The meeting has been convened to consider the Committee Stage of the Regulated Professions (Health and Social Care) (Amendment) Bill 2022. Among other matters, the Bill provides for issues relating to the registration of social care workers, the complaints investigation function of the Medical Council and the registration of doctors. I welcome the Minister for Health, Deputy Stephen Donnelly, to the meeting this morning. I remind members that should a vote be called, they must physically come to the committee room in order to vote. I call the Minister.
Regulated Professions (Health and Social Care) (Amendment) Bill 2022: Committee Stage
SECTION 1
I am happy to move straight to the amendments, if that suits the Cathaoirleach and committee members.
Amendments Nos. 1, 2, 4, 5 and 8 to 11, inclusive, may be discussed together.
I move amendment No. 1:
In page 5, line 16, to delete “This Act, other than Part 4,” and substitute “Section 6”.
These are technical amendments relating to numbering issues.
What do these amendments propose to do that was not provided for before?
They just relate to numbers. Various subsections and sections change as part of the amendments.
They are tidying up the legislation.
Amendment agreed to.
Section 1, as amended, agreed to.
Sections 2 and 3 agreed to.
SECTION 4
I move amendment No. 2:
In page 6, line 3, to delete “subsection (2)” and substitute “subsections (2) and (4A)”
Amendment agreed to.
I move amendment No. 3:
In page 6, line 10, after “State” to insert “, a Member State or the United Kingdom”.
Social care work is a designated profession under the Health and Social Care Professions Act 2005. The profession, as members will be aware, is due to be regulated by CORU in November this year. This Bill, as initiated, proposed amendments to the registration of social care workers during the two-year period following the opening of registration. During this period, special provisions allow for the grandfathering of existing practitioners, who do not hold the current approved qualifications but were legally practising the profession for a prescribed period. It is standard policy that when a profession is being regulated like this for the first time, there is a grandfathering aspect to it for existing practitioners. It was considered that the 2005 Act was not sufficiently clear that applicants seeking registration through grandfathering must have gained their professional experience in this country. One of the Bill’s original provisions was to make this more explicit.
Following Second Stage, concerns were raised by the Attorney General's office that the obligation that experience must have been gained in this State might not be compatible with EU law for reasons I think we all understand. This has therefore been further explored and legal analysis has concluded that the grandfathering route to registration must be available for appropriate experience gained in any member state to avoid the risk of indirect discrimination. Accordingly, this amendment provides for that.
I hope members will agree in view of our historical co-operation in matters relating to cross-border healthcare and strong worker mobility between Britain and Ireland and our unique geographies. I also believe it is important to make provision for acceptability of experience for the UK. It is essentially the EU and the UK. It upholds the common travel area, supports broader service provision and essentially makes it easier for workers North and South and east and west. CORU’s original position had been for a patient safety reason, it would be easiest for it to stand over experience gained in Ireland. The Attorney General felt we needed to go broader, to the EU and I have gone one step further and added Great Britain and Northern Ireland.
Is there practical evidence to underline the points made from cases in the past that showed blockages in the system regarding employment of professionals in this jurisdiction? On the one hand, there have been several controversial issues in recent years and it appears that permission should not have been granted by whatever means for some professionals who ended up on the wrong side of the law. Will the Minister shed some light on that? We all deal with these cases from time to time but we tend to move on afterwards and take it as read but still they come up again. In veterinary practice, it is almost like getting the proverbial camel through the eye of a needle because the profession protects itself but that does not necessarily protect standards, even though there is a severe shortage of practitioners. Are we satisfied that the questions that arose are now being fully addressed?
Yes, I think we are. A later, substantial amendment deals with what guidelines CORU will put in place for employers to certify that the type of work experience discussed in this amendment is legitimate and can be considered sufficient to be registered. There are a few different aspects to the matter. The first is whether we are in compliance with EU law. Part of what this does is it makes sure we comply with our EU obligations. As committee members will be aware, we recognise medical or nursing qualifications from any member state and the UK. One amendment we will deal with later is to allow UK medical students or medical graduates to do internships in Ireland; the post-Brexit aspect is recognised. We have established practice and regulation around recognising qualifications and experience from other EU member states and the UK. We may be thinking of the same cases.
There have been doctors, for example, who were granted a licence to practice here, including from the UK, and things did not turn out so well. That is an ongoing matter for the regulator, the Medical Council, the employer, and CORU, in this case, for social care workers. The obligation in the first instance is with the employer. If any employer hires anyone from anywhere, from our country, the UK or any EU member state, there is an obligation on the employer to make sure that person is fit to practice, adequately supervised and that all of the necessary, normal patient safety issue measures are in place.
An additional benefit of moving to a regulated profession - exactly the Deputy’s point - is that for the first time ever, social care workers will be obliged to do continuous professional development. In a 12-month period, they have to do quite a significant amount. This is completely new. To date, this has been an unregulated profession, even though we have some very fine college graduates with superb training and degrees in the area.
What this Bill will do is make sure that exactly the kinds of quality control that the Deputy is raising concerns about will be in place through continuous professional development and through regulation.
Are there likely to be any unforeseen consequences?
The nature of unforeseen consequences is that it is difficult for me to say that they will arise. We have to endeavour, as with all of the healthcare professions, to make sure they are well regulated, well supported, feature continuous professional development as part of that and that we as legislators make sure that the regulators – the professional bodies and training bodies – have what they need to ensure patient safety and quality. It does not mean that there will not be issues. I can get the numbers but I think there were about 55 complaints to CORU about individuals in the regulated professions annually over the last few years. There will always be cases where patients want to voice concerns to the regulator. We just need to make sure that the right processes are in place to respond to that.
I think we have drifted into amendments Nos. 4 and 5.
If I may come in, I wish to raise the issue of recognition and the grandfather clause. A problem arose before the Minister’s time on the specialist register in the medical profession. We had to do amending legislation to deal with it. Have we made sure that a glitch like that does not arise in this case?
