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Seanad Éireann díospóireacht -
Thursday, 6 Nov 2014

Vol. 325 No. 6

Health (Miscellaneous Provisions) Bill 2014: Second Stage

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

I welcome the Minister of State, Deputy Kathleen Lynch, to the House.

I am pleased to have this opportunity to address the House on Second Stage of the Health (Miscellaneous Provisions) Bill 2014. This is quite a technical Bill, with 44 sections in total. The Bill has three main objectives. It will provide for the subsuming of the Opticians Board into the Health and Social Care Professionals Council; it will make certain efficiency amendments to the Health and Social Care Professionals Act 2005 and ensure consistency with the legislation governing other health regulators; and it will amend the Health Act 1970 to ensure statutory contributions are payable by recipients of residential support services who, while maintained, are not directly accommodated by or on behalf of the Health Service Executive.

The first objective, and the original main purpose of the Bill, is to subsume the Opticians Board into the Health and Social Care Professionals Council. This is in furtherance of the ongoing programme of State agency rationalisation. The intention is to effect the amalgamation by transferring the regulation of the professions of optometrist and dispensing optician from the Opticians Act 1956 to the Health and Social Care Professionals Act 2005.

The amalgamation of the Opticians Board with a more broad-based, multi-profession regulator will move the regulation of these professions into a modern regulatory regime where the primary and overriding focus will, however, continue to be on the protection of the public.

I pay tribute to the Opticians Board's outgoing president, its members, its registrar and their predecessors who have been regulating the optical professions in Ireland for almost 60 years. The advice and assistance of the professional bodies, the Irish Association of Dispensing Opticians and the Association of Optometrists Ireland, over many years and, in particular, leading up to and during the current transitional phase has also been much appreciated.

The interim Optical Registration Board, which was established earlier this year and whose members will be appointed to the new statutory board when this Bill is enacted, is currently preparing the necessary by-laws to be made by the new statutory board. When these by-laws have been made the Opticians Act 1956 will be repealed and the regulation of the optical profession will pass to the new board under the Health and Social Care Professionals Act 2005.

I will provide the House with some background to the Health and Social Care Professionals Act 2005 which will apply to the optical professions on the enactment of this Bill. I will also update the House on the implementation of the Act to date. The Act currently provides for the statutory regulation of 12 designated health and social care professions. Regulation under the Act is primarily by way of the statutory protection of professional titles by confining their use solely to persons granted registration.

The structure of the system of statutory regulation comprises a registration board for each profession, a committee structure to deal with disciplinary matters and a Health and Social Care Professionals Council with overall responsibility for the regulatory system. These bodies are collectively known as CORU and are responsible for protecting the public by regulating health and social care professionals in Ireland.

The Act provides for a two-year transitional or grand-parenting period during which existing practitioners must register on the basis of specified qualifications. After this period, 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. As the optical professions are already regulated under the 1956 Act, no transitional period will apply to them and their transfer to the 2005 Act will be seamless.

To date, the registers of two professions, social workers and radiographers, have been established. The Social Workers Registration Board's two-year transitional period ended in May of last year. This means that all persons using the title of social worker are now obliged to be registered and are subject to the provisions of the Act. The transitional period for the profession of radiographer will end in October of next year.

The registers for the professions of speech and language therapist and dietitian were established by their registration boards last Friday, 31 October. The occupational therapists register is expected to be open for applications for registration very early next year. The remaining professions are following close behind and I expect that the registration boards of all 12 professions will be established by the end of next year.

From a public protection viewpoint, a crucial milestone in the regulation of the Act's designated health and social care professions will be the introduction of the 2005 Act's fitness to practise regime. This will involve the commencement of Part 6 of the Act to allow complaints about the conduct or competence of registrants to be investigated. Disciplinary sanctions, where complaints are substantiated, up to and including the cancellation of registration, may be imposed. This fitness to practise regime will be similar to that applicable to medical practitioners, nurses and midwives. CORU is currently putting in place the necessary legal and administrative arrangements to allow the new fitness to practise regime to be implemented. Arrangements are in train for the making of the necessary commencement order before the end of this year.

I am aware of other professions seeking designation under the Act. Creative arts therapists and audiologists, for example, have been making a case for regulation for some time. The immediate priority, however, is to establish the regulatory regimes for the 12 professions already designated and to transfer the regulation of the optical professions to the 2005 Act. The Minister also needs to make final decisions in 2015 on the details of bringing the regulation of counsellors and psychotherapists within the ambit of the Act. The first stage of the required consultation process is currently under way.

When all the registers have been established, towards the end of 2016, the Department will ask CORU to prepare a risk assessment, in terms of public protection, of the principal health and social care professions seeking designation and to make recommendations concerning options for their possible future regulation.

The second objective of the Bill is to make certain amendments to the Health and Social Care Professionals Act 2005 in the interest of the efficient running of the regulatory system and to ensure consistency with the legislation governing other health regulators.

