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Dáil Éireann debate -
Thursday, 15 Sep 2022

Vol. 1026 No. 2

Regulated Professions (Health and Social Care) (Amendment) Bill 2022: Second Stage

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

On behalf of the Minister for Health, I am pleased to address the House on the Bill, which is fundamentally about health practitioners, the individuals who work tirelessly to deliver the health and social care services on which we, as patients, rely. It is about ensuring we have a safe workforce, that patients are protected and that if a complaint is made, it can be investigated as quickly and as thoroughly as possible.

In Ireland, our regulated health professionals are governed by six regulatory bodies, two of which, the Medical Council and CORU - Regulating Health & Social Care Professionals, are the subject of the measures in this Bill. When it comes to setting the standards for education, training experience and practice for the respective professions, the regulators are the experts. They also have responsibility for taking action if a complaint is made. The measures proposed in the Bill are very much guided by the advice given to the Department of Health by the regulators.

I will provide a brief overview of the most important measures the Bill addresses before discussing them in more detail. As Deputies will be aware, social care work is one of the professions that CORU is in the process of regulating. Measures in this Bill will ensure that when the social care workers registration board opens, those applying for registration during the transition period will have to meet the same standards that applied to CORU's other professions. The Bill also addresses a number of issues relating to medical practitioners. First, it will enable holders of UK medical degrees to once again apply for intern registration with the Medical Council. This, in turn, will allow these graduates to take up an offer by the HSE of an intern training post in an Irish hospital were such an offer to be made. It also addresses several of the technical issues related to the registration of doctors.

The Bill will also support the complaints investigation function of the Medical Council by allowing the CEO to appoint external experts to provide advice and assistance. To address these issues, it is necessary to amend three separate Acts: the Health and Social Care Professionals Act 2005; Medical Practitioners Act 2007; and Regulated Professions (Health and Social Care) (Amendment) Act 2020. Before explaining the Bill’s provisions in more detail, I will provide the House with some background regarding each of the Acts being amended.

The Health and Social Care Professionals Act currently provides for the statutory regulation of 12 professions, with a further six professions, including social care workers, to be regulated. Regulation under the Act is mainly achieved by protection of professional titles. This means that only someone who is on the register for a profession may call themselves by that title. For example, if someone calls himself or herself a physiotherapist and he or she is not on the register, he or she has committed an offence and may be prosecuted. The Act established 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.

The Medical Practitioners Act provides for the regulation of doctors in the State. One of the council's main responsibilities is the registration of medical practitioners. It holds the register, determines the divisions and sets the terms and conditions that doctors must meet to secure and retain registration. The council is also responsible for the investigation of complaints against registered doctors. While the council performs other functions, these two primary functions are central to its overall patient safety objective.

The Regulated Professions (Health and Social Care) (Amendment) Act is long and technical legislation which was enacted in October 2020. It amends the five Acts that regulate health professionals working in the State. These amendments are mainly in the areas of registration and fitness to practise. The Act introduced important new patient safety measures that create more robust obligations on health professionals. It also provides greater protections for those professionals working within our hospitals and communities.

As the 2020 Act is bringing about significant changes to administrative processes, its sections are being commenced on a phased business. This is to ensure each of the regulators is in a position to begin operating under the changed systems. Of the five Acts amended by the 2020 Act, the Medical Practitioners Act saw the most significant changes to its provisions on registration and investigation of complaints systems. Prior to commencing the sections of the 2020 Act, my officials carried out a final, thorough review to ensure the complex amendments being activated were correct. Unfortunately, during the checking process, some technical problems were found in provisions relating to the Medical Practitioners Act. If commenced, these would have prevented certain groups of doctors who had trained in two or more countries from joining the general division of the register. This Bill will amend those sections to ensure they operate correctly and those difficulties are avoided.

I will outline some main provisions of the Bill in more detail. It has four Parts and contains 14 sections. Part 1 provides for standard provisions, including the Short Title, commencement and definitions.