Can the Deputy give me more information on that?
The regulation came in where there was an obligation to go through a set training process to get onto the specialist register here in Ireland as a medical practitioner and there was an issue with people who trained under the old system. For argument’s sake, let us say that the regulation came in on 1 January. Anyone who was already in a consultant post on 1 January immediately got onto the specialist register but anyone who took up a job on 1 March and they had trained under the old system were not entitled to get onto the specialist register. We had to do amending legislation in the last two years to deal with that particular issue. Have we made sure that we do not have a glitch like that in the system that we are looking at the moment?
We are very much into amendments Nos. 4 and 5 here. I will be guided by the Cathaoirleach. We can discuss it now.
Take it now.
Is that okay? I am fine to discuss it now but this is very much covered by amendments Nos. 4 and 5. The proposed approach is that the CORU will open the period of registration from November and there will be a two-year period when social care workers can register. There are a few different routes to registration. There are competency-based exams; the professional qualifications which are contained in the schedule where there are now 30 courses which are now covered and understood by CORU to be the courses; and there is also this grandfathering, which goes to Deputy Burke’s point where there is a list of qualifying criteria. I think this is in amendment No. 4 or 5. One of the criteria would be a letter from an employer or a previous employer but critically against very clear guidelines that will be set out by CORU. It is not just an employer saying whatever it wants. CORU can also decide whether it is satisfied that any individual employer is legitimate, or whatever the right word might be. There is this two-year period where work experience, according to a set of guidelines that CORU will issue to employers and only for employers that CORU deems appropriate will be able to grandfather across. When that grandfathering period is over then that is that. You will need the other criteria to kick in like having one of the qualifications.
I thank the Minister for the clarification.
Amendment agreed to.
Amendments Nos. 4 and 5 are related and may be discussed together. We have already had discussion on them. Does anyone wish to add anything?
I have come across a number of conflicting situations that can arise where professionals may have competence or recognition in another field that is not their own area and it may require specific qualification. To put it crudely, say an engineer in construction may not be appropriate even though he or she might have a good grasp of the subject but they do not have a qualification in that area. What do they have to do if they want to get the benefit of the provisions in amendment No. 5? It states “the person holds a professional qualification that, in the opinion of the Social Care Workers Registration Board, is sufficiently relevant to the profession of social care worker....”. In other words, I would think one would need to have majored in the area in question in order to be able to say that one’s opinion is superior or equal to all others. That is often not the case outside of health but it is the health qualification that I refer to here.
Can we hear the Minister’s rationale for No. 5?
I move amendment No. 4:
In page 6, line 16, to delete “and”.
Amendment No. 4 is consequential on No. 5. The Bill as initiated sought to remove a provision in CORU’s legislation which would allow social care workers to seek registration on the basis of their employer's opinion of their proficiency during the grandfathering period. That speaks directly to the point that Deputy Durkan made. The Bill as initiated sought to remove the ability for workers to get on to the register based on the employer's opinion. That was the Bill we discussed on Second Stage. It was proposed to replace this with a requirement that practitioners who do not hold an approved qualification must pass a competence test. That proposal was introduced on the basis of concerns by CORU which advised that its implementation could be challenging. At the time of the Bill’s Second Stage debate, legal advice provided to my officials suggested that in order to ensure full compliance with an EU directive on the proportionality of professional regulations, a public consultation on these measures should be carried out. That directive requires member states to conduct a public consultation and an assessment of the proportionality of any new or amending regulatory provisions which may result in restricting access to a regulated profession, that is, exactly what we are doing here. The public consultation took place in November and sought the views of a broad range of stakeholders. The outcome suggested that an overly challenging assessment process and, in particular, the obligation to sit a competency test could potentially remove a large cohort of existing practitioners from the social care workforce. Concerns were also raised that the new measures did not adequately recognise that existing social care workers are employed in diverse settings. Some very competent practitioners might now have specialised skills and could have difficulty passing a broad assessment. If dedicated, competent and experienced staff were unable to continue in their profession, services and clients could be very severely impacted. My officials assessed the potential negative impact on the existing practitioners of the proposed amendments from both a proportionality and fairness perspective. The risks identified by CORU were also re-examined alongside other risks such as the impact on service provision and ultimately the patients’ safety in the event that the supply of social care workers was diminished by the new requirements. CORU was also consulted and the conclusion from the exercise was that registration through the employers attestation of proficiency during the grandfathering period should be retained. However, in order to maximise patient safety, I propose to make clear that the social care workers registration board may refuse to grant registration in various circumstances. Examples include where there are doubts as to the competence of the employer or the duration of employment.
Amendment No. 5 states that one or more requirement specified in subsections (d)(i) to (iv), inclusive, must be met. The requirements are as follows: (i) the person holds a qualification listed, that is the current 30 courses; and "(ii) the person holds a professional qualification that, in the opinion of the Social Care Workers Registration Board, is sufficiently relevant to the profession of social care worker" - that relates to the point that the Deputy was making - "and attests to a standard of proficiency corresponding to a qualification listed opposite the profession in the third column of Schedule 3."
The third requirement is: "(iii) the person successfully completes an assessment of professional competence set by the Social Care Workers Registration Board in accordance with any guidelines issued by the Council". The fourth is: "(iv) subject to subsections (2A) and (3), the person’s employer or former employer attests, by written opinion, to the person’s having achieved the standard of proficiency required for the practice of the profession of social care worker". There are additional safeguards around that. CORU can say, for example, that it does not accept a certain employer or it does not accept an employer's evidence, level of proficiency as standard or timelines. CORU will issue a very detailed guideline of what an employer must consider when attesting to the proficiency of any member of staff. CORU, at any point, can say on an individual application or to an employer in total that it does not accept the evidence at all or in regard to the individual employee.
Is the Minister talking about all professions here?
No, just social care workers.
Just social care. Amendment No. 5 applies only to social care.
