Dáil Éireann debate -
Tuesday, 11 Dec 2018

Vol. 976 No. 4

Health and Social Care Professionals (Amendment) Bill 2018 [Seanad]: Second Stage

Minister of State at the Department of Health (Deputy Jim Daly)

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

I am pleased to address the House on the Second Stage of the Health and Social Care Professionals (Amendment) Bill 2018. The Bill was initiated in the Seanad on 27 September 2018 and completed its passage through that House, without amendment, on 7 November 2018. It is a short, technical Bill with only five sections. It provides for the amendment of certain provisions of the Health and Social Care Professionals Act 2005, which relate to the recognition of non-Irish professional qualifications.

Before explaining the Bill in more detail, I will provide the House with some background to the Health and Social Care Professionals Act 2005, which this legislation seeks to amend and a brief update on its implementation to date. The Act currently provides for the statutory regulation of 17 designated health and social care professions. Regulation under the Act is primarily by way of the statutory protection of 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, HSCPC, 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 and 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 specified qualifications. Following 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. From a public protection viewpoint, a crucial milestone in the regulation of the Act's designated professions was the commencement in recent years of Part 6 which introduced the Act's fitness to practise regime. The regime is similar to that applicable to medical practitioners, nurses and midwives.

To date, registration boards have been established in respect of 13 professions. The registers for nine of these professions are open and their respective professional titles are now fully protected under law following the close of the two-year transition period attaching to each register. The registration boards for the professions of medical scientist, podiatrist, psychologist and social care worker, while established, have not yet opened their registers but are working hard to do so.

I will also take this opportunity to update the House on the regulation of counsellors and psychotherapists. The Minister signed the regulations in April this year designating for the purpose of regulation the new professions of counsellor and psychotherapist and establishing the Counsellors and Psychotherapist Registration Board following the approval of the regulations by both Houses. This was followed with an advertising campaign by the Public Appointments Service, PAS, to recruit 13 members for appointment to the registration board. This process concluded in late September 2018 and the Minister intends to make the board appointments in the coming weeks. 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 applying for registration in the transition period and for future graduates.

I am aware of other professions seeking designation under the Act. Professions such as creative arts therapists, play therapists, athletic rehabilitation therapists, chiropractors and audiologists, to name but a few, have made a case for regulation for some time. The immediate priority, however, is to bring to conclusion the regulatory process for the 17 professions already designated.

When all the registration boards have been established and their work programmes are well under way, the Department will turn its attention to the question of how best to treat the unregulated professions. As a first step, a risk assessment of public protection of the principal health and social care professions seeking designation will be undertaken in 2019. It will inform decisions to be taken concerning options for their possible future regulation.

In addition, the recently adopted EU directive on a proportionality test before the adoption of new regulation of professions must be taken into consideration. The directive establishes rules for member states to conduct proportionality assessments before the introduction of new, or the amendment of existing, professional regulations to ensure the proper functioning of the Internal Market while guaranteeing transparency and a high level of consumer protection and public health.

Its intention is that before member states introduce regulations on professions, they will harmonise the ways in which proportionality tests are carried out and the criteria to be applied in accordance with European Court of Justice rulings. It does not, however, affect a member state's competence to decide whether and how to regulate a profession within the limits of non-discrimination and proportionality. The directive must be transposed by July 2020.

I propose to provide some background to the amendments contained within the Bill. The Bill will amend the Health and Social Care Professionals Act 2005 to provide that all non-Irish professional qualifications which have been recognised by the Minister and by bodies acting on behalf of the State prior to the introduction of statutory registration for a health and social care profession will continue to be recognised for the purposes of registration under the Act. This will allow holders of such qualifications to be statutorily registered and practise their professions.

