Counsellors and Psychotherapists Registration Board: Discussion

On behalf of the joint committee, I thank Ms Deirdre Walsh and Mr. Aidan Tumbleton from the professional regulation unit of the national human resource division of the Department of Health for coming to talk to us. In this session we will discuss the following draft regulations referred to the committee by an order passed by the Dáil on 20 February and the Seanad on 27 February: the Health and Social Care Professionals Act 2005 (Section 4(2)) (Designation of professions: counsellors and psychotherapists and establishment of registration board) Regulations 2017 and the Health and Social Care Professionals Act 2005 (Section 4(7)) (Membership of Council) Regulations 2017.

By virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by it to cease giving evidence on a particular matter and continue to so do, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or an entity by name or in such a way as to make him, her or it identifiable. I also advise that any opening statement made to the committee may be published on its website after the meeting.

Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official, either by name or in such a way as to make him or her identifiable.

I invite Ms Walsh to make her opening statement.

Ms Deirdre Walsh

I thank the Chairman and committee members for inviting us to talk about the draft regulations to be made by the Minister for Health, Deputy Simon Harris, designating the professions of counsellor and psychotherapist under the Health and Social Care Professionals Act 2005. The Houses of the Oireachtas are being asked to approve two sets of regulations. The Health and Social Care Professionals Act 2005 (Section 4(2)) (Designation of professions: counsellors and psychotherapists and establishment of registration board) Regulations 2017 will designate the new professions of counsellor and psychotherapist under the Act and establish one registration board for both professions, each with its own register. The Health and Social Care Professionals Act 2005 (Section 4(7)) (Membership of Council) Regulations 2017 are consequential to the first set of regulations. The designation of two new professions will create two new professional positions for the professions of counsellor and psychotherapist on the Health and Social Care Professionals Council. The regulations will increase by two the number of lay positions on the council to ensure a continuing lay majority.

I will comment briefly on the background to the regulations. They represent an important step in implementing the decisions of the Minister for Health that the professions of counsellor and psychotherapist be regulated under the Health and Social Care Professionals Act 2005 and that each profession have its own register under one registration board. These decisions were taken on foot of an initial consultation with the Health and Social Care Professionals Council, followed by a wider public consultation process which generated over 80 submissions.

The Act provides for the protection of the public by promoting high standards of professional conduct, education, training and competence through statutory registration of designated health and social care professionals. There are 14 and the addition of counsellor and psychotherapist will bring the number to 16. Under the Act regulation is primarily by way of registration of practitioners and the statutory protection of professional titles. The use of protected titles is restricted to practitioners granted registration under the Act. Registrants must comply with a code of professional conduct and ethics and are subject to fitness to practice rules similar to those which apply to nurses, midwives, doctors, dentists and pharmacists. The structure of the system of statutory regulation comprises registration boards for each profession, a committee structure to deal with disciplinary matters and the Health and Social Care Professionals Council which has overall responsibility for the regulatory system. These bodies are collectively known as CORU.

Registers have been established and titles protected for seven of the ten registration boards appointed. This represents 13,000 registrants of a potential 25,000 and more likely 30,000 registrants when all designated professions are registered. The remaining three boards of the ten appointed are actively working towards establishing their registers as soon as possible. They include social care workers, medical scientists and psychologists. It is intended to have two more registration boards established in the second quarter of this year, one being the podiatrists registration board and, subject to obtaining the approval by the Oireachtas of the regulations before the committee, the other the counsellors and psychotherapists registration board. This will leave the remaining designated professions of orthoptist and clinical biochemist to be progressed before work concludes in the regulation of all professions designated under the Health and Social Care Professionals Act 2005.

Counsellors and psychotherapists are not designated under the Act. They assist people with psychological, emotional and-or mental health issues. There is concern that, in many cases, there is no statutory oversight of their competence and conduct and that some practitioners lack the qualifications and professional training needed to work with such vulnerable clients. The regulation of counsellors and psychotherapists under the Act will ensure those registered will have minimum qualifications, that only registrants will be entitled to use the title or titles protected under the Act and that registrants will be subject to a range of sanctions, including suspension or cancellation of registration, in the case of a substantiated complaint of professional misconduct or poor professional performance.

The legal position is that section 4(2) of the Health and Social Care Professionals Act 2005 provides that the Minister for Health, after consulting the Health and Social Care Professionals Council and having given other interested parties an opportunity to make representations to him or her, may designate a health or social care profession that has not already been designated if he or she considers that it is in the public interest to do so and if specified criteria have been met. Section 4(8) of the Act provides that regulations may be made under section 4 only if:

(a) a draft of the proposed regulations has been laid before the Houses of the Oireachtas, and

(b) a resolution approving the draft has been passed by each House.

Subject to the approval of the Houses, the next steps will be to make the regulations to designate the professions and appoint the 13 members of the registration board following the submission of suitable candidates for the Minister’s consideration by the Public Appointments Service. Once the counsellors and psychotherapists registration board has been established and its members appointed, the board will be asked to advise the Health and Social Care Professional Council and the Minister on some of the outstanding issues to be decided. They include the professional titles to be protected by regulations under the Act and the qualifications that ought to be required of existing practitioners in order to register.

