I move: "That the Bill be now read a Second Time."
I am pleased to have the opportunity to address the House on Second Stage of the Health and Social Care Professionals Bill 2004. This Bill provides for the establishment of a system of statutory registration for certain health and social care professionals.
Statutory registration is a system underpinned by law whereby each member of a profession may be recognised by a specified body as competent to practice within that profession. As a legally binding process, with a mechanism for the prosecution of offences, it ensures a robust system that serves the dual function of protecting the public while ensuring that the good reputation of a profession is not called into question by the poor practices of an individual member.
Although a number of professions have informal or voluntary systems of registration organised by their respective professional bodies, only five health professions are currently subject to statutory registration in Ireland: doctors, dentists, nurses, opticians and pharmacists. The health strategy, Quality and Fairness — a Health System for You, gave a firm commitment to strengthen and expand provisions for the statutory registration of health professionals. The Health and Social Care Professionals Bill therefore represents an important step forward in strengthening the regulatory environment and is the first of three Bills intended to improve and develop the regulatory environment for health professions. Further legislation will follow for medical practitioners and the nursing profession.
Equity, a people-centred approach, quality and accountability are the four tenets of the health strategy. The health strategy is clear on strengthening and clarifying accountability systems. It is clear on the value of building on quality initiatives. It is also clear on the importance of good human resources management. The system of statutory registration put forward in the Health and Social Care Professionals Bill helps deliver these essential objectives. It will ensure that members of the public are guided, protected and informed, so that they can be confident that health and social care professionals providing services are properly qualified, competent and fit to practice. The system proposed will also ensure professional conduct and the maintenance of high standards of professional education and training among health and social care professionals.
The principles underlying effective regulation of health professionals as set out in the health strategy and the various initiatives on regulatory reform, including the OECD report on regulatory reform in Ireland and the White Paper, Regulating Better, have been key considerations in the development of the proposed system. The most important consideration is that the interests of service users head the policy agenda. We all share the view that the present system of voluntary self-regulation can operate well and the professions themselves must be commended on the development of these voluntary systems. However, in well developed and established professions, even better protection to the public can be achieved through statutory registration. It allows the consumer to be confident that the person providing a service is properly qualified, of good standing and competent to practice in his or her profession. Statutory registration has long been advocated by many of the professions.
The health and social care professions have been to the forefront in setting and maintaining standards of patient care and professionalism. They have been proactive in working towards a statutory system of registration and are supportive of the general principles underpinning the system. A consultation process with the relevant professional bodies took place throughout 2000 with a discussion document, prepared by my Department, forming the basis for the process. A series of one-day facilitated workshops followed at which all of the major issues raised by the discussion document, and others raised by the professional bodies, were considered in some detail. These discussions culminated in the publication in October 2000 of a document titled, Statutory Registration for Health and Social Care Professionals — Proposals for the Way Forward, in which the practical arrangements for a system of statutory registration for health and social care professionals was set out in some detail. The proposals set out in this document emerged from a very positive spirit of co-operation and openness from all parties, without which it would not have been possible to devise the outline scheme.
There are fundamental reasons for the proposals put forward in the Bill. Most importantly, we need to ensure the delivery of the best possible service to patients and service users. This is our primary concern when developing a system of registration for health and social care professionals in Ireland. We are living in an age where we enjoy more personal control with regard to our own health as individuals. We have more choice in health care than previous generations.
As users of professional services we need to be assured that the service providers meet accepted standards. We must know there is a proper forum to bring justified complaints that will deal fairly with those complaints. The system of registration proposed allows for investigation of any allegations of incompetence or misconduct and for the taking of disciplinary action. It also provides a mechanism whereby practitioners compromised by ill-health or addiction can be appropriately dealt with. The Bill also provides for a mediation process and other informal means for less serious complaints by agreement of both parties.
The system proposed provides a legislative framework for the appraisal and approval of education and training courses and the proper development of education and training across the professions. It will provide a more widely informed and participative forum for the administration and implementation of the EU directives on the mutual recognition of qualifications in EU member states. It will also lead to greater consistency in the application of these directives.
