letter from the Irish Society of Chartered Physiotherapists refers to that body being "Members of the World Confederation for Physical Therapy". On the one hand it wants to draw the distinction between its members and physical therapists and on the other it is happy to be a member of the World Confederation for Physical Therapy. I am slightly confused.

The word "chartered" is clearly important to chartered physiotherapists as it denotes a degree of qualification, which members of the other profession do not have. It emphasises to professionals and lay people alike that being a chartered physiotherapist requires a particular qualification, only achieved consequent on passing examinations of a particular standard and having attended a course of study of a particular standard, which makes it clearly distinct from physical therapy. I hope some light shines on both bodies allowing them to come together and resolve the issue. The ongoing dispute between both bodies does no service to either.

Overall I welcome the Bill, which is very worthwhile. The provision of health care services is very dear to all in the House. The regulation of health care services is a natural consequence of their provision. Anything that improves the provision and regulation of health care is to be welcomed.

Mr. Stanton

I am pleased to have the opportunity to speak on this quite important legislation. At the outset I wish to declare a possible interest in that I am a counsellor. I am not sure how I would fit into the required qualifications for a psychologist, who according to the Bill should have "A recognised university degree or diploma obtained with first or second class honours in which psychology was taken as a major subject and honours obtained in that subject".

The professions listed can have a major impact on the lives of ordinary people when they seek help. It is important that people should have confidence when seeking such help. I am very concerned that anybody can put his or her name on a plate and declare himself or herself a counsellor. We are talking about the areas of psychology, psychotherapy etc. Significant damage can be caused by going to a person who is not trained in the particular area. Often serious deep emotional issues can be brought to the surface. If the counsellor, psychotherapist or psychologist is not adequately trained to help, support and treat, considerable damage can be caused. I suggest that counselling be examined in this light.

Some podiatrists have brought to my attention their concern that the professional title of podiatry is not recognised in the Bill. They argue that this has been an accepted international term for many years. They seek to protect the public by enshrining continual professional development in the wording of the Bill. Those who have been in contact with me maintain that the Bill as drafted would result in the unsatisfactory position whereby a podiatrist could fail to practise for nearly five years and return to work without any retraining or update, or could be registered year-after-year without having to demonstrate any commitment to continual professional development. That could be the case in other areas and the Minister should examine it. They maintain that it is unacceptable and at variance with the Government claim to be developing a quality health service.

The professionals that wish to register are required to have a bachelor of science degree in podiatry. They maintain that it would be anomalous to maintain the title of chiropodist only. Both titles have been in use for over 20 years and this degree qualification succeeded the diploma since the early 1980s. They argued that the name of podiatry is not so well known in Ireland and this is because there is no school of podiatry in the country. Deputy Seán Ryan of the Labour Party already alluded to that. Those wishing to study podiatry do so at one of the universities in the UK. They put forward the argument that recent legislation in the UK has protected both titles and they claim that we risk losing Irish graduates in podiatry to the UK if the title of podiatry is not protected under Irish legislation.

Is it possible that persons could be registered in two professions? They claim that this does not pose a problem if persons have recognised qualifications in both. However, there is a possibility of registering persons via transitional arrangements in one profession while they have qualifications and are registered in another profession, such as An Bord Altranais and so on. They also state that the legislation should be amended to give assurances on competence. It is essential to keep up with current practice and recent evidence in health care. They claim that continuing professional development is an essential element of clinical governance and should be enshrined in the Bill. They also state that continuing education is a quality issue and that the health strategy is undermined by the principles of quality and fairness.

Section 6 of the Bill deals with complaints. My reading of it is that the council cannot act unless it receives a complaint. I stand to be corrected, but it seems to me that the section is complaint driven. Irish people are slow to make complaints. We do not want the hassle and we let the issue go. Where medicine and the health professions are concerned, Irish people are slower to make complaints because they are afraid. A friend of mine called me this morning. His wife is in hospital, an operation went wrong and she is now seriously ill. He is very concerned about the quality of care she is receiving, but he does not know where to go because there is no mechanism to make a complaint. I suggest to the Minister of State that we allow feedback in all our hospitals. If one is in a hotel, one is given an feedback form to determine whether service was satisfactory. If patients leaving our hospitals were to do something similar, that could be taken on board. This legislation should also include provisions to allow for feedback.