As Deputies are aware, the Health and Social Care Professionals Act 2005 provides for the introduction of a system of statutory regulation for 17 health and social care professionals. When statutory regulation is introduced for a profession, a practitioner cannot practise in his or her professional capacity without being registered with the relevant registration board established under the Act, one of the requirements for which is that the applicant must hold an approved qualification. Section 38 provides that persons hold such a qualification if they hold an Irish qualification which has been approved by the relevant registration board, if they hold a European Economic Area, EEA, qualification which has been recognised under Directive 2005/36/EC on the recognition of professional qualifications, if they have been practising the profession for not less than five years and hold certain Irish historical qualifications, or if they hold a professional qualification which the registration board decides attests to a standard of proficiency which corresponds to the approved relevant Irish qualification.

As it stands, however, section 38 does not encompass EEA persons who have previously had their non-Irish qualifications recognised under a directive which has been subsequently repealed, non-EEA persons or persons with non-EEA qualifications whose qualifications have been recognised on an administrative basis using processes that mirror those of Directive 2005/36/EC or its predecessors. A serious difficulty has arisen for these persons when they apply for registration. While their qualifications may have been recognised in Ireland in the past, the legislation as currently framed does not allow for their registration. This gap in the legislation must be resolved to allow such persons register and practise their professions. The Bill addresses this gap by providing in section 38 that the qualification of an applicant who has evidence that such qualification has been recognised by the Minister or by a body acting on behalf of the State prior to the introduction of statutory registration for the relevant profession will be considered to be an approved qualification under the Act. This means that there will be no requirement for reassessment of the qualification.

The Bill has five sections. Section 1 provides that the "Principal Act" referred to throughout is the Health and Social Care Professionals Act 2005, while section 2 amends the definition of "qualification" in that Act. Section 3 amends the registration provisions of the Act to address the gap that exists in the legislation by providing that a member of a relevant designated profession who holds a relevant professional qualification that has been recognised by a relevant person is considered to hold an "approved qualification". Section 4 provides for the insertion of a Schedule to the Bill which sets out the list of relevant designated professions and corresponding relevant persons. Finally, section 5 provides for the Short Title of the Bill.

In conclusion, this matter is a priority as without these amendments each registration board at CORU is required to undertake a detailed assessment of the professional qualifications of certain health and social care professionals whose qualifications have previously been recognised by the State. Such persons must submit an application to CORU and await a decision, which can take a number of months as their formal training and post-qualification experience must be compared on a case-by-case basis against the current Irish reference standard. This puts a consequential administrative burden on applicants and CORU. For these reasons I am keen that the Bill proceeds through the various Stages of this House and is enacted as quickly as possible. I commend the Bill to the House.

Deputy Stephen S. Donnelly

The Bill amends the Health and Social Care Professionals Act 2005 to provide that any non-Irish health professional qualification that was recognised in the State prior to the introduction of the statutory registration at the Health and Social Care Professionals Council, CORU, will not have to be re-recognised for the purposes of registration under the Act. It pertains to a wide range of health and social care professions. The 15 professions recognised under the Act are clinical biochemists, counsellors and psychotherapists, dieticians, dispensing opticians, medical scientists, occupational therapists, optometrists, orthopists, physiotherapists, podiatrists, psychologists, radiographers, radiation therapists, social workers and speech and language therapists. It is a valuable and important group of people for our medical and social care systems.

The Bill provides a new route for non-Irish qualifications to be recognised and for the practitioners to be allowed, therefore, to use their professional titles. If the foreign qualifications were recognised by the Minister or bodies acting on behalf of the State prior to the creation of the new statutory registration regime, they will still be recognised without reassessment being required by CORU. As such, those practitioners will be allowed use their professional titles.

The Health and Social Care Professionals Act 2005 was important legislation because it provided for quality control, registration and protection for the public in the context of this wide range of services. Until that point, only doctors, dentists, nurses, opticians and pharmacists were subject to the statutory registration. That was greatly expanded in 2005 and supported by the establishment of CORU, which also promotes standards of professional conduct, education, training, competence and more and, therefore, is an important body doing important work.

Fianna Fáil considers the amendment to the Act to be sensible and we will support the Bill in its passage. While the Bill is largely technical in nature, as the Minister of State noted, new routes to professional recognition once deemed safe and appropriate are to be welcomed because we are running out of, or are desperately short of, many of the professionals referenced in the Bill.