As with other systems of statutory registration in Ireland, the system proposed for health and social care professions will be self-financing, that is funded from the contributions of registered members. This proposed system of statutory registration will apply, in the first instance, to 12 health and social care professions: chiropodists, clinical biochemists, dietitians, medical scientists, occupational therapists, orthoptists, physiotherapists, psychologists, radiographers, social care workers, social workers, and speech and language therapists, regardless of whether they work in the public or private sector or are self-employed. It is estimated that 14,000 practitioners will be subject to regulation, approximately 15% of whom are employed in the private sector. These initial 12 professions are long established providers of health and social care within the health service and in some instances have a long history of self-regulation. In addition, the qualifications of the majority of these professions are already regulated within the public health service.
While the proposed system of statutory registration set out in the Bill will apply in the first instance to the 12 health and social care professions I have outlined, the legislation empowers the Minister for Health and Children to include, by regulation, additional health and social care professions in the proposed statutory system as appropriate, on the basis of specific criteria.
Given the number of professionals involved it was considered inappropriate to establish a separate registration system for any individual profession. It was considered vital to develop an integrated, mutually supportive system of registration across the professions. The regulatory structure proposed in the Bill therefore comprises a registration board for each of the professions to be registered, a health and social care professionals council with overall responsibility for the regulatory system and a committee structure to deal with disciplinary matters. A chief executive officer and staff will administer the system.
Each registration board will comprise 13 members, six being registrants of the designated profession with seven members appointed by the Minister for Health and Children representing management in the public and private-voluntary health sector, the public interest and the education sector. Each registration board will determine criteria for registration and will establish and maintain a register of professionals who meet these criteria and will also approve and monitor education and training programmes for the relevant profession.
The health and social care professionals council will comprise 25 members. Membership provisions ensure an appropriate balance with public accountability and provide for representation by the registered professions — 12 members; consumers — nine members; management in the public and private or voluntary health sector — two members; the third level education sector — one member; and an independent chairperson. The health and social care professionals council will, through appropriate co-ordination and oversight, ensure the consistency and coherence of the system as a whole and will promote uniformity of practice among registration boards. The council's co-ordinating role in procedures is particularly relevant in respect of disciplinary matters where a substantial legal and administrative burdenmay perhaps occur and central expertise indealing with complex legal issues can be developed.
To deal effectively with complaints and other disciplinary matters, there will be three statutory committees common to all the registered professions within the system. A preliminary proceedings committee will, following notification of a complaint, give an opinion on whether there is sufficient cause to warrant the taking of further action regarding the complaint. A health committee will deal with cases where a registered practitioner's ability to practise is impaired by reason of a physical or mental ailment, an emotional disturbance or an addiction to alcohol or drugs. A professional conduct committee will investigate complaints against registered practitioners in respect of professional misconduct or poor professional performance.
If a preliminary proceedings committee considers that a complaint should be investigated further, it is referred to a committee of inquiry — either a professional conduct committee or a health committee — for hearing unless, with the consent of the complainant and the practitioner concerned, the complaint is referred for mediation or other forms of dispute resolution.
Hearings of a committee of inquiry will generally be heard in public. In the course of a hearing, a committee of inquiry will be empowered to receive evidence, enforce the attendance of witnesses, examine witnesses and compel the production of records. If considered appropriate, a professional conduct committee may transfer the complaint for hearing by a health committee and vice versa.
In extreme and urgent circumstances, the council may apply to the High Court to suspend a practitioner pending completion of an inquiry if it considers it is in the public interest to do so. Following completion of an inquiry, one or more of the following sanctions may be imposed on a registered practitioner: admonishment or censure, attachment of conditions to registration, suspension for a specified period, cancellation of registration or prohibition from applying for a specified period for restoration to the register. No sanction becomes effective until confirmed by the High Court and it may be made public following this confirmation.
Certain titles will be protected under the legislation and the Minister is empowered to protect additional titles. It will be an offence for an unregistered practitioner to use a protected title or to represent himself or herself falsely as being a registered practitioner. The Bill was amended and its accountability and transparency provisions were strengthened during its passage through Seanad Éireann.
Let us consider the main provisions of the Bill as passed by the Seanad. Section 4 designates the 12 health and social care professions I specified to be subject to the provisions of the Act, regardless of whether they work in the public or private sectors, and provides for the designation of additional health and social care professions by regulation in the future as appropriate and in line with specific criteria.
