Vol. 271 No. 2
For the information of Members, please note that the House, by agreeing to the motion to recommit, allows a Committee Stage style discussion on the amendments only. That is, Members may speak more than once on each amendment.
Government amendment No. 1 arises out of recommittal proceedings. Amendments Nos. 1 to 6, inclusive, 13 to 18, inclusive, 22 to 26, inclusive, 29 and 30 are related and may be discussed together by agreement. Is that agreed? Agreed.
In line with a signal given on Committee Stage that it might be necessary to introduce correcting amendments on Report Stage, a number of amendments to make typographical changes to sections relating to the Dentists Act, the Health and Social Care Professionals Act, the Pharmacy Act and the Medical Practitioners Act are required. These amendments can be explained under three headings. First, the correcting of a minor drafting error that relates to the internal numbering of section 71A of the Medical Practitioners Act. Second, the correcting of the spelling of "speciality". In amendments proposed to the Medical Practitioners Act and the Dentists Act, the Bill spells it "specialty" with an additional "i", making it "speciality". Given that there are other references in both Acts to "specialty", it is necessary to correct these drafting errors to ensure consistency. Third, amendments are required consequential on the Emergency Measures in the Public Interest (Covid-19) Act 2020, which was enacted in March. That Act added sections to the ends of the four Acts in question. These additional sections necessitate the renumbering of certain sections in the Bill.
I welcome the Minister of State and congratulate her on her new role. This is the first time Members of this House have had the pleasure of addressing her since her appointment.
I have no issue with these technical amendments. Indeed, the Bill is largely technical in nature. I appreciate that the Minister of State has accepted an amendment I tabled on Committee Stage in late 2019, which seems like another era, to give recognition to the category of pharmaceutical assistants. That amendment is to section 53. There are other technical amendments to some of the provisions contained in Part 4 and relating to the Pharmacy Act. The Minister of State's amendments Nos. 15 to 18, inclusive, are to that Part. I am grateful that she did not in any way change my amendment, which thus stands and recognises properly for the first time this small group of professionals. My mother, Rina Bacik, is a pharmaceutical assistant, so I am declaring a personal interest. Colleagues who were in the previous Seanad will recall that, when we debated this Bill last November, a group of pharmaceutical assistants were in the Gallery watching. They are keenly following this debate and are anxious to see the provision commenced as soon as possible. They are delighted that it will pass and that their grouping will be recognised. They number only 300 or so. The last person to qualify as a pharmaceutical assistant did so in 1986. They have been working in a professional capacity alongside pharmacists. I am pleased to see that they will get their due recognition and I hope to see this provision commenced as soon as possible after the Bill is passed.
I am delighted that the Senator is in the House to ensure that her mother's work is formally recognised in this legislation. I thank her for the amendment that she tabled in the previous Seanad.
The Minister of State is welcome. Sinn Féin does not oppose the technical amendments as outlined. We have an amendment of our own, of which the Minister of State will be aware. I was not party to the debate on previous Stages, so I will look to the Cathaoirleach to keep me right in terms of when my amendment is coming up so that I might speak to it.
In the broadest sense possible, this is important legislation for all of the reasons that Senator Bacik outlined and more. We are seeking to approach our amendment in a collaborative and positive way with the best of intentions. It is an important one to make on behalf of the lobby that it impacts and I will speak to it when it arises. I wish the Minister of State well.
To be clear, just as the Senator is seeking guidance from me, I will seek it from the Clerk. Amendments Nos. 29 and 30 are related. I believe the Senator's amendment is No. 29.
My colleague's amendment No. 7 will create a new section 29.
I thank Senator Bacik.
I thank Senators for their kind words. To address Senator Bacik's points, I worked closely with pharmaceutical assistants in Waterford.
I am very aware of what the Senator is speaking about. I recognise that in years to come, many of these pharmaceutical assistants will retire, as the last one came into this profession in 1986. One of the first questions I asked my officials this morning was where we were on this situation. Many pharmacies have found circumstances challenging in the past six months and pharmaceutical assistants play a huge role there, especially in rural pharmacies where only one pharmacist might be on duty. They could not operate without pharmaceutical assistants, so I am delighted that the Minister accepted Senator Bacik's amendment. I will speak to him about enforcing it as soon as possible.