The Bill will divide, for the purposes of the Health and Social Care Professionals Act 2005, the designated profession of radiographer into the two designated professions of radiographer and radiation therapist. The Bill will also permit a registration board to regulate two or more designated professions. Under this objective, the Bill will introduce uniformity between the Act and certain provisions of other Acts which regulate medical practitioners, nurses and midwives.

The division of the designated profession of radiographer into two designated professions of radiographer and radiation therapist for the purposes of the 2005 Act is in response to the evolution of the profession into two professions for all practical purposes. Over time, the training, qualifications and scopes of practice of diagnostic radiographers, who take images, and radiation therapists, who apply radiation treatment, have continued to diverge. The division for regulatory purposes has been recommended by the Radiographers Registration Board and the Health and Social Care Professionals Council.

The existing 13-member Radiographers Registration Board will regulate the professions of radiographer and radiation therapist and the Optical Registration Board will regulate the professions of optometrist and dispensing optician. This is a new departure as up to now each profession had its own registration board.

The Bill also provides that newly designated professions may, in the future, be regulated by an existing registration board. These measures will limit the number of new registration boards to be established as new professions are designated. Registration boards with two or more professions would still have 13 members, the existing balance between the number of lay and professional members would be maintained and each of the board's professions would have at least one professional member on the board.

The Bill also proposes to introduce uniformity between the Health and Social Care Professionals Act 2005 and certain provisions of other Acts which regulate medical practitioners, nurses and midwives. The Bill will amend the Act in a number of respects to bring its provisions into line with those of the Medical Practitioners Act 2007 and the Nursing and Midwives Act 2011.

The final objective of this Bill is to address an unintended lacuna in section 19 of the Health (Amendment) Act 2013, which came to light during the implementation planning phase. That Act modernised the contributions regimes in a wide range of residential settings so as to better reflect current models of residential care service provision in the disability, mental health and care of older people sectors.

Under the national disability strategy and A Vision for Change, there is an ongoing drive towards community-based living in the disability and mental health sectors. In line with this, the increasing trend - in particular in the disability sector - is for accommodation needs to be met by the agencies of the State, such as local authorities, responsible for addressing the accommodation needs of citizens generally. However, the 2013 Act, unintentionally, omitted situations where service-users are maintained, although not accommodated, in specified settings by or on behalf of the HSE. The primary purpose of Part 3 is, therefore, to ensure that affordable contributions towards ongoing daily living costs will apply to those maintained in such settings, subject to appropriate safeguards. For example, the level of contribution will be reduced to reflect the extent to which service-users meet their accommodation and-or maintenance costs themselves.

I will now outline the main provisions of the Bill. The Bill is divided into 3 Parts. Part 1 has three sections which provide for the repeal of the Opticians Act 1956 and for the standard provisions relating to Short Title, commencement and expenses. Part 2 contains 37 sections relating to the amendment of the Health and Social Care Professionals Act 2005. It applies the Act to the professions of optometrist and dispensing optician. The primary sections in this regard are sections 6, 12, 17, 20, 22, 34 and 36.

It also amends the Act, in sections 6, 12 and 21 of the Bill, to divide, for the purposes of that Act, the designated profession of radiographer into the two designated professions of radiographer and radiation therapist. Sections 6, 12, 13 and 16 will permit a registration board to regulate two or more designated professions.

Amendments to provide for the introduction of uniformity between the Health and Social Care Professionals Act 2005 and the Medical Practitioners Act 2007 and the Nursing and Midwives Act 2011, and consequential and other technical amendments, comprise the remaining sections of the Bill. The amendments required to align the 2005 Act with the 2007 and 2011 Acts may be broken down into the four main areas of governance, fitness to practice, registration and offences.

The principal governance amendments relate to the election of a deputy chairperson of the Health and Social Care Professionals Council, the role of the council's chief executive officer, quorums and the holding of certain meetings of the council and registration boards by video link or the circulation of papers.

The Bill amends CORU's fitness to practise regime to allow for the following: the cancellation of the registration of a registrant convicted of an indictable offence if it is in the public interest to do so; the appointment of persons to assist in investigating complaints against a registrant; the application for immediate suspension of the registration of a registrant on an ex parte basis; and the publication of the transcript of the proceedings of a committee of inquiry.

In regard to registration, the Bill provides for the charging of fees for approving education and training programmes and for attaching conditions to the registration of a registrant with a relevant medical disability. The Bill modernises the Act's provisions relating to the prosecution of offences and provides the Health and Social Care Professionals Council with new investigation powers similar to those of the Medical Council and the Nursing and Midwifery Board of Ireland.