Let me just grab a copy of amendment No. 5.
It is the long one.
Yes. I beg the Deputy's pardon.
It applies only to social care.
It seems the intention of this is to lower the bar. I do not know if that is the case but my impression is that the bar for standards in social care is being lowered. I am sure there are potentially safety issues and risk issues involved in that but what concerns me is that there is not consistency. The work the board is doing is about assessing the level of risk and saying that there are some professions that would put patients potentially at much greater risk than social care workers would. The need to assess the risk for the other professions that are not included in CORU is being reviewed. Yet, in relation to social care, the standard is being lowered. There is a lack of consistency here. It seems to be kind of backfilling to address the issue that arose last year in relation to students in the business school.
That is a slightly different issue but I hear the Deputy's point on the amendment. I share her concern and I interrogated the issue at length with officials. Essentially, the following happened. In the Bill as we discussed it on Second Stage, the employer route was not included. In order to comply with the EU directive post Second Stage, there was a public consultation. Social care workers were spoken to and employers and CORU were engaged with. We have thousands of social care workers across the country. The competence-based exam would reflect much of the college training, which covers all of the different sectors. There is training in homelessness, disability, addiction – various different areas. Many social care workers will have spent their entire career in addiction services, disability services or homeless services and have never been trained in all the different areas. The view expressed was that while an awful lot of them are excellent healthcare professionals who are highly trained and experienced and definitely should be on the register, they have not been trained in all these other areas and, as such, will not pass the competency exam. What would then happen is that thousands of social care workers would potentially be told they cannot work where they are working or in their profession.
In this amendment, we are trying to find the best outcome for patient safety. A person may have ten years’ experience in homeless services. CORU has to be satisfied of the bona fides of the employer. If that person’s employer can certify their experience, and CORU is satisfied with the individual evidence given, which has to be given according to very strict guidelines set out by CORU, that person can be grandfathered in. That is part of the grandfathering process, which is normal enough. Whenever we do this, there is a grandfathering period for those who do not have a college degree or whatever it might be. This is the best outcome.
While I understand the aim of the proposal, what will be the outcome in relation to standards? For example, the Minister talked about somebody who could have ten years’ experience in addiction services and is very well qualified in that area. Does that person’s employer then say the person is suitably qualified to work in social care across any of its elements? The fact that somebody has a lot of experience and is well qualified in addiction services does not mean that he or she is appropriately qualified, say, in older people services or children’s services.
That is true. However, the profession does not have different subsets. It is not that someone is a social care worker in one of those areas. I hear the Deputy and I do not disagree with some of the positions she has taken. I have had the same conversation with the officials. However, the view is that social care is single regulated profession. Therefore, if a person has sufficient experience in the view of CORU, and in the view of the person’s employer under the CORU guidelines, that person can be on the professional register. Even though that person may never have worked in disability services and will now work in disability services, that person would not have the modules that a college-trained social care worker had in those disability areas.
That is a strange approach to take on standards.
I agree.
The Minister is saying that a person is qualified to, for example, work in older people services, even though he or she may never have worked a day in older people services.
We are saying that the person is a regulated social care worker, based on experience.
We are talking here about the quality of the regulation, however.
That is right.
Declaring somebody qualified in one aspect of social care does not mean that he or she is qualified in other aspects of it. That is what the Government is seeking to do with this amendment.
We are seeking to have a professional register for social care workers. We are cognisant that social care workers, by their nature, work in different aspects of healthcare and social care. They may work, for example, in disability services, addiction services or homeless services, and various other services. We are creating a professional register. I hear the Deputy and I do not disagree. Moving to regulate a profession in which the vast majority of members have been working for many years outside a regulated environment is not a perfect mapping. It is not like saying that all of our doctors have a medical degree and we can work like that. The grandfathering process is not perfect.
We have thousands of highly trained and experienced social care workers and we are moving to a regulated profession. We have to find a way to move them across. The original way, which is a reasonable proposal, is the competency-based exam, which goes exactly to the concerns the Deputy is raising. That is still one of the mechanisms. However, through the public consultation that took place from November, a conclusion was reached that if there was only the competency-based exams for those who have not reached level 7 – I think it is level 7 that is required for the courses – we would potentially lose thousands of high-quality, experienced social care workers. The question then arises of how we deal with that. None of this is perfect but this was the best solution found. CORU will issue some clear guidelines on what is expected and the employer will attest to those guidelines and experience having been met. CORU can then say "No" on any individual application or any individual employer and then, critically, once the social care workers have registered now for the first time, they must now engage in continuous professional development. The continuous professional development will speak to some of the concerns the Deputy raised, which I share.
I have had exactly this conversation with the Department.
Just to clarify, is the Minister saying they must engage in CPD?
Who arranges that?
The profession arranges that, but CORU will oversee it. They must have a certain number of hours or units of CPD per year.
Therefore, that would be a requirement for all social care workers.
What is that requirement?
It is 30 CPD credits in a 12-month period.
I just think it would have been more appropriate to have some kind of conversion course for people in those circumstances, people who only had experience and expertise in one particular element of social care.
Yes. May I just say-----
It seems to be a case of needs must, which is not the best way of regulating.
It is not perfect, but I think the CPD almost is the conversion course. There are thousands of these health professionals across the country.
I am a bit uneasy about this. My unease has not been in any way assuaged. I know the Minister is very persuasive.
I raise another issue which is not directly related to this one but which it affects professional individuals who may well have a degree in one area and feel that with a little bit of training, on-the-job practice and so on they will be suitable to deal with, for instance, children's rights in the courts because these cases end up in the courts. Some of them are there now. I have found there is a strong lobby of people who question the qualifications of the people who give expert evidence in the courts on matters very close to the subject we are discussing. Are the amendments we are discussing now likely to enable people who do not have appropriate qualifications, which are being questioned now, to practise as they wish to? A Supreme Court judge recently raised questions about expert witnesses and their appropriateness. It would almost appear that they were achieving celebrity status and that a number of such people covering that area in the courts were either tutors to or tutored by some of the other people who practise along with them and who are being questioned similarly.