The registration board will also commence drafting the various by-laws to allow it to establish its registers. They will include by-laws relating to the approved qualifications that will be required of future graduates. Following the opening of the register, there will be a two-year transitional period to allow existing practitioners time to apply for registration and satisfy the registration board that they meet the requirements for the profession.

I thank Ms Walsh.

I thank the witnesses for coming before the committee and for their evidence. Following approval of the regulations, it will be an offence - down the line, obviously, not the following morning - for someone to represent himself or herself as a counsellor if he or she does not fulfil the minimum requirements and is not appropriately registered. Will the witnesses confirm this and confirm what powers there are in this regard, if any? There are very specific incidents in which people represent themselves as counsellors. In some circumstances they deal with women, in particular women in crisis, and they call themselves counsellors when they are very clearly not and they could really damage women, certainly women in desperate situations. What penalties are available if someone misrepresents himself or herself as a counsellor, or is this something for the future? Now that the title is protected, which obviously is a very good thing, what penalties exist? Are they similar to those that exist for those who pretend to be nurses or members of other protected professions?

Regarding the next steps, once the counsellors' and psychotherapists' registration board has been established and its members appointed, the board will be asked to advise the Health and Social Care Professionals Council and the Minister. I suppose it is, in this context, advice. Who is ultimately the person or entity that makes final decisions? Ms Walsh said the board will be asked "to advise ... on ... the outstanding issues [including] professional titles to be protected by regulation under the Act and the qualifications that ought to be required of existing practitioners in order to register". I am rereading her words to point out what I am trying to establish. She also said the board will draft various by-laws. This goes back to the original question about advice. Who, ultimately, makes the final decisions on who can be registered, the training programmes and so on? Is it the health and social care professionals, the Minister or the board?

I will bring in Senator Colm Burke, so the witnesses might bank the questions.

I thank the witnesses for their overview and the work that has been done in this area. An area that has not been brought up previously is people who provide scanning services. There does not appear to be any regulation of this. I have come across a number of cases recently, in particular outside of Dublin, in which scanning services were provided. I heard of one case recently in which a scanning service was provided on a Saturday and fairly negative news given to the patient and then that person had no medical practitioner to whom to turn for help or advice on a Saturday. When the person who provided the scan was questioned on it, they said it was not their job. Is this in any way on the list of areas that need to be regulated? Many people are popping up providing scanning services with no backup medical support, and I am concerned about it.

Ms Deirdre Walsh

I will start with Deputy O'Reilly's questions about the process. She touched on crisis pregnancy counselling and protection of title. The regulations are in effect already drafted, so once we get the approval, the Minister will sign them. Then we will go to the Public Appointments Service, PAS, to appoint the board. The appointment of the board starts a very extensive work programme. Generally speaking, for most professionals, the pattern to date has been that the work takes about two years between a board being appointed and it actually opening its register. Going back to Deputy Kelleher's point, it is a 13 person board on which sit six practitioners of the profession and a seven-person lay majority. The first element this board will look at is people's present qualifications and how they are registered. In effect, this is what is called grandparenting. We call it a transition period under the Act. The board, for each profession, will do work. It has the practitioners and the lay majority on board but will often commission work, talk to professional bodies and carry out research. It then comes to a point where it makes solid advice. On the issue of grandparenting, it comes back to the Minister via the council. The council may also have input into it. It comes back to the Minister with advice on the qualifications that would be set for grandparenting - this is for existing practitioners - but it is the Minister who then makes that element of the process. He decides, based on the board's advice. He can also input his own advice, obviously.

He could amend that advice.

Ms Deirdre Walsh

He could, but to date, successive Ministers have not. Nonetheless, it is the Minister who makes that point.

The second piece on which the board advises the Minister is protection of title. The process is the same, and the same 13 person board is involved. The board may commission research, talk to professional bodies or get additional advice. It regularly sets up sub-committees and can draw on the expertise of those who may not be members of the board. Again, the board will advise the Minister, and it is the Minister who makes the regulations on protection of title.

Then there is a third piece, namely, the desirable qualifications for new graduates into the future. These people will not be grandparented, as it were. These are future qualifications. It is the registration board that makes these regulations. Those are the three processes.

This links back to Deputy O'Reilly's point. Nothing will happen overnight when these regulations are signed. The board is appointed, it starts this period of work and then, at the end of the transition period, which might be 18 months or two years, it establishes its register. It is then open to receive registrants, and there is a two-year period within which people can register. Once someone registers, if he or she decides to register on week one as opposed to six months later, he or she is subject to full fitness-to-practise, as applies to doctors, nurses and so on. It could be that someone has a complaint about someone using the title which is now protected or someone is accused of professional misconduct or poor professional performance, the same as other bodies. It is the same fitness-to-practise process. Preliminary proceedings are held, the committee investigates and the cases go to fitness-to-practise if substantiated.

