Health and Social Care Professionals (Amendment) Bill 2018: Second Stage

Question proposed: "That the Bill be now read a Second Time."

It is great to be back in the Seanad. I could nearly have honorary membership at this stage as I am in here a lot at the moment. I thank Members for considering this Bill and giving it a Second Reading. This is a short, technical Bill with only five sections. It provides for the amendment of certain provisions of the Health and Social Care Professionals Act 2005, which relate to the recognition of non-Irish professional qualifications.

Before explaining the Bill in more detail, I will provide the House with some background to the Health and Social Care Professionals Act 2005, which this Bill seeks to amend, and a brief update on its implementation to date. The Act currently provides for the statutory regulation of 17 designated health and social care professions. Regulation under the Act is primarily by way of the statutory protection of professional titles by confining their use solely to persons granted registration. The structure of the system of statutory regulation comprises registration boards, a committee structure to deal with disciplinary matters and a Health and Social Care Professionals Council, HSCPC, 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. CORU is also charged with the promotion of high standards of professional conduct and professional education, training and competence among the registrants. The Act provides for a transitional period of two years during which existing practitioners may register on the basis of specified qualifications. Following this period, only registrants of a registration board, who are subject to the Act's regulatory regime, or those who applied during the transitional period and whose applications are still being determined or are under appeal are entitled to use the relevant protected title or titles.

From a public protection viewpoint, a crucial milestone in the regulation of the Act's designated professions was the introduction of the Act's fitness to practise regime in recent years. This involved the commencement of Part 6 of the Act to allow for complaints about the conduct or competence of registrants to be investigated. Where complaints are substantiated, disciplinary sanctions up to and including cancellation of registration may be imposed. The regime is similar to that applicable to medical practitioners, nurses and midwives.

To date, 11 registration boards have been established in respect of 13 professions. Eight registers are open and their respective professional titles are now fully protected under law following the close of the two-year transition period attaching to each register. The registration boards for the professions of medical scientist, podiatrist, psychologist and social care worker, while established, have not yet opened their registers but are working hard to do so.

I would also like to take the opportunity to update the House on the regulation of counsellors and psychotherapists. As Deputies may recall, these professions were not designated for regulation under the 2005 Act. Following consultations with the HSCPC and a detailed public consultation on the question of regulating counsellors and psychotherapists, I decided last year to proceed with the designation of two distinct professions under the Act, that of counsellor and psychotherapist - each with its own register under one registration board. I signed the regulations in April this year designating the new professions and establishing the Counsellors and Psychotherapist Registration Board following the approval of the regulations by both Houses. This was followed with the advertising over the summer period by the Public Appointments Service, PAS, of a campaign to recruit 13 members for appointment to the registration board. Following the conclusion of that process in September 2018, I intend to make the board appointments in the coming weeks. Once appointed, the registration board will give consideration to a number of outstanding issues and will advise the council and the Department accordingly. These include titles to be protected and the minimum qualifications to be required of existing practitioners applying for registration in the transition period and for future graduates. As the House will appreciate, and given that a number of other jurisdictions have tried and failed to regulate these professions, this is a challenging work programme that will take CORU time to achieve but I thank it for taking this work on. It is important that we get this area right. Counsellors and psychotherapists come across people who are often at the most vulnerable moments in their lives and it is important that when someone goes to see a counsellor or psychotherapist, they know who they are going to see and their qualifications. This is a big body of work but one that is worth doing and getting right.

I am aware of other professions seeking designation under the Act. Perhaps it is a sign of the times that we have gone from a system where people might not have wished to be regulated or fear regulation to one where nearly everybody comes forward and asks for their profession to be regulated. Of course, there needs to be proportionality in this regard but professions such as creative arts therapists, play therapists, athletic rehabilitation therapists, chiropractors, audiologists and various scientific professions, to name but a few, have been making a case for regulation for some time. The immediate priority, however, is to bring to conclusion the regulatory process for the 17 professions designated. We must finish that body of work.

When all the registration boards have been established and their work programmes well under way, the Department will turn its attention to the question of how best to treat the unregulated professions. A risk assessment, in terms of public protection, of the principal health and social care professions seeking designation will be undertaken in 2019 as a first step. I very much welcome this. It will inform decisions to be taken concerning options for their possible future regulation. Department officials will work with CORU in progressing this project taking into account the ongoing and extremely demanding work programme being undertaken by the agency.

