Health and Social Care Professionals (Amendment) Bill 2017: Second Stage

I move: "That the Bill be now read a Second Time."

I am pleased to address this House on Second Stage of the Health and Social Care Professionals (Amendment) Bill 2017. This is a short Bill with only nine sections. The Bill amends the provisions of the Health and Social Care Professionals Act 2005 in three main areas. It will address gaps in the Act regarding appointments to the State boards established under the Act, insert new provisions for applicants for registration who have not yet practised their professions and introduce temporary provisions relating to registration in the register of physiotherapists in advance of regulations to protect the title of "physical therapist" as well as the title of "physiotherapist."

First, the Bill will address the gaps that have been identified in the Act's provisions relating to the appointment of professional members to the Health and Social Care Professionals Council and the registration boards. Second, it will permit a registration board to apply criteria conditions in respect of further education and training to experienced applicants for registration who, although qualified, have not yet practised their profession. Third, the Bill will make necessary amendments to the Act in advance of bringing forward draft regulations to protect the title of "physical therapist". The Act already provides for the protection of the title of "physiotherapist" for the exclusive use of those granted registration by the Physiotherapists Registration Board.

Before explaining the Bill's provisions in more detail, I will provide the House with some background to the Health and Social Care Professionals Act 2005, which this Bill seeks to amend, and a brief update on its implementation to date. The Act currently provides for the statutory regulation of 14 designated health and social care professions. Regulation under the Act is primarily by way of the statutory protection of the professional titles by confining their use solely to persons granted registration. The structure of the system of statutory regulation comprises registration boards, a committee structure to deal with disciplinary matters and a Health and Social Care Professionals Council with overall responsibility for the regulatory system. These bodies are collectively known as CORU and are responsible for protecting the public by regulating health and social care professionals in Ireland.

CORU is also charged with the promotion of high standards of professional conduct, professional education, training and competence among the registrants. The Act provides for a transitional period of two years, during which existing practitioners may register on the basis of their specified qualifications. After this period, only registrants of a registration board who are subject to the Act's regulatory regime or those who applied during the transitional period and whose applications are still being determined or are under appeal are entitled to use the relevant protected title or titles. Title protection is the key to public protection under the Act and is central to the Bill's provisions relating to the physiotherapist registers. I will provide more details of this aspect in a moment.

To date, the registers of ten of the designated professions have been established. The professional titles of seven of these professions are now fully protected under law. The register of physiotherapists was established last September, while the registration boards for the professions of social care worker and medical scientist are working hard towards establishing their registers. I hope to establish the psychologists registration board and appoint its members in the coming weeks. Registration boards for the remaining professions will follow close behind, and it is expected that the boards for all 14 professions will be operating by the end of 2018.

From a public protection viewpoint, which is what this is all about, a crucial milestone in the regulation of the Act's designated professions was the introduction of the Act's fitness to practice regime two years ago. This involved the commencement of Part 6 of the Act to allow complaints about the conduct or competence of registrants to be investigated. Disciplinary sanctions where complaints are substantiated, up to and including cancellation of registration, may be imposed. The regime is similar to that applicable to medical practitioners, nurses and midwives. While a number of complaints have so far been investigated by CORU's preliminary proceeding committees, none has yet been referred for a full investigation.

I would also like to update the House on my proposals to regulate counsellors and psychotherapists. The Act provides that the Minister for Health may designate health or social care professions not currently designated if he or she considers that it is in the public interest to do so and if the specified criteria have been met. Towards the end of last year, following consultations with the Health and Social Care Professionals Council, I undertook a detailed public consultation on the question of regulating counsellors and psychotherapists. The consultation process yielded information that has been of considerable assistance to me and to my officials. The 80 submissions received showed majority support for statutory regulation of the professions and for it to be undertaken in the context of the Health and Social Care Professionals Act 2005.

Having considered the submissions carefully, I decided last month to proceed with the designation of two distinct professions under the Act, that of counsellor and psychotherapist. Each will have its own register under one registration board. This decision has now been communicated to the council, the relevant professional bodies and all the respondents to the public consultation process. My Department will commence work as soon as possible on the preparation of the necessary regulations to designate the professions. These regulations, when drafted by the Office of the Parliamentary Counsel, will require the approval of this House and that of the Seanad. These will be the first in a suite of regulations that will need to be made over a period of time. It is a very important body of work to regulate counsellors and psychotherapists and I know it has often been discussed in this House.