I am still uneasy. In respect of the issues that I have referred to, I do not want somebody coming along in six months' time saying that we have resolved that problem now. That is what they see in it and I do not see a resolution coming that way. It may need to be resolved in a different way altogether with the appropriate training etc., for the person with the appropriate academic qualifications. In other words, going back to my original statement, there is not much sense in having a civil engineer, who could be a very important witness in a case in question, on the basis of on-site training. It is likely to create really serious controversy.
Last night, I had somebody on the telephone who pointed this out to me. This is a person I am well aware of, unfortunately, but they were not withdrawing from the scene. They were emphasising the point of appropriate academic qualification. In whatever sphere, there should be some correlation and we should not find ourselves having to create the situation to fill the need at this particular time. There is a habit of legislation in this country growing and extending itself by its own volition and need, as the case may be. It then becomes established and we find out a little further down the road, that it was not really appropriate and we should not have done it. That is the story of our lives unfortunately in this country.
I am particularly concerned about it in this social care area and the way the professions feel about it. As Deputy Shortall pointed out, this might solve the issue of filling the posts and so on, but if we fill the posts inappropriately, it is still not right.
The Deputy mentioned a few things. The appropriateness of an expert witness or so-called expert witness in court is a matter for legal teams and the courts. We are in the healthcare business and we are regulating a profession here. I am not dismissing the Deputy's concerns, but I think they have been dealt with. My understanding is that legal teams can question the appropriate qualifications of any expert witness or so-called expert witness.
There is a problem with that.
I do not think we can deal with that within our own thing.
They cannot; that is the problem.
We are in the business of healthcare, however. I share the concerns that are being raised by committee members. I raised exactly the same concerns, myself. This is a change. The original Bill we debated on Second Stage did not allow this particular mechanism. We are not creating a workforce from scratch here. We are not saying that we have a new regulated profession and we will start to fill the register based on college graduates who have three-year or four-year full-time degrees in training. The graduates coming out now are really highly trained. We have these 30 courses. CORU has pored over the suitability of the courses, modules and so forth. That is not what we are doing.
These 10,000 to 12,000 workers already exist. They are out there working in disability services, homeless services, addiction services and other services, and have been for many years. They already exist; they are doing a great job. By and large they are really good important healthcare professionals. Now for the first time we are about to regulate this group of people and what they do. There are recognised college courses, recognised competency tests and recognised experience. There are various safeguards in place in respect of all those things. As we move to a regulated profession, there will be CPD.
CORU is now in as a regulator. There will be a mechanism for professional complaints to be made. We need to bear that in mind. We are not starting from scratch here. This is a grandparenting process. Such a process is rarely a simple transition, and certain calls need to be made. There are at least five different quality-control measures in place here. The first is that it is time bound. This registration will only be open for two years. After that people cannot come along and say that their employer testifies to their many years of experience and so forth. Therefore, it is time bound. The second is the breadth of the assessment. An employer looking to attest to someone's qualifications will need to consider five separate domains: professional autonomy and accountability; communication, collaborative practice and team working; safety and quality; professional development; and professional knowledge and skills. Those are the five areas that need to be gone through. They will be fleshed out in much more detail by CORU. The third is the duration of employment - at least six months of the two years must be with that employer. The fourth is the competence of the employer. CORU can determine whether it is satisfied or not. The fifth, of course, is CPD. All registrants will be required to achieve 30 credits within a 12-month period.
We are taking an existing workforce, doing an existing job where there is no regulation. The concerns raised by committee members are the same as those I raised with officials when I said, "Hang on a second; what happens if a social care worker in the disability sector applies for a job in homeless services or in addiction services?"
In the first instance, the employer will have to satisfy themselves that this person is appropriate to do the job. The Deputy referenced engineering. I am an engineer. I was a mechanical engineer.
I know that.
However, mechanical engineers are not employed to pour concrete or build buildings for very good reason. They might be a certified engineer but they are not trained in that, so no employer would employ a mechanical engineer to build roads or pour concrete. We are dealing with a situation where an unregulated group of healthcare professionals, who are interacting with vulnerable people, can move wherever they want. There is no oversight, regulation, or requirement for continuous professional development but we are now regulating that, which is going to materially improve the safety. However, I fully agree that the two-year grandfathering process is an imperfect process.
This is the last intervention. I am still not satisfied. The reason I am not satisfied is that over the past 12 months in particular, I have had numerous conversations along these lines, not directly related to what we are at but some of the people involved and likely to be regulated may be affected. This may allow some of people who are not regulated at present to become regulated because they are in situ already doing the task. This is being hotly challenged by those who strongly object to these people, given their present qualifications, sitting in judgment in an area in which other people have particular expertise. There are strong challenges coming from that and eventually it will have to be dealt with. I do not want to see a situation arise where somebody tells me in six months' time that they had a difficulty, which they did not admit to, or that they were incompetent in terms of dealing with a particular subject but that now that it has been changed under Regulated Professions (Health and Social Care) (Amendment) Bill 2022, they have resolved the problem. I do not want to see that happen because I would have at least as strong an objection to that happening as I would to anything else that is likely to happen.
This does, and can, end up in court. The reason I keep mentioning court is that many cases in this particular area end up in court for one reason or another. That is when the professions are challenged by the opposite side, that is, if they are allowed to be questioned by the other side because in some cases they are not allowed by virtue of the coterie of people who are involved. They all say they agree with something. They do not say they tutored that person, or were tutored by that person. In one particular case, the court dismissed the approval one professional was giving in a situation on the basis that it was his own thesis and that he had taught his pupil well. The judge questioned this and disallowed it but not all judges do that.