In addition, I am also obliged to take into consideration the recently adopted EU directive on a proportionality test before the adoption of new regulation of professions. This directive establishes rules for member states to conduct proportionality assessments before the introduction of new, or the amendment of existing, professional regulations to ensure the proper functioning of the internal market while guaranteeing transparency and a high level of consumer protection.

Its intention is to harmonise the ways in which proportionality tests are carried out before member states introduce new regulations on professions and the criteria to be applied in accordance with European Court of Justice rulings. It does not, however, affect the member states' competence to decide whether and how to regulate a profession within the limits of non-discrimination and proportionality. This directive must be transposed by July 2020, following which member states which wish to adopt new regulatory procedures will be required to justify to the European Commission that such procedures are necessary and appropriate. The Commission may take action if it deems such regulations to be insufficiently justified and, therefore, disproportionate, for example regarding their effect on free movement.

I propose to provide some background to the amendments contained within this Bill. The Bill will amend the Health and Social Care Professionals Act 2005 to provide that all non-Irish professional qualifications which have been recognised by the Minister and by bodies acting on behalf of the State prior to the introduction of statutory registration for a health and social care profession will continue to be recognised for the purposes of registration under this Act. This will allow holders of such qualifications to be statutorily registered and to practise their profession. As Senators are aware, the Health and Social Care Professionals Act 2005 provides for the introduction of a system of statutory regulation for 17 health and social care professionals. When statutory regulation is introduced for a profession, a practitioner cannot practise in his or her professional capacity without being registered with the relevant registration board established under the Act, one of the requirements for which is that the applicant must hold an approved qualification.

Section 38 provides that persons hold such a qualification if they hold an Irish qualification which has been approved by the relevant registration board, if they hold a European Economic Area, EEA, qualification which has been recognised under Directive 2005/36/EC on the recognition of professional qualifications, if they have been practising the profession for not less than five years and hold certain Irish historical qualifications, or if they hold a professional qualification which the registration board decides attests to a standard of proficiency which corresponds to the approved relevant Irish qualification.

Section 38 as it stands, however, does not encompass non-EEA persons or persons with a non-EEA qualification who have previously had their qualifications recognised in Ireland on an administrative basis using processes that mirror those of Directive 2005/36/EC or its predecessors. A serious difficulty, therefore, has arisen for these persons when they apply for registration. While their qualifications may have been recognised in the past, the legislation as currently framed does not allow for their registration. This gap in the legislation must be resolved to allow such persons register and practise their professions. The Bill before us addresses this gap by providing in section 38 that the qualification of an applicant who has evidence that such qualification has been recognised by the Minister or by a body acting on behalf of the State prior to the introduction of statutory registration for the relevant profession will be considered to be an approved qualification under the Act. This means that there will be no requirement for reassessment of the qualification.

The Bill has five sections. Section 1 provides that the "Principal Act" referred to throughout is the Health and Social Care Professionals Act 2005, while section 2 amends the definition of "qualification" in that Act. Section 3 of the Bill amends the registration provisions of the Act to address the gap that currently exists in the legislation by providing that a member of a relevant designated profession who holds a relevant professional qualification which has been recognised by a relevant person is considered to hold an "approved qualification". Section 4 provides for the insertion of a Schedule to the Bill which sets out the list of relevant designated professions and corresponding relevant persons. Finally, section 5 provides for the Short Title of the Bill.

In conclusion, this matter is a priority as without these amendments each registration board at CORU is required to undertake a detailed assessment of the professional qualifications of certain health and social care professionals whose qualifications have previously been recognised by the State. Such persons must submit an application to CORU and await a decision which can take a number of months as their formal training and post-qualification experience must be compared on a case-by-case basis against the current Irish reference standard. This puts a consequential administrative burden on applicants and CORU. As we know, CORU has enough to be doing and we would like it to focus on the areas we need it to focus on, rather than placing an additional and unnecessary burden on it or the applicants in this regard. For these reasons I am keen that this Bill proceeds through the various Stages of this House and the Dáil as quickly as possible in order that we can pass it into law and address what is a technical but important matter. I commend the Bill to the House.

I welcome the Minister back to the House. Fianna Fáil will support this Bill, which makes minor technical amendments to the relevant Act and will facilitate any non-Irish health and social care professional qualification which was recognised in the State prior to the introduction of statutory registration with CORU in 2005. Although a number of professions in 2005 had informal or voluntary systems of registration organised by their respective professional bodies, only five health professions were then subject to statutory registration in Ireland: doctors, dentists, nurses, opticians and pharmacists.