I thank the Minister of State for her generous and kind words. It is always lovely to see someone with a Waterford connection in this Chamber, as I have one myself. I am grateful to her for passing that message on to the Minister. Committee Stage of this Bill was held on 18 December 2019, which is when we debated and agreed the amendment. I will not take up the time of the House any further but I wish to express my gratitude to the Minister and Minister of State. I thank the Minister in particular for sending me a letter last week to let me know that this amendment would stand. It is a good day for the Seanad and for pharmaceutical assistants.
Absolutely.
It is also a good day for Senator Bacik's mother. I congratulate her.
I move amendment No. 7:
In page 32, between lines 28 and 29, to insert the following:
“Amendment of section 36 of Act of 2005
29. Section 36 of the Act of 2005 is amended, in subsection (1), by the substitution of the following paragraph for paragraph (a):
“(a) within one year after the board’s establishment day, or within one year of the enactment of this Act if the registration board was established prior to the enactment of this Act, establish a register of members of that profession.”.”.
This amendment is self-explanatory in what it seeks to do by making that addition to the Act. With the indulgence of the Cathaoirleach, I will give a brief background to my proposed amendment. Counselling and psychotherapy, CP, is a relatively new profession in this State. It grew in response to long-standing severe deficits in mental health services and the need for an effective and accessible alternative to the medical model of treatment. It is now developed and well-respected. It embraces a wide variety of issues, including addiction, depression, anxiety states, family problems, rape crisis, bereavement, PTSD, children and adolescent mental health, etc. Four-year training courses to master's level in psychotherapy are now available, as well as three and four-year courses to BA level in counselling in some universities and ITs. The profession is currently self-regulated, with clearly defined accreditation criteria and procedures with two main professional bodies. There are 6,000 practitioners in the State.
Following extensive deliberations, study and lengthy public consultation, statutory registration for CP was specifically approved by the Dáil in 2019 under the Health and Social Care Professionals Act 2005. This was widely considered appropriate for the protection of the public and the development of the profession in the interests of the community. A registration board for CP was recruited by the regulator CORU and established in 2019. During this process, the Government position was that it was pushing through with this registration quickly and decisively as an enlightened policy.
Counselling and psychotherapy has been accorded a key role under the newly-announced Government mental health policy, Sharing the Vision, which has all-party support. For example, recommendation No. 16 of Sharing the Vision states:
Access to a range of counselling supports and talk therapies in the community/primary care should be available on the basis of identified need so that all individuals, across the lifespan, with a mild-to-moderate mental health difficulty can receive prompt access to accessible care through their GP/Primary Care Centre. Counselling supports and talk therapies must be delivered by appropriately qualified and accredited professionals.
It is clear that the sector requires some further development and accreditation regulations to fulfil its mental health policy role.
There are two registers, as announced by the Minister for Health, under the newly-established registration board, for both counselling and psychotherapy. The registration requirement for counselling is expected to be level 8, via a bachelor's degree, while for psychotherapy, at least level 9, a master's degree. The existing professional bodies, such as the Irish Council for Psychotherapy, the Irish Association for Counselling and Psychotherapy and the Irish Association of Humanistic and Integrative Psychotherapy, would lose all accreditation powers in respect of both individuals and courses under the new arrangements. CORU announced suddenly, in meetings with counselling and psychotherapy professional bodies in July 2019, that all this progress was to be stopped and that statutory registration would not happen for at least five years.
This is an area of deep frustration and disappointment for that sector. While I appreciate that it is a sector within the broadest remit of the Department, and that various medical and healthcare services need to be provided, it is crucial that we support it in its work and that it have the opportunity to be registered and accredited in a way that does not raise the bar beyond the reach of many existing professionals.
The wording of the amendment is clear. I wished only to provide some context and I hope Senators will be prepared to support the amendment on that basis.
The amendment relates to section 36 of the Health and Social Care Professionals Act, which requires registration boards to establish a register of members of that profession as soon as is practicable after the registration board's establishment. The effect of the amendment would be to require registers to open within a year of the establishment of a board or, where boards have been established, within a year of the enactment of the Bill, even where the work necessary to open the register safely is not complete.