Arrangements will also be put in place to establish the registration board and to appoint its 13 members following their recruitment through the Public Appointments Service. This will be undertaken in conjunction with CORU’s ongoing work in completing the establishment of the registration boards for professions already designated under the Act. Once appointed, the registration board will give consideration to a number of outstanding issues and will advise the council and the Department accordingly. These include titles to be protected and the minimum qualifications to be required of existing practitioners and future graduates. While the consultation process did not yield consensus on these key issues, I am pleased to say that it provides the basis for the registration board to progress matters. The submissions received will assist the council and the registration board, when it is established, with the challenging work programme that now lies ahead. As the House will appreciate, this is a challenging undertaking, encompassing an extensive legislative and administrative work programme that will take some time to achieve. However, the decision to proceed with having both professions designated for regulation under the 2005 Act is the crucial first step in enabling this work to begin.

I am aware of other professions seeking designation under the Act. Creative art therapists, play therapists and audiologists, for example, have been making a case for regulation for some time. The immediate priority, however, must be to establish the regulatory process for the 14 professions already designated and to make progress on the regulation of counsellors and psychotherapists. Next year, when all the registration boards have been established and the professions of counsellor and psychotherapist have been designated under the Act, the Department will turn its attention to the question of how best to treat the unregulated professions. As a first step, it will ask CORU to prepare a risk assessment with regard to public protection of the principal health and social care professions seeking designation and to make recommendations concerning options for their possible future regulation.

I now propose to outline the main provisions of the Bill in more detail. The Bill has 9 sections. Section 1 provides the definitions. Sections 2, 3 and 4 of the Bill deal with appointments to the Health and Social Care Professionals Council and to registration boards. The three sections address gaps that have been identified in the Act relating to the appointment of professional members to these State boards.

Specifically, section 2 amends the Act to allow the Minister to make the initial appointment of a professional member to the council when a new profession is designated by amendment of the Act. At present, the Act provides for such appointments only when a profession is designated by regulation. The professions of optometrist and dispensing optician were designated when the Act was amended by the Health (Miscellaneous Provisions) Act 2014. Representatives of these two professions are currently attending the council in an observer capacity. This amendment will allow me to formally appoint these professional members. This section also permits the Minister to appoint professional members to the council to fill casual vacancies where a relevant registration board has not yet established its register or has not conducted an election and is therefore not in a position to nominate elected members for appointment to the council.

Sections 3 and 4 will allow the Minister to appoint professional members to a registration board during the transitional period of the profession concerned when the boards do not have sufficient registrants to hold elections for these positions.

Section 5 will permit a registration board to make by-laws to apply criteria or conditions in relation to further education, training and experience to applicants for registration who, though qualified for a specified period of time, have never practised their profession. It will apply to all the designated professions. The Act already has such provisions in respect of applicants who wish to resume the practice of their profession.

Section 6 amends section 38 of the Act to provide for an amendment consequential to section 5. It also provides for the registration in the register of physiotherapists, on a one-off basis and for a limited period ending on 31 December 2019, of recent graduates of the Institute of Physical Therapy and Applied Science, Dublin, and of the current students of the institute’s programme that will graduate in 2019 with the relevant qualifications.

Section 7 provides for the registration in the register of physiotherapjsts, on a once-off basis and for a limited one-year period, of existing users of the title of physical therapist who hold specified qualifications awarded by the institute or equivalent qualifications or who successfully complete an assessment of professional competence set by the Physiotherapists Registration Board. Assessments of professional competence are a standard feature of the Act and are available to all the designated professions under the Act’s grandfathering provisions. I must stress that it is available to all of the designated professions under this Act. In this particular case, it will be available only to those who can demonstrate existing practice under the title of physical therapist for at least two years in the past five. Such existing practitioners without the required formal qualifications will be provided with the opportunity to make their case to the registration board to continue to practise their livelihood under the title of physical therapist. The rigorous assessments will be set by the Physiotherapists Registration Board and will require the applicants to prove that their competence in musculoskeletal therapy is at least equal to that of graduates of the Institute of Physical Therapy and Applied Science.