The 2001 health strategy, Quality and Fairness: A Health System for You, gave a firm commitment to strengthen and expand provisions for the statutory registration of health professionals. The Health and Social Care Professionals Bill, therefore, represented an important step forward in strengthening the regulatory environment. The Health and Social Care Professionals Act 2005 provides for the introduction of a system of statutory regulation for certain health and social care professionals: clinical biochemists, counsellors and psychotherapists, dietitians, dispensing opticians, medical scientists, occupational therapists, optometrists, physiotherapists, podiatrists, psychologists, radiographers, radiation therapists, social care workers, social workers and speech and language therapists. This means that a practitioner cannot use the protected title, that is, he or she cannot practise in his or her professional capacity, without being registered with the relevant registration board. Among other things this regulation protected vulnerable people from those who sought to prey on them with alternative therapies, which is important.

One of the requirements for registration under the Act is that the applicant must hold an approved qualification and section 38 provides several routes for the recognition of qualifications. This Bill adds a new route which provides that any non-Irish health professional qualification which was recognised either by the Minister or by bodies acting on behalf of the State prior to the introduction of statutory registration for a health and social care profession, will be considered to be an approved qualification under the Act with no requirement for assessment by CORU.

Section 3 is the key section of the Bill. It proposes to amend section 38 of the 2005 Act. A relevant professional qualification for the purpose of this section is defined as a professional qualification that has already been recognised by a relevant person as of a standard of proficiency which rendered the holder eligible for recruitment by the HSE in that profession. Recognition must have been granted either before the establishment of the register for that designated profession, or on or after the establishment of the register where an assessment for recognition was commenced by the relevant person before that date. The health and social care professions have been to the forefront in setting and maintaining standards of patient care and professionalism in this country. They have been proactive in working towards a statutory system of registration and are supportive of the general principles underpinning the system.

We are happy to support this Bill and we look forward to seeing it implemented in the near future.

I join in welcoming the Minister to the House, and I acknowledge the dynamism and commitment he brings to his Ministry. We are delighted to have him in the House yet again.

My party is happy to commend the Bill also and to add to the unanimity around it. The Health and Social Care Professionals Act 2005 was of extraordinary importance. It established statutory regulation which was crucial for the whole social care practitioner area. Societal change, the needs and complexities of society, greater resources and a new environment have all created myriad new social care worker areas. Therefore, regulation was and is crucial, and the 2005 legislation was seminal to that extent. It established statutory legislation which ensures there is a minimum standard of education, proficiency and, insofar as it can be achieved, objective standardisation in these professions, which is to be welcomed.

I commend and welcome the amendment to the 2005 Act proposed by the Minister in the Bill to incorporate non-EEA personnel who have qualifications previously validated by the regulatory bodies in the host country, in this case, Ireland, whereby they will automatically gain registration and acceptance, as would be the case if they were from the EEA. This is the objective of the Bill.

Having commended and endorsed the Bill, and having recognised the serious importance of the 2005 Act in the first instance, I will make some general observations. The Minister referenced the importance of regulating counsellors and psychotherapists. As he said, people are in a very vulnerable state when they go to somebody like this. They almost put themselves in a complete dependency situation. It could be extraordinarily dangerous if we do not have the highest standards and regulations, proper qualifications and recognised monitoring and establishment of those occupations. This is crucial. As the Minister said, this all happens under CORU, the registration body for all 17 designated health and social care areas. It is good that the range is wide and that nothing escapes this net.

This is a Second Stage debate, which allows a level of latitude, but my next point is pertinent. I have discovered through meeting people and through general evidence, anecdotal and otherwise, that there is a huge problem with CORU's speed of processing. I have come across instances of returning emigrants who, to continue in their profession, must establish that while they were abroad, they gained a certain amount of professional experience. There is undue delay because, they are told, there must be a board meeting but surely a board could have designated officers who operate the established criteria of the board. These would be proper professionals who understand the board's objectives and criteria and who could adjudicate on individual applicants with haste, without a lack of thoroughness but with haste. Returning emigrants deserve this.

