25 November 2004
Dr. Henry: There is great sense in Senator Browne’s amendments as there is great sense in my own. It can be presumed that new people will be coming on to the register every year as they qualify and those who have died will no longer appear. My amendment proposes an update on a yearly basis. I support Senator Browne’s amendment that the register be available for inspection by members of the public. I prefer my own proposal of yearly rather than on an up to date basis, which could mean yearly but then it might also mean more than yearly, which would be an onus on the registration board. Any sensible kind of register must be updated on a yearly basis. The amendment proposing that the public be allowed see the register is very important.
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Dr. Henry: The Minister of State is such a nice man so I will not say that is a likely story or something like that. I can see his point. Could the phrase “at least yearly” not be included? I ask the Minister of State to consider my proposal. Registers exist which are left saecula saeculorum and I know some of them. I am not be happy with the looseness of this section of the Bill.
Senator Browne’s proposal for access by the public has not been dealt with. The Minister of State’s proposals are not satisfactory. I am an agreeable woman but the section must include a phrase such as “at least on a yearly basis” or something stronger if the Minister of State wants it more up to date, which would be splendid. I have known of registers which have not been reprinted for years in some cases. It is very important to include this proposal.
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Dr. Henry: The Minister of State is correct, they are statutory and that is the reason I wish this to be statutory. I have in mind the electoral rolls for the university seats. The Minister of State’s suggestion of an annual basis would be perfect.
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Dr. Henry: The Minister of State’s response makes good sense. However, the House has on previous occasions expressed concern regarding notorious cases in which none of the individuals concerned made a complaint, whether due to embarrassment about complaining about someone they trusted or for other reasons. The health boards were in the position — I do not know what the position is since their abolition — to initiate barring orders and so forth if a matter was believed to be getting out of hand, for instance, in circumstances in which a woman repeatedly makes complaints against her husband, only to withdraw them.
While I accept the logic of the Minister of State’s argument, perhaps he or his officials could devise a way to deal with issues of this nature when they arise. There have been notorious cases in the medical profession in which it was well known that certain individuals were behaving improperly, yet no one complained. This is a difficult issue and perhaps it does not come within the scope of the Bill. Perhaps we are seeking to protect people from themselves too much. A problem arises, however, when one cannot find anyone to make a complaint against a person behaving in a professional matter, even when it is widely known. It is even more difficult to find complainants in small localities than in cities.
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Dr. Henry: I have not seen the relevant part of the medical practitioners Bill. Is it possible to include a provision on whistleblowers in this legislation? I will not labour the point but I ask the Minister of State to consider that option. We are all anxious about this matter and I know the Minister of State and his officials are not trying to be unhelpful. Perhaps provisions similar to the relevant sections of the medical practitioners Bill could be included in the Bill.
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Dr. Henry: It is useful to point to section 51(3) but it does not say whether the person must give permission. If the person is a minor or has a mental impairment or illness the complaint must be made on his or her behalf but there is nothing there to indicate that the person must give permission, which might be a problem.
Mr. T. O’Malley: I take the Senator’s point and will consider the matter for Report Stage.
Amendment, by leave, withdrawn.
Section 27 agreed to.
Sections 28 to 30, inclusive agreed to.
Dr. Henry: I wanted to say a couple of words on section 28.
An Cathaoirleach: It is agreed now.
Dr. Henry: Very well, I will say it on the next section I can.
An Cathaoirleach: The Senator might be able to make her point on Report Stage.
Dr. Henry: Can I say something now?
An Cathaoirleach: The section is agreed and we cannot go back on it.
Dr. Henry: I am glad it is agreed.
Ms O’Rourke: Thank goodness for that.
Dr. Henry: Many representations have been made to me to the effect that the professions wished they were in the majority on these boards. I explained this was not to be and the Minister of State has explained that the Medical Council and the nurses will receive the same treatment.
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Dr. Henry: I move amendment No. 11:
In page 26, subsection (3), line 19, after “state” to insert “or an Irish national”.
This amendment is to reassure me that wherever the Bill refers to citizens of member states it includes Irish people. I hope it is unnecessary.
Mr. T. O’Malley: It is unnecessary.
Dr. Henry: I put it down to reassure myself that it was because I presume where the Bill refers to a member state it does not refer only to other member states of the European Union but includes us as well.
Mr. O’Malley: The definition of a member state set out in subsection (6) on page 27, line 14, includes Ireland, therefore, a national of a member state includes an Irish national.
