Health and Social Care Professionals Act 2005 (Section 95(3)) (Variation of Title: Physical Therapist) Regulations 2018: Motion

We are meeting officials from the Department to discuss the draft Health and Social Care Professionals Act 2005 (Section 95(3)) (Variation of Title: Physical Therapist) Regulations 2018, following referral by the Dáil and Seanad. I welcome Ms Deirdre Walsh and Mr. Aidan Tumbleton.

Ms Deirdre Walsh

I thank the Chairman and the committee for inviting us here to speak about the draft regulations to be made by the Minister for Health to protect the title of "physical therapist" as a variant of "physiotherapist". The Houses of the Oireachtas are being asked to approve the following regulations in draft: Health and Social Care Professionals Act 2005 (Section 95(3)) (Variation of Title: Physical Therapist) Regulations 2018. These regulations are being made pursuant to the Health and Social Care Professionals Act 2005, which 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.

The registrants must comply with a code of professional conduct and ethics and are subject to fitness to practise 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 physiotherapist is specified under section 79 of the 2005 Act for the exclusive use of qualified professionals registered with the Physiotherapists Registration Board. The board first met in June 2014. One of the first items on its agenda was protection of title and how best to address the question of protecting the title of physical therapist. In other English-speaking countries physiotherapists often use the title of physical therapist interchangeably with that of physiotherapist. In Ireland, however, in the absence of regulation and of title protection, the title of physical therapist has been used by other providers of musculoskeletal therapies practising in the private sector. Those using the title of physical therapist are predominately members of the Irish Association of Physical Therapists. This association has approximately 300 members, most of whom are degree level graduates of the Institute of Physical Therapy and Applied Science in Dublin. Like physiotherapists, graduates of the institute provide musculoskeletal therapies. Physiotherapists, however, are also trained to provide cardio-respiratory and neurological therapies.

In 2016, the then Minister for Health, Deputy Varadkar, concluded extensive consultations with the registration board and other relevant organisations concerning the protection of title. He decided that protecting the title of physical therapist under the Act as a variant of the title of physiotherapist would be the best way to eliminate the risk of title confusion and the consequent risks to public safety. The Physiotherapists Registration Board established its register on 30 September 2016. The two-year transitional period ended in September 2018, at which time entitlement to use the title of physiotherapist was confined to members of the register.

The Health and Social Care Professionals (Amendment) Act 2017 provided for the registration in the register of physiotherapists on a once-off basis and for a limited period, ending in December 2018, of certain qualified users of the title physical therapist. The Act facilitates the Minister in making regulations to prescribe the title of physical therapist as a variant title of physiotherapist. Section 95(3) of the Health and Social Care Professionals Act 2005 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 section 95(3) only if a draft of the proposed regulation has been laid before the Houses of the Oireachtas and a resolution approving the draft has been passed by each House. The effect of prescribing the title of physical therapist as a variant of the title of physiotherapist will be to protect both titles under the Act by confining their use solely to registrants of the Physiotherapists Registration Board.

The regulation was laid before both Houses of the Oireachtas in June this year. The motions to approve the regulation were moved in both Houses of the Oireachtas on 16 October. It is proposed that the regulations will come into operation in December 2018. I am happy to take questions.

I thank Ms Walsh.

My understanding in layperson's language is that essentially physiotherapy and physical therapy will now be interchangeable.

Ms Deirdre Walsh

Yes, in respect of the title. It is confined to those on the register.

Once a person has the qualifications and is approved by CORU, the person is registered. Ms Walsh seemed to suggest physical therapists and physiotherapists are different.

Ms Deirdre Walsh

Yes.

Physiotherapists have additional training. I am unsure but I am guessing that within the areas of similarity there may be difference in training.

Ms Deirdre Walsh

Yes.

Is there not, therefore, room for some confusion? Let us suppose a member of the public walks into one of these therapists. Is it not useful to know who is a physiotherapist? I am unsure whether I have understood the briefing correctly. Maybe this is unfair and maybe they are more highly trained or trained in a different way. Is there potential for confusion or for the public to be unable to differentiate between the two?