I have problems with this and the Minister has problems with it too because there is obviously a move in some quarter to cover something that has not been covered so far. The Minister knows that as well as I do. I strongly urge caution if we fall into that particular trap of empowering people who do not have the appropriate powers at the moment, and giving them that cover. I reserve judgment and I am not a judge.
I concur with the point made by Deputy Durkan. It is a poor attempt to deal with something that should have dealt with long ago. This raises very big questions about CORU and about the legislation. I do not think the response is adequate.
Does the Minister want to reply?
I think we have covered it.
Is the amendment agreed to?
I accept it reluctantly. I emphasise "reluctantly".
There is no need to put it to a vote then.
I will be the first person to raise this if I see it going into practice as we have feared.
Amendment agreed to.
I move amendment No. 5:
In page 6, to delete lines 17 to 19 and substitute the following:
“(b) applies during the transitional period to the Social Care Workers Registration Board for registration,
(c) complies with section 37(2) and with any requirement imposed on, or request made to, the person under section 37(3) as applied by this section,
(d) meets one or more of the following requirements:
(i) the person holds a qualification listed opposite the profession of social care worker in the third column of Schedule 3 or a corresponding qualification;
(ii) the person holds a professional qualification that, in the opinion of the Social Care Workers Registration Board, is sufficiently relevant to the profession of social care worker and attests to a standard of proficiency corresponding to a qualification listed opposite the profession in the third column of Schedule 3;
(iii) the person successfully completes an assessment of professional competence set by the Social Care Workers Registration Board in accordance with any guidelines issued by the Council;
(iv) subject to subsections (2A) and (3), the person’s employer or former employer attests, by written opinion, to the person’s having achieved the standard of proficiency required for the practice of the profession of social care worker,
(e) satisfies the Social Care Workers Registration Board that the person is a fit and proper person to engage in the practice of the profession of social care worker, and
(f) pays the required fee to the Council.”,
(c) by the insertion of the following subsection after subsection (2):
“(2A) Nothing in subsection (2)(d)(iv) shall be construed to prevent or restrict the Social Care Workers Registration Board from refusing to grant registration to a person where it is satisfied that it is in the public interest to do so having regard to the person’s proficiency in the profession of social care worker by reference to—
(a) the competence of the employer or former employer concerned to form an opinion, or
(b) the duration of the employment relationship between the person and the employer or former employer concerned.”,
(d) by the substitution of the following subsection for subsection (3):
“(3) An opinion is not valid for the purpose of subsection (2)(d)(iv) unless the employer or former employer concerned has, in forming the opinion, adhered to any assessment guidelines issued by the Council for that purpose, including on—
(a) an employer’s competence to form an opinion for the purpose of subsection (2)(d)(iv), and
(b) the minimum duration of an employment relationship between the applicant and an employer required to form an opinion for the purpose of subsection (2)(d)(iv).”,
(e) by the deletion of subsection (4), and (f) by the insertion of the following subsection after subsection (6):
“(7) In this section—
‘Member State’ means—
(a) a state, other than the State, which is a member of the European Union,
(b) a state, other than a member of the European Union, which is a party to the agreement on the European Economic Area signed at Oporto on 2 May 1992 as adjusted by all subsequent amendments to that agreement, and
(c) Switzerland;
‘United Kingdom’ means—
(a) the United Kingdom of Great Britain and Northern Ireland,
(b) the Channel Islands, and (c) the Isle of Man.”.”.
Amendment agreed to.
Section 4, as amended, agreed to.
Section 5 agreed to.
NEW SECTION
I move amendment No. 6:
In page 7, between lines 6 and 7, to insert the following:
“Report into the future of regulating health and social care professionals
6. The Minister shall, within 3 months of the passing of this Act, prepare and lay a report before both Houses of the Oireachtas, and the relevant committee, setting out the implications of introducing an established criteria for determining which health and social care professions to regulate into the future under the Act of 2005.”.
My amendment requests that the Minister shall with three months of the passing of this Act, prepare and lay a report before both Houses of the Oireachtas and the relevant committee, setting out the implications of introducing established criteria for determining which health and social care professions to regulate into the future under the Act of 2005.
I repeat the point I made a few minutes ago which is that there are serious questions about the operation of CORU. There are serious questions about the fact this is legislation from 2005 to regulate health and social care professions. It stipulated that CORU would regulate 17 professions. It opened registers on ten of those. This is 2005 legislation and CORU has only opened registers on ten of these with some preparatory work going on on the remaining ones. What happens all of those other professions that were not included in the original legislation and other professions that have evolved and developed since 2005? Medical science moves pretty quickly and there are many new areas, especially related to diagnostics, that should be included in the CORU professions but were not included. The idea with starting with setting out in legislation what the totality of the professions to be regulated should be was a flawed approach. It should have been possible to add to that list of professions as new professions evolved.
One would have to ask why progress has been so painfully slow in including all of the original 17 professions. Questions have to be asked about the appropriateness and the competence in such an important area in terms of regulating different health and social care professions. At the end of the day, this is about ensuring risk is minimised and that patient safety is the priority. How can the Minister give any kind of assurance that patient safety is a priority when patients are being treated by professionals who are not regulated? That is not to say for a moment that all health and social care professions have to be regulated. It is about assessing the risk and then identifying those professions that carry a high risk.
However, that has not been the approach taken in this country. It is the approach taken in other countries and we have something to learn from it. In the past while, I have had dealings with many different professional organisations, including the Irish Institute of Clinical Measurement Science. With the progress being made in diagnostics in particular, we have a very large number of clinical measurement physiologists. These are people who operate different diagnostic machines. Clinical measurement is carried out across five disciplines within clinical measurement science. These professionals are responsible for diagnostics and the monitoring of disease within cardiology, gastroenterology, neurophysiology and respiratory and vascular medicine. They are key people in medical science and medical care but their field is not regulated. They have been in touch with the Department on an ongoing basis to seek regulation but it has not happened. These are people who are crying out for regulation. It is a really important science and a really important profession. They could do so much more including, in many cases, replacing consultants. Croí gave a very good presentation on this last year. It showed how medical scientists can measure heart function in the same way that people previously had to be referred to a consultant and go on a waiting list to avail of. There are many new professions that can greatly improve the level of care people receive. They want to be regulated.