Dr. Henry: That is fine, I thank the Minister of State.
Amendment, by leave, withdrawn.
Question proposed: “That section 37 stand part of the Bill.”
Dr. Henry: It has been put to me that the acceptance of qualifications from some other countries is very open. This arose decades ago in connection with medical qualifications and the freedom of movement in Europe but there is very little we can do about it. If we are entitled to work in other places, people are entitled to come and work here. I was asked whether this was not too open but I am not asking the Minister of State to do anything about it because he cannot do so.
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Dr. Henry: I share Senator Browne’s concern that people might come back on to the register following a significant gap. There is very little in the Bill to cover continuing professional development or training, or whatever one wishes to call it. Perhaps it is being left to the boards but it does appear possible for someone to return to a register after quite a long gap. The practice of medicine changes rapidly and the people we are discussing are mainly paramedical practitioners.
If there has been a gap of some duration, some evidence of continued competence should be required of the person who seeks to go back on the register.
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Dr. Henry: Of course it is in the registration board’s powers and it is terribly important. The council will have a great duty to ensure that the powers in those sections are very carefully supervised. They are of extreme importance to the general public.
Mr. T. O’Malley: I accept that.
Dr. Henry: I move amendment No. 14:
In page 30, subsection (1)(b), line 23, after “register” to insert “yearly”.
We have come to an understanding that the word “annual” will be inserted in the text on Report Stage as a Government amendment. I am sure the Minister of State will give me full credit for having thought of it.
Amendment, by leave, withdrawn.
Amendment No. 15 not moved.
Dr. Henry: Having sat beside Senator Quinn for over ten years, I feel that electronic means should be considered when publishing the register.
Mr. T. O’Malley: I thank both Senators for bringing this matter to our attention. I have no problem with the suggestion made and we will try to facilitate it.
Question put and agreed to.
Sections 45 and 46 agreed to.
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Dr. Henry: I was concerned at the looseness of these committees. We should at least state what constitutes a quorum, in case a couple of people were deciding on extremely important issues to do with a person’s livelihood. It might have been wise to state the minimum size of a committee because there is nothing more important than the disciplinary committees. I am not hung up on the size of the committee, but we should state the minimum size as well as a quorum. Nothing could be more important for someone on a register than coming before a disciplinary committee. To find that it might be two people and that there is nothing in the legislation to state that that cannot be the case is a poor idea.
I would like the Minister of State to elaborate on this section. My amendment states that the committee should consist of at least nine members, while the quorum should be five. That is quite a large number, but we are trying to ensure that one third of them are registrants. That is not possible with seven as we would end up with part of a person. A little more delineation is required to ensure that we have set up a suitable committee in fairness to the person that has to go before it. I am particularly anxious about the fact that the committee could be very small. There is nothing in the legislation that states that a committee of two cannot sit.
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Dr. Henry: Can we think about the need for a minimum number of people on the committees? The Minister of State’s comments make good sense, but we should ensure that each committee comprises a minimum number of people. Nothing could be more important.
Mr. T. O’Malley: Section 22(1) provides that the council “may make rules” to provide for the “membership, functions and procedures of committees”. It is expected that such rules would relate to matters such as quorums. The Department will examine Senator Henry’s suggestion.
Dr. Henry: I thank the Minister of State.
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Dr. Henry: I support Senator Browne’s amendment, which addresses the kind of unfortunate case that can happen. It would be right to make clear that a registrant against whom a complaint has been made should not be present at meetings of the council at which the complaint is being discussed.
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Dr. Henry: The Bill does not seem to state that a person whose complaint was found not to warrant further action should be informed as well.
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Dr. Henry: Does the Minister of State think the complainant should be informed if the complaint is found not to warrant further action?
Mr. T. O’Malley: Yes, I do.
Dr. Henry: Perhaps an amendment to that effect can be made on Report Stage.
Mr. T. O’Malley: Yes.
Dr. Henry: I thank the Minister of State.
Question put and agreed to.
Sections 54 to 56, inclusive, agreed to.
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Dr. Henry: It is always very flattering to hear that another Senator remembers what one said, especially a person as busy as Senator Browne. However, the issue is important. I am not worried about hearings being in public from the registrant’s point of view, but I am a little concerned about the complainant. I have seen in court cases — as I am sure has the Minister of State — that they do not realise what personal details may be brought out.