Part 3 has four sections which, under subsection 1(3) of the Bill, will come into operation in tandem with section 19 of the Health (Amendment) Act 2013. The Bill provides, in section 42, for amending section 67A of the Health Act 1970 to define or redefine key terms. The thrust of the amended definitions provision is to ensure that the statutory contributions regime will address ongoing essential daily living costs such as food and utility bills where these are met by or on behalf of the HSE, irrespective of whether the service user is accommodated by or on behalf of the HSE.

The Bill also provides for a number of amendments to section 67C of the 1970 Act, including provision for the following: reducing contribution amounts automatically for those maintained but not accommodated by, or on behalf of, the HSE; and varying contribution amounts based on service users' income levels and-or levels of dependence or independence, and making appropriate transitional arrangements in relation to the new contributions framework if deemed necessary.

This Bill will modernise the regulation of the optical professions. It will ensure that all those maintained by the HSE and its agents in specified settings contribute within their means towards their daily living expenses while retaining a reasonable amount of income for personal use. It will also enable the Health and Social Care Professionals Council to continue to fulfil, in a more effective way, its objective to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions. I commend the Bill to the House.

Cuirim fáilte roimh an Aire Stáit. She is welcome to the House. Fianna Fáil broadly supports this legislation, in particular, the regulation of professionals. We have some concerns about Part 3 relating to the statutory contributions for residential support services. If I understand this correctly, in this context we are probably talking about older people with mental, intellectual or physical disabilities who have been decongregated and are now living in the community, probably in housing provided by a local authority or a housing agency. I had the privilege in recent weeks of being in the company of such people who were attending a social function and I was very impressed by the provision for people who find themselves in that situation.

There is a reference to contributions in the Health Act of 1970 and there is cap involved in that respect. It cannot be greater than 80% of the State non-contributory pension. Perhaps more detail is needed on the charges because they will impact largely on very vulnerable people who already have their challenges in life and we do not want to add to their stress in any way. I would have thought that a fundamental change such as this should be based on a very broad, inclusive and consultative process.

I wish to refer to a communication I received from the Disability Federation of Ireland. It states there has been no consultation with the sector regarding what we are now debating. It further states it has come to its attention that a committee was established to examine this that had members from the Department of Health and the HSE but none from the disability sector. It also states that it will call for the Bill to be withdrawn to ensure that there would be full consultation. I would like to hear the Minister of State's comments on this. The communication goes on to state that the Bill does not appreciate the complexity and the diversity of the disability sector. That matter is worth debating and teasing out in this House. The communication states that with decongregation a number of people with disabilities are living in social housing and association housing in the community and that it is unclear how these charges will impact on them. It states that charges like this could discourage people from moving into the community, therefore, stalling implementation in respect of moving on from congregated settings. There seems to be some confusion, and it may be in my interpretation, about what categories of residential services are included in terms of the charging scheme and what ones are not included.

Irrespective of the purpose of legislation such as this, and we have been told that it not about raising revenue and I accept that on face value, and if it is being introduced to improve services, we need to be sure we go about this in a way that will ensure we will not have to revisit it at a later stage.

To return to my earlier point about having the privilege of being in the company of people who avail of these types of services, I am impressed by those who provide these services directly as distinct from receiving a grant aid or subvention from the HSE. I am impressed at what they are able to do for people who are so old that they could very easily be forgotten about and for people with mental or intellectual problems. I see the way those people develop in the community when they come into a social setting, as distinct from what might have happened in the past where they might have been locked away and people almost being embarrassed about them. That was another culture and we have moved on a long way from that but I am sure the Disability Federation of Ireland did not write that communication without giving it a good deal of thought.

I am sure the federation did not write it just to be obstructive or confrontational in some way. Its members must be picking up vibes from those who are practitioners, including the professional people in the areas concerned. I am concerned, as are other members of Fianna Fáil, that in some way Members may be making their work more difficult because of the additional stress these provisions would put on people. I seek the Minister of State's comments in this regard because legislation is one thing and can be exceptionally prescriptive. However, behind that always must be the human aspect of the topic with which Members are dealing. The Minister of State has done a good job today in outlining the legislation for Members, but it is a completely different matter for the people on the ground and the recipients of those services about which Members are speaking because they do not think in legislative, legal or clinical terms. They simply ask themselves in what way their lives will be changed.

In the 1970 Act, it always was important that a small amount of money would remain for people. This was for themselves in the first instance, to maintain their dignity. However, one should bear in mind that there also are dependants, out in the real world, who still are involved. This is the point I wish to put forward to the Minister of State because I am sure that a lot of consideration already has been given to this issue. Nevertheless, to put their minds at ease, members of the Disability Federation of Ireland also should be able to hear this themselves. They should be reassured that Members would in no way take from the good work that is being done or from people's comfort of mind and above all else, from the voluntary input I can see being put into this area. I will conclude by observing that having got away from the archaic system of the past and in respect of those who make and have made their own contribution to life, I always have thought there is no such thing as a human being who does not make a contribution in some way, even by inspiring others by the manner in which he or she takes on board additional challenges. Therefore, my main concern is that it will be possible to reassure them that this is not about raising revenue but is about improving the service.