I will mention another profession, that of athletic therapists. For at least the last two years, the Minister has received representations from Dublin City University and also from South East Technological University, specifically from what was previously the Institute of Technology, Carlow. These institutions are providing very high level training courses in athletic therapy. Athletic therapists are people who deal with injuries in all areas of sport but who also deal with other recreational injuries and workplace accidents. They can manage a great deal of demand in that area as it relates to musculoskeletal injuries and yet there is no move to regulate their profession. Both of those universities have been appealing to the Minister for some time. They are saying that the absence of appropriate recognition is unfair to those who have qualified in this discipline as it precludes them from taking up roles in a number of areas, including in HSE facilities throughout the country. There is terrific capacity there but these therapists are excluded because of the absence of regulation. They do very high quality training courses and are really well qualified people. They should be fully utilised. The universities are also concerned that the absence of appropriate recognition has the potential to increase patient risk. These are two key areas the Minister should be concerned about: availing of as much capacity in the health service as possible and ensuring that patient risk is reduced.
These are two major areas that are crying out for regulation and there does not seem to be any plan to regulate them. Equally, as members of the committee, we all received correspondence from the Irish Dental Association yesterday. That association proposed amendments to this legislation. It is looking for regulation as well. It is seeking statutory continuing professional development training for dentists to be recognised. It says that there are a number of gaps in the Dentists Act 1985 and, again, that there is the potential for serious risk. The association wrote to the Department in 2021. It is looking for inclusion by way of amendment to this legislation.
In a reply I got from the Minister, he referred to 20 different professional groups that are not included in the CORU legislation. It is not clear what approach the Minister is taking to these groups. There is an argument for going through each one and adding them in a Schedule to the Bill but one has to ask whether there is sufficient capacity within CORU. If it could not deal with the original 17 going back over all the years since 2005, how could it have the capacity to deal with another 20? This is a very urgent matter. I recognise that the Minister asked the Health Research Board to take a look at the matter and see what has happened in other countries. It is saying that regulation should be proportionate to the level of risk posed by health and social care professionals. I accept that fully. Some pose a lower risk and not all need high level regulation. However, what is the Minister doing about it? As I have said, there have been very strong appeals from very important categories of health and social care staff and from their training bodies but there is no indication of what the Minister intends to do to address the very concerning shortcomings within CORU and the legislation underpinning it not being fit for purpose. With this legislation, he is amending the Act to only a very minor degree when there is major work to be done as regards amending that original legislation.
My amendment seeks action on this matter within a reasonable period. It requests that the Minister bring forward a report in three months setting out how he intends to proceed with regard to the major gaps in regulation which exist in this country in respect of health and social care professionals. I appeal very strongly to the Minister and to other members of the committee to support the amendment. It is reasonable and proportionate. We need to recognise the significant gaps that exist and see some progress.
I still have issues. I do not want to vote against a Bill sponsored by Government but I will not vote against my conscience either nor will I vote contrary to what I have learned over the past number of years about people who, while in a different category, will definitely be affected by the legislation. I know what is going to happen. Constituents whom I have represented have claimed that they are not getting fair play in the courts because these professions are not regulated. The so-called experts do not have appropriate qualifications. I know what is going to happen. They will have appropriate qualifications after this legislation is passed. I ask the Minister to look at it again, if necessary. We should adjourn the meeting today and the Minister should come back before us some day next week or as soon as possible. It is important enough to do that. Deputy Shortall was the leader of a party. The Minister himself was once a member of that party himself so he has experience of two sides of the House. I am a mere backbencher and backbenchers have a certain sort of anti-aura surrounding them. Their opinions are only tolerated and not necessarily taken into account. This one will be taken into account as far as I am concerned because I have been given the runaround for as long as that has been possible. The whole thing comes down to the competence of the so-called qualified experts.
In family law courts this crops up on a regular basis. It is controlled and continued by the same people. An equal number of people or more strongly object to it. I am in the presence of a good lawyer here as well but notwithstanding the law and the professionals in that area, I challenge what this might do to make my job more difficult. I know my job reasonably well. I would ask the Minister to hold off for the moment and consult with some of the people concerned. He should be able to tell me whether the issues I have raised are affected, or if they are going to be affected in one way or the other. I know they will be. I do not want to hold against the Bill but if I am forced to do it, I will.
I have no difficulty in principle but the period of three months is way too tight. In fairness to the Department there is a fair bit of work involved in that. If the three-month period was modified I would certainly take serious consideration of the amendment but that timeframe is far too tight.
I will just point out that the Health Research Board, HRB, has produced its report so it is a matter of a decision being taken in the Department.
In fairness to the Department, there is a bit of work still involved in going through what has been produced and what needs to be dealt with, looking at all the different angles. I think a three-month period might be a bit too short. I am not sure of the Minister's view on it, even if the time was extended to allow the Department to deal with the issue.
I thank the Deputies. There is a lot to unpack there. On the procedural point, I am not minded to postpone the proceedings. This is an important piece of legislation. I am very happy to discuss these issues with Deputy Durkan off-line. I have not heard them before and I do not have the detail. I am very happy to meet him and discuss them. We have Report Stage still to come. I do not think it would be helpful to adjourn Committee Stage although obviously that is a matter for the committee, not for me. It is certainly not a call I would be supporting. However, I am very happy to discuss these issues with Deputy Durkan. I would need to understand exactly how they relate to the regulation of the profession. It sounds like a concern that is not just about social care workers but something one could raise across many different aspects. It is much broader than this legislation. I am very happy to discuss it in detail with the Deputy off-line. If he would like a meeting with the Department I will certainly arrange it and we can work through his concerns in detail and get him a very detailed response.