It would also be useful if the Minister included some form of a whistleblower mechanism. If someone rings the council and makes an informal complaint, the council should send an inspector to the clinic involved. If it is not up to standard, the council could take action. Such a provision would be very useful and it should be in the Bill.

Some of these professions find it difficult to source clinical placements. I praise the Government for bringing forward 75 badly needed new places for occupational therapy. However, many occupational therapists cannot find clinical placement. The Government needs to make it easier for them, so that they can get the experience they require.

The objective of the council is to protect the public by promoting high standards of professional conduct and professional education, training and competence among the registrants of the designated professions. I welcome the fact that each of the designated professions will be represented on the council, along with representatives of the public, voluntary and third level sectors as well as the general public. Given that the initial council will have 12 members from the professions and 12 members from the other sectors, there will be a healthy balance within the council. Will this balance be affected when additional professions come into the registration system? How long will members of the council hold office? Can members be re-appointed? If so, for how many terms?

Part 7 makes it an offence to use the title of any registered practitioner unless entitled to do so. I welcome the protection for both the public and the registered professions. We possibly need to go further. People put advertisements in the newspapers claiming to improve health by providing this or that therapy. We need to control that and it is related to what is happening in the Bill.

We know of doctors who claim to be able to cure cancer. I know people whose children had cancer and who visited these doctors, who paid out huge sums of money, who got medication and physically suffered in getting this medication. At the end of it all, the child died. This has happened more than once. The State needs to step in and take hold of this situation. People at their most vulnerable will grasp at any straw. It is dreadful that people will raise the hopes of parents of children who are terminally ill and take advantage of their vulnerability knowing that it is pure quackery. The State has a duty to ensure that this does not happen in any of the professions. This Bill provides a statutory basis for protecting members of the public who may be very vulnerable against exploitation.

I note the Minister has retained the power to extend and add to the list of occupations in the Bill, which is welcome. I hope over time occupations which are not mentioned will be included. There will be an opportunity on Committee Stage when amendments are being discussed for Members to make suggestions to include other professions.

I welcome this important Bill. The wider issues involving complaints, especially in the context of hospitals, must be taken on board by the Government. It would help if a feedback mechanism were made available as people have nowhere to go at the moment. While I do not wish to cast aspersions on doctors and nurses who, in the main, work extremely hard under a great deal of pressure, if something goes wrong or a patient is dissatisfied, it would be useful for hospital management to have access to feedback to enable them to put matters right. A mechanism to address the gap would be an innovation for the Minister of State to take on board to make a name for himself. He is well known, of course, as it is.

I commend the Bill and wish the Minister good luck with it.

Mr. Durkan

I am glad to have the opportunity to say a few words on a Bill that is about setting clear standards for various professionals and ensuring that the description of a service relates in some measure to its quality. That is a theme I wish to develop following a point raised by Deputy Stanton on qualified professionals in the health service. It is vital to ensure that they are not only qualified but experienced enough when functioning in an emergency to provide the counselling or advice required by a vulnerable person or group of people. Professionals must be able to ensure that the way in which they handle a subject is the best possible. I am sure every Member can cite instances in which that has not happened, which is not a criticism of any profession but of the way in which professions have been integrated in the mainstream and of the in-service training they receive.

The list of designated professions, which I note is not yet complete, should be much more extensive than currently drafted. I do not know why the opportunity has not been taken to take that course of action. To take up another point raised by Deputy Stanton, we have all heard of a particular case involving a person practising alternative medicine. While I am not opposed to alternative medicine, which has a great deal of merit and needs to be supported, certain standards should prevail. That the integrity of the entire practice can be severely damaged by one or two cases in which the highest standards have not been applied became extremely obvious in the instance of a particular case which came to public notice. Deputy Stanton was correct to note that when a vulnerable person believes he or she has a serious illness and is informed that a person or group is capable of alleviating the problem and restoring the patient to full health, he or she will tend to pay again and again for a service.