I welcome the Minister of State to the House and welcome this legislation. It is extremely complex legislation in the sense that it contains 44 sections and I note it proposes to amend a total of 19 different Acts. I pay tribute to the Minister of State, to the Department of Health and to those involved in drafting this legislation because it was not an easy Bill to draft. It is important that Members give recognition to the work that has been done. This welcome legislation provides that the Opticians Board, which was set up under the Opticians Act 1956, be subsumed into the Health and Social Care Professionals Council. The legislation in question is more than 50 years old and obviously has served its time. This Bill brings matters forward into the current state of play with regard to health care in Ireland and that is welcome. The Minister of State mentioned how 12 different professions will be brought under a single umbrella and that is welcome. It is necessary and is about co-ordination of the health care sector and I certainly believe this legislation does that.

In response to my colleague across the floor who raised the issue about Part 3, I attended a conference yesterday at which a presentation was given by Professor Mary McCarron on some interesting research on people with disabilities, both intellectual and physical, and about the fact that they now are living a lot longer. This is the first study ever done of the ageing process with regard to that group of people. My understanding is that a lot of information has been made available on the website, idstilda.tcd.ie. It is well worth people's time to look at this welcome research because it examines the difficulties that exist, while also considering how this can be managed into the future.

I have suggested to the Chairman of the Joint Committee on Health and Children that Professor McCarron be invited to give a presentation to that committee because there is a lot of useful information to be gained. This goes back to the issue about Part 3. Previously, when people went into care, it was a structure that was permanent for seven days a week and for 52 weeks a year. We have moved on from that structure and it is important to realise that the cost of care continues to increase because the level of care being provided has continued to improve. It is important that a balance is reached both in respect of how that care is provided and about the sharing of the cost. I believe Part 3 certainly deals with that issue where a contribution is also made by the recipient. Therefore, I certainly have no objection to the provisions in the Bill as set out.

It is important to note the Bill also provides for other areas. I refer to the level of specialties covered by the Health and Social Care Professionals Council, of which there are 12, which include clinical biochemists, dieticians, physiotherapists, radiographers, social care workers and social workers. There are other areas for which there is a need for regulation. For instance, there will be growing demand for and an expansion of home care and the question is whether Members should seek the registration of that sector. The Law Reform Commission published a detailed report in 2011 on that issue and Members should begin to consider it now because in the case of the aforementioned 12 services under discussion here, it is important to have proper regulation and scrutiny of the service being provided.

Similarly, in the case of home care, it also will be important to make sure that what is being offered reaches the required standard. This is a subject that Members should consider in the long term. I am unsure whether it will be possible to do that during the lifetime of the present Government but it certainly should be undertaken in the not-too-distant future. The population is ageing as people are living longer. I believe that at present, there are 585,000 people who are over 65 but within 17 years, that figure will reach 990,000, which is a huge increase. Therefore, there also will be an increase in demand for services. I refer to one thing from which we must move away and on which the Minister of State has a strong view. It is about making sure that people can be kept at home for the longest time possible. This is the reason Members must ensure there is proper regulation with regard to all the services that are then available.

I welcome this Bill and it is important to proceed with it. Thereafter, it will be important to take the various steps that must be taken to bring each of the 12 professions under proper structures. The Minister of State has set out the targets in this regard, which will be reached without too much difficulty. However, it is important that the legislative structure is in place and this Bill certainly accommodates all these requirements.

I welcome the Minister of State, Deputy Kathleen Lynch. During her tenure in health, she has been one of the most productive Ministers with whom to do business and I thank her for all her efforts. I broadly welcome the Bill. There clearly is a need for an enhanced degree of scrutiny, regulation, oversight and professional input into the regulation of those various incredibly critical allied health specialties, which bear so much of the burden of keeping the health service on the road, particularly a service that, as Members are aware, is constrained in respect of medical numbers, nursing numbers and so on. I believe this new entity, its new structures and the additions to the entity will offer a chance to learn from the experience of some of the more established boards. It always is a good time for a little bit of reflection. One thing I sometimes fear with organisations and in particular, although I do not say this pejoratively in any sense, Hydra-like organisations with multiple heads, is they sometimes tend to compete to an extent with one another and one can get a degree of mission creep and bureaucratic expansion.

There is a huge responsibility for the safety of the public involved in the mission of these organisations.

Some of the professions represented in the legislation are not well paid historically. There is a need and requirement for those organisations to exercise self-control in terms of their costs and the burdens they pass on to their members, some of whom will pay it out of pocket and some of whom, in some cases, will have it paid by the State or by tertiary employers.

