I move: "That the Bill be now read a Second Time."
I am pleased to address this House on the Second Stage of the Regulated Professions (Health and Social Care) (Amendment) Bill 2019. The purpose of this Bill is to improve processes within the health professional regulatory bodies and amend their Acts following the amendments to the European Union professional qualifications directive, which provides mechanisms for the recognition of qualifications as well as the conveyancing of disciplinary information within the EEA space.
This is a mainly technical Bill containing seven Parts and 169 sections. The Bill amends the five health professional regulatory Acts, which are the Dentists Act 1985; the Health and Social Care Professionals Act 2005; the Pharmacy Act 2007; the Medical Practitioners Act 2007; and the Nurses and Midwives Act 2011. The Bill also makes some minor amendments to the Health Act 1953, the Health Identifiers Act 2014, and the Children and Family Relationships Act 2015.
When the United Kingdom leaves the European Union, the professional qualifications directive will no longer apply to the UK. The UK becomes a third country, that is, a state other than Ireland and the European Economic Area member states. The Bill includes a number of third country provisions related to qualification recognition and the conveyancing of disciplinary information. These amendments are to give further effect to the requirements of the so-called modernised professional qualifications directive, which Ireland transposed into law in January 2017. The Bill is included in the Brexit legislative programme because the provisions which relate to third countries will apply to the UK post Brexit. These are important given the volume of movement of health professionals between Ireland and the UK. The Bill also makes a number of other important amendments to each of the five Acts in respect of a number of matters, mainly related to fitness to practise and registration.
I will now outline some key provisions of the Bill in more detail. The Bill is divided into seven parts. Part 1 provides for the short title and commencement; and for repeals. Parts 2 to 6, inclusive, contain amendments to each of the five health professional regulatory Acts. Part 7 provides for amendments to the Health Act 1953, the Health Identifiers Act 2014 and the Children and Family Relationships Act 2015. Most of the amendments to the health regulatory Acts are common to more than one Act, and a number of the amendments are common to all of the Acts. These are repeated throughout parts 2 to 6 to effect the relevant change in each Act. In outlining the key provisions, I am therefore grouping the amendments under the headings: fitness to practise; registration; other amendments; and amendments to other legislation.
On fitness to practise and appeal of minor sanctions, currently there is no right to appeal the sanctions of advice, admonishment or censure in writing, called the "minor sanctions". This Bill amends the five Acts to give health professionals the right to appeal the imposition of a minor sanction to the High Court, in line with other sanctions.
With the increased mobility of health professionals, the importance of maintaining patient safety, while supporting professional mobility, is ever important. The alerts mechanism provision of the modernised professional qualifications directive aims to give greater protection to EU citizens, as it requires member states to inform competent authorities of all other member states about health professionals who have been restricted or prohibited from practising their profession, even temporarily, by national authorities or courts. However, the directive does not specify what action a competent authority, i.e. the regulatory body, should take when it receives such an alert. To deal with this matter, I have decided to introduce additional grounds for complaint in each of the five Acts. It will be possible to make a complaint against a person who is the subject of an alert. For the further protection of the public, the Bill provides that such a complaint can be made against a person where the person is working in the health and social care profession they were prohibited or restricted from practising in, or where the person is working in a different health and social care profession. By way of example, the Bill provides that a complaint can be made against a person who is the subject of an alert as a doctor, but who is practising in the State as, say, a dentist.
There is no obligation on third countries, which will include the UK post Brexit, to report to other countries any restrictions or prohibitions on the practise of health professionals in their jurisdiction. However, Irish regulatory bodies need to be aware of such restrictions or prohibitions on the practice of any registrant or applicant for registration, including those from third countries.
The Bill, therefore, provides that all registrants or applicants for registration are required to make a declaration in relation to restrictions and prohibitions on their practise. In addition, all regulated health professionals will be required to make declarations at registration and annually in relation to any sanction or pending relevant proceeding.
I am also making amendments in the fitness to practise provisions of the five Acts to provide that regulatory bodies can use disciplinary information from other countries in fitness to practise cases. Currently, information on minor sanctions imposed by regulators is not published, while information on other sanctions imposed is only published if the regulator is satisfied that such publication is in the public interest. The five Acts also provide that such information is made known to me as Minister of State and the HSE and an employer, where known. I am amending all five Acts to provide that each regulator will be required to publish all sanctions it imposes in the State. I am removing the notification to the Minister as it is not necessary for me, as Minister of State, to receive this information.
