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Joint Committee on Health debate -
Wednesday, 2 May 2018

Health and Social Care Professionals Act 2005: Draft Regulations

In this second session, we are meeting with officials from the Department of Health to discuss the order passed by the Dáil on 24 April and by the Seanad on 25 April 2018 on the proposal that both Houses approve the following regulations in draft: the Health and Social Care Professionals Act 2005 (Section 95(3)) (Variation of Title: Dietician) Regulations 2018; and the Health and Social Care Professionals Act 2005 (Section 95(3)) (Variation of Title: Speech Therapist) Regulations 2018.

On behalf of the committee I welcome Ms Deirdre Walsh and Mr. Aidan Tumbleton of the Department of Health. I draw their attention to the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of the evidence they give to this committee. However, if they are directed by the committee to cease giving evidence in regard to 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 they are asked to respect the parliamentary practice to the effect that, where possible, they should neither criticise nor make charges against any person or entity by name or in such a way as to make him, her or it identifiable. I also advise them that any opening statements they make may be published on the committee's website after this 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 now invite Ms Walsh to make her opening statement.

Ms Deirdre Walsh

I thank the Chairman and members for inviting us here to talk about the draft regulations to be made by the Minister for Health to protect the title of speech therapist as a variant of speech and language therapist and, dietician, spelled with the letter "c" as a variant of dietitian. As the Chairman said, I am Deirdre Walsh, principal officer in the professional regulation unit and I am joined by my colleague, Aidan Tumbleton, assistant principal.

As the Chairman outlined the Houses of the Oireachtas are being asked to approve the following two regulations in draft: the Health and Social Care Professionals Act 2005 (Section 95 (3)) (Variation of title: Dietician) Regulations 2018; and the Health and Social Care Professionals Act 2005 (Section 95 (3)) (Variation of title: Speech Therapist) Regulations 2018. These regulations are being made pursuant to the Health and Social Care Professionals Act 2005. The Act provides for the protection of the public by promoting high standards of professional conduct, education, training and competence through statutory registration of the health and social care professionals designated under the Act. Regulation under the Act 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 applying to nurses, midwives and doctors. The structure of the system of statutory regulation comprises registration boards for the professions, a committee structure to deal with disciplinary matters, and the Health and Social Care Professionals Council with overall responsibility for the regulatory system. These bodies are collectively known as CORU.

The Act prohibits a person whose name is not on the register from using the title of a designated profession and provides that CORU may initiate a criminal prosecution summarily to enforce the prohibition on a designated title's misuse. The title of dietitian is currently specified under section 79 of the 2005 Act for the exclusive use of qualified professionals registered with the Dietitians Registration Board. However, the US spelling of dietician with a "c" also appears to be in use in Ireland. CORU report that it has received a number of referrals concerning persons who are not registered with the Dietitians Registration Board using the title "dietician".

Legal advice has been obtained to the effect that a prosecution initiated against an unregistered person using the variant spelling dietician would be unlikely to succeed unless the title is prescribed pursuant to section 95 (3) of the Act. The purpose of the first draft regulation is to protect the public by restricting the use of the variant title dietician to qualified professionals registered with the Dietitians Registration Board.

The Dietitians Registration Board has written to the Department formally requesting that regulations be made to prescribe the title of dietician as a variant of the specified title of dietitian. The registration board has also furnished the opinion of legal counsel, who recommends the variant title be prescribed to remove ambiguity concerning its use. Representations have also been received from the Chairman of the Board of the Irish Nutrition and Dietetic Institute requesting that the variant title dietician is protected.

On the prescription of title of speech therapist as a variant title of speech and language therapist, the title of speech and language therapist is currently protected under section 79 of the 2005 Act for the exclusive use of qualified professionals registered with the Speech and Language Therapists Registration Board. Historically, professionals were referred to as speech therapists, and, although the profession has long since adopted the title of speech and language therapist, practitioners are often referred to by the outdated title. Legal advice has been obtained by Health and Social Care Professionals Council, CORU, to the effect that a prosecution initiated against an unregistered person using the historic variation speech therapist would be unlikely to succeed unless the title is prescribed pursuant to section 95 (3) of the Act.

The purpose of the second draft regulation is to protect the public by restricting the use of the variant title speech therapist to qualified professionals registered with the Speech and Language Therapist Registration Board.

The Speech and Language Therapist Registration Board has written to the Department requesting that regulations be made to prescribe the title of speech therapist as a variant of the specified title of speech and language therapist. The registration board has also furnished the opinion of legal counsel, who recommends the variant title be prescribed to remove ambiguity concerning its use.

The legal position is that section 95(3) of the Health and Social Care Professionals Act 2005 Act provides that the Minister for Health, after consulting the registration board of a designated profession and any organisations that he or she considers appropriate, may, by regulation prescribe one or more than one title that is a variant of the title designated in the Act for the profession. Section 95(7) provides that:

A regulation may be made under subsection (3) only if—

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

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

The regulations have been laid before both Houses. The Minister made a motion to move both regulations in the Dáil on 24 April 2018, and as the Chairman noted, in the Seanad on 25 April. Subject to the approval of the Houses, it is proposed these regulations will come into effect in the coming weeks.