It is of considerable importance, therefore, to provide for some degree of transparency and accountability in such circumstances. No consumer or patient should be left open to exploitation by any group, professional or otherwise, but the degree to which the Department can impose standards remains to be seen. It is obviously not happening to the extent that it should. I have great respect for those who practice alternative medicine having been a beneficiary of their activities from time to time. I would not be able to walk around as I do without the services of chiropractors. While many people have a deep suspicion of all alternative medicine practitioners, there are those who have a knowledge of anatomy, especially spinologists, which others do not specialise in. It is, therefore, important to ensure high standards and a quality end service. As with every profession, there will be some practitioners who are not as good as others and who are not perfectionists.

Mr. Stanton

They are not included in the Bill.

Mr. Durkan

I have noticed that too. To protect those who excel, every relevant profession should be included. Even if a profession is self-regulating, the relevant body will make some attempt to ensure the highest standards prevail as to do so is in their own interests. Alternative medicine practitioners offer good services that stand up to scrutiny, which is why cases such as the one referred to by Deputy Stanton require urgent action. The case in question should have been addressed before now. It should not be the case that the Minister or I can establish an alternative practice with as much credibility as certain people are currently doing.

There is a great need for speech therapists and other practitioners from among the designated professions. Anyone who deals with the boards of management of schools will readily attest to the shortage of speech therapists, special needs providers and psychologists, all of whose services are in great demand. While we do not have enough of them, we must ensure that those we have are good at their jobs. My experience with those with whom I have dealt is that they are good at their jobs and that they make a difference. More are needed given the requirement to a greater extent than used to be the case for their services. While statistics are available which inform various theories, I do not know the underlying reason for the increased demand for services. These circumstances, however, require a response which meets the demands of quantity and quality. It is right, therefore, that the provisions of the Bill incorporate the professions providing services in this area.

Self-regulation is important to enable professionals to take responsibility for the actions of all members of their professions. Collective as well as individual responsibility tends to improve service quality. There must also, however, be an overarching regulator as a self-regulating body should not constitute the only supervisory authority for a profession. I presume the legislation will make provision in this respect as every regulatory authority needs a certain amount of supervision from time to time. All State institutions should set an example.

When I was a member of a health board I always tried to apply the same standards to the health board institutions that the health board purported to apply to others. Things have changed and I am afraid it does not always happen that way. I do not know what is the cause of that. I have a general idea that for some unknown reason as we progress further into the Celtic tiger infested forest, people no longer care and do not wish to take individual responsibility.

People no longer have the vocational commitment that existed 25 or 30 years ago. This can be measured by talking to older professionals in any profession, including those who come within the compass of the Bill. If one compares the degree of vocational commitment that existed when those people trained and got their first jobs, and the level of commitment evident today, there is a vast difference. It even relates to the professionals in this House. We must recognise that this is a fact of life.

There is a colossal difference, for example, in the degree to which volunteering takes place now compared with 25 or 30 years ago. Voluntary commitment in any area or profession is vastly different from what it was. The older professionals operated above and beyond the call of duty. I have reasons for citing that commitment which I do not particularly want to go into in this House. Many people protest when this matter is raised but it is a fact and we are all culpable when we examine the extent to which we are required to make sacrifices in the course of our jobs.

Let us look at how the standards apply. It is important that each profession applies the highest possible standards. It follows that in the field of operation one professional will observe another and the degree to which the standards to which they all aspire are applied. If there is a weakness in any area, far from that weakness becoming the subject of a whistleblower, it will become the norm. The lowest common denominator becomes the standard.

I regret a development that sadly applies to the health area in particular, which is not a criticism of the Minister of State, Deputy Brian Lenihan. If a Member of this House asks a question about any aspect of the health service, it is to protect the Minister as much as to protect the members of the Opposition and the public, and if the answer is not forthcoming, there must be a reason. There are no circumstances in which the information sought should not be made available to the House. It makes no difference whether the Minister has direct responsibility for the matter, the Minister will ultimately be held responsible if a major scandal arises under the Ministers and Secretaries Act 1924, as was borne out in a recent speech made by a former civil servant. He correctly identified that the Minister is responsible, directly and indirectly, for everything that happens within his or her Department even though he or she may not have known what was happening.