Parts 2 to 4, inclusive, provide for the amendments to the three Acts to which I referred. As I mentioned, CORU currently regulates 12 professionals and a further six are soon to be regulated. Each of the professions has its own registration board, which is responsible for the registration of members of the profession. The initial two years after a register is opened are known as the transition period. During this period, existing practitioners can apply for registration if they satisfy a registration board that they meet certain criteria. These criteria include either a requirement to hold an approved qualification or completing what is known as an assessment of professional competence set by a registration board. In addition, applicants must provide evidence of two years of professional practice as a member of the profession.

Social care workers are designated in the 2005 Act as a profession to be regulated by CORU and work is ongoing by its social care workers registration board to open the register for the profession in November 2023. When the 2005 Act was drafted, it provided certain unique provisions for social care workers applying for registration during the transitional period. For example, the Act provides that the registration board must register any applicant who has been practising the profession of social care work anywhere in the world for a continuous period of two years and whose employer states that he or she meets the standards for that profession. CORU has significant concerns that this is simply not safe for patients. Protection of vulnerable patients must always be our focus and it is clear that the measures sought by CORU, which bring social care workers into line with other professions, are necessary and proportionate. This amendment will align the registration route requirements during the transitional period across all the CORU professions. It will require social care workers applying through this route to complete successfully an assessment of professional competence set by their registration board. The change will mean the registration board can stand over those applying to be placed on the register on the basis of their training and experience.

It will also require that the necessary two-year minimum period of practice must be obtained within the State, as is required for other CORU professions. Currently, other CORU professions can accumulate their work experience in a non-continuous way. Periods can be added together to reach the minimum threshold of two years. This work experience must be gained in the five-year period before the register is established. Uniquely for social care workers, the Act requires that their two years' work experience be continuous. This Bill will remove that requirement and non-continuous experience will now be allowed. This harmonises social care workers with other CORU professionals. However, in order to assist social care workers, it has been decided to retain a provision in the 2005 Act that gives them an additional two years to gain the minimum practical experience to be registered. Instead of needing two years' professional experience prior to the date the register is established, they will have the option of gaining this experience in the two years afterwards. This amendment will, in effect, allow those who wish to register as social care workers until the end of the transition period, which is expected to be in November 2025, to gain two years of professional practice.

This is an important support that will give social care workers every opportunity to meet the requirements for registration. It will also better achieve the objective of the transitional period, which is to ensure patient safety, balancing that with the rights of practitioners. Following the opening of a register, there is, as I said, a two-year transitional period to allow existing practitioners time to apply for registration and satisfy the registration board they meet the requirements. Practitioners can do this by way of attesting to professional experience or by holding a qualification that is acceptable for registration for existing practitioners during the transitional period. Schedule 3 to the 2005 Act lists these qualifications. However, Schedule 3 was drafted 17 years ago and, as Deputies will appreciate, some of its content is now out of date for professions that have not yet opened a register. It is important that the Schedule can be kept up to date. Therefore, the Bill includes a provision that will allow the Minister for Health to add to or amend the qualifications list in Schedule 3. This provision will help to future-proof the Act and will ensure the necessary powers are in place to prescribe or vary the qualifications that are acceptable for practitioners.

The remainder of the Bill addresses issues relating to medical practitioners and the operation of the Medical Practitioners Act, the first of which relates to the investigation of complaints. The 2020 Act revised and updated the procedures to be used in the investigation of complaints against doctors. Those investigations have typically taken quite a long time, which can cause distress for both complainants and doctors. The changes are intended to make investigations more efficient and speedier, which will be welcomed by both doctors and complainants. One of the most significant changes is that complaints will now be made to the CEO rather than to the preliminary proceedings committee. Investigations will be carried out by authorised officers appointed by the CEO. The preliminary proceedings committee will continue to be the deciding body when an investigation report is produced. However, the changes mean that a significant amount of progress can be made by authorised officers before a committee meets.