The Bill covers radiographers. A colleague of mine was contacted in his constituency in Kildare by general practitioners, GPs, who said they no longer had direct access to DEXA scanning. It is an important bone-density scan for which GPs are able to make direct referral in many, although not all, hospitals. We submitted a parliamentary question on the issue and I received a letter in return from the HSE through Naas General Hospital. The letter acknowledged receipt of my letter and said the DEXA service to GPs is suspended due to a national shortage of radiographers. It went on to say the hospital is making every effort to fill the current vacancies. Hospitals and radiographers, as well as the consultants, doctors and nurses who work with those radiographers, will say the same thing, namely, that they cannot hire the staff.

One of the things we need to do is open the diagnostic suites more because there is a massive backlog of people waiting for diagnostics. We have the machines, and in some other countries the diagnostic suites are open 24-7, or from 6 a.m. until 12 midnight six days a week. Typically, we do not that do that, and our hospitals are open from approximately 8 a.m. to 5 p.m., Monday to Friday, although it varies somewhat. When one talks to the hospital managers and asks them why they are not doing more diagnostics, they do not say they do not have the machines or that they cannot bring patients into the hospital. When one talks to patients who say they have been waiting months for what could be very important scans, and when one asks if they would mind presenting at the hospital on a Saturday or Sunday, or at 7 a.m. or 9 p.m., they will reply of course they would not mind as they need the scan. All the hospitals, nurses and doctors will tell one they cannot hire the radiographers, which is a serious matter.

On children with special needs, the reference to occupational therapists and speech and language therapists is worth reflecting on. I looked at the waiting lists in preparation for this session. Although men and women are also waiting for speech and language therapy, a significant number of those waiting are children.

There are many adults as well with an acquired brain injury, stroke and all sorts of conditions. Many of the people awaiting speech and language therapy in the Minister of State's constituency and mine are children. The number of patients, men women and children, in the country waiting for initial assessment from a speech and language therapist is 14,501. In the Kildare-Wicklow area there are more than 800.

Occupational therapy and occupational therapists, OTs, are used for the rehabilitation of a wide range of chronic conditions and all sorts of other conditions. Many of the people who use them have spinal injuries. Many children, including children with special needs, are waiting for occupational therapy. I took a look at these figures as well. The total number of people in Ireland right now waiting for an initial assessment from an occupational therapist is 32,102. In the Kildare-Wicklow area again, it is in excess of 2,800 people.

On the issue of physiotherapists, there is a chronic shortage of rehabilitation facilities. The National Rehabilitation Hospital does its very best. It is a phenomenal place with phenomenal people but they are screaming out for more beds and proper step-down facilities. I was very involved with one case involving a very unfortunate event that happened where a fit, healthy young man working out in a gym on the west coast had an accident in the gym. When he woke up on the floor of the gym, his spine was fractured and he was quadriplegic. Unless medicine evolves very quickly, that is the prognosis. He received fantastic care in the National Rehabilitation Hospital. From memory, he was discharged in September of last year with other people with serious injuries very much in need of his bed. In fairness, the HSE, after taking a long time to get going, finally did row in behind us and we managed to get Andrew O'Malley his bed around May. He was sitting in the National Rehabilitation Hospital, taking up a bed that somebody else needed, and was unable to go to a step-down facility.

When one talks to those in charge of disability services, those in the National Rehabilitation Hospital, or those running the step-down facilities, they will say that they do not have enough physiotherapists. This Bill is relevant because it is a small step in making it easier for qualified physiotherapists, occupational therapists, speech and language therapists and a wide range of very important people in our system by removing one barrier to them being able to do their job. The chronic shortage of these professionals, be they speech and language therapists, occupational therapists, radiographers or physiotherapists - the list goes on and on - is causing untold pain and suffering. In many cases it is depriving people, especially children with special needs where there has to be as much early intervention as possible and it is taking three and a half years for them even to begin treatment, of leading the best future life that they can live. It is not exactly what the Bill is about, but it is about these professionals in our country. We need to do a hell of a lot more to keep them, reward them, and understand how to make their jobs better and more rewarding and make sure that they have the staffing ratios, pay and conditions, professional learning environments and training they need so that we can keep the fantastic professionals we train and so that we can become a place of choice of employment for these professionals from all over the world.

