Ms Teresa Cody:

I thank the Chairman and members of the committee for inviting us today to talk about the Health and Social Care Professionals (Amendment) Bill 2016.

I would like to introduce myself and my colleagues. I am assistant secretary in charge of national HR division in the Department of Health. I am joined by Ms Deirdre Walsh, principal officer, Mr. Kieran Duffy, assistant principal officer, from the professional regulation unit of my division, and Ms Geraldine Luddy, principal officer, bioethics unit, which forms part of the office of the Department’s Chief Medical Officer.

The Health and Social Care Professionals (Amendment) Bill 2016 seeks to amend the Health and Social Care Professionals Act 2005. While I do not intend to go into details on the provisions of the 2005 Act in my opening statement, it is important to give the joint committee a brief overview of the 2005 Act, as this is key to considering the amendments proposed in the 2016 Bill. The information brief furnished to the committee also provides detailed background information on the operation of the Act and progress to date on the regulation of the designated professions.

Regulation under the 2005 Act is primarily accomplished through the statutory protection of professional titles by confining their use solely to people who have been granted registration. The structure of the system of statutory regulation comprises registration boards, a committee structure to deal with disciplinary matters and the Health and Social Care Professionals Council, known as CORU, which has overall responsibility for the regulatory system. CORU is Ireland’s only multi-profession health regulator, with 14 professions currently designated for regulation under the Act. Government policy is to conclude, by late 2018, the regulation of the 14 designated professions and to designate by regulation in the coming months the professions of counsellor and psychotherapist for regulation under the Act.

I will now turn to the Health and Social Care Professionals (Amendment) Bill 2016. Deputy Howlin’s primary concern, as shared by others, is to better protect women who are experiencing crisis pregnancies and seeking support at a time of extreme distress and vulnerability. He seeks to ensure crisis pregnancy agencies and individual counsellors offering crisis pregnancy counselling do so responsibly. This concern is shared by Government and the Minister for Health, Deputy Harris, has advised the Dáil that officials will work with Deputy Howlin to address these concerns. Deputy Howlin’s Bill seeks to amend section 4 of the 2005 Act to address the issue of persons who masquerade as counsellors, providing information on crisis pregnancy that is clearly neither truthful nor objective. The Bill seeks to do this by adding crisis pregnancy counsellor to the list of 14 professions designated for regulation under section 4 and to define the scope of practice of a crisis pregnancy counsellor by regulating the activity engaged in.

As outlined in detail by the Minister, Deputy Harris, during the debate on Second Stage, there are a number of policy, legal and implementation difficulties with the detail of these proposals. First, the Bill seeks to establish crisis pregnancy counsellors as a profession separate and distinct from counsellors as a whole. Crisis pregnancy counsellor, not being a distinct profession, does not meet the criteria for designation nor does it fulfil the legislative requirements with regard to implementation by way of establishment and population of a professional registration board and maintenance of a professional register. It is intended that the priority work currently under way on the designation in the coming months of counsellors generally by way of regulation under the 2005 Act, will encompass crisis pregnancy counsellors as part of this profession. This does not require an amendment to the primary Act and will provide an opportunity to assist in addressing Deputy Howlin’s concerns.

The amendment Bill also seeks to regulate crisis pregnancy counsellors by way of defining the activity engaged in. However, the activity outlined is also undertaken by a variety of other regulated professionals who may include doctors, nurses, social workers and psychologists. The 2005 Act regulates professions by way of setting qualifications and protecting title, and not by activity or scope of practice. There are very sound policy and legal reasons for this.

The amendments to the 2005 Act proposed in the Private Members' Bill would not prevent rogue crisis pregnancy counsellors from deliberately providing incorrect information. Registration under the 2005 Act is voluntary. While it is an offence for non-registrants to use protected titles, rogue practitioners, including those struck off the register for professional misconduct, could get around this by using an alternative title such as adviser.

Scope of practice is ever changing as education, training and the impact of technology on health and social care professions evolves, as indeed it should do. The activities engaged in by a number of professions can overlap and the professions are often regulated by different regulatory bodies with differing legislative provisions. Defining in primary legislation the scope of practice or the activity engaged in by a health profession, or both, has the potential to hinder health professionals working to ever-expanding scopes of practice, something which is vitally important in the delivery of services across all health settings. It would also result in primary legislation having to be amended on an ongoing basis as scope of practice evolves and, most importantly, to ensure those working to an expanded scope of practice did not find themselves being brought to fitness to practise arising from their scope of practice being rigidly defined in primary legislation.