Ms Deirdre Walsh

I suppose the issue was exactly the point Deputy Donnelly is making. That is where we started off. The public was confused. People did not realise whether they were going to a physiotherapist or physical therapist. What we know as a chartered physiotherapist is known as a physical therapist internationally so there was confusion.

Deputy Donnelly is correct. Now on the Physiotherapists Registration Board we have physiotherapists who are qualified in three streams, namely, cardio-respiratory, neurological and musculoskeletal. A limited number of registrants are on the same register with an interchangeable title and who only practise in the field of musculoskeletal therapy. They practise in one stream and the others practise in three streams. There is a once-off provision to ensure there is no risk to the public. No more physical therapists of the one-stream category will be registered. To protect the public, those physical therapists with a one-stream musculoskeletal practice have signed up to a code of conduct and ethics. This means they can only practise within their level of education and training, which is musculoskeletal. If they stray outside that area, they are brought to fitness to practise. That is the protection in place.

The group who are physical therapists have training in one area. Are they allowed call themselves physiotherapists who have training in three areas?

Ms Deirdre Walsh

They are under the Act, although the reason they sought registration was to continue as physical therapists and to protect their profession in that stream. In law they are entitled to use both titles.

What is the position for new physical therapists who graduate and begin to practise? Will they be allowed to call themselves physiotherapists?

Ms Deirdre Walsh

No, an institute offered that training but that course has now ceased. There will be no further graduates of the physical therapist qualification. They cannot register. There was a once-off window for the 300 who had been practising for 25 years with established practices. There is no more opportunity post the registration date. There would be people in future who will have qualifications in musculoskeletal therapy of a different kind, but they are not entitled to register with CORU or use the protected title.

The physical therapy training is gone, essentially. It is now physiotherapy. Is that correct?

Ms Deirdre Walsh

That is correct.

There are approximately 300 practitioners. Is that right?

Ms Deirdre Walsh

There are approximately 300 physical therapists. They are in the private sector.

Presumably they can call themselves physiotherapists.

Ms Deirdre Walsh

They can, although that was not their wish. The reason they sought the regulation was to continue as physical therapists.

Yet, they can call themselves physiotherapists. Is that right?

Ms Deirdre Walsh

Yes, they could.

Is there any onus on them? I understand they are signing up to a code of conduct to agree to operate within the stream they are trained in. Is there any way for a member of the public to know when he walks in whether the person has trained in one stream or in three streams?

Ms Deirdre Walsh

One way is for the member of the public to ask. Other than that, the physical therapists are quite clear that their professional code includes telling patients that they are physical therapists and telling them about the service they provide in the same way as a physiotherapist will tell a patient about the service she provides. It is back to the code of conduct and sticking to the ethics of the profession.

How many physiotherapists are there?

Ms Deirdre Walsh

Between the private and public sectors there are approximately 4,000 on the register.

This is relevant for approximately 300.

Ms Deirdre Walsh

Some 300-odd are affected.

The Department has no concern about the public. Is that so?

Ms Deirdre Walsh

We could never say that we have no concern. I suppose we rely on the code of conduct and the ethics of both professions. We also rely on the fitness to practise provisions of the Act.

I will be brief. I thank Ms Walsh for the presentation and for giving time to this. Obviously, it was a contentious issue. I am happy that the time was given, the parties engaged and then a solution was found. I believe that solution will benefit the public and will ensure that the titles are protected. That is what everyone wanted out of it and I wish to put on record my thanks for that. We have been working with both groups, as have the Department officials, and we are pleased that this will go through.

We will not impede it in any way.

I thank our guests for the clarification. This was a very contentious subject and we received copious representations about it. My question is whether all the concerns have been alleviated to a satisfactory level at this stage, insofar as that is possible.

Ms Deirdre Walsh

Yes. Insofar as it is possible, they have been alleviated. The registers are live and these people are entitled to register. That has been addressed.

Effectively, the term "physical therapist" is to be phased out and replaced by that of "physiotherapist" from this point on.

Ms Deirdre Walsh

Yes, as per the agreement. The physiotherapist register closed on 30 September and the physical therapist register will close on approximately 20 December. We had to give them a slightly longer time to get them registered.