Deputy Louise O'Reilly

Sinn Féin will be supporting this Bill. It is technical in nature and it is not the most glamorous legislation but it is very important nonetheless, providing as it does the amendment of certain provisions of the Health and Social Care Professionals Act 2005 relating to the recognition of non-Irish professional qualifications.

There have been many Bills seeking to amend the Health and Social Care Professionals Act 2005 over recent months, and important changes have been made to that legislation regarding physical therapists and physiotherapists. The Minister of State outlined for us here the work done to date on bringing in counsellors and psychotherapists. This is an issue that I have discussed with Minister, Deputy Harris, on a number of occasions and one that has been well rehearsed in the media. It has relevance to the legislation we were discussing last week in that until there is regulation of what are commonly known as rogue crisis pregnancy agencies, we will still have people purporting to call themselves counsellors, experts and every other thing and telling women who access terminations that abortion can lead to cancer. That needs to be addressed.

I welcome the work that has been done to date, as outlined by the Minister of State. I assure him of the support of Sinn Féin in anything that he does to bring some regulation into this area. In a couple of weeks, the hope rather than the expectation is that the heat will go out of the issue of discussing abortion. We have been discussing it for a long time. This is one of the loopholes that need to be closed. There are other things relating to sex education in schools and so on. This is a very important one. I very much welcome the work done to date and commit my party to working with the Minister of State to ensure that regulation is brought in.

The core legislation that we are amending is important. The Act provides for the statutory regulation of 17 designated health and social care professions by way of statutory protection of professional titles, confining their use solely to the persons granted that registration. The structure of the system of statutory regulation comprises registration boards, a committee structure dealing with disciplinary matters, and a health and social care professionals council with overall responsibility for the regulatory system. These bodies, collectively known as CORU, are responsible for protecting the public by regulating health and social care professionals in this State. CORU is also charged with the promotion of high standards of professional conduct, and education, training and competence among the registrants.

The Bill is short and technical and provides for all non-Irish professional qualifications which have been recognised by the Minister and by bodies acting on behalf of the State prior to the introduction of the statutory regulation of health and social care professionals to continue to be recognised for the purposes of registration under this Act. This will allow holders of this qualification to be registered statutorily and to practise their professions. The existing legislation does not allow for the registration of non-EU persons or persons with non-EEA qualifications whose qualifications have previously been recognised here. There is a gap to that extent in the current legislation and the Bill rectifies that. It is important that we tie up these loose ends because the social care professionals who are affected need security so that they can register and patients also need security in this regard.

The regulatory bodies that we have in the health area comprise CORU, the Nursing and Midwifery Board of Ireland, NMBI, and the Medical Council. For various reasons, I am aware of the functions of all of those boards, as no doubt is the Minister of State. For a brief period I represented some of the workers in An Bord Altranais. I know the work that goes on among them in terms of research, regulation, and educational support and provision. Among the health professionals who pay a fee every year to be registered, however, there are those who often feel aggrieved. If the Minister of State checks social media tonight, he will see a particular group feature. That is not the reason I raised the issue as it was in my head to raise it anyway. Such people feel there is a very heavy emphasis on regulation, fitness to practise inquiries and the punitive aspects rather than on support. We could talk all day about these matters and I know the Minister of State will profoundly disagree with me, but I believe the Government and previous Governments have made sure that the health service is a very unattractive place for health and social care professionals to work in.