Sections 6, 7 and 8 establish the health and social care professionals council, define the object of the council as being to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions, provide that the council must exercise its powers and perform its functions in the public interest and set out the functions of the council.
Section 9 lays down the membership of the council as comprising 25 members, 12 being members of the registered professions with 13 members representing the management of the public and voluntary health or social care sector, third level educational establishments and the interests of the public to ensure an appropriate balance with public accountability. Sections 11 and 12 provide for the council to appoint a chief executive officer and staff to manage the administration and business of the council and the registration boards. The chief executive officer also acts as registrar of each registration board. Section 17, in keeping with the principle of the council's being a self-financing body, provides that the council must meet, out of funds at its disposal, expenses incurred by the council, the registration boards and any committees established.
Section 22 enables the council to make rules providing for such matters as the form and manner in which registration boards are to maintain registers, the details relating to registrants that, in addition to their names, are to be entered in registers and the receiving and recording of evidence by committees of inquiry. It also requires the council to publish a draft of any rule and invite comments on the draft before a date specified in the invitation.
Sections 26 and 27 provide for the establishment of a registration board for each of the 12 professions to be registered, define the object of each registration board as being to protect the public by fostering high standards of professional conduct and professional education, training and competence among registrants of that profession and set out the functions of each registration board. Section 28 lays down the membership of each registration board as being 13 persons, including six persons from the particular profession elected by members of that profession and seven from outside the profession representative of the management of the public and private health or social care sector, third level educational establishments and the interests of the public.
Section 31 enables each registration board, with the council's approval, to make by-laws regarding such matters as qualifications attesting to the standard of proficiency required for registration; procedures for assessing qualifications awarded, training or professional experience acquired outside the State; education, training and continuing professional development of registrants; and adoption and revision of a code of professional conduct and ethics. Where a proposed by-law might result in an additional burden being imposed on the Exchequer, both the council and the Minister must approve the draft by-law. Section 32 requires a registration board to publish a draft of any by-laws it proposes to make and to invite comment on the draft. It also requires a registration board to submit certain draft by-laws to the Competition Authority for its opinion.
Sections 36 to 38 provide that each registration board must establish and maintain a register of members of that profession and the procedure to be followed by a person seeking registration. Sections 43 and 44 provide that a registrant may appeal a decision of a registration board to refuse to grant or restore registration to the council and subsequently to the High Court. Section 46 requires each registration board to make the register available for inspection by members of the public at all reasonable times and also requires each registration board to publish the register, by electronic means or otherwise, at least once a year.
Section 48 enables each registration board to approve or withdraw approval for education and training programmes for the education and training of candidates for registration. Section 49 requires a registration board to monitor the ongoing suitability of education and training programmes approved by the board, including any clinical training and experience being provided, at least once in every five years. Section 50 sets out the definitions to be used in regard to complaints, inquiries and discipline.
Section 51 requires the council to establish a preliminary proceedings committee, a professional conduct committee and a health committee to perform functions and exercise powers in regard to complaints, inquiries and discipline and sets out the membership of these committees.
Section 52 enables any person to make a complaint to the council concerning a registrant on the following grounds: professional misconduct; poor professional performance; impairment of the registrant's ability to practise by reason of a physical or mental ailment, an emotional disturbance or an addiction to alcohol or drugs; a failure to comply with a term or condition of registration imposed under fitness to practise procedures; a failure to comply with an undertaking or any action specified in a consent given under section 61; a contravention of this legislation, the rules or by-laws; and a conviction in the State for an offence triable on indictment or a conviction outside the State for an offence consisting of acts or omissions that, if done or made in the State, would constitute an offence triable on indictment.
A complaint may also be made on the grounds of professional misconduct or poor professional performance even though the matter to which the complaint relates occurred outside the State. Section 53 provides that the council must refer each complaint to a preliminary proceedings committee for its opinion on whether there is sufficient cause to warrant further action being taken regarding the complaint.
Section 56 provides that where there is sufficient cause to warrant further action being taken on foot of a complaint, the preliminary proceedings committee must refer the complaint either for resolution by mediation or other informal means or to a professional conduct committee or a health committee. If a preliminary proceedings committee is informed that a complaint referred to mediation cannot be resolved, the committee must refer the complaint to a committee of inquiry.