While those registered under these provisions will be obliged to continue their practice to musculoskeletal therapy this is not provided for in this Bill for a good reason. They will be required to confine their practice to that therapy, but defining a fixed scope of practice for a designated profession is not a feature of regulation under the Act. Instead, regulation is primarily by way of registration and protection of professional titles. It is an offence for non-registrants to use a protected title. Recognising that scopes of practice evolve over time, and to ensure public protection, each profession’s code of professional conduct and ethics obliges registrants to act within the limits of their knowledge, skills, competence and experience. Any breach of the code is defined in the Act as professional misconduct and would be liable to investigation and sanctions, up to and including cancellation of registration, under the Act’s fitness to practice provisions. The Physiotherapists Registration Board has such a code. Section 8 provides for an amendment to the Act consequential to section 7.

Finally, section 9 provides for the short title of the Act and for the commencement of its provisions. I would like to give the House some background to the amending provisions in the Bill relating to the register of physiotherapists. In other English-speaking countries, physiotherapists often use the title of physical therapist interchangeably with that of physiotherapist.

In Ireland, however, for the past 25 years or so, and in the absence of regulation and of title protection, the title of "physical therapist" has been used by other providers of musculoskeletal therapies practising in the private sector.

Those currently using the title of "physical therapist" are predominately the members of the Irish Association of Physical Therapists. They number about 300 and most of them are degree level graduates of the Institute of Physical Therapy and Applied Science in Dublin. These practitioners and physiotherapists, mostly the 3,000 members of the Irish Society of Chartered Physiotherapists, all provide musculoskeletal therapies. Physiotherapists, however, are also trained to provide cardio-respiratory and neurological therapies - there is a significant difference.

The profession of physiotherapist is a designated profession under the Health and Social Care Professionals Act 2005. Three years ago, in June 2014, the newly established Physiotherapists Registration Board held its first meeting. One of the first items on its agenda was protection of title and how best to address the question of protecting the title of physical therapist.

Early last year, the previous Minister for Health, now the Taoiseach, Deputy Leo Varadkar, concluded extensive consultations with the registration board and other relevant organisations. He came to the conclusion that protecting the title of "physical therapist" under the Act as a variant of the title of "physiotherapist" would be the best way to eliminate the risk of title confusion and the consequent risks to public safety.

This would need to be done by regulations that would require the prior approval of both Houses of the Oireachtas. The effect of prescribing the title of "physical therapist" as a variant of the title of "physiotherapist" will be to protect both titles under the Act by confining their use solely to registrants of the profession of physiotherapist.

It was also decided to allow certain practitioners who are users of the title of "physical therapist", who are not physiotherapists but who hold qualifications of a certain standard, to continue to use the title. This would require amendments to the Act to allow such practitioners to apply, on a once-off basis and for a limited period, to register in the physiotherapists register.

These decisions took into account, appropriately and subject to ensuring public protection, the legitimate concerns of all of the practitioners involved and of the other parties that will be affected by the regulations to protect the title of "physical therapist". The decisions were welcomed by the two main professional bodies involved, the Irish Society of Chartered Physiotherapists and the Irish Association of Physical Therapists.

As I mentioned before, the registration board's code of professional conduct and ethics will ensure that those registered under these provisions will act within the limits of their knowledge, skills, competence and experience. In other words, such practitioners, or indeed any physiotherapist without the up-to-date skills in cardio-respiratory and neurological therapies, will be obliged to confine their practice to musculoskeletal therapy or face investigation and sanctions under the 2005 Act's fitness to practise provisions. I want to be extraordinarily clear on that. Anybody who is not a physiotherapist, or indeed any physiotherapist who lacks the up-to-date skills in the areas of cardio-respiratory and neurological therapies, will be obliged to confine their practice. That is really important, in terms of protecting the public and in terms of providing clarity as to who can do what when it comes to interacting with the public.

On taking office, I confirmed that I would be implementing these decisions in full and the Bill before the House now provides for the necessary amendments to the primary legislation. Specifically, the Bill will permit the registration in the register of physiotherapists, on a once-off basis and for a limited period, of qualified existing-practitioner users of the title of "physical therapist", of recent graduates of the Institute of Physical Therapy and Applied Science, Dublin and of current students who graduate from the institute's final programme that commenced in 2016 and will end in 2019.

It is intended that the regulations to protect the tile of "physical therapist" will be made during the 12-month period provided for in this Bill. As I mentioned earlier, the Physiotherapists Registration Board established its register on 30 September 2016. This means that all of the legislation necessary to protect the title of "physiotherapist" is now in place. When the register's two-year transitional period ends in September 2018 entitlement to use that title will be confined to members of that register.