There is no doubt that we should also acknowledge that some of the areas which are represented, and will be represented, were historically desperately under-provided in our health service. The general rule for people on the list of professions who are part of the organisation or board is as follows. If they work in hospitals they are usually desperately under-provided but if they work in some other setting they tend to be somewhat less under-provided which tells us something about the management practices in the hospital system which tends to impose great degrees of constraint.

We have an extraordinary shortage of physiotherapists which I have spoken about before. We have high quality physiotherapy education in this country which results in the majority of the graduates immediately emigrating. As I wrote in the an article published in the newspapers some years ago, they also go to work in other areas in retail and in other parts of the economy. That is a shocking waste of an incredibly precious and well-trained human resource that is desperately needed.

A similar situation and limitation applies in the case of speech therapy and occupational therapy. These are particular areas where there are simply extraordinary shortages. The same applies to hospital-based social workers, dieticians and also, to an extent, scientists. People do not see this problem because it does not tend to be on the front line. There are tests and individual investigations that we would like to order for patients in the hospital that would guide more rational therapy and thus would save money and stop us giving treatments inappropriately. Sometimes for the want of a pair of skilled hands in a country which has quite a few science graduates, we do not have the ability to use those skills maximally and efficiently.

I am glad that the Minister of State is here because I know she takes things seriously. I have had particular representation about the following area. Before the Bill reaches the next Stage there is an absolute need for the Minister of State or whatever Minister is primarily responsible, but I presume it will be her, to sit down with the ophthalmologists - the medical doctors who treat diseases of the eye because they have real concerns about this legislation. We have an incredibly well-trained though small cohort of ophthalmologists here. We also have an extraordinary good group of allied health professionals who are variously called opticians. Historically they were called optometrists and dispensing opticians but increasingly it is just ophthalmic opticians. They are a very skilled group of people whose main daily existence is based on testing eyes and correcting vision with spectacles.

We sometimes forget, like we sometimes forget physiotherapists, that they are often the group of people who are the first ones to notice a disease that requires treatment. I do not mean to be sectarian about my own specialty of oncology. However, I have a particular expertise in a particular kind of cancer which often arises in the eye. I know a very large number of those patients originally presented to an optician who was testing their eyes. During a routine eye test they look into the eyes with their ophthalmoscope and if they see something that should not be there, they refer people on to a specialist eye doctor who will then, in some cases, refer the patient on to somebody like me if it is a malignant tumour which requires some degree of treatment.

The medical scientists, the radiotherapists who were known historically as radiographers who supervised the treatment of cancer with radiotherapy machines, and the radiographers tend to work in intensely medically supervised environments. Physiotherapists tend to have a foot in two different camps. Some physiotherapists work in hospitals doing what is requested by medical doctors in consultation with them. There are independently practising physiotherapists as well who are a primary resource that patients can self-refer to. It is a similar situation with opticians because people can self-present to an optician. In the overwhelming majority of cases an optician is the correct person to approach.

Let me outline one little problem with the Bill which relates to the new governing councils for the different new specialties. Apparently they have the ability to define the scope of the practice of the specialists in those areas. That means, in theory, somebody could define the scope of optical practice as including areas which involve the treatment of diseases diagnosed in the eye. This may seem like a fairly theoretical concern but it is one that I know has, with no disrespect to opticians, been raised by the ophthalmologists. They are very keen that the Minister of State has a discussion with them and considers putting in an amendment which would place a mandate on opticians who notice a medical condition of the eye to notify patients and tell them that they should seek medical attention for same. There are many conditions that opticians treat with glasses, etc. There are many other conditions where, critically, they are the ones who make the diagnosis. If it was not for skilled opticians we would have far more blind people in this country. Very often the first person who diagnoses glaucoma, a very treatable eye condition, will not be an medical doctor. In the overwhelming majority of cases it will be an optician. There are other conditions such an inflammatory conditions of the eye which may be part of a multi-system disorder like rheumatoid arthritis or lupus. They can also be an indication of blood pressure, circulatory diseases, diabetes or thyroid disease.

We recognise the right of the new governing boards to make determinations about the scope of the practice. However, we think it is important for the protection of optical specialties, and critically for the protection of patients, that an obligation should be very specifically inserted into the legislation. I refer to the obligation that when a medical condition is suspected, the person will be recommended either to see his or her family doctor or an ophthalmic specialist. In most cases it will probably be the family doctor because that is the way our referral patterns tend to work.

I can see that the Minister of State is being advised by her officials. She is an extraordinarily courteous Minister and I shall just draw breath to give her a chance to hear her consultation.

I am not certain that a list of diseases, etc., needs to be prescribed because they can change over time or if there needs to be a more general statement or principle. I urge her to please make time to meet the ophthalmologists before Committee Stage. I have given them an undertaking that if the Government does not table an amendment to the Bill on Committee Stage, I am prepared to do so. It would be more appropriate if the amendment came from the primary sponsor of the Bill.