Mr. T. O’Malley: Owing to the potentially personal and sensitive issues that might arise in the course of conducting an investigation before a health committee, it is proposed in the Bill that its hearings be held in private, unless the registrant specifically requests otherwise regarding all or part of the hearing. It is accepted that, as is proposed in the case of an inquiry carried out before a professional conduct committee, it is appropriate that there be some checks and balances on a registrant’s right to reverse the general principle set out in the Bill, particularly where sensitive personal matters relating to a complaint may be the subject of examination. The content of the proposed amendment from Senator Browne is acceptable, subject to drafting changes required by the Parliamentary Counsel, which I propose to present on Report Stage. In particular, the words “otherwise than” should be deleted from the proposed subsection (b).
Dr. Henry: It is very good that the Minister of State is taking that view. I presume he knows that we had a very serious problem with a physician who for a long time prevented a case against him going forward that involved video recording some of his adult female patients naked. He naturally tried to get the case held in public, and the women were not enthusiastic about it. What the Minister of State is trying to do is right. The complainant may not be deterred from pursuing the complaint because the registrant says that the hearing must be held in public.
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Dr. Henry: I move amendment No. 24:
In page 47, between lines 16 and 17, to insert the following new subsections:
”(6) In this Act, the titles physical therapist and physiotherapist are synonymous and both titles use are restricted exclusively to those professionals who are registered as physiotherapists.
(7) In this Act, the titles Podiatrist and Chiropodist are synonymous and both titles use are restricted exclusively to those professionals who are registered as Podiatrists.”
This situation concerns the protection of titles. I had time to examine other legislation, particularly regarding physical therapists and physiotherapists. I have legislation from the United Kingdom and the State of Victoria in Australia before me. I will quote the latter first. Section 57 of the Physiotherapists Registration Act 1998 states: “A person who is not a registered physiotherapist must not take or use the title of registered physiotherapist or registered physical therapist or any other title calculated to induce a belief that the person is registered under the Act.” The equivalent UK legislation provides under the section relating to protected titles for physiotherapist and physical therapist. I am sure I could have found other instances. The UK introduced the Health Care and Associated Professions Order 2001, which was made on 12 February 2002. That is up to date and it states, “A register should have one or more designated title ... physiotherapist and physical therapist.”
This issue must be taken seriously. No one is trying to take away the livelihoods of a body of people who do good work but we must ensure our register is in line with other international registers. The Good Friday Agreement specified that the Republic should examine UK legislation in this area. Other registers will be created and, therefore, it should be ascertained what other nomenclature could be used for people who describe themselves as physical therapists. I told their representatives when I was contacted by them that they do extremely useful and good work. I know people who have attended such therapists and found them useful. Most of their work is hands on. It is not beyond the bounds of possibility to come up with a title that would be suitable to establish a register.
Only one school provides training for physical therapists and I do not know whether international bodies should be involved but a separate register must be established with the agreement of those who call themselves “physical therapists” otherwise we will run into trouble if this title is not recognised separate to that of physiotherapist. Their representatives have been saying this for the past ten years or more.
I also included podiatrists and chiropodists in the amendment, as they should be considered synonymous. Last week Senator Ryan stated someone without qualifications could call himself or herself a podiatrist under the legislation and, therefore, it is even more important to explain that podiatry and chiropody are synonymous but both are restricted to people with training and a registration board oversees their training.
Schedule 3 outlines the proper training for all these disciplines but the amendment is useful. I hope the Minister of State will examine it because title is a serious issue. I do not seek to deprive anybody of a living but I wish to ensure people who use a certain title live up to the international nomenclature. I hope the Minister of State will look favourably on the amendment. I am not a proud woman and if he cannot accept it, I am happy for him to reflect on it and ascertain whether he can do anything with it. However, it is worthwhile to tackle this issue because if we do not, something will have to be done down the line and we will have created more problems than we will have solved by creating sloppy registers. No one wants that.
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Dr. Henry: Many physiotherapists, many of whom are my constituents, for a long time have objected to me about the use of the title “physical therapist”.
Ms O’Rourke: Was this before this Bill came about?
Dr. Henry: Yes, many years before. This Bill has been in gestation for some 15 to 20 years. The physiotherapists have been objecting about the matter for a long time. In the legislation in Northern Ireland “physiotherapist” and “physical therapist” are the protected titles.