Going back to the point on-----

I apologise for interrupting. It might be that I did not make my question clear or perhaps that Ms Walsh will come to it. Obviously, the people who want to do it right will get all the paperwork and so on to ensure they have the qualifications and register. I am talking about, for want of a better word, chancers who will not go through the process of registering. Will they face a penalty if they set up ABC counselling services or whatever they want to call it and try to misrepresent themselves? I know that if one misrepresents oneself as a nurse or doctor-----

Ms Deirdre Walsh

Exactly.

-----there are penalties. Will there be similar penalties for those who misrepresent themselves as counsellors, etc.?

Ms Deirdre Walsh

Yes, and this is linked in a sense to protection of title. It depends what titles are protected. Obviously, the word "counsellor" and variants of titles will be protected. However, there is an issue, and it relates to all professions registered, whether dietician, speech and language therapist or whatever else, that a person could operate using a title other than the protected title. If a person is holding oneself out to be performing the role of a counsellor, a complaint can be followed through on that basis. The Minister, Deputy Harris, when before the committee previously on a related topic, made the point that the ultimate aim in registering counsellors and psychotherapists, particularly in respect of crisis pregnancy counselling, is that once the register is open and populated, titles protected and qualifications set, other legislation, such as the Regulation of Information (Services Outside the State For Termination of Pregnancies) Act 1995, which is being reviewed as part of a wider exercise on the eighth amendment and related work, would be amended to ensure that anyone providing such information services must be registered with CORU. It is a matter of closing the loop on that.

Senator Burke asked a question about scanning. I am sorry but I am not sure what kinds of scans he referred to. Are they radiographers or-----

No. People are providing pregnancy scans and so on, giving out information and offering scanning services, especially outside of Dublin, which are not attached to any medical practice. It is happening.

Ms Deirdre Walsh

I suspect, without knowing the detail of the matter, that is probably more relevant to the licensing legislation. If the persons working in these scanning services are radiographers, though, they are registered with CORU, so complaints can be made in that context. However, if it is about the service of scanning-----

I am not sure. They may have qualified in other jurisdictions, not necessarily in Ireland or England, but they are now offering scanning services. There is a question mark that, since they are not attached to a hospital or any kind of medical facility, if negative news is being given to patients, the support is not there for them.

Their view is that they are only providing a service and what happens after that is a matter for someone else. A number of people have approached me about this issue.

Ms Deirdre Walsh

It is not relevant to the registration of the practitioner by CORU, but that is not to say that it is not relevant. I suspect it may a licensing or a servicing issue.

I do not believe it is a licensing issue where people are offering scanning services. Is there any supervisory structure in place in this area?

Ms Deirdre Walsh

Not unless the staff are registered practitioners such as nurses, radiographers or doctors. If it is private service, it possibly is not regulated.

My concern is that it is not regulated such that anyone from eastern Europe can come here and offer services. I am not questioning the qualifications of anyone from eastern Europe but there are services operating here that have no connection to any of our public or private hospitals.

Ms Walsh referred to counselling. Are all counselling services, including addiction counselling, alcohol counselling, marriage guidance counselling and so on covered under this regulation?

Ms Deirdre Walsh

This is one of the issues that arose in the public consultation, on which we received submissions from a multiplicity of counsellors, including marriage guidance counsellors, relationship counsellors, and addiction counsellors. The new board will look at all of these areas and decide who meets the standard for registration or regulation and what their qualifications are. It is too early to say who, following on from this process, will be registered and able to use the protected title.

These regulations are underpinned by the Health and Social Care Professionals Act 2005. The new board will meet and make recommendations to the Health and Social Care Professionals Council and the Minister on protected title, qualifications, training programmes and so on. Where people do not comply or remain outside of this process and they continue to advertise on, say, a plaque on a wall that they are counsellors or psychotherapists, what sanctions will apply? Are sanctions in this regard contained in the Health and Social Care Professionals Act or elsewhere? For example, will this be deemed a criminal offence or will a person just be struck off by the Health and social Care Professionals Council?

Ms Deirdre Walsh

The 2005 Act includes a section on fitness to practise which is applicable to all medical professionals. Within that is a complaints process. If a complaint is made, it goes through preliminary proceedings. If it is a prima facie case, it then goes to full fitness-to-practise, the result of which can be that a practitioner would be struck off, or a criminal conviction. Provision is also made for enforcement and inspection powers. It is a wide-ranging process but it does not happen until such time as a person is registered.

What is the position in respect of a person who is not registered?

It is a criminal offence.

Is that the case?

Ms Deirdre Walsh

Yes.

This important piece of work is due in no small part to the issues raised in the media by Ellen Coyne and others. We have made progress and I would not like that to go unmarked because very often we do not manage to conclude, or even come close to concluding, issues.

On behalf of the committee, I thank Ms Walsh and Mr. Tumbleton for being here today.