Registration boards are established under Part 3 of the Health and Social Care Professionals Act, to perform functions assigned to them under the Act. The objective of the registration board of a designated profession is to protect the public by fostering high standards of professional conduct and professional registration of education, training and competence among registrants of that profession. As part of that work, the Act sets out a range of duties the board must undertake, some of which are required before the register can open. By way of example, the board must set standards of proficiency necessary for the profession and the education standards required for registration of that profession. Course providers must then apply to have the course they provide recognised as courses that meet those standards and thereby the threshold for entry to the profession. These courses must be reviewed and assessed to ensure they meet the threshold.
The work required to approve training programmes for entry to the profession is significantly easier for a board overseeing the registration of one profession, in particular one that is long established, such as speech and language therapy. In the case of a board responsible for the registration of two professions, or professions with multiple entry pathways, or where multiple course providers are applying for recognition, such as in the case of social care workers, it is clear the work is much more complex and is likely to take longer. We must not forget that the purpose of regulation is protection of the public by ensuring that registrants of a profession have met the standards set to practise that profession. Where those standards are not set, or are set but it is not clear whether the educational courses provided meet those standards, this poses a clear risk to patient and user safety.
A suite of by-laws also has to be made by the board before a register is opened. The board makes by-laws in respect of the following: applications for registration on the register of that profession; qualifications approved for the purposes of registration, as attesting to the standard of proficiency required for registration; the conditions for registration in a division of a register of that profession; and where applicable, police or Garda clearance, health declarations, conduct declarations, and return-to-practise requirements if an applicant has not practised for more than two years. The board must also review international qualifications as it becomes the competent authority, under EU legislation, to allow international applicants to apply for registration.
Accordingly, mindful of the work of each board to ensure the registers are opened safely, it would be utterly counterproductive and dangerous to impose a statutory date by which these registers would open without any consideration of whether the work necessary to open them is safely completed. Therefore, I must oppose the amendment.
I thank the Minister of State for her comprehensive response. In many ways, we are on the same page in what we are seeking to do. I take her point that this needs to be handled professionally and that we need to ensure the fullest rigour regarding public health and safety and people's well-being, but we are now at a point where we have to act to achieve that. With this amendment, we could add impetus to bring about the necessary change at a critical time when so many people need to avail of a variety of services. In no way did I seek to undermine public safety and the well-being of people availing of any of the services. From engagement with the sector, I am sure it is geared up and wants to proceed, with the Department and Government, in the most collaborative, effective, efficient and safe way possible. Therefore, we need to enable those concerned to get on with that. I will be pressing the amendment to a vote.
Twelve registration boards have been established to date, and eight of these have opened registers incorporating ten professions. The remaining four boards are working towards the opening of the registers for an additional five professions. I fully appreciate that some practitioners and service users may be frustrated that it is taking longer than expected for some registers to open. It should be appreciated, however, that when applying a statutory regulation to a profession, there is only one opportunity to have the register opened correctly. This takes time and must be done in consultation with the relevant professions.
Entry onto a professional register provides a significant signal to members of the public that the individual in question has reached important standards of training, expertise, conduct and competence. Patients can have confidence in someone's professional standing on the basis that his or her qualifications have been independently verified. Limiting the period available to assess educational programmes to less than a year radically undermines this confidence and introduces an enduring patient-safety risk. I do not doubt the good intentions of the Senators in proposing this amendment but, for the reasons I stated, having consulted the regulator and being mindful of the implications for patient safety associated with a mandatory one-year requirement, I cannot support the amendment.
Amendment No. 8 is a Government amendment arising out of recommital proceedings. Amendments Nos. 8 to 12, inclusive, are related. Amendments Nos. 8 to 11, inclusive, are consequential on amendment No. 12. Therefore, amendments Nos. 8 to 12, inclusive, may be discussed together, by agreement. Is that agreed? Agreed.