I commend the effort that went into this legislation. This is a complex undertaking and is important. I wish to mention a general principle which is not specific to this Bill. We need to note that virtually every one of these specialties is somewhere between grossly and grotesquely understaffed here at this point in time. This morning we had an interesting time at the health committee because we talked about the extraordinary deficiencies in urology and neuro-surgical services. I said it this morning and I shall say it again here, we treat head injuries desperately badly in this country. We have people going to hospitals that are not set up to look after head injuries. Ambulances bring people with head injuries to hospitals where they cannot and should not be looked after. There is a real need for us to look at a lot of these areas.

I compliment the Minister of State on the good work she has done. My one request is that she makes time available to meet the ophthalmologists. Go raibh maith agat.

I welcome the Minister of State to the House. The Bill is fairly weighty as it comprises 44 very technical sections. As has been stated, it is a vastly technical piece of work, not least the fact that it attempts to bring together 19 legislative pieces.

By the time the fourth speaker in the House gets his or her turn most of the points will have been raised. Senator Ó Murchú has mentioned and clearly articulated some rather important concerns about Part 3. I would like to hear the Minister of State's response to them and look forward to exploring it in greater detail on Committee Stage.

The Bill is a welcome piece of legislative reform. It points again towards the work being done by Government to bring together legislation in order to be more efficient, coherent and clearer and I commend the Minister of State.

It is very welcome, overdue and a little surprising that it has taken since the 2005 Act until the present to achieve or bring forward proposals to create a statutory protection for professional bodies. The provision is important because it confines practice solely to those persons granted registration under the Act.

That is very important and has some significant implications for other professions and emerging professions in the counselling and therapeutic area, particularly around mental health. We need to be cautious in how we proceed in this. The Minister of State mentioned one or two professions in her opening remarks and I would like her to address the status of progress in some of those other emerging professions.

The Bill provides that newly designated professions may in future be regulated by existing registration boards. That presents some potential difficulties with how we create the proper match between a profession and its regulatory board. There are some concerns about this and perhaps the Minister of State could say a word or two on it.

I cannot allow the moment to pass without challenging the Minister of State to refute the concern that Senator Ó Murchú raised about the finance-raising element of the Bill. I raise this in the context of the concerns of 89,000 active registered nurses who find themselves facing a 50% increase in their registration fees. It is certainly going to present a problem to us in the new year, when these fees fall due for payment. The representative bodies of the various nursing disciplines have advised their members not to pay. This is going to create an appalling vista in the new year when we may find that we have up to 89,000 active nurses who will cease to be registered. I would like the Minister of State to say a few words of explanation about this. As it happens, I am a psychiatric nurse and am on the active register, although I am not actively working, but I and many of my colleagues are at a loss to justify such a substantial increase in the registration fees.

I will of course be supporting the Bill and commend it to the House.

I welcome the Minister of State. We had the Minister for Health, Deputy Varadkar, in the House earlier in the week and he had many interesting thoughts, including his views on the ambulance service and how it might be adapted to treating people in their homes or in the ambulance, rather than being - without wishing to be derogatory - a taxi service to an already overcrowded accident and emergency unit. That was interesting thinking. He volunteered the Minister of State, Deputy Lynch, to come to the House and talk on mental health. I do not know if he has told her this yet but he did volunteer her to do this later on in the term.

The Minister of State mentioned, on the first page, the furtherance of the ongoing programme of State agency rationalisation. There is a danger, as Senator Crown said, that agencies become an end in themselves. Bureaucracy can have its own object, namely, to maximise its functions and its budget through mission creep and so on. The Department of Health and indeed central government, perhaps the Department of Public Expenditure and Reform, have to keep an eye on these agencies because they can just grow like Topsy. We had a bank regulator who mysteriously missed everything that was happening in the banks. He was recorded in the The Irish Times as having forgotten vital facts about 89 times. Putting something under a regulator may not always be the complete answer. We have had some unsatisfactory experiences in other fields of endeavour as well. Statutory regulation carries its dangers.

George Bernard Shaw wrote that "all professions are a conspiracy against the laity", that is against the public interest. The professions devise new ways of keeping people out. That is something we have to watch out for. One example that particularly irritates me and the former Senator, Dr. Mary Henry, is the health professions admission test, HPAT, which seems to be a mechanism designed to prevent women from entering medical school when we need women doctors. It is as though the men in that profession decided on a new system because they felt that women were gaining far too many places through the leaving certificate points system. They have managed to get away with that, as far as I can see.

The other danger I see is that when the State regulates a profession, the profession, with legal assistance, seems to assume that because the State regulated it, the State must provide compensation for every single mistake that it makes. That has a current cost of about €1 billion in the State Claims Agency. Our colleague, Senator Burke, has asked that there be compulsory insurance for people in cosmetic surgery, for example. I think he has a Bill before the House on that issue. Rather than say that the State regulates that profession and therefore the State must pick up the tab for incompetence, we should have a requirement that people have insurance in those cases.

