Health (Miscellaneous Provisions) Bill 2014

Sick people have always been easy prey for charlatans. In fact, that has never been more the case than today, when we, more than any previous generation, are obsessed with health, fitness and diet and the pursuit of a longer and better quality of life.  This is not a bad thing, but it does leave people open to the influence of quackery, mountebanks and very dubious medicine in a whole range of areas, from the magic diet that will give one the perfect figure to offers of foolproof cancer cures. Moreover, the Internet, which is now available to everybody, greatly facilitates this. It is understandable that people who are desperately ill or unhappy want to believe there is a cure for their ills. It is not something for which we can comprehensively legislate, because no legislation can protect people entirely or prevent them from accessing such doubtful services.

 

I am not suggesting that because a service is not regulated it is necessarily bad, but there are some services which are so important they must be regulated. I was appalled recently, in the aftermath of the Y case, to see fly postering all over Dublin advertising a website for the purchase of abortion pills. Abortifacients are not of themselves dangerous, but they can be both dangerous and ineffective if taken without proper supervision and information, if not taken at the right time, or if taken by persons who have no access to after care, if such is necessary. This particular issue is not entirely relevant to the Bill before us this evening, but it is an example of the types of practices to which people who are desperate will resort and which are facilitated by the Internet.

 

My colleague, Deputy Dan Neville, has frequently raised concerns regarding the lack of regulation of counsellors and psychotherapists offering various services, particularly to people who are at risk of suicide. I have regularly had flyers through my door offering services to both adults and children. The persons advertising these service may well be properly qualified, but it is difficult to know for sure. Before anybody is allowed to go mucking around with the minds of people who are unwell and vulnerable, there should be a way of ascertaining whether they are suitably qualified to do so. People seeking these services should know how to access providers who are competent and whose qualifications are recognised. As I said, it may be that most of these people are qualified, but the point is that we do not know. I understand there are moves afoot which would allow this group to reach agreement on the standards and qualifications necessary to allow members to assign themselves part of a designated group of professionals, so members of the public will know where to go to access these services. The Minister of State might elaborate on that.

 

On the other hand, there is always a danger when setting standards to regulate any profession or allow access to a profession that such regulation becomes so prescriptive as to create a restrictive practice or anti-competitive situation. In fact, that has been in the case in the health sector in the past, with some professionals acting as gatekeeper to their services or the services of others in the profession. The Minister of State might recall the fight put up by opticians some years ago when pressure was applied to them to end their monopoly on the sale of reading glasses. I assume that monopoly was protected in law at the time, but we can be thankful that the same no longer applies and people can now buy what is essentially a pair of magnifying glasses at a reduced price from a range of outlets.

 

I am very glad to be able to buy them cheaply. The work opticians do is vital and specific but it is no reason they should be the gatekeeper to buying what is just a magnifying glass. I mention this because there is an onus on the council and on registration boards to be wary of these kinds of practices, even down to the setting registration fees, lest they also become a barrier to entry. After all, the idea is not to protect the professions but to protect the public. The public interest should be paramount in all the deliberations and determinations of the council and the registration boards.

 

 While the thrust of these provisions and the parent Act is to protect the public, there are two enormous benefits to the professionals themselves whose titles are being protected. They will not, for instance, find their careers being undermined by individuals who have not gone through the same training, who do not have the same qualifications and who have not obtained the same standards as they have. Once their profession is registered, people cannot just come in and set up without registering and having the recognised qualification. This is recognised by the various professionals because they have always been anxious to have statutory backing for their specialty and, indeed, we have had representations for further specialties. 

 

If I remember correctly, this designation of professions facilitates compliance with an EU directive which allows mutual recognition of qualifications of those who are designated. This gives a huge benefit to the professions because it gives them ease of mobility and they can practice across the 28 EU countries. It is a benefit to the HSE in that when there is a shortage in a particular profession, it can go abroad and know that the standard of those it recruits in the EU is of a similar standard.

 

The 2005 legislation anticipated that further professions would join the registration system, beyond the initial 12 designated. The legislation was flexible enough to facilitate that and what is happening now, that is, the inclusion of opticians, with a single board registering the two branches of the profession. The same split is being accommodated for radiographers, which is right, because clearly they are two very different specialties. I am surprised it was not recognised initially because it is something that requires very different qualifications and it is right they should be registered separately and be subject to different standards.