I would be happy with that. The last word comes in the operation, afterwards. I know of mothers who have had their children taken away from their custody and put elsewhere on the expert advice of a so-called qualified professional. It impinges on this area. It is about childcare and social care. On the basis of the evidence, these things have happened and continue to happen. The courts present someone as an expert witness but the women come back and say the person is not an expert witness as they have no qualification in that particular area at all. They are establishing it as time goes by and have become experts in the area, to the extent that a Supreme Court judge commented that they were taking over the job of the courts and there was no need for the courts at all. It was just a matter of referring to the expert witness who is now a celebrity. It is crazy stuff.
It sounds like it is an issue that would need consideration by my Department, the Department of Children, Equality, Disability, Integration and Youth, the Department of Justice and maybe others.
That is correct.
In the first instance, I will organise a meeting between the Deputy and my officials and maybe we could discuss it there. It sounds like a very significant concern that applies more broadly than one profession. Is that okay?
Absolutely. I thank the Minister.
With regard to Deputy Colm Burke's point, I will talk to the substance of the concern in a moment but on the amendment itself, it is the timing that is the issue. Yes, I am very happy to do a report and indeed have a committee session on it or do an informal briefing for committee members with the Department. There is a very substantial piece of work going on and the HRB report is one part of it. It is specifically just a timing issue. We will not have that done within 12 weeks of the passing of the Bill. If the Deputy is happy to bear with me, we will keep the committee members informed, do an informal briefing or a formal committee session if that is better. It is just going to take a bit longer than three months after passing the Bill. The advice I have is that we should have something much more substantive, probably coming into the autumn session. Maybe we could schedule a committee hearing and I could organise an informal briefing as well or instead, if members wanted. It is not going to be ready just in the next few months.
If the time period was changed to six months, would the Minister have a report ready for us on the approach he intends to take in respect of the unregulated professions?
Leave that with me. It certainly something we can discuss further and we could maybe consider bringing it in on Report Stage. Let me just talk further with the officials on what that might encompass. I would not be averse to that.
To the various points Deputy Shortall made, I share a lot of those concerns. I am not satisfied with the progress that has been made today. I am not satisfied with the current approach whereby every single profession has its own governing board. I am not satisfied with the lack of progress made on psychology. I will update the committee in a moment; there has been progress in the last few weeks on that. As the Deputy says, this Act has been around since 2005. We have nine regulated professions. We have another three which are in process. We have counsellors and psychotherapists, psychologists and the one before us today, social care workers. We then have another two which are designated, so they are next in line, namely orthoptists and clinical biochemists. To the Deputy's point, there are 20 more that are looking for regulation and I have met various members of the professions the Deputy referenced. In that list of 20, for example, a really important one is home care assistants. That is going to be a big one. There is a massive piece of work going on in respect of the interRAI pilots around that. If we were to let things continue as they are, it could be 20 years before we all of these regulated. I share a lot of the Deputy's concerns and frustrations.
The plan is to modernise the governance structures in CORU and if we need to give CORU additional funding and staff to move this along, we will do that as well. We need a more sustainable model of statutory regulation. I am advised that this was first flagged, believe it or not, 11 years ago in 2012. I guess the former Minister, James Reilly, would have flagged it or maybe it could have been Deputy Shortall herself. I am advised that work began in earnest in 2018 when CORU took a look at its own governance model in the context of a request from the Department. A lot of things were paused during Covid as we are aware. This is one of the things that did not progress at the speed anyone would have liked. In January of this year, CORU submitted a project plan to the Department. That plan was approved in February.
The project is due to commence in the coming weeks. It is going to be led in-house. The expectation is that it will be an 18 month project. This is a full root and branch review of how it has worked since 2005. The estimated cost is about €330,000, with staffing replacement, stakeholder engagement and so forth. On conclusion of the project, it is expected that a new proposal will be in place for a more modern approach to this. My view is that the current approach of having different governing bodies for everything simply does not work. We looked for psychology to be regulated. CORU went out to the profession but there were so many different views from different groups within the profession. CORU came back to me and we proposed a twin-track approach which is now happening. We are prioritising counselling psychology, clinical psychology and educational psychology. I have written back to CORU and asked it to prioritise those three. This is based on patient risk, which is something we all understand.
I would not accept, and I do not think the Deputy would expect me to, that there is a lack of focus on patient safety. Obviously there is a big focus on patient safety. To that end, I think we need a different approach to this. We may need some pretty substantial amending legislation for it. I agree that many of them, although not all of them necessarily, are crying out for regulation. We have audiology, healthcare assistants, clinical scientists, clinical measurement physiologists, pharmacy technicians, physician associates and the exercise professionals.
To clarify one point, the HSE is able to hire non-regulated people. The Deputy gave the example of the exercise professionals. There is nothing stopping the HSE from hiring those people into various roles. For example, the HSE hires lots of psychologists and counsellors. They are not regulated either. It would help if they were regulated but the HSE hires audiologists, physician associates and healthcare assistants. I agree with the Deputy's core point and I share the concerns, so we are going to quite fundamentally shake this up.
I would like clarification on the point the Minister made about the athletic therapists because the president of DCU and the president of the South East Technological University have both been in touch about this. They say that these people do very extensive training, a four year, full-time, BSc honours degree programme. They are working in places like the FAI, the GAA, in many independent clinics, and private hospitals providing world-class care but they cannot apply for HSE roles. There is a disconnect somewhere because this is a matter of concern for people who do that level of training and who can contribute so much to the public health service. Could we have clarification on that?
It is not that the HSE is precluded from hiring them because they are not regulated. It is that the HSE does not have that role. That role has not been created within the HSE. It is probably a different conversation that needs to be had as we move towards more prevention, healthy Ireland and more exercise. The question then is where we should be creating exercise professional roles within the HSE. At the moment we do not, so that is certainly something we could look at in different ways. I imagine in terms of preventative work there would be a lot of value to it. We can probably have two separate conversations about it. First, should the HSE be hiring these professionals? Second, should we be regulating that profession?