The Minister of State mentioned that the Department of Health would ask CORU to prepare a risk assessment. The briefing document we got from the Oireachtas Library and Research Service quotes a statement from CORU that its name:

"...originates from an Irish word, "cóir", meaning fair, just and proper. These are values that resonate deeply within our organisation and perfectly reflect our commitment to protecting the public by regulating health and social care professionals. CORU is not an acronym.

I have certain reservations when people call themselves "the caring professions" in that way. We all care. Everybody in Leinster House cares, in the Dáil and the Seanad. Families care. Even dismal scientists and economists care. There is a certain sanctimonious content when bodies issue those kinds of statements about themselves.

There are misgivings, of which the Minister of State may be aware, on ophthalmology and the opticians. Senator Crown has referred to those. The president of the Irish Association of Dispensing Opticians expressed a fear that the reference to the selling of glasses could deregulate the more professional and technical areas as well. I am sure that is something the Minister of State will be thinking about between now and the next Stage.

As has been stated, the Bill commands wide support in the House. Senator Crown has spoken on behalf of the university panel. It is the right way to proceed. A point has been raised about the reference on the first page to the consolidation and furtherance of the ongoing programme of State agency rationalisation. We found that in a lot of cases there were no savings. That is a pity, because the less we can spend on bureaucracy, the more we have for the objectives that we all share and that the Minister of State wishes to promote. Notoriously in the case of water, we were supposed to save money by putting 34 bodies together and they went and recruited 900 extra staff. There must be some way in which the Cabinet can say "the case has been made that there will be a programme of rationalisation of bureaucracies and agencies so let us see the savings now". I hope there will be a stronger emphasis on that because just allowing bureaucracies to grow when we have so many vital national priorities is too expensive a way to proceed.

I thank the Minister of State for coming to the House and wish her well with this legislation.

I support the thrust of the Bill. As previous Senators have said, there are a number of technical concerns that we have and that various organisations have raised with us. I will raise them again and will try to correct some of them on Committee Stage. This is largely a technical Bill, but it contains some important elements that need to be examined as they will have a significant effect on certain healthcare practitioners and professions as well as on the public at large. The Bill proposes to subsume the Opticians Board into the Health and Social Care Professionals Council, CORU, and to divide the profession of radiographer into two professions of radiographers and radiation therapists.

It also seeks to ensure contributions are payable by recipients of residential support services who are maintained by, or on behalf of, the HSE.

The Federation of Ophthalmic and Dispensing Opticians Ireland has expressed concern about section 34 of the Bill, which proposes to insert new sections 81A and 81B into the Health and Social Care Professionals Act 2005. These sections provide that spectacles may not be dispensed or sold by someone other than "a registered medical practitioner or a registrant of the designated profession of optometrist or dispensing optician". I might ask whether this Bill aims to change the current practice with regard to the sale of spectacles.

Sinn Féin has also received correspondence from the Irish Society of Chartered Physiotherapists, which has requested that the title of "physical therapist" be included in this legislation. The World Confederation for Physical Therapy has suggested that the titles of "physiotherapist" and "physical therapist" can be used interchangeably and are the sole preserve of people who have qualifications approved by the national professional bodies which are members of the confederation. This is not the case in Ireland, however. The Irish Society of Chartered Physiotherapists has been recognised by the World Confederation for Physical Therapy as the sole authoritative body for physical therapy in Ireland. The title of "physiotherapist" is currently protected under Irish law. This is not the case with the title of "physical therapist", however. This situation does not exist in the other 100 members of the global professional body. It could lead to people confusing the two roles in Ireland, and thereby losing confidence if one of the roles does not meet their expectations. Indeed, evidence received by the Irish Society of Chartered Physiotherapists, which has been provided, suggests that the public is unaware of the differing roles of physiotherapists and physical therapists in Ireland.

Part 2 of this Bill divides the profession of radiographer into two separate professions of radiographer and radiation therapist. This issue has already been raised. As the two roles have somewhat specific focuses, I welcome the distinction that is being drawn. I hope it will further the development of these roles and increase public confidence in them.

The Health and Social Care Professionals Council is to be given new investigative powers, similar to those of the Medical Council and the Nursing and Midwifery Board of Ireland. While we can trust the vast majority of those working under this council, we must also be able to reassure the public that rogue practitioners will not be tolerated. Any reduction in the contribution amounts that cover essential daily living costs for those maintained by the HSE, but not accommodated by or on behalf of HSE, would be of concern.