The Bill includes a number of amendments to increase the effectiveness of the fitness to practise processes set out in the Medical Practitioners Act and the Nurses and Midwives Act. Currently, complaints are made directly to the preliminary proceedings committee for investigation and progress in investigations is dependent on when and how often the committee meets. To expedite investigations, the Bill provides that complaints will be made to the CEO and investigated prior to being referred to the preliminary proceedings committee. Transferring responsibility to investigate complaints to the CEO who will then refer them to the preliminary proceedings committee for decision will shorten the time it takes to process complaints and mean the preliminary proceedings committee’s time can be used more efficiently in making decisions on complaints. The Bill also amends the Acts to provide that an undertaking or consent to a sanction can be given by a registrant at the earlier preliminary proceedings stage rather than having to wait until the fitness to practise stage to do so.
One of the grounds for complaint in relation to fitness to practise is a conviction for an indictable offence. The process to obtain evidence on convictions can be difficult and sometimes requires the garda involved in a case to appear before the fitness to practise inquiry to give oral evidence about a conviction. That is not always a good use of Garda time. I am, therefore, amending each of the five Acts to allow the CEO or registrar of each regulatory body to request information on convictions from An Garda Síochana when dealing with a complaint. The CEO can also seek information from the relevant court which convicted the person. I trust this amendment will result in better use of Garda time and more efficient processes in fitness to practise inquiries.
I am providing for the separation of qualification recognition from registration in the Acts where it is not currently provided, namely, the Dentists and Medical Practitioners Acts. The Acts currently provide that a professional whose qualification has been recognised must be registered. Separating qualification recognition from registration will allow the regulators to introduce language and fit and proper person checks prior to registration. Currently, the Medical Practitioners Act requires doctors whose qualifications are from non-EEA countries to hold the equivalence of the certificate of experience to access specialist training in Ireland. The certificate of experience is evidence of satisfactory completion of internship. This is limiting the career pathway of some doctors who wish to advance their training in this country, notwithstanding the fact that they are registered as medical practitioners in Ireland. I have, therefore, decided to remove the equivalence of the certificate of experience as one of the requirements for entry to the trainee specialist division of the register of medical practitioners. I am also removing the equivalence of the certificate of experience as a route to registration in the general division of the register of medical practitioners, given the possible patient safety concerns raised by the Medical Council in relation to this route to registration. Henceforth, such a person will need to either sit an examination or have his or her qualification recognised under another part of the Act.
Currently, the Medical Practitioners Act provides for only one register, it being the register of medical practitioners. The Bill is providing for the creation of two new registers, namely, the register of interns and the register of adapters. The registers are for those who are in training to be medical practitioners or whose qualifications are not yet recognised. All interns will be registered on the register of interns. An intern is a person who holds a medical degree and is undertaking a period of clinical training and practice before he or she is a fully qualified medical practitioner. Currently, interns are registered in the trainee specialist division of the register of medical practitioners. The amendment will not affect an intern’s ability to perform any function associated with being an intern such as prescribing.
Under the professional qualifications directive, a person who has been assessed under the general system of the directive may, before their qualification can be recognised, be required to undertake a period of adaptation. It is, therefore, proposed to establish a new register of adapters. Persons will be registered on this register while they undergo such period of adaptation as may be prescribed by the Medical Council under the directive. It is not expected that a high volume of applicants will use this qualification recognition route because of the existence of the directive’s automatic recognition route and other routes for registration in the legislation, but it is necessary to provide for it in order to give full effect to the directive.
I will briefly outline some of the other key amendments. The Pharmacy Act is being amended to allow the council to make rules under which it can recognise professional qualifications in pharmacy from other countries which it cannot recognise at present. Currently, under the Pharmacy Act, a pharmacist who is an undischarged bankrupt is precluded from registering and, therefore, working as a pharmacist during the period of his or her bankruptcy. I am removing this provision from the Act, as it unfairly prevents such pharmacists from earning a living.
The Bill amends the Health Act 1953 to remove specific requirements regarding the composition of interview boards for medical consultant posts. The amendment should speed up the recruitment process.
The Children and Family Relationships Act 2015 requires an amendment to include a definition of registered midwife and provide that registered midwives are persons who can perform donor assisted human reproduction procedures. A minor technical amendment is also being made to the Health Identifiers Act 2014 consequent on an amendment being made in the Bill to the Dentists Act.
That is an overview of some of the key provisions included in the Bill. I look forward to discussing the Bill in more detail on Committee Stage. I commend it to the House.