One of the matters raised by the physical therapists concerned X-rays and the use of X-ray equipment. Has that been dealt with in the regulation?

Ms Deirdre Walsh

No, that is a separate matter. The physiotherapists raised that in the context of the basic safety standards directive, which is currently being transposed into Irish law. It was one of the professions that sought to be included as a referrer in that directive. The Minister, having considered the matter, is transposing the directive for those professionals already covered under the older directive, so he is modernising it. They are not being included at this point but this concerns the wider exercise. These people were party to one from a number of professions that sought to be included under the basic safety standards directive. It goes to the heart of scope of practice and extended scope of practice. Within the Department they are looking at workforce planning and within that strategic framework they are looking at scope of practice for a range of health and social care professionals. The matter is in that basket and it is not appropriate to these regulations. It relates to the basic safety standards directive.

It is not in these regulations.

Ms Deirdre Walsh

No.

It applies to physiotherapists as it applies to physical therapists.

Ms Deirdre Walsh

That is right.

When is that scope of practice likely to be dealt with?

Ms Deirdre Walsh

It is part of the strategic workforce planning framework, which is quite a large exercise. It will be at least another year or two years before it comes around.

In the meantime, if somebody provides a service with X-ray facilities, will he or she technically not be entitled to provide it?

Ms Deirdre Walsh

No, people are entitled to provide what they have always been providing within the health service. However, under the basic safety standards directive, they were looking to expand their scope of practice, and this is very specific to the provisions of ionising radiation. They can still do what they could always do but they will not be extending into the basic safety standards directive.

To clarify, if a physical therapist or physiotherapist provided services relating to X-rays-----

Ms Deirdre Walsh

At the moment.

Yes, and that practitioner has done so for a number of years. May he or she continue doing that?

Ms Deirdre Walsh

That practitioner can continue doing as he or she has always done.

I thank the witness for the work done on this. It is very much appreciated, particularly in the context of taking on board the concerns that physical therapists had about the regulations. I thank all the departmental officials for their work on the matter.

Something caught my attention, as I am sure the Chairman suspected. The witness mentioned ionising radiation, which applies in another area with which the committee has dealt. Will the radiation directive apply to a range of other health-associated professional bodies? What is the position currently? Is the matter being pursued selectively under particular headings or is it obligatory to transpose this into Irish law?

Ms Deirdre Walsh

It is obligatory to transpose a directive into Irish law. As I said to Senator Colm Burke, the matter is complicated but the older version applies to radiographers and radiologists in the main. They are the professionals entitled to use the basic safety standards directive. In the updated version, it is being extended and modernised for existing radiographers and radiologists but beyond that it is still under debate as to who may or may not be added to those professions. The Minister has yet to sign the transposed directive and it is not yet complete.

That has implications for other matters we have discussed. I must express my concerns about it. I asked a question quite some time ago about when this decision was first mooted and by whom. It was clearly about health and safety grounds, as this is what we have been told. We do not know and there may be other ancillary matters as well, which we believe we know. There is a warning in that and we must be careful in how we proceed with the transposition of the directive into Irish law. We need to know if it will be possible to include or exclude bodies, and particularly if we can include bodies that have heretofore had access to radiology referrals and will wish to continue to do so. If I go to a physiotherapist, a physical therapist or whomever, I would expect to be able to have full access to what is required, including X-ray treatment. If not, that body providing the service would not have available to it the full services it requires to do the job properly. I am worried about that.

Ms Deirdre Walsh

I am not working on that directive so I cannot really comment on it.

It would be a help if somebody told us with whom this particular proposal originated. I am a great believer in drilling down to find out from where the information has come. If oil comes out the top, it must come from somewhere. In the same way, if there is pressure for a particular directive to proceed in a particular fashion, sometimes there is a good reason but sometimes it is for reasons relating to exclusivity, for want of a better description. Is there a possibility of getting information on the driver of this particular directive?

Ms Deirdre Walsh

Okay, we can take that back with us.

On behalf of the committee, I thank Ms Walsh and Mr. Tumbleton for attending and for providing the relevant information on the regulations.