That is not helped by the atmosphere that can be created by paying every month or paying every year into an organisation for which one sees no real benefit. I do not say there is not a benefit because I know that there is. I know that the men and women who work for those boards work hard and they do a lot of good work, but very often that is not seen by the professionals who are subject to the board. What people see on the news is the hearings. We could discuss all day whether the hearings should be in public or private, but they are in public. People see their colleagues on the news being brought before their professional body and it is tough on them. I remember every single case I ever took to An Bord Altranais because of the significant toll they took on the individuals concerned. Many colleagues of those individuals were asked to give evidence and the business is conducted with the authority of a court and it is a very formal environment for people who work hard to have to face. Errors can happen because of a shortage of staff. It is not the fault of the people who turn up to work. They are the ones that are there, and it is the fault of the HSE and the Government that the health service is not an attractive place to work. Where there is short staffing and errors occur, people are constantly worried and then they get to pay for the privilege of having a body to regulate them.

Regulation is extremely important and I back it, but in discussing the regulatory bodies it would be remiss of me not to say that notwithstanding the good work they do, they are not viewed as an ally or an asset by many healthcare professionals. They are viewed as a sort of big brother because the good work they do is rarely seen but the public trials and fitness-to-practise hearings are always visible, and the reputation and public perception of the bodies is based on that.

Some years ago, An Bord Altranais put up the fees for the registration of nurses and there was a campaign by the trade union to have the decision reversed. In every workplace I went to people asked me why they were paying An Bord Altranais. They said their workplace was short-staffed and if there was an error, they would have to go to the board they pay for to account for things that are not necessarily their fault. People make complaints when errors happen, which they do for a variety of reasons, but nurse after nurse and midwife after midwife have come to me to ask why they are paying for that. They said they are working hard to earn their money, to pay money to those people who are going to regulate them, and they could find themselves accounting for something that genuinely might not be their fault and could be due to a systems error, short-staffing or any one of a number of reasons.

Sinn Féin will support the legislation. We are actively looking forward to the legislation regulating counsellors and psychotherapists but I urge the Minister of State, Deputy Jim Daly, to do more to promote the good work that is done by the regulatory bodies or even to have a discussion with them to bring home to them the reality of how they are viewed in their own communities because that is not always evident. There should not be an adversarial relationship between the healthcare professional and his or her regulatory body because there is an element of support and education available and that is very often not seen by many of the people who are regulated.

Deputy Michael Collins

I am pleased to have an opportunity to speak on the Bill this evening. It will provide for the recognition of non-Irish professional qualifications which have been recognised by the Minister and State bodies prior to the introduction of statutory registration for health and social care professionals. They will continue to be recognised for the purpose of registration under the Act. In layman's terms, the Bill will allow holders of non-Irish professional qualifications to be registered and to be able to practise their professions here in Ireland. The existing legislation does not allow for the registration of non-EU persons or persons with non-EEA qualifications whose qualifications had previously been recognised in Ireland. Currently, we have a shortage of healthcare professionals and the Bill could help relieve the problem. I have repeatedly called on the Government to act to reduce the long waiting lists that exist, but it is not listening.

Deputy Danny Healy-Rae and I have taken 18 buses to Belfast and the 19th is travelling next week to allow people to avail of a 15 minute cataract procedure. Otherwise, they would be expected to wait for up to four years for such treatment on the public waiting list. I had a constituent in his 90s who was expected to wait four years for a cataract procedure. He was slowly getting more blind each year and I dread to think would have happened if he was still waiting on the Government to provide a cataract procedure for him.

On many occasions in this Chamber I suggested that Bantry General Hospital or Mallow General Hospital could be utilised for cataract procedures as that would go a long way to reducing waiting lists. In Belfast the hospitals operate a weekend model where procedures such as cataracts, hips, knees and every other imaginable operation can take place on Saturdays and Sundays. Why can we not have a similar system here? Why do most hospitals shut down in Ireland at 5 p.m. on a Friday evening and real healthcare only resumes on Monday morning? We cannot continue to do that if we are to tackle waiting lists and help people who are suffering while waiting for procedures to be carried out. It is a joke. We know that many operating theatres, especially in rural hospitals, are not operating at full capacity. Some of them only operate two to three days a week. I have been told that it is due to staffing levels. No wonder our waiting lists are at an extremely critical point in this country.

