Opticians and Ophthalmologists

[Speaking in the Seanad during Second Stage of the Health (Miscellaneous Provisions) Bill]

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 a certain 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 in number 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 their 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 in 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 make it a general principle 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.

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