I emphasise this issue because scarcely a day goes by without some circumstance coming to light where somebody is wronged and their rights are infringed upon because somebody somewhere would not answer a question or raise his or her voice. The media invariably blame the person who did nothing about it. The only people who can do something about this are the Members of this House and members of other parliaments throughout the world. If the answers are not forthcoming, it ultimately reflects on the person who did not provide the answer for one reason or other.

It has always been my view that there is a need for Ministers on taking office to call their senior civil servants together and explain to them that everything that happens within the ambit of the Department should be made known to the Minister forthwith, and that regular evaluations to this effect would be carried out and communicated to the Minister. That would protect Ministers, Governments and those in Opposition. More importantly, it would protect the public. If that approach is not taken, problems will arise.

I know that the Minister of State, Deputy Brian Lenihan, will agree with that principle. I have a different reason for saying it, not because I am in Opposition, but because I believe it protects people in Government as well as those in Opposition. When criticism is made and there are valid grounds for it, the public blames the institutions as a whole. They do not distinguish between them. It may be good for those who are in Government when the odium is equally applied to everybody and it may be good for the Opposition to say that the Government is to blame, however, ultimately it reflects on all of us if matters are not handled in the best possible manner.

Why has this ethos begun to develop? I believe we live in a time in which nobody ultimately wants to take responsibility, when everybody wants to shirk his or her responsibilities. People want to give good news when there is good news but to run like hell when there is anything else to be said. That is a sign of the times, and it goes hand in hand with the lack of vocational commitment to which I referred. I foresee great difficulties arising in future unless something is done about this because it does not matter who is in Government or who is Taoiseach or Minister, ultimately, events will catch up with them as something will happen along the line that will emerge three, four or ten years later and when it does, it will reflect on all of us in this House.

Something was said to me recently in a different context about how to make the democratic process more efficient. I had to remind those concerned that democracy is not about efficiency, it is about transparency, accountability, the right of the people to elect those who represent them and the right of the public to ensure that those whom they elect to high office are ultimately accountable to them. One cannot do that on the cheap. It has to be done in the hard, old fashioned way. Alternatives to this have been tried in many countries. They were tried for 50 years in eastern European countries and they failed.

I wandered a bit from the area where I started — professionals — but my remarks relate to professional accountability and responsibility.

Mr. B. Lenihan

I never saw the Deputy wander less.

Mr. Durkan

Thank you. I never thought I wandered before, however, a certain amount of latitude is granted to people from time to time. I emphasise that individually and collectively we all have a role to play as individuals in this House. I see the means in this House of addressing some of the problems and that is a matter for us. We must have the guts to give hard answers to hard questions.

When I was a Minister of State, as Deputy Brian Lenihan is now, an official in the Department came to me one morning in a terrible panic because somebody had tabled a parliamentary question which he believed could be very embarrassing. I looked at the question and did not consider it embarrassing. I had no difficulty answering that question. It was answered and was therefore done and dusted. There are those who believe a question is done and dusted if one does not answer it. It is not and that is the difference.

Let me refer to a number of professionals, some of whom are included, some of whom are not and others of whom do not need to be included. They all have a responsibility to maintain a high standard of service and integrity within their respective professions. They have done great work in times gone by and some, but not all, still do so. Unfortunately, those who dally and do not aspire to the highest standards result in everyone being branded as the same, as is the case in politics. This is the sad part but it is the way it is.

I was listening to Deputy Glennon who was perplexed by the degree to which two professionals can argue over a particular title. It should be possible for mature professionals to work out a solution that accommodates both their professions, unless the services they offer are identical, in which case there should be a means of differentiating between the two.

I support the principle in the Bill of introducing a list of professions, standards and what I hope will amount to accountability and transparency. I hope that as a result of the passage of the legislation, attention will be paid to a number of other areas that have been referred to in the course of the debate and which now urgently need attention.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

I thank Deputies on all sides for the broad welcome they have extended for this measure. I agree with Deputy Durkan that while we can put legislation in place to ensure a high standard in a given profession or occupation, the basic motivation and spirit must exist among members of that profession to observe the highest standards. His point was well made in that regard, especially in respect of the need for one to take responsibility for one's actions. It is often forgotten that the health and child care services often include many of the social services as well as the physical and mental health services. A vast number of employees are encompassed and no political head of a Department or public servant charged with administration on the permanent side in the Department can hope to implement policy without the wholehearted co-operation and taking of responsibility by everyone within the system.