We are encouraging nurses, health professionals and social care professionals to return to Ireland and it is wonderful we are in this space. The Minister has made a big effort to get many health professionals back working in this country. If we invite them back should we leave them in limbo? I could cite for the Minister privately later, as it would not be appropriate to do so publicly, instances of people sitting for months awaiting registration after returning home. In one instance a particular high-quality professional is working in the bar business. There is absolutely nothing wrong with working in the bar business per se but she is working in hospitality when in fact she is a qualified professional who has worked abroad. She has been waiting for months for the registration process. This is completely unacceptable. The Minister is a very senior member of the Cabinet and this point needs to be made to him. We encounter emigrants coming home from Australia, the US and England who are allegedly welcomed to Ireland, and we would all state there is a céad míle fáilte for them, but they are having nightmares with banking, insurance and driver licenses. To be germane to what we are speaking about, they are having nightmares with delays in professional recognition. These roadblocks to the talent and brains we are trying to attract back to our country should be removed. It is a real issue. I encounter it throughout the area and it needs addressing.

I ask the Minister to examine two particular issues with CORU. These are whether it needs more staffing resources and the degree to which it could delegate within the organisation in order that it is not necessary to have cumbersome board meetings - that happen only at intervals of a few months - to register people . This would mean that someone who appears with qualifications does not have to wait for the next board meeting. I gather the next meeting is scheduled for November, which is appalling if it is true. If it is not true I would be happy to be so informed by the Minister but I understand the next board meeting of CORU to process material will be in November. What happens to a person who has come home and who has dependants, a mortgage and normal living expenses which, God knows, are high? What must that person do in the intervening period?

As a professional myself, I cannot see how established professional people in CORU, who understand the objectives of the board, could not be delegated with the capacity to register people on a day-to-day basis. There should not be a cumbersome bureaucratic procedure. An issue of policy and accepting a particular qualification may arise in a broad sense but surely it could be executed efficiently on a day-to-day basis. I look forward to hearing the response of the Minister on a real issue for the people whom I represent.

I thank the Minister for bringing forward the legislation, which is very welcome. There is a need for regulation and I have come across it quite a bit in recent years. Certain areas not covered by this are still not regulated and I acknowledge the Minister is also working on these areas. It is important that we make sure everyone who provides a professional service has gone through a unified standard of training, whether it is for physiotherapy, speech and language therapy or social work, in order that we have a standard to be met before a person can hold him or herself out as being professionally qualified.

I have come across an issue on a few occasions with regard to medical practitioners. We must ensure those applying for jobs have not been barred from practising in the country from which they have come. This is something that can easily fall through and it needs to be very carefully watched. Recently, I came across the case of a medical practitioner who had obtained a job in a hospital and who had given information that was absolutely incorrect. When it was corrected, the hospital acted immediately to remove the person from working on the wards and that person was suspended immediately. Information had been supplied inaccurately and wrongly. This is a huge area because people are going abroad to obtain qualifications and people are coming from other jurisdictions with qualifications.

I agree with Senator O'Reilly on the registration process. I came across one case of someone who had set up in Ireland after practising in the UK for more than ten years, believing that a suitable qualification to carry on the practice here was held. However, the person has been dealing with CORU for the past four to five months and has been requested to close down the facility, which is unfortunate. We have come across problems where people set up practices and genuinely felt that they had fulfilled all of the criteria and had gone through the registration process but, for some reason, there was a misunderstanding about what had and had not been done.

That is a challenge. All those seeking registration must comply in full with the regulation and produce all of the necessary documentary evidence to show that they are qualified and can provide a service.

Although it is not covered by the Bill, the area of physical therapists is of concern. It is being followed up on by the Department. There is a concern regarding many physical therapists who are practising in Ireland but may not be allowed to continue their work in a particular area. That issue must be addressed. The Oireachtas Joint Committee on Health, of which I am a member, has written to the Department on the issue on a few occasions. It is an issue of great concern which must be dealt with by the Department.

Another area not covered by the Bill and which needs to be monitored is that of people who provide scanning services. Many companies offer scanning services without providing any additional support. I previously gave the example of a pregnant woman going for a scan on a Saturday with a person operating privately and being advised that the foetus was not alive but no back-up support being immediately available for the woman. That is an issue which causes me great concern. It is important that anyone providing scanning services has professional indemnity insurance and so on. Some GPs have difficulty getting such insurance. If they wish to provide a scanning service, they must have adequate professional indemnity insurance. That area must be addressed. Aside from the issue of incorrect information being given, if there is no back-up support in a clinic, where can a person go to access such support, in particular at weekends? It is an area that must be looked at.