While the register has been open for receipt of applications since September last I am disappointed to hear that the rate of application has been slower than for other professions. This is a process that has been followed by other professions and it is disappointing that the rate of application to date has been slower. It is important that CORU be given the opportunity to process as many applications as possible before the 30 September 2018 deadline. Otherwise, if the existing practitioners leave it to the last minute to apply for registration, it is likely that a number of non-registrants will still be using the protected title of "physiotherapist" after that date and until their applications are processed. This would be far from ideal from a public safety perspective or, indeed, from the perspective of a practitioner.

It would be best if both titles, that of "physiotherapist" and that of "physical therapist", could be protected together, from September 2018. This will require the end of the 12-month application period for existing practitioners that is provided for in this Bill to coincide with the end of the physiotherapists register's two-year transitional period in September 2018.

In order for this to happen, this Bill will need to be enacted, with the relevant sections commenced, before 30 September of this year. This would then allow the regulations to be made to protect the title of "physical therapist" to come into operation on 30 September 2018 thereby ensuring the statutory protection of both titles with effect from that date. For these reasons I am keen that this Bill proceeds through the various Stages of this House and of the Seanad as quickly as possible and I would seek support, from all parties and none, in this regard on this important piece of legislation.

In conclusion, this Bill will provide for the necessary amendments to the Health and Social Care Professionals Act 2005 to allow me to bring forward regulations to protect the title of "physical therapist" alongside that of "physiotherapist", and will make the other technical amendments to the Act to enable the Health and Social Care Professionals Council to continue to fulfil its object to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions.

I commend the Bill to the House.

I wish to share my time with Deputy John Brassil.

Is that agreed? Agreed.

Fianna Fáil will support this Bill which makes minor technical amendments to the relevant Act and will facilitate the implementation of the decision to protect the title of "physical therapist". These decisions were taken following a consultation process and were welcomed by the professional bodies involved.

The Bill will amend certain provisions of the Health and Social Care Professionals Act 2005 to: address identified gaps in the provisions relating to the appointment of professional members to the Health and Social Care Professionals Council and to registration boards; permit a registration board to apply training and education conditions to applicants for registration who have not yet practised their profession, an important point to which the Minister alluded; and provide further conditions for the registration of physiotherapists-physical therapists in the register of physiotherapists.

There are some gaps in the principal Act and these are being addressed. With regard to membership of CORU and its registration boards, the Bill proposes technical amendments to enable ministerial appointments of professional members of newly designated professions to CORU.

A related amendment proposed in the Bill is to allow the ministerial appointment of professional members to fill casual vacancies where the relevant registration board has not yet been established or has been established but has not yet conducted an election of its members. A further technical amendment proposed will, if enacted, enable the appointment of professional members to registration boards during their two-year transitional period following first establishment. The Bill proposes to amend the Act to allow registration for applicants who are qualified but who have not yet practiced their profession for a specified period of time.

A protected title is the professional title of the designated health and social care professions named under the Health and Social Care Professionals Act 2005. A registrant of a profession is entitled to use the title specified for that profession.

The issue of protection of the title of "physical therapist" as a variant of the title of "physiotherapist" relates in the main to confusion, among the public and other health and social care professionals, regarding the similarities and differences in the role of physiotherapists and physical therapists. Even that contribution is confusing in itself but it highlights the difficulties that both the professional and the public have in understanding the differences.

The Bill proposes to protect both titles under the one prescribed protected title of "physiotherapist" in order to eliminate the ongoing risk of title confusion and the consequent risks to public safety. There have been many debates over the years in this House on the question of registration. The key issue is the protection of the public to ensure it can have full confidence in the various professions, how they are governed and how they operate in terms of oversight.

Physiotherapists primarily work in the public sector and are trained to provide the following therapies: musculoskeletal therapies, cardio-respiratory therapies and neurological therapies. In Ireland, physical therapists mostly work in the private sector and are trained to provide musculoskeletal therapies solely and have been educated in a different higher education institution from those that provide qualifications for physiotherapists. Confusion has arisen as physiotherapists often use a title of "physical therapist" interchangeably with that of "physiotherapist". The Physiotherapists Registration Board estimates that in Ireland currently, approximately 300 people are practising as physical therapists and over 3,000 are practising as physiotherapists.

Several developments have lead to the decisions as provided for in the Bill. These revolve around the consultation process with stakeholders in respect of three options. The title of "physical therapist" should be protected for the sole use of physiotherapists in the interests of public safety and avoidance of confusion.

Debate adjourned.