09 November 2004
Dr. Henry: I welcome the Minister to the House and I welcome the Bill. The Bill has been sought for approximately 20 years and it is good to see it before the House today.
I have taken note of the sensible words of Senators Browne and Glynn but it is important to recognise that we cannot protect the general public from themselves. If they insist on going to unregistered practitioners there is very little we can do but the Bill puts everything in a much better framework because people will now be in a position to look up registers and see if these people have the necessary qualifications. It is important for fellow professionals as well because all health work, as the Minister is well aware, is team work and one would like to think the people one is working with are properly qualified. We have appalling examples of people claiming to have qualifications which they do not have. We have seen people appointed to jobs only to discover afterwards they do not have the qualifications. That is why they are now asked in many cases to send in the original degree certificates. It is good to see this Bill being brought forward.
Senator Glynn brought up the case of a man who was on the medical register but it was well known for many years that he was promoting fraudulent treatments and taking a great deal of money from the unfortunates in the general public who had very serious illnesses. There appears to be no method under this legislation whereby the council could taken action about something which was publicly well known. A complainant has to come forward but people are sometimes reluctant to come forward to denounce someone they have trusted. They sometimes feel very foolish. Might it be possible to examine whether the council can initiate a complaint if something was known to be a public scandal?
These boards are not self-regulatory. The professionals in each board will be outnumbered by the ministerial appointments but there does not appear to be anything which would prevent the Minister appointing people who are fit to be registered on those boards. That would mean that the profession could be in a majority on the boards. The same appears to have happened in the veterinary council Bill where a vet could be put forward by the Food Safety Authority and some of the other nominating bodies. I do not know if the Minister means the registrants are always to be in a minority or if she does not mind whether that is the case. The council will oversee the registration boards and the chief executive officer of the council will be a very busy person. I was glad to see that he or she will be able to delegate some of his or her duties to juniors.
There is confusion among the general public about the qualifications of some persons. Senator Browne highlighted the situation regarding physiotherapists and physical therapists. It is only in the past few years that physical therapists who are not physiotherapists have set up practice here. Some of them do an excellent job but in the United Kingdom and internationally the title “physical therapist” is synonymous with the title “physiotherapist”. The titles are interchangeable and the professional qualification requirements are the same. This fact is recognised in 92 countries, all of whom are members of the international organisation of physiotherapists. The main concern of the society in this country is the protection of the public, which it believes can only be done by protecting the titles “physical therapist” and “physiotherapist” in the Bill, and I will table an amendment to that effect.
In recent years, practitioners who were physical therapists have become confused in the public’s mind with physiotherapists, and the confusion often arises when they try to get physical therapist fees reimbursed by the Voluntary Health Insurance or BUPA, only to discover that the therapist they attended was not a physiotherapist and they are not entitled to a reimbursement of fees.
The other group about which there could be confusion is chiropodists because they are required to have a bachelor of science in podiatry. It might be as well to call them chiropodists-podiatrists or something like that because there will be enough trouble trying to sort out the grandparenting situation. I understand there are about five different groups which for many years have been in discussion with the Department of Health and Children about the qualifications and criteria that will be allowed in this Bill.
I do not know who will do the assessments but this is an important area because with the dreadful increase in diabetes in this country, foot clinics and the referral of patients by the medical profession and others to properly qualified chiropodists-podiatrists, is vital. One of the great expenses incurred by diabetics is due to the fact that those who get ulcers on their feet are admitted to hospital for about a month, at goodness knows what cost, when they could be properly treated in a foot clinic or by a well-qualified chiropodist-podiatrist.
I was delighted to see an attempt was being made to provide for mediation between the professional and the complainant. That is a very good idea. From experience with medical litigation cases, I am aware that if some attempt had been made at mediation earlier in the proceedings, many court cases might have been stopped.
I was delighted also to see that professional conduct committees and health committees will be established under the Bill. As the Minister will be aware, the problem has frequently been a health issue involving drink and drugs or something like that. These cases are unsuited to being dealt with by professional disciplinary committees. That is a welcome development.
Under the Bill, the professional conduct committee is mainly to be held in public. That is fine for the professional but I hope the complainant is given sufficient warning as to the private details that may be explained in public. Some of it can be held in public, some in private, but I am aware that people who have taken medical cases to court have been horrified by the medical details brought forward. I have no objection to the committees being held in public, which is probably a good idea, but it is not nearly as hard on professionals as it is on complainants and I hope they are given sufficient warning.
Another area which concerns me is the fact that a register will only be published from time to time. It should be published every year. That is essential because people leave and join the register, and it will have to be up to date. I am sure Senator Quinn will mention, as he always does, that reports must be published and laid before the House promptly, not as soon as is practicable.
Another aspect about the registers that concerned me was the restoration of names. For example, if a person decides not to work for a certain number of years and leaves the register because there is a retention fee to be paid, there is nothing in the Bill about continuing professional development. Changes will have taken place in the time the person was not working. This is a major problem and I have had to be tough about continuing medical education. I am sure the Minister has seen that with pharmacies. One could not be out of that profession for two years without having to deal with all the dreadful changes. One would spend all the time looking up MIMS. That is an important aspect because we do not want people sliding back onto the register, so to speak. With the best will in the world, we all think we are keeping up to date with matters by reading The Irish Times health supplement but there is a little more to it than that if one is practising as a professional. I hope that something could be done to require people to show they have tried to keep up in that regard.
I welcome the Bill. I will table amendments. As the Minister of State’s officials will be aware, regardless of how warmly Senators welcome Bills, the House can always improve them. I look forward to energetic debates on Committee and Report Stages.