I am happy to take questions.

I thank Ms Walsh and call on Deputy Margaret Murphy O'Mahony.

To date, the word "professional" is restricted to practitioners such as nurses, doctors and midwives. Why is this the case?

Ms Deirdre Walsh

The titles are restricted for the protection of members of the public because when one registers, one must meet certain criteria, namely that one must have an approved qualification, be a fit and proper person, which is essentially a form of vetting, one must subject oneself to continuing professional development, CPD, and adhere to the professional code of conduct and ethics. One must have that package in order to be registered and by being found to meet that standard, one has an entitlement to use the title. If the title were not protected, someone like myself could come along and set myself up as a dietitian or a speech and language therapist, never having met any of those requirements. The idea is to protect the title.

The way the 2005 Act is constructed, each register has protected title at the end of the two year transition period following the opening of the register. However, there is a fine line between protecting a title and over-protecting titles, therefore there is an option of protecting a variant, as we are doing here, when evidence has emerged that there are people who are seeking to practise who are not registered. Rather than protect a series of titles from the outset, one protects the main title, and, subject to evidence emerging of abuse of the system, one protects a variant but one is careful not to over-protect or to protect ten titles.

That makes sense, I thank Ms Walsh. Obviously the removal of any ambiguity is important but how is it that the spelling variant of dietician is only coming to light now?

Ms Deirdre Walsh

It is an American variation, for the most part, and on some computer packages the title comes up spelled with a "c". The Act was written in 2005, so the title at the time would have been dietitian, as we are used to, and it is only with the passing of time that the use of the word spelled with a "c" has come on board in Ireland. If one were starting to write an Act now, one would probably use both titles, but back in 2005 the use of the word spelled with a "c" was not relevant.

Is there a requirement for speech therapists and dietitians to be a member of a professional organisation?

Ms Deirdre Walsh

No, prior to the introduction of the Health and Social Care Professionals Act, when there was not a State regulator for health and social care professionals, the standard was to be a member of a professional body. Sometimes, one would see the HSE, and the health boards prior to that, when stating their qualifications in requirement for recruitment, they would state that an applicant had to be a member of the professional body. That has been replaced by the State regulator. One is not obliged to be a member of a professional body, however, generally one would find that virtually all practitioners are for reasons of professionalism as distinct from a statutory regulation.

Therefore, to engage in continuing professional development, this is run through the professional body.

Ms Deirdre Walsh

It is. The regulator will set a requirement for it and will set out a scheme as CORU does, then providers compete to provide that. Generally, it is the professional bodies which provide them but not exclusively, although they are the best placed.

To be clear, the title for dietitian includes "dietician", spelled with a "c"?

Ms Deirdre Walsh

Yes, with a "c".

While the title for speech and language therapist is now "speech therapist".

Ms Deirdre Walsh

It is now "speech therapist". These titles are in addition to the already protected full titles.

Are all the professionals encompassed within the regulations satisfied with the changes before us here?

Ms Deirdre Walsh

Yes. Each profession has a registration board and, as I outlined in my opening statement, those boards have been consulted. They represent the practitioners and the professions. In the case of dietitians, its professional body also wrote to the Minister seeking to have it protected. It is something that they have sought. If it is not protected, the ambiguity means that people other than their profession operate which is an issue for the public.

Are there any disappointed people who might have wished to be associated and encompassed within the new regulations who are not covered?

Ms Deirdre Walsh

As CORU has brought to our attention, there are people who operate as dieticians, spelled with a "c", who would not meet CORU's standard. Once these titles are protected, they will no longer be able to call themselves a dietician, whether spelled with a "t" or a "c". They may continue to provide a service under a different title, so that one could call oneself a nutritionist or food adviser, for instance, but one cannot hold oneself out to be a "dietitian" or "dietician". If a member of the public seeks the services of a dietitian, one can look at CORU's website and check the register. If the person is not there, then they have not met the standard.

Are the people in question aggrieved?

Ms Deirdre Walsh

They are aggrieved.

Ms Deirdre Walsh

They probably are miffed.

Ms Deirdre Walsh

Yes, they are probably both, but they simply do not meet the State's standard.

I saw reference to that on a programme recently, which is why I raised the question. It is just a case that they do not meet the standard.

Ms Deirdre Walsh

They do not meet the qualifications.

They acknowledge that they do not meet the standard.

Ms Deirdre Walsh

Yes they do. Many people also practise as nutritionists who do not want to be called dietitians but it happened that a number of people were exploiting that loophole.

From what I gather, an area is emerging where there is a multiplicity of advices to the consumer and the general public, some of which are of no relevance and some which are hugely important. Obviously, there was correspondence with all the respondents in this case and we will not find that they have come back to us in a few weeks to say that they had been excluded or that they should have been included. That is not likely to happen.

Ms Deirdre Walsh

No.

This regulation really does change the title only as opposed to introducing any change in regulation.

Ms Deirdre Walsh

It extends the protection of title. There was a protected title and now there is a title and a variant of the title.

On behalf of the committee, I thank Ms Walsh and Mr. Tumbleton for coming in.

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