13th December, 2001
Dr. Henry: Before speaking on the matter I wish to raise, I am delighted that the height requirement for gardaí has been changed, a matter about which I wrote to the Minister for Justice, Equality and Law Reform for years because Special Branch officers were obvious on account of their height and bulk. It was almost impossible for them to go about incognito.
The matter I wish to raise is of national importance. I want to keep the nation on its feet, as I am sure the Minister of State does. Some years ago the Minister for Health and Children established a committee to examine the statutory regulation of various paramedical professions. He subsequently produced a White Paper covering physiotherapists, speech and occupational therapists, and chiropodists or pediatrists as some are called. However, there has been a considerable delay in introducing regulations for the various groups concerned. The training of chiropodists varies from diploma or degree courses in the United Kingdom to correspondence courses.
A dispute arose within the profession regarding the statutory basis and this led to a High Court case which is still awaiting a final settlement. That is the concern of the profession and the Department of Health and Children. My concern is that those involved in the dispute are unable to be registered to provide services for patients on the GMS list.
The Minister has a list of recognised chiropodists to whom these patients can go, but the list has been closed since January 2000 because of the dispute. This has led to many problems because some chiropodists have retired and others have died. The people who have taken over as replacements in those practices are not eligible to be recognised for payment for GMS patients even though in all the cases that have come to my attention they are very well trained. This has resulted in a serious loss of service to the patients, particularly the elderly and those with systemic diseases such as rheumatoid arthritis and diabetes.
I am the president of the Diabetic Federation of Ireland and I take a very active interest in the medical problems of diabetics. They can have serious foot problems and the maintenance of good foot hygiene and regular chiropody is extremely important for their health. Sixty per cent of the money spent on treating diabetes goes towards treating the complications of diabetes. Diabetic ulcers on the feet are a serious problem and require hospital admission. Hospital beds are taken up by cases which could have been treated at primary level.
I was concerned that diabetes was not mentioned in the quality and fairness health strategy. There is an international plague of diabetes due to the increase in obesity and lack of exercise. I was pleased when I read the primary care document. Top of the list of proposed membership of primary care teams was chiropody. The Minister therefore recognises that chiropody is extremely important in primary health care. I suggest that it is also extremely important in secondary and tertiary health care because chiropody treatment will keep people out of hospital. Two years is a long time in a patient's life. I ask the Minister to outline his proposals to ensure that the places on the list are re-opened immediately. Too many patients have suffered in the past two years.
Minister of State at the Department of Health and Children (Ms Hanafin): I thank Senator Henry for putting the case for chiropodists so well. She has highlighted for us all the range and importance of the service they provide. This issue has a long history but hopefully not such a difficult future. I will outline the background to the issue and indicate how we intend to move forward.
Until February 2000, the assessment of chiropodists wishing to work in the health service was carried out on behalf of the Minister by the chiropody assessment and advisory committee. This committee formed a panel and only those whose names appeared on this panel were eligible for employment in the public health service.
An individual whose name the chiropody assessment and advisory committee declined to put on this panel brought a case to the High Court, contesting that the committee had denied him the opportunity to show that his combined qualification and experience gave him a competence equal to that of a chiropodist with a degree. Following negotiations, both sides agreed to a settlement under which the delegation to the chiropody assessment and advisory committee was withdrawn. Under the terms of this settlement, it was agreed to establish a revised mechanism to deal with the assessment of chiropodists who wish to work in the health service.
The Department of Health and Children has been working with the four organisations in Ireland representing chiropodists and podiatrists with a view to obtaining their agreement to this revised mechanism. As a first step, a proposal on the implementation of the High Court settlement was circulated to the professional bodies representing chiropodists in February this year. As there was no agreement among the professional bodies to the content of this proposal, an individual with considerable industrial relations expertise was subsequently commissioned by the Department to consult with the professional bodies to achieve a consensus among all concerned. Arising from these discussions, revised proposals and subsequent clarification have been circulated to the four chiropody organisations with a view to obtaining their agreement to a new assessment mechanism for chiropodists wishing to work in the public health service, but to date no agreement has been reached.
On behalf of my colleague, the Minister, Deputy Martin, I wish to inform the House of the proposals for the implementation of the High Court settlement. It involves the establishment of two committees, a criteria committee and an assessment committee. The remit of the criteria committee will be to advise on the criteria to apply for public health service employment of chiropodists, including those without a degree level qualification. The remit of the assessment committee will be to assess chiropodists for eligibility for public health service employment based on input and recommendations from the criteria committee. The proposed membership of these committees comprises nominees of the four professional bodies representing chiropody in Ireland, representatives of other relevant professions, an orthopaedic surgeon and a consultant endocrinologist, along with a consumer representative and an internationally recognised expert in chiropody. The Minister believes it necessary that there should be close interaction between the criteria committee and the assessment committee so the same person will chair both committees. This will ensure that a formal line of communication is established between both committees.
At present, there is no system of statutory registration for the chiropody profession in Ireland. However, the Department agreed the principles of a system of statutory registration with a number of professional bodies representing health and social care professions, including chiropodists, in November last year. The Department is currently finalising draft heads of a Bill and it is hoped to submit these heads to Government for approval early next year. It is anticipated that statutory registration will become operational within the next 18 months to two years. Although it is likely that the work of both the criteria committee and the assessment committee will have been completed within this timeframe, the activities of both committees will become defunct in the event of the system of statutory registration becoming operational.
The Minister fully recognises that in the current circumstances the health boards are finding it increasingly difficult to ensure the adequate provision of chiropody and podiatry services, in particular to the elderly and those with diabetes under the GMS scheme. The Minister has asked me to assure the Senator and Members of the House that the Department is doing its utmost to resolve this current impasse. A first meeting of the criteria committee has now been scheduled for Monday, 21 January. The Minister hopes that all the professional bodies, in partnership with the other experts participating in the assessment mechanism, will play a full and constructive part in securing early progress in this matter, particularly in light of the pressing need for the services of chiropodists within the public health system.
Dr. Henry: I thank the Minister of State. I will rely on her to keep reminding the Minister for Health and Children that I am anxious nothing will happen before their feet fall off.