...
Dr. Henry: I welcome the Minister to the House and I welcome the Bill. The Bill has been sought for approximately 20 years and it is good to see it before the House today.
I have taken note of the sensible words of Senators Browne and Glynn but it is important to recognise that we cannot protect the general public from themselves. If they insist on going to unregistered practitioners there is very little we can do but the Bill puts everything in a much better framework because people will now be in a position to look up registers and see if these people have the necessary qualifications. It is important for fellow professionals as well because all health work, as the Minister is well aware, is team work and one would like to think the people one is working with are properly qualified. We have appalling examples of people claiming to have qualifications which they do not have. We have seen people appointed to jobs only to discover afterwards they do not have the qualifications. That is why they are now asked in many cases to send in the original degree certificates. It is good to see this Bill being brought forward.
Senator Glynn brought up the case of a man who was on the medical register but it was well known for many years that he was promoting fraudulent treatments and taking a great deal of money from the unfortunates in the general public who had very serious illnesses. There appears to be no method under this legislation whereby the council could taken action about something which was publicly well known. A complainant has to come forward but people are sometimes reluctant to come forward to denounce someone they have trusted. They sometimes feel very foolish. Might it be possible to examine whether the council can initiate a complaint if something was known to be a public scandal?
These boards are not self-regulatory. The professionals in each board will be outnumbered by the ministerial appointments but there does not appear to be anything which would prevent the Minister appointing people who are fit to be registered on those boards. That would mean that the profession could be in a majority on the boards. The same appears to have happened in the veterinary council Bill where a vet could be put forward by the Food Safety Authority and some of the other nominating bodies. I do not know if the Minister means the registrants are always to be in a minority or if she does not mind whether that is the case. The council will oversee the registration boards and the chief executive officer of the council will be a very busy person. I was glad to see that he or she will be able to delegate some of his or her duties to juniors.
There is confusion among the general public about the qualifications of some persons. Senator Browne highlighted the situation regarding physiotherapists and physical therapists. It is only in the past few years that physical therapists who are not physiotherapists have set up practice here. Some of them do an excellent job but in the United Kingdom and internationally the title “physical therapist” is synonymous with the title “physiotherapist”. The titles are interchangeable and the professional qualification requirements are the same. This fact is recognised in 92 countries, all of whom are members of the international organisation of physiotherapists. The main concern of the society in this country is the protection of the public, which it believes can only be done by protecting the titles “physical therapist” and “physiotherapist” in the Bill, and I will table an amendment to that effect.
In recent years, practitioners who were physical therapists have become confused in the public’s mind with physiotherapists, and the confusion often arises when they try to get physical therapist fees reimbursed by the Voluntary Health Insurance or BUPA, only to discover that the therapist they attended was not a physiotherapist and they are not entitled to a reimbursement of fees.
The other group about which there could be confusion is chiropodists because they are required to have a bachelor of science in podiatry. It might be as well to call them chiropodists-podiatrists or something like that because there will be enough trouble trying to sort out the grandparenting situation. I understand there are about five different groups which for many years have been in discussion with the Department of Health and Children about the qualifications and criteria that will be allowed in this Bill.
I do not know who will do the assessments but this is an important area because with the dreadful increase in diabetes in this country, foot clinics and the referral of patients by the medical profession and others to properly qualified chiropodists-podiatrists, is vital. One of the great expenses incurred by diabetics is due to the fact that those who get ulcers on their feet are admitted to hospital for about a month, at goodness knows what cost, when they could be properly treated in a foot clinic or by a well-qualified chiropodist-podiatrist.
I was delighted to see an attempt was being made to provide for mediation between the professional and the complainant. That is a very good idea. From experience with medical litigation cases, I am aware that if some attempt had been made at mediation earlier in the proceedings, many court cases might have been stopped.
I was delighted also to see that professional conduct committees and health committees will be established under the Bill. As the Minister will be aware, the problem has frequently been a health issue involving drink and drugs or something like that. These cases are unsuited to being dealt with by professional disciplinary committees. That is a welcome development.
Under the Bill, the professional conduct committee is mainly to be held in public. That is fine for the professional but I hope the complainant is given sufficient warning as to the private details that may be explained in public. Some of it can be held in public, some in private, but I am aware that people who have taken medical cases to court have been horrified by the medical details brought forward. I have no objection to the committees being held in public, which is probably a good idea, but it is not nearly as hard on professionals as it is on complainants and I hope they are given sufficient warning.
Another area which concerns me is the fact that a register will only be published from time to time. It should be published every year. That is essential because people leave and join the register, and it will have to be up to date. I am sure Senator Quinn will mention, as he always does, that reports must be published and laid before the House promptly, not as soon as is practicable.
Another aspect about the registers that concerned me was the restoration of names. For example, if a person decides not to work for a certain number of years and leaves the register because there is a retention fee to be paid, there is nothing in the Bill about continuing professional development. Changes will have taken place in the time the person was not working. This is a major problem and I have had to be tough about continuing medical education. I am sure the Minister has seen that with pharmacies. One could not be out of that profession for two years without having to deal with all the dreadful changes. One would spend all the time looking up MIMS. That is an important aspect because we do not want people sliding back onto the register, so to speak. With the best will in the world, we all think we are keeping up to date with matters by reading The Irish Times health supplement but there is a little more to it than that if one is practising as a professional. I hope that something could be done to require people to show they have tried to keep up in that regard.
I welcome the Bill. I will table amendments. As the Minister of State’s officials will be aware, regardless of how warmly Senators welcome Bills, the House can always improve them. I look forward to energetic debates on Committee and Report Stages.
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