I welcome the Bill. It is extremely important that the regulations are properly implemented for all of the professions listed in the Bill and that structures are in place to ensure adequate supervision. I thank the Minister and his officials for bringing forward the legislation and for the work that has been done by all involved, including those who agreed to sit on the boards. It is very important that people are giving a commitment and are dedicated to ensuring that there is a standard which is maintained and improved on a constant basis. I thank CORU for the work it is doing. However, it is of great importance that the issues raised by Senator O'Reilly be addressed.

I thank Senators Swanick, O'Reilly and Colm Burke for their contributions and unanimity on the importance of what is a technical Bill that we need to pass as quickly as possible through both Houses of the Oireachtas in order that CORU can place its attention, effort and resources where we all want them to be. We do not wish to cause delay to people who are perfectly well qualified to provide services here and whose qualifications have been recognised but who, under the existing Act, would again have to go through an individual assessment process. I thank the Senators for their support in that regard.

I thank Senator O'Reilly for raising several important issues and for his support regarding the need to regulate counsellors and psychotherapists. This is a big area. As I stated in my opening remarks, other jurisdictions have tried and failed to implement such regulation. I am determined that we will succeed and get this right. In the course of discussions of women's healthcare I have been horrified by some of the advice which I was told had been given to women, often pregnant women or women in crisis, by people who call themselves counsellors or psychotherapists. If one examines the qualifications or lack thereof of such individuals, one would not want them to treat one's loved ones. It is very important to regulate in this area out of respect for the qualifications of the many brilliant and qualified people who work in it and in order to control the rogue elements which often enter it.

On CORU, its busyness and the potential for delays, I thank Senator O'Reilly for highlighting this important issue which he encountered through interaction with people in his constituency of Cavan-Monaghan. Applications for recognition of non-Irish health and social care professional qualifications are assessed in accordance with the European directive which I outlined. It provides for a detailed assessment on a case-by-case basis of an applicant's formal training and post-qualification professional experience and how those compare with the qualifications required to practise here. The competent authority must issue a decision to an applicant within four months of the submission of a complete application. Of course, the Senator is correct that due to the improved economic climate and the fact that we are increasing the number of professional registers, far more people are now applying for recognition. In fact, the volume of applicants seeking registration has more than doubled since 2015.

The Senator is entirely correct that more people are coming to Ireland, want to work here and want their qualifications to be recognised. In response, CORU has allocated additional resources, including additional staff, to ensure that the four-month timeline stipulated in the directive is met. Although CORU endeavours to process applications as quickly as possible, its overarching objective, as the Senator will agree, must be to ensure patient safety and that the required criteria are applied rigorously. I have some good news in that regard because I have been advised by CORU that an online application system which will greatly assist applicants and CORU in terms of processing applications will be operational in the coming months and should lead to an improvement in the situation. Documentation accompanying an application is often incomplete, which adds to the back and forth between the applicant and CORU. Ensuring that complete applications are submitted and then dealt with in a chronological and fair order is how CORU must proceed. I will keep a very close eye on its resourcing and staffing but the new online application system will be of assistance to applicants and CORU and I hope it will result in an improvement in some of the issues highlighted by Senator O'Reilly.

The Senator also asked me to consider the issue of delegation. While I understand his point, the situation is quite complex in the context of the 2005 Act, under which it is clear that the board makes the decision. However, I will consider the broader point he raises.

The whole-of-government point made by the Senator in regard to returning emigrants is very important. The Government has discussed the issue on several occasions. Thankfully, we are back in an era of net immigration into our country. All Members want the return of Irish people who had to leave the country because they could not get a job or did not see a future here. Thankfully, as we approach full employment, people are coming back to our country. The Minister of State with responsibility for diaspora affairs, Deputy Cannon, is very eager to ensure their return is as smooth as possible and I will pass on the Senator's comments in that regard to him. It is an issue in which the Taoiseach has taken a personal interest.

I will write to Senator Colm Burke regarding the issue of physical therapists and the correspondence I received from the Joint Committee on Health in that regard. I will pass on his important remarks regarding scanning to the HSE and, in particular, the national women and infants health programme. It is important that a full range of services and supports are provided along with the results of a scan. It is sometimes traumatic and very difficult for people to receive certain scan results.

I commend the Bill to the House.

Question put and agreed to.

When is it proposed to take Committee Stage?

Committee Stage ordered for Tuesday, 23 October 2018.
Sitting suspended at 1.30 p.m. and resumed at 3 p.m.