Section 58 provides that the conduct of a hearing and a hearing before a professional conduct committee will generally be held in public. A hearing before a health committee generally will be held in private. At the hearing, the registrar presents evidence in support of the complaint, testimony of witnesses is given on oath and there is a full right to cross-examine witnesses and to call evidence in defence and reply. This section provides that a committee to which a complaint is referred may transfer the complaint to another committee of inquiry but only if it is satisfied that it is appropriate to do so and that the legal rights of the registrant will not be prejudiced.
Section 60 enables the council to apply to the High Court for an order directing a registration board to suspend a registrant's registration pending completion of an inquiry, if it considers that the action is necessary to protect the public.
Section 63 requires that on completion of an inquiry a committee of inquiry must submit its findings in writing to the council, and specifies the items that must be included in the report. Section 64 provides that on receiving the report of a committee of inquiry concerning a complaint, the council shall, if allegations have not been substantiated, dismiss the complaint or, if allegations have been substantiated, request the registration board concerned to recommend one or more than one disciplinary sanction to be imposed on the registrant.
Section 65 provides that the registration board concerned must recommend that one or more than one of the following disciplinary sanctions be imposed on the registrant: an admonishment or a censure; the attachment of conditions to his or her registration, including restrictions on the practice of the designated profession by the registrant; the suspension of his or her registration for a specified period; the cancellation of his or her registration; and a prohibition from applying for a specified period for restoration to the register.
Section 66 provides that following consideration of the registration board's recommendation, the council may direct the board concerned to impose on the registrant one or more than one of the disciplinary sanctions referred to in that section.
Section 68 provides that a direction given by the council to a registration board to impose a disciplinary sanction, other than an admonishment or censure, does not take effect unless the direction is confirmed by the High Court. Section 69 provides that a registrant to whom a direction to impose a disciplinary sanction, other than an admonishment or censure, relates may apply to the High Court within 30 days for an order cancelling the direction.
Section 70 provides that if the registrant does not, within the time allowed, apply to the court for an order cancelling the direction, the council may apply to the High Court for an order confirming a direction to a registration board to impose a disciplinary sanction, other than an admonishment or censure, on a registrant.
Section 73 provides that the council may direct a registration board to restore to its register the name of any person whose registration has been cancelled and may attach to the registration any conditions it considers appropriate. Section 76 provides that the council shall notify the Minister and employer, if known, as soon as practicable after any sanction imposed on a registered professional takes effect. This section provides that the council must also notify the Minister and employer, if known, if it comes to its attention that, under the law of another country, the above actions have been taken in relation to a registrant.
Section 77 provides that the council may, if it is satisfied that it is in the public interest to do so, advise the public when a sanction imposed on a registered practitioner takes effect. Section 79 makes it an offence to use the title of any registered practitioner as set out in section 4 or prescribed by the Minister by regulation, unless entitled to do so. Sections 82 to 89, inclusive, provide for the dissolution of the National Social Work Qualifications Board.
Section 91 sets out grandparenting arrangements for those practitioners who have been in practice at any time during the five years ending on the day the register for the particular profession is opened.
Section 95 confers power on the Minister to make regulations for matters prescribed in the Act and provides that such regulations must be laid before each House of the Oireachtas and that either House may annul such regulations by a resolution passed within 21 sitting days after the making of the regulation. This section provides that the Minister may make regulations to prescribe additional titles to be protected for use by registrants only if a draft of the proposed regulation has been laid before the Houses of the Oireachtas and a resolution approving the draft has been passed by each House.
Schedule 1 sets out miscellaneous provisions for the council. Schedule 2 sets out miscellaneous provisions for each registration board. Schedule 3 lays down the qualifications required by existing practitioners to be granted registration under Part 9 — the grandparenting provisions.
This Bill is a significant step in meeting the task set by the health strategy as regards the regulatory environment for the health professions. As I have stressed, members of the public are entitled to guidance and protection so that they are confident that the professional providing the service is properly qualified and competent and that unqualified or insufficiently qualified persons are excluded from professional activity. For their part, the professions require protection, including that through a mechanism for sanctioning professional misconduct, so that the good name and reputation of the majority are not damaged by the actions of a very tiny minority.
I commend this Bill to the House and look forward to hearing the views of Deputies.