On the basis of the conversation we have had, I am happy to withdraw that amendment but I will be retabling it with six-month timeline on it on Report Stage. On the basis of what the Minister said, and talking about the autumn, I would expect he would accept that amendment or else have a similar one.
Let me take a look at it. I cannot commit to it yet but I certainly would not disagree with the approach.
Are chiropractors included in this or are they regulated at the moment?
No, they are on the list of 20 that are looking to be regulated.
There was a proposal some years ago, I think, in James Reilly's time or in the Minister, Deputy Harris's time, to regulate them but it suddenly fell from the table. If the institutions do not want something, that amorphous mass that I would call the dead hand falls down and nothing further happens. Chiropractors were very keen on the idea and they are still waiting. It is an appropriate time to look at what they do. They are professionals in the area. They have an expertise but the medical profession does not like to see them on the same platform. As a result of that, they are waiting. They have expertise and they are looking for the right to refer, to do X-rays and scans, etc., all of which would be helpful to their profession. The reason I know so much about this is that I have had to call upon their services from time to time. Hopefully, I will do so again when they are professionally recognised and regulated.
On the practical side of things, what is the Minister's intention in relation to CORU, given the slow progress that has been made? What additional staff are required there? When is it expected that it will get through the seven remaining professions that it has not been able to deal with so far?
It is the remaining 25 professions. There are the three that are hopefully under way now. There are the two designated and then there is the remaining 20. Chiropractors and osteopaths are included, both of which I have been to many times after I broke my back as a much younger man. I have had much relief from chiropractors and osteopaths, and I could not agree more.
Regarding CORU, the answer to that lies in this review. The Department will be working very closely with CORU. I want the stakeholders, the professions, involved as well. We will be able to answer that question in terms of funding and resourcing when we have a proposal that we agree with to move this on. We need to be honest. Deputy Durkan raised the issue of chiropractors and osteopaths and Deputy Shortall highlighted various professions as well, all of whom I agree should be regulated. If we keep going as we are, these professions are not going to get regulated in the next three, four or five years.
Who is going to develop that proposal?
That is being done between CORU and the Department. The work will kick off in the next few weeks. We have allocated €330,000 to it to get it moving.
Amendment, by leave, withdrawn.
Section 6 agreed to.
NEW SECTION
I move amendment No. 7:
In page 7, between lines 22 and 23, to insert the following:
“Amendment of section 49 of Act of 2007
7. Section 49 of the Act of 2007 is amended—
(a) by the substitution of the following subsection for subsection (1):
“(1) The Council shall register in the Trainee Specialist Division a medical practitioner who has completed a course of study wholly or mainly in the State, a Member State or the United Kingdom, resulting in the award of a basic medical qualification and who intends to practise medicine in an individually numbered, identifiable intern post which has been approved by the Council for the purposes of intern training.”,
and
(b) by the substitution of the following subsection for subsection (6):
“(6) In this section—
‘Member State’ means—
(a) a state, other than the State, which is a member of the European Union,
(b) a state, other than a member of the European Union, which is a party to the agreement on the European Economic Area signed at Oporto on 2 May 1992 as adjusted by all subsequent amendments to that agreement, and
(c) Switzerland;
‘relevant day’ means the date specified in the notice referred to in subsection (5) published in Iris Oifigiúil as the date on which the Council shall commence to grant certificates of experience;
‘United Kingdom’ means—
(a) the United Kingdom of Great Britain and Northern Ireland,
(b) the Channel Islands, and
(c) the Isle of Man.”
There are new sections but we have not heard the case being put for them.
Do I need to move amendment No. 7?
The Minister has already done that. Does he wish to speak about it?
As outlined on Second Stage, one of the most time-sensitive measures in the Bill is the restoration of eligibility for UK medical degree holders to access internship training posts in Ireland. Following the UK leaving the EU, the Medical Practitioners Act 2007 prevents holders of UK medical degrees from internship registration. I am keen to address this in time for the next group of interns coming in July, I believe. The registration provisions in the Medical Practitioners Act 2007 are substantively revised by the Regulated Professions (Health and Social Care) (Amendment) Act 2020. However, prior to its commencement, certain errors were discovered in that legislation, which are corrected in this Bill. Eligibility for medical interns will be restored in the wider suite of registration provisions but certain steps must be completed before the 2020 Act can be fully commenced. In view of the tight timeframe for the incoming cohort of interns, a new section is being introduced to this Bill specifically to provide for this. The new section of the Bill amends section 49 of the Medical Practitioners Act 2007 and will be commenced on enactment.
Amendment agreed to.
Sections 7 to 11, inclusive, agreed to.
SECTION 12
An Cathaoirleach: Amendments Nos. 8 to 11, inclusive, are related and may be discussed together.
I move amendment No. 8:
In page 9, between lines 13 and 14, to insert the following:
“(a) by the renumbering of the said section 36D as subsection (1) of that section,”.
Amendments Nos. 8 to 11, inclusive, are technical amendments to introduce a definition to section of 12 of the Bill. That section addresses the UK medical degree holder policy we dealt with in the previous amendment.
Amendment agreed to.
I move amendment No. 9:
In page 9, to delete line 26.
Amendment agreed to.
I move amendment No. 10:
In page 9, line 33, to delete “section 11.”.” and substitute the following:
“section 11.”,
and”.
I move amendment No. 11:
In page 9, between lines 33 and 34, to insert the following:
“(d) by the insertion of the following subsection after subsection (1), renumbered
under subsection (1), of said section 36D:
“(2) In this section, ‘United Kingdom’ means—
(a) the United Kingdom of Great Britain and Northern Ireland,
(b) the Channel Islands, and
(c) the Isle of Man.”.”.
Amendment agreed to.
Section 12, as amended, agreed to.
Sections 13 and 14 agreed to.
Title agreed to.
Bill reported with amendments.