Deputies raised the introduction of statutory registration for health professions over and above the 12 apostles outlined in the Bill. It is important to note that these 12 professions were selected because they are long-established providers of health and social care within the health service and, in most instances, have established experience of self-regulation. The qualifications of the majority of these professions are regulated within the public health service.

Environmental health officers were involved in consultations with the Department on the development of the proposals for statutory registration. They were to be covered by the system but, following discussion with the relevant union and professional body, the view was taken that as the majority of the work of environmental health officers involves monitoring compliance with legislation on food safety and environmental matters, the participation of their profession is not appropriate to this legislation at this point. However, there is a provision in the Bill whereby environmental health officers or other professionals can be brought into the statutory registration system. Deputies will find this provision in section 4.

The regulation of counsellors and psychotherapists in particular was raised by Deputies. I fully appreciate their concerns in this matter and am very aware that the provision of counselling and psychotherapy services to the public has increased over recent years. The former health board chief executive officer group had established a working group to examine the role of psychotherapy in the health service to assess the requirement for the future. The working group's report has been finalised and the next step will be for an action plan to be put in place for making progress on the issues, including issues regarding the development of an appropriate model of service. The outcome of this work will form an integral part of the formal process that would be required, as set out in the Bill, to determine whether statutory registration is warranted. An integral part of the legislation is that it will always enable the designation of further professions.

While welcoming the Bill for its contribution to enhanced regulation of conventional health care professions, Deputies also spoke of the need for better regulation of complementary therapists. These practitioners do not come under the provisions of the Bill. I agree that the regulation of these therapists is especially important bearing in mind the increasing number of people who have recourse to such practitioners. I agree with Deputy Durkan that recourse to these practitioners can have beneficial results. That said, the often informal nature of how some complementary therapies are practised requires more scrutiny. Greater controls in the complementary therapy area are also in the interest of all reputable practising therapists as the presence of some unscrupulous practitioners undermines the sector as well as presenting risks to those using the therapies.

A national working group on the regulation of complementary therapists was established in May 2003. It has met regularly and was expected to report by the end of this year. In light of the urgency attached to this matter, the Tánaiste asked that the work of the group be expedited. I understand the report will be finalised within the next few months. The approach to putting in place the most appropriate framework to regulate the activities of complementary therapists will be informed by the group's recommendations.

The issue of protection of title was raised by a number of Deputies. The position is that one title is protected for each profession under the legislation, with a provision that variants can be protected by regulation under section 95(3). This is in line with the legal advice available to the Department. It will clearly be an offence for an unregistered practitioner to use a protected title or to represent himself or herself falsely as being a registered practitioner.

There has been a debate within the chiropody-podiatry profession on the most appropriate title for that profession within the primary legislation. I am well aware of this debate. The title "chiropodist" is used in the Bill because it reflects the current more common title by which the profession is known to the public. However, the profession is having discussions on its title and varying views are entertained by groups within the profession on the most appropriate title to be used in the primary legislation. Some groups have expressed a preference for the title "podiatrist". The professional bodies representing chiropodists and podiatrists have not yet been able to reach a unanimous decision on which title to protect under the primary legislation. The Department's position has been to encourage all stakeholders involved to develop an agreed solution to the issue of the protection of title and I hope the matter can be resolved.

The Bill also provides for the protection of the title "physiotherapist" for use by those professionals registered with the physiotherapists registration board. As Deputies are aware, the Irish Chartered Society of Physiotherapists is also seeking the protection of "physical therapist" for use by those professionals registered with the physiotherapists registration board. Several Deputies referred to this in the debate. The society considers both titles to be interchangeable in an international context and believes there is a risk of confusing the public if the title of "physical therapist" were not protected for use by physiotherapists. However, members of the Irish Association of Physical Therapists, who train with the Institute of Physical Therapy and who use the title in this country want to retain the title. There are complex legal, competition related and public interest issues involved in resolving this matter.