These amendments are primarily consequent on an amendment made on Committee Stage in the Dáil. In 2017, the Health and Social Care Professionals Act 2005 was amended to provide that persons who were awarded certain specified qualifications after 1 January 2013 could apply for registration to the Physiotherapists Registration Board. It provided a two-year grandparenting window during which appropriately qualified persons, including persons awarded the qualification before 1 January 2013, could seek registration under this provision. This grandparenting clause required applicants to have practice in the State for a minimum period prior to application. This two-year window ran from 20 December 2017 until 31 December 2019.
Legal advice subsequently determined that the 1 January 2013 qualification date requirement introduced under the 2017 Act was legally problematic as it rendered ineligible for registration persons who had received the very same qualification before 1 January 2013 and who also were not able to apply for registration under the grandparenting clause.
This applies to a small number of qualified professionals who may have returned to the State after practising in another jurisdiction or who may have spent a number of years out of practise. It was, therefore, necessary to amend this provision and provide a window during which these people could also apply for registration. Accordingly, an amendment was introduced on Committee Stage in the Dáil that removed the reference to qualifications awarded after 1 January 2013 and extended the registration window for applicants from 31 December 2019 to 31 December 2021. However, as currently drafted, extending the registration window from 31 December 2019 to 31 December 2021 is dependent on the Bill being enacted before the end of 2019. As we all know this did not happen and the registration window closed on 31 December 2019.
If the Bill is enacted, as currently drafted, it will incorrectly imply that the registration window remains open. Accordingly, the amendment proposed here is a corrective measure. It addresses the fact that there is now a period where a cohort of applicants are unable to apply for registration with the Physiotherapists Registration Board, CORU. It allows applications, which were received by CORU prior to 31 December 2019 but where no decision has been reached by the board in relation to them, to be considered as valid applications thereby removing the need for an applicant to submit a second application. Furthermore, it extends the window of registration for qualifying applicants from the date of the commencement of the Bill until 30 June 2022, which I trust will provide a sufficiently adequate time for these applicants to avail of these registration provisions.
The amendment also clarifies that any applications received during the current period when the application window was closed, between 31 December 2019 and the commencement of the section, are not to be considered by the registration board though it is open to an applicant to reapply when the application window reopens.
Finally, the amendment provides that applicants who seek registration under the provision will be required to comply with return-to-practise by-laws in the same way that other applicants for registration, on the Physiotherapists Registration Board, are required.
Amendments Nos. 19 to 21, inclusive, and Nos. 31 to 33, inclusive, are related and may be discussed together by agreement. Is that agreed? Agreed.
I propose to take amendments Nos. 19 to 21, inclusive, and amendments Nos. 31 to 33, inclusive, together.
The Bill as passed by the Dáil amended the Medical Practitioners Act 2007 and the Nurses and Midwives Act 2011 to provide that subcommittees of the preliminary proceedings committee, PPC, and the fitness to practise committee, FTPC, are established pursuant to rules. These subcommittees can perform any of the functions of the respective committee as if they are the committee. This was aimed at better utilising the time of both the PPC and FTPC and facilitating the more expeditious processing of complaints.
The amendments brought forward today provide additional clarity on the procedures for the establishment of these subcommittees. Specifically, they provide that the chairperson or such other committee member as may be designated by rules can establish a subcommittee of the respective committee. As drafted, the provision could be interpreted as meaning the entire committee is required to establish a subcommittee. These amendments remove any risk of ambiguity or uncertainty around the mechanism for establishing subcommittees and I ask Senators to support them.
Amendments Nos. 27, 28 and 34 are related and may be discussed together, by agreement. Is that agreed? Agreed.
These amendments, which are technical in nature, do not arise from proceedings on Committee Stage. Sections 88 and 89 of the Medical Practitioners Act 2007 set out the duties of the Irish Medical Council relating to education and training for medical qualifications. They require the Irish Medical Council to approve programmes of training and the bodies that deliver the training. However, although the Act is explicit that the council may refuse to approve a body as a body that may deliver undergraduate or postgraduate training programmes, the Act does not explicitly provide for the council to refuse to approve an individual training programme.