The Irish Medical Council is confident this will be a more efficient system and a better use of resources. However, the Department of Health has been advised by the council that the triage of early stages of investigations of complaints is often complex and requires specialist expertise. It is important that the CEO and the authorised officers have access to the medical and other expertise necessary to discharge their functions properly at the right stage in the complaints process. The Bill, therefore, provides a power for the CEO to appoint certain experts and specialists to support the council, as well as making some minor amendments to the powers of authorised officers. These amendments will ensure the investigation function is properly supported with the resources and expertise it needs, all of which goes towards the overarching objective of promoting public protection.

The appointment of external support requires a consequential amendment to the 2007 Act, which provides immunity from liability in civil proceedings for members of the Irish Medical Council, the CEO, members of staff and certain persons appointed to assist with the investigation of complaints against doctors. I understand this is a common protection provided for those working in this area. The 2020 Act and the other provisions of the Bill I have described expand the cohort of people who can be appointed to assist the council in the performance of its functions. As Deputies will appreciate, some of the work carried out by regulators is highly contested and often results in legal proceedings. This amendment is necessary to ensure all of those who are properly appointed under the Act can carry out their work without fear of liability in civil litigation.

I turn to an amendment relating to the eligibility of holders of UK medical degrees to apply for internship registration and internship posts in Ireland. The Medical Practitioners Act currently restricts internship registration to graduates who have completed a course of study in the State or a member state. Prior to Brexit, holders of UK medical degrees, by virtue of the UK being a member state, were able to apply for internships in Ireland. For the past two years, the Act has prevented those graduates from applying. We have a long history in Ireland of our heath and social care workers travelling back and forth to the UK to study and work. This has been mutually beneficial to both countries and it is important that those strong ties continue.

While I understand the number of UK graduates who take up an intern placement here is typically low, it is nevertheless important that this option remains available. Deputies will be aware that under the common travel area agreement, Irish and British citizens have the right to access all levels of education and training, and associated student support, in each other's state on terms no less favourable than those for the citizen of that state. While the number of graduates currently affected might be small, it is important that the letter and spirit of that agreement be fully respected.

Deputies will be aware there are new opportunities for medical education in Northern Ireland with the opening of Ulster University's Magee campus school of medicine. It is imperative, therefore, that graduates from Northern Ireland be eligible to apply for intern placements here. The restoration of eligibility is something the Minister very much supports, as does the HSE and the Irish Medical Council. I understand the application window for next year's group of interns will close before the end of this year, so the support of colleagues to progress the Bill as quickly as possible through the Houses will be greatly appreciated.

The final element of the Bill relates to the registration of doctors on the Irish Medical Council's general division. The 2020 Act significantly revised the registration system for doctors by separating qualification recognition from registration. This was to enable the Medical Council to introduce important safeguards between qualification recognition and registration, such as language and fit-and-proper-person tests. The Act also sets out the requirement to be met for recognition of qualifications and registration on all divisions of the register. These provisions are highly technical, cross-cutting and complex and it was only during the checking process to ensure the Act's safe commencement that Department of Health officials identified difficulties for a small cohort of internationally trained doctors who were inadvertently excluded. Were the 2020 Act to be commenced without revision, these doctors would have no route to qualification recognition and registration on the general division. In some instances, they would be unnecessarily required to sit an additional exam. The Minister for Health is acutely aware that the Irish health service is supported by highly skilled and caring doctors from across the world. It is therefore important to ensure the Medical Practitioners Act continues to support the registration of doctors who meet the appropriate standards. The Bill will change the 2020 Act to ensure no doctors will be unintentionally affected. It is important to say no doctors have been affected by this anomaly, as it was detected prior to the sections of the 2020 Act being commenced.

This Bill includes some consequential and other technical amendments but the provisions I have outlined are the principal issues. On behalf of my colleagues and the Minister for Health, I look forward to hearing Deputies' views and discussing it further

Debate adjourned.
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