The Department has met the Irish Society of Chartered Physiotherapists and the Irish Association of Physical Therapists before and since the publication of the Bill with a view to encouraging both organisations to develop an agreed solution to the issue of the protection of title that takes account of the issues involved. I salute the great work of the officers in the Department who endeavour to conduct a number of peace processes in regard to these titles.

The question of registration of practitioners who do not hold national qualifications was raised during the debate. The Bill provides for the assessment of qualifications obtained within or outside the European Union. This matter will, however, be kept under review as the Bill progresses to ensure that it deals comprehensively with the issue.

Several Deputies referred to the composition of the health and social care professionals council and registration boards. The membership provisions are designed to ensure the best balance of professional expertise, health sector knowledge and public interest. There will be consultation on these appointments.

The effect of the inclusion of additional professions in the system on the number of council members is provided for in the Bill. It will therefore deal with an increase in the number of professionals, or any additional professions recognised.

The role of the Minister for Enterprise, Trade and Employment was mentioned in the context of the appointment of members to the council and boards. Several Deputies tried to see very far-reaching implications in that proposal. According to the old adage, all professions are in conspiracy against the public. The Minister took the view that it was not enough for the Minister for Health and Children to regulate the professions and that the Minister for Enterprise, Trade and Employment should also have a role in the matter. This is in the public interest, because the Minister for Enterprise, Trade and Employment must protect the public interest with regard to matters of competition. Professions often become anti-competitive and succeed in persuading the Department that it is supposed to regulate them in an anti-competitive manner. Therefore it is desirable, in a measure such as this, to have provision for the consent of the Minister for Enterprise, Trade and Employment. The Bill provides that members who are representative of the public interest be appointed by the Minister for Health and Children with the consent of the Minister for Enterprise, Trade and Employment.

The Bill's provisions in regard to the constitution of the council, registration boards and disciplinary committees will facilitate openness and transparency and ensure that the right talents and experience are put at our disposal with regard to the regulation of these professions.

Concern was expressed about the need for consistency among the registration boards. The health and social care professionals council will have a co-ordinating role ensuring uniformity of procedures throughout the system. The chief executive officer of the council will act as registrar for the registration boards.

Deputies showed considerable interest in the provisions for dealing with complaints about persons on the register and expressed concern that health professionals might feel fearful of suffering adverse consequences in bringing a complaint against a colleague. The provisions of the Bill facilitate a fair, just and open process for bringing and dealing with complaints. I appreciate the concern that peer pressure may hinder a practitioner from making complaints. However, practitioners are aware of the need to act in the immediate interest of patients to protect patient safety and in the wider interest of their profession to ensure that it is not brought into disrepute by the behaviour or incompetence of a minority.

Deputies also referred to the provisions of section 61, which facilitate a situation where a registrant accepts admonishment or censure from a committee of inquiry following a complaint. A committee of inquiry has particular powers under the proposed legislation and the health and social care professional council can apply to the High Court for an order directing a registration board to suspend the registration of a registrant against whom a complaint has been made if the council considers that the suspension is necessary to protect the public until further steps are taken with regard to the complaint.

The role of the representative bodies was also raised. Each of the professions designated under the Bill already has one major professional body, the role of which has been significant in the past and will remain so.

Deputies referred to the importance of the work of the national social work qualifications board. The continuity of the work and contribution of the NSWQB to professional development, education and training of the social work profession will be maintained and built upon in the legislation. Deputies mentioned university courses for chiropodists and podiatrists and the Department is examining the education of the profession with the Department of Education and Science.

With regard to a lack of student places and staff shortages, there have been significant advances in recent years in terms of increasing the number of students coming into the professions covered in the Bill. There has been a very clear increase in the numbers employed in the public health service. The medical profession is the subject of different legislation which is promised and will deal with some of the issues raised by the Deputies about medical practitioners engaging in complementary therapies. The registration boards will be empowered to make by-laws that can encompass continuing professional development.

I thank Deputies for the attention and care they have given this legislation. If improvement is required on Committee Stage, the Tánaiste and I will be open to any reasonable suggestion.

Question put and agreed to.