I met the management of Bantry General Hospital as recently as last month to put forward the suggestion that the hospital could provide cataract procedures. I keep hearing the argument that the hospital does not have enough staff or facilities for such procedures in rural hospitals. Therefore, the sooner this Bill is amended, the sooner appropriately qualified healthcare professionals can register with the registration board and practise their professions. It is important that happens across the health sector.

I do not shy away from the fact that this is an important Bill. It is vital that we have proper regulations and that there is proper accountability. That goes without saying. We also need to address the fact that we have an influx of returning emigrants. I welcome them home, but I want to address the issues they face. For them to continue in their profession they must establish that while they were abroad they gained a certain degree of professional experience. Currently, there is undue delay in dealing with them. A board meeting must be held to establish their level of experience among other things. It is an inefficient system to have a board meeting. We should consider a board having a designated officer who would operate in accordance with the established criteria of the board. Such an officer would be a professional who would understand the board's objectives and criteria, and who could adjudicate on individual applicants, thus speeding up the process for returning emigrants who want to work in the medical profession. We must examine such matters as we need to encourage nurses, health and social care professionals to return to Ireland. How are we encouraging such healthcare professionals to return home when they are left in limbo on returning home? We know there are health professionals who have returned home who have been left waiting months for their registration. That is unacceptable. Those people on returning home cannot immediately work in their profession because of the delay in processing their registration and they have to resort to taking up part-time, unskilled work. That is an appalling way to treat our healthcare professionals.

Returning emigrants from Australia, the US and England not only have to face the difficulty of applying for their professional registration, they also have the difficulty of sorting out their banking, insurance cover and driving licence. All those are major issues for our emigrants returning home. Why are we making it so hard to welcome people home and get them back into their old employment to do what they have been trained for down through the years? We should welcome them with open arms.

I will be a little parochial, but this is an important and valid point. Presumably the same situation is found in other places. There are two consultant posts in Bantry General Hospital which have not been filled because the hospital cannot get consultants. Why is that? I firmly belief proper incentives are not being given to attract consultants to take up those positions in the hospital.

The Minister of State knows the importance of Bantry General Hospital to over 84,000 people in west Cork and much of Kerry. The Minister for Health was there recently, making announcements. He can be making announcements until the cows come home but if the consultants are not there to carry out the work, there is no point making any announcement. In the case of Bantry General Hospital, we have to put in the foundation before we start talking about all the other things that need to be done there. In my view, the foundation is the consultants. The HSE has failed to provide incentives that would bring consultants to the hospital. It has left it in a situation where the two consultants that are required have not been attracted and the posts have had to be advertised again. Are there incentives this time to attract consultants? If not, we are back to square one. As the Minister of State knows, management is doing an excellent job in Bantry General Hospital but we need the HSE to wake up.

We have a five-day hospital when we should have a seven-day hospital. Many people are suffering. I know of a young mother in west Cork who urgently needed an MRI scan at the weekend because she was suffering serious pain but she could not get it. That is outrageous and very unfair, and issues like this have to be tackled. We seem not to understand the system that is needed. It is sad that I have to go to the North of Ireland to see how the system works. If the Minister of State walks into Kingsbridge hospital in Belfast, he will see how it works, and he is welcome to come with me sometime. It is flat out there on Saturdays and Sundays. People are cared for, no matter what their situation or their ailments, seven days a week, non-stop. That is the system we need to build. We have a second class healthcare system at the moment and it will stay second class until we tackle those issues. I will support the Bill.

Minister of State at the Department of Health (Deputy Jim Daly)

I thank the Deputies for their constructive contributions to the Second Stage debate and their support for the Bill overall. As I indicated earlier, the purpose of this technical Bill is to amend the Health and Social Care Professionals Act 2005 to provide that any non-Irish health and social care professional qualification which has previously been recognised in the State will not have to be recognised again for the purposes of registration under the Act. Holders of such qualifications can then be statutorily registered and practise their professions. I commend the Bill to the House.

Question put and agreed to.