Introducing a defined scope of practice for one profession under the 2005 Act would undermine the entire legislative construct of the 2005 Act which is based on protection of title and not defined activity. If the 2005 Act were amended to define activity for one profession, it could give rise to similar amendments being sought by some or all of the other 14 designated professions. This could restrict entry to the professions and pose significant legislative and practical difficulties given that their scope of practice overlaps, in part. As in the case of crisis pregnancy counsellor, defining the activity or scope of practice of these professions in primary legislation could also result in restricting their delivery of services on the ground and complicate implementation of the 2005 Act’s fitness to practise provisions.

With regard to other technical matters, the Bill as drafted does not provide for a number of key requirements such as the critical issue of setting grandfathering qualifications, a challenging but essential requirement for the registration of existing practitioners. When a designated profession is being regulated for the first time, the level of grandparenting qualifications to be set will determine the number of existing practitioners who will be granted registration. In addition, provision would also have to be made for the establishment of a 13-person registration board and a range of consequential amendments that would have to be made to the Health and Social Care Professionals Act 2005.

During the Second Stage debate on the amendment Bill last November, the Minister, Deputy Harris, in his desire to be constructive and make progress on this matter, detailed a sizeable and important body of work to be undertaken over a period to give consideration to better protecting the public from certain crisis pregnancy agencies or counsellors that are providing information that is clearly neither truthful nor objective. He committed to making progress through the forthcoming registration of counsellors, the existing Regulation of Information (Services outside the State for Termination of Pregnancies) Act 1995, and the review of this Act.

With regard to the regulation of counsellors, having consulted the Health and Social Care Professionals Council, as required under the 2005 Act, and having proceeded to public consultation in September 2016, 84 submissions were received by the closing date of 30 November 2016. Following examination, it is envisaged that the next steps in the statutory regulation of the professions under the Act will commence in the coming months with the submission of draft designation regulations to the Houses of the Oireachtas. This will be followed by the establishment and appointment by the Minister of the 13-member registration board charged with establishing the registers, which in turn commences the two-year transitional period, after which only registrants will be permitted to use the protected titles.

I will now turn to the Regulation of Information (Services outside the State for Termination of Pregnancies) Act 1995. This Act prescribes the conditions for making available information to pregnant women and the public about services lawfully available outside the State for the termination of pregnancies.

During the Second Stage debate on the Health and Social Care Professionals (Amendment) Bill 2016 the Minister undertook to have the Bill reviewed by the Department to establish whether its provisions needed to be strengthened. The review is ongoing and a range of possibilities are being examined. Subject to the views of the Attorney General, for example, it may be possible to amend the Act to ensure only registered professionals would provide service under it. In particular, this might be feasible if, as expected, it were to be decided to proceed with the statutory regulation of counsellors. This would be looked at in tandem with forthcoming decisions on the statutory regulation of counsellors.

It is important to note in relation to publicly funded crisis pregnancy services, that under the crisis pregnancy programme in the HSE a framework for crisis pregnancy counselling services was developed. The standards were designed in line with HIQA's national standards for safer and better health care and consist of eight themes broken down into 28 essential elements. The framework commenced in 2015 and there is a requirement to implement it in the HSE's funded services. This requirement is outlined in the signed service agreements between the HSE and the individual service providers. However, the agencies that seek to manipulate women by providing "disingenuous" crisis pregnancy counselling services have, in the main, been private establishments that appear to set up and close down over short periods and have no linkage with State funded services.

The Minister for Health, Deputy Simon Harris, committed to keeping Deputy Brendan Howlin informed on matters as work progressed. He wrote to him on 11 January 2017 and departmental officials also met the members of his team on Wednesday, 8 March to engage further on the matter.

I hope my statement has assisted the committee in appreciating what appears to be a short and straightforward Bill but which, in fact, poses significant policy, legal and practical difficulties in the operation and ongoing implementation of the Health and Social Care Professionals Act 2015 and the regulation of health and social care professionals in general when the broader context is considered. I reiterate that it is the Minister's intention to address the serious issues involved by working through the sizeable and important body of work under way. My colleagues and I will be happy to take questions from members.