 

There are other aspects of the legislation which give new powers to the registration boards – for instance, to suspend members of the profession when they are under investigation, if it is in the public interest to do so, and to cancel registration if they have been indicted of particular offences, again if it is in the public interest to do so. That is essential. One must be able to enforce standards. There is no point having standards if one cannot enforce them, so they are welcome additions to the powers of the registration boards.

 

There is a new power to add conditions to certain professionals if, for instance, they are suffering from a mental or physical disability of some sort. That is reasonable. It should not be black and white where one is struck off if one has a disability. People can do a job to a certain standard. I am glad that flexibility is included.

 

If I have a criticism it is the inordinately long time it has taken to implement the 2005 Act. I am not laying this at the Minister’s door because it goes back over several Governments. This Bill is the second legislative change to the Act. For all intents and purposes, the Act has not yet been implemented. It took a while to get the boards in place but at this stage, we should be looking at a situation where all the boards should be at least registering the professions. As long as this goes on, the potential of the Act to protect the public is unrealised and there can be no mechanism in place to deal with fitness to practice complaints. The key to this kind of legislation is that the standards set are enforced. If that is not possible, there is no point setting standards at all. It is time for this legislation to be implemented and to be up and running. I hope this additional legislation will act as a spur to action, so that at least we can get all of the professionals registered and operating.

 

I refer to the section on statutory contributions because this is a miscellaneous provisions Bill. Like Deputy Finian McGrath, who spoke before me, I have a child – a son – in residential care. I can also say people have suffered over the years of cutbacks. There are different providers but I can only speak for the provider for my son which is Cheeverstown House. It has done an enormous amount of cutting back and has created enormous efficiencies. It is now at a stage where there is very little room for manoeuvre and services are definitely suffering. Like Deputy Finian McGrath, I hope its hardship can be eased as times get better and that it is prioritised.

 

The reason I mention it at all is that I fully support the whole notion of contributions. There was a bit of an outcry when statutory contributions were first introduced. The contribution made is only a fraction of the cost of the service. I would be delighted to make the contribution required, as I think most people would be, given the huge contribution taxpayers make towards the services. This measure in the Bill is a belt and braces provision to ensure persons who are supported or maintained by the HSE or its agents are liable for charges for that support although they are not actually accommodated by the HSE. The purpose is to give legal backing, even though I presume, in most cases, they are already paying. 

 

I understand the need to include the whole new range of accommodation types because there has been a proliferation of different types of services in recent years. As well as the kind of sheltered accommodation provided by local authorities, there are many new living arrangements for people with disabilities. I am sure the Minister will agree that as the recession bit, the provision of new residential care places virtually came to a standstill and families with people with disabilities had to become ever more involved and had to find more innovative ways to find housing solutions, including buying homes, sharing homes and lending homes. Sometimes a number of families have come together to provide a home. They are more than happy to pay for the services with a certain percentage remaining with the clients as pocket money. Indeed, that arrangement is not dissimilar to the direct provision system for asylum seekers which has received much comment recently, but it is the system which pertains for many people in residential care. We should welcome the fact the HSE is flexible enough to look at these new models of housing for people with disabilities. The recession has forced us all to be a bit more imaginative in the way we provide services, whatever they may be.

 

I agree with previous speakers that it is a little bit worrying to read that the HSE does not know how many people this legislation will apply to or how much it is currently collecting from them.

 

If the system is to work fairly, it has to be flexible and recognise the different circumstances in which people might get supports from the HSE. The HSE and local authorities have to be able to respond flexibly. I recently dealt with a case involving a married couple who rented from their local authority. The husband had to enter a mental health facility for several months. He paid the charge in the mental health facility, which meant his wife did not have that income, but she was charged by the local authority based on the benefits accruing to a married couple. Local authorities and the health service need to co-operate so that people are not disadvantaged. That is an aside, however, and I welcome the legislation overall. I am delighted to have the opportunity to speak on it and I look forward to seeing it being implemented at the earliest opportunity so that it can provide the safeguards it envisages.