As I said at the outset, we support the Bill and the principal thrust of it. While it focuses on the necessary regulation of health care professionals, unfortunately there is a great lack of those practitioners. I refer particularly to occupational therapists, physiotherapists, physical therapists, social care workers and speech and language therapists. It is unfortunate that this was not addressed in last month's budget. My party's alternative budget suggested that extra funding of €31.3 million should be provided for community physiotherapists, speech and language therapists and occupational therapists. Despite this and other elements of the Bill, we will be supporting it. I look forward to hearing the Minister of State's response to the concerns that have been raised by the various organisations that have been in contact with us all.

I thank everyone who contributed to the debate on this technical Bill. I suggest we should begin from the premise that the legislation is essential in the interests of public safety and registration. I fully accept that most medical professionals start from that premise. I have always believed that. If we start from that premise, it will be evident that this legislation is worthwhile. It is something that we should be doing on an ongoing basis. Practice and theory will change as we make progress and as our knowledge increases. That is why flexibility is needed in legislation and within the boards that are charged with registering and monitoring how the service is delivered to the public. I think everyone accepts that fully.

I will take on board what Senator Ó Murchú had to say about Part 3 of the Bill. I know he has a particular interest in a wide range of disability issues, including the intellectual, physical and mental health difficulties that people encounter as they live their lives. Part 3 of the Bill is not a finance-raising exercise. We have done a degree of consultation, not with the various organisations but with the people who deliver these services to those who need them. When we dig even deeper, we will probably find that the circumstances of those who receive these services will improve. Senator Ó Murchú and other Senators will be well aware that at present, some 80% of the income of people who live in congregated settings and in different institutions is paid as a contribution towards their maintenance and upkeep. With this addition to our legislative process, we are trying to ensure people who gain a greater degree of independence will have that recognised. This legislation will ensure that in such circumstances, the contributions they make will be reduced in a way that allows them to fund from within their own resources the type of social interaction we would like them to have.

I would like to reassure people that this is not about additional revenue to the State. It is about ensuring people have the right to a more independent life regardless of the nature of their disability. Equally, it is about enabling people to feel they are making a contribution and appreciate they have a right to expect more from those who are delivering the service on the basis that they are now equal members of society and are contributing towards their own keep. I hope that clarifies the matter. I hope people will accept my bona fides when I say that when it comes to people who have difficulties in life, it is always my intention to make their lives better, as opposed to what might be suspected. I hope that would be the intention of all of us. I know that it is, even if there are times when every one of us cannot do everything we would like to do.

I assure Senator Crown that we have consulted the optometrists, who are a vital and key part of this service. I know from personal and family experience and from experiences generally that they are often the first people to spot that there are difficulties. We sometimes do not see these difficulties ourselves. We have consulted them. We believe the questions they sent into the Department have been fully answered. I accept that may not be the case. In addition, they will be part of the consultation on how the board is-----

Is the Minister of State referring to the ophthalmologists - the medical doctors - as opposed to the optometrists?

Yes, the ophthalmologists.

The ophthalmologists are not the ones who are regulated. They are worried about regulation.

I will check that for the Senator.

I appreciate that.

The Senator can raise this point on Committee Stage.

We need to know now so that we can submit amendments on Committee Stage.

It is important to be absolutely certain that we are talking about the same thing. I am informed that the ophthalmologists have written to us. We believe we have answered all of the questions they asked in a frank and upright way. If we have missed something - they may have written again to the Minister, Deputy Varadkar - we are quite prepared to go back and look at it again.

I thank the Minister of State.

There is no point in doing this if we cannot do it properly. It is not about excluding people. First and foremost, it is about ensuring the health and safety of the public is safeguarded. Equally, it is about ensuring those who are charged with delivering the service can do so in a practical way. It is not our intention to exclude anyone. I assure Senator Crown that if anything further needs to be done, we will not have a problem in taking a look at it.

I hope that will satisfy, but we will go back and take another look.

There were concerns in regard to an aspect of the Bill about non-registered sales assistants in the selling of spectacles. We have taken that amendment on board. We have made it now beyond doubt and explicit that those who are not registered can continue to assist in the sale of spectacles after the prescription has been filled. I hope that answers the questions raised.

Senator Gilroy asked about the increase in the registration fees of both nurses and midwives. I am not certain I can answer that now. It is not an issue for the Bill but it is an issue for the registration board. I am aware of it. I am sure that negotiation goes on. I would fully accept the Senator's point, that if 9,500 nurses fail to register next year it would cause a problem that we do not want to have. The Senator's concerns will be conveyed to the Minister, but I am not certain what we can do about it in terms of this Bill. As the Senator will probably be aware, I am a great believer in solutions. There is a solution to everything, as far as I am concerned. I hope that problem can be resolved because it is not a situation that we want to see.

Question put and agreed to.

When is it proposed to take Committee Stage?

On Tuesday next.

Committee Stage ordered for Tuesday, 11 November 2014.

When is it proposed to sit again?

At 2.30 p.m. on Tuesday next.

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