Can we do something about those people here, who come from one small unit and comprise approximately 200 people? They do not need the same qualifications to get into that unit as one needs to qualify as a physiotherapist in the universities, one of the most difficult courses to get into as it requires some of the highest points. Those who run the Institute of Physical Therapy and Applied Science Limited, 17-18 Priory Hall, Stillorgan have been open with me about their courses. They do not require people to have anything like the admission requirements required for physiotherapy. The course is not the same in content or length. It is not a university qualification but is from a limited institute, which I am sure is very good. Most of the treatment the physical therapists give appears to be manual, which patients like because it is hands-on. Perhaps they could be called manual therapists.
The problem is not what the physical therapists are doing and is not concerned with trying to deny them a living. The problem is the protection of a title. I have quoted from two Acts, one from Australia and one from the United Kingdom. I am sure I could find more that show that the protected titles “physiotherapist” and “physical therapist” go together. We are supposed to be trying to ensure we are on a par with international title protection and nomenclature. Nobody is trying to harm the physical therapists. There must be some way to accommodate them. They should set up their own register and bring forward an agreed title. They should bring forward what they consider suitable training to the Department of Health and Children, to see if they can be set up and recognised. We will have to consider other people in the same manner, for example, psychotherapists and counsellors. Thankfully, it is the council that will have to do this, not us.
The issue must be examined. I provided the dates of the Acts from the United Kingdom and Victoria of which we must take account.
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Dr. Henry: I do not see how physical therapists could have been much more active, apart from giving out to me because the title was not protected. Protecting titles is one of the Bill’s objectives. As the title was not protected, there was not much point in them giving out about people calling themselves physical therapists, except to me. People who are long retired complained to me about the situation.
I do not wish to prolong the debate any further. If it is the will of the House I am happy to take the Minister of State’s suggestion and withdraw my amendments. Let us see what can be done behind the scenes.
Dr. Henry: I move amendment No. 27:
In page 50, subsection (1), line 35, after “date” to insert “(subject to a minimum period of practice of 3 years)”.
A period of five years, provided for here, is a rather long time. The Bill states: “who, at any time”, it does not state, “who has been in practice during that period of five years”. One could have someone applying at the 11th hour on the 11th day of the 11th month in the last year to point out that nearly five years ago they were in practice. One needs to keep up to date in these professions, especially clinical biochemists, medical scientists and orthoptists, where things change almost by the hour. The same is true of radiographers and radiotherapists. I consider five years to be quite a long time. I realise that what is termed the “grandparenting situation” is extremely important and that they will have to undergo assessments.
One other matter struck me which I will bring up at this point. As the Leader pointed out, there is no school for podiatrists in this country. Does it matter if five years pass after this Bill is enacted and there is still no school for such people? Three years would be better than five, in view of the fact that so many of these professions must keep up to date.
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Dr. Henry: I suppose it is not unreasonable to leave it to the registration boards. However, people should have been in a practice for a minimum amount of time. They should not be allowed to apply at the last moment having just qualified and not engaged in any practice. The Minister of State could examine the issue further. The purpose of the provision is to ensure that the person is competent. If the Minister of State wants to leave the issue to the boards, that is fair enough as it is not vital to the Bill. However, the amendment might prevent people applying right at the last moment, having only been in practice for a few weeks five years previously.
Mr. T. O’Malley: They must prove their competence.
Amendment, by leave, withdrawn.
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Dr. Henry: Along with the Minister of State, Senator Browne and other Senators, I have been lobbied. Psychotherapists are a particularly important group with which to deal as rapidly as possible. There is an idea that, because one is not doing something physical with a person, it is not possible to do them any damage. However, people who set themselves up as some sort of psychotherapists without training — which is quite possible at present — can cause a great deal of damage. We cannot please everyone. The Department must decide when it meets with the Irish Council of Psychotherapists what criteria it will use in respect of their qualifications, training and experience. The Department should just go with it now because we can add other groups later if necessary. It would be better to do so than to allow matters to drift. I acknowledge that dealing with all these groups is terribly hard work but this is a very important and worthwhile Bill.
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Dr. Henry: Good definitions of qualifications have been included in Schedule 3. However, I was asked by the clinical biochemists to point out that a degree in biochemistry, where it was just taken as the final subject, would be a minimum requirement for becoming a clinical biochemist. Clinical biochemists must have postgraduate degrees in this area because they will be in charge of hospital and other laboratories. I discussed with the Minister’s officials whether I should table an amendment to include the higher degrees that must be taken but if this is what is required for existing practitioners, it might be superfluous.
However, Senators should be aware that any clinical biochemist dealing with them in this country will have a considerable amount of postgraduate qualifications and not just simple training in biochemistry or in some science subjects where biochemistry is among the subjects taken in the finals.
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