A similar matter arises in section 85 of the Nurses and Midwives Act with respect to the training of nurses and midwives. This is problematic for both regulators in that whereas they can attach conditions to a programme, they do not have the express power to refuse to approve a training programme that does not meet the required standard.
Both the Irish Medical Council and the Nursing and Midwifery Board of Ireland have identified this as a weakness in the respective Acts and, accordingly, these amendments give both regulators the express power to refuse to approve training programmes.
The Bill amends the Health Act 2004 to give the Minister for Health the power to designate the HSE as the competent authority to compare the equivalents of non-Irish qualifications to the qualifications it sets for certain health professions. These are professions which are not regulated on a statutory basis but are regulated for the purposes of EU Directive No. 2005/36/EC, the professional qualifications directive, for which the Minister is currently the competent authority. On Committee Stage in the Seanad, concerns were raised on behalf of the Environmental Health Association of Ireland regarding the HSE's role as the competent authority for environmental health officers, EHOs, one of the professions for which it will assume that role if so designated. The then Minister for Health undertook to further review the situation before the Bill returned to the Seanad. I understand the Environmental Health Association of Ireland believes there would be a conflict of interest if the HSE acted as both employer and deciding body in regard to the recognition of qualifications. The association is also concerned about the appropriateness of the HSE acting as competent authority for EHOs when it is not their exclusive employer. Many EHOs are employed outside the health sector, for example, by local authorities.
As the then Minister for Health informed the House, the Department received advice from the Office of the Attorney General on how to prevent any potential conflict of interest arising in respect of the HSE undertaking the dual role of employer and competent authority. However, I acknowledge the legitimacy of the other concerns raised by the Environmental Health Association of Ireland, which will need to be reviewed and fully considered by officials. Until such time as they can be fully considered, the Minister is satisfied that it is appropriate and safe for the status quo to remain. It is therefore proposed to remove this provision.
When is it proposed to take next Stage?
Is that agreed? Agreed.
When is it proposed to take next Stage?
Is that agreed? Agreed.
I thank the Minister of State and congratulate her on her appointment. I know she will do a fantastic job. I thank her for coming to the House today and speaking on behalf of the Minister for Health.
I would like to say a couple of words. It is great that this Bill has been passed. I would like to thank Opposition Members for their contributions, their suggestions and their amendments to the Bill as it passed through these Houses. I thank the Minister of State, Deputy Mary Butler, for her attendance here today. It is a difficult time for all of us but we know that everybody in the Department of Health is under particular pressure, so we appreciate the Minister of State's work.
I wish to join others in thanking the Minister of State for getting this Bill through at such a difficult time for all of us, particularly for those in the Department of Health and front-line healthcare workers. Although it is largely technical it is good to see this Bill passed. I am particularly pleased for pharmaceutical assistants to have the recognition that section 53 will provide.
I wish to congratulate the Minister of State and wish the legislation well as it passes its next steps. I wish to echo the words of thanks and commendation for all those working in the Department, particularly those working on the front line of our healthcare services. It is a challenging time, but I know this Chamber stands ready to assist in all efforts to help the Department and all those working on the front line.
I wish to thank all the Senators here today for helping to progress this Bill. This Bill has been in train for quite a long time and I especially wish to thank the officials from the Department for all the work they have done on it. The purpose of this Bill is to improve the registration and fitness to practise processes of the health professional regulatory bodies and to amend the five health regulatory Acts to give further effect to the EU professional qualifications directive. This modernised directive provides mechanisms for the recognition of professional qualifications and the conveyance of disciplinary information within the European Union.
As we all know, we are in the midst of a pandemic.
It is a very difficult time for all front-line staff, all the people in our country and especially all the families that have lost loved ones so this Bill is timely. As I said to Senator Bacik earlier, I will speak to the Minister on the part she is interested in and we will get it moved on as quickly as possible.
It is my first time in this Chamber since the new Seanad was convened and I congratulate the Cathaoirleach on his election. I also congratulate Senator Joe O'Reilly on being elected Leas-Chathaoirleach of the Seanad today and I congratulate all new Members of this House. It is great to see the Dáil and the Seanad up and running and we can now get through the legislative work, which is so important. Gabhaim buíochas leis na Seanadóirí.
