Paul Kehoe (Wexford, Fine Gael)
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The minutes of our previous meeting are agreed. On behalf of the committee, I welcome: Dr. Padraig Walsh, chief executive, Quality and Qualifications Ireland, QQI; Ms Ginny Hanrahan, chief executive and registrar of CORU; Professor Orla Sheils, vice-provost and chief academic officer of Trinity College Dublin, representing the Irish Universities Association, IUA; Ms Mary McHugh, Technological University of the Shannon Midlands Midwest, TUS, representing Technological Higher Education Association, THEA; and Ms Patricia O'Sullivan, executive director of the Higher Education Colleges Association, HECA. The witnesses are here to discuss the professional accreditation of higher education courses, with specific reference to health and social care professions. This matter was highlighted in the media some time ago. The Central Applications Office was invited to attend but declined without giving a reason. The Higher Education Authority also declined to attend. It contacted the clerk and explained that it has no role in accreditation. The authority followed this up in writing.

The format of the meeting is that I will invite the witness to make a brief opening statement. Dr. Walsh will be first. He will be followed by Ms Hanrahan, Professor Sheils, Ms McHugh and Ms O’Sullivan. Each of the witnesses will have a five-minute slot. As they are probably aware, the committee will publish the opening statements on its website following the meeting.

I remind members of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against any person or entity inside or outside of the Houses. Witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if witnesses' statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.

I ask Dr. Walsh to make his opening statement and to confine himself to five minutes in doing so. The opening statements will be followed by questions from the members. Each member will have a five-minute slot in which to ask questions of and take responses from the witnesses

Dr. Padraig Walsh:

QQI is grateful for the opportunity to provide a submission to the committee.

Publicly funded higher education institutions such as universities, technological universities and institutes of technology have the power to make their own awards. QQI has no role in the approval of individual programmes offered by these institutions. Private higher education institutions do not have their own awarding powers but many choose to come to QQI to have their programmes validated in order that their learners can receive QQI awards.

There are many professions where the admission of new entrants is legally controlled by professional and statutory regulatory bodies, PSRBs. These bodies admit entrants by approving programmes offered by higher education providers as satisfying the standards for admission to the profession. PSRBs generally oversee the register of practitioners and can conduct fitness to practise inquiries into the conduct and continuing competence of a registrant.

Public higher education providers and QQI validate professional higher education programmes and make awards. The awards they make to learners are permanent. Providers and QQI have no role in the initial or continuing registration of practitioners. PSRBs approve programmes offered by higher education providers for the purposes of admission to their respective professions on the basis of criteria or standards set by the PSRB. While some PSRBs make awards, they do not do so for initial admission to professions in health and social care. I hope it is clear that the process of admission to the professions being discussed today requires both an education awarding body and a PSRB.

When requested to validate a new higher education programme from a provider whose institutional quality assurance procedures it has already approved, QQI assembles an expert panel to meet with the programme design team.

In the case of a programme designed to prepare a learner for a regulated profession, the provider must declare that the programme complies with applicable statutory, regulatory and professional body requirements. The process is termed ex antevalidation. This is because the evaluaon must be completed prior to any students being admitted to the programme.

Following the successful validation of a programme, a higher educaon provider can submit the programme to the relevant PSRB for approval. In the case PSRBs such as the Nursing and Midwifery Board of Ireland, NMBI, or the Teaching Council, this can be done once the programme has been academically validated. That is because these bodies also operate a system of ex anteapproval.

In the case of PSRBs such as the Dental Council of Ireland or CORU, ex anteapproval is not currently employed. Instead, a programme has to be up and running and graduates have to have completed it before it can be approved. This is known as an ex postapproval process. The programme approval processes designed by CORU include a site visit to the relevant provider during which the visiting panel meets current students and graduates of the programme.

In the case of more recently regulated areas like social care, the use of a system of ex postprogramme approval carries the risk that a programme that is already up and running will not pass the subsequent PSRB approval process. This presents a potential barrier for new entrant providers in that students may be understandably unwilling to take the risk of commencing a programme whereby they have no guarantee of entry to the profession upon graduation.

In 2019, QQI began to facilitate the Finding Common Ground programme of engagement with PSRBs. Building on this, QQI has, in conjunction with the higher education institutions, HEIs, and PSRBs, developed a set of high-level accreditation principles aimed at improving quality assurance and eliminating the unnecessary administrative burden between professional and academic approval processes.

QQI validates some programmes offered by private providers in the areas of teacher education, nursing and social care. In the case of nursing and teaching, the QQI validation process precedes the submission of the programme to NMBI or the Teaching Council and QQI sets as a condion of validation that no students can be admitted to the programme prior to the programme receiving accreditation from the relevant PSRB.

To my understanding, there is no legislative barrier to CORU operating an ex anteprogramme approval process. However, CORU's ex postapproval process may be influenced by the current legislation appearing to only permit the binary possibility of approving or refusing to approve a programme, without a statutory power to impose follow-up conditions on the provider.

QQI and PSRBs such as NMBI and the Teaching Council have the power legislatively to refuse or approve a programme but, crucially, can also approve, subject to conditions, which must be fulfilled by the provider within a specified period.

With the imminent statutory regulation of programmes in counselling, psychotherapy and psychology it is imperave that awarding bodies work closely with PSRBs to ensure that the chances of newly validated higher education professional programmes gaining subsequent regulatory body approval are maximised. This may necessitate all regulatory bodies having some form of ex ante approval process for new programmes. It is also important that if legislation governing PSRBs needs to be updated to assist this process, then it should be progressed.

Ms Ginny Hanrahan:

CORU is Ireland’s first multi-profession statutory health regulator. Our role and legislative mandate is to protect the public by regulating the work of designated health and social care professions. How do we protect the public? We do so by setting minimum thresholds for the professional standards that members of each profession must meet in order to practice in Ireland. This protects the public by ensuring that CORU's registered health and social care professionals, who are often providing care to the most vulnerable in our society, meet the standards that are required to provide safe and effective care. Only those professionals who meet these standards may register with CORU and use the protected title.

The first register opened by CORU in 2011 was for social workers. Since then, we have regulated a further 11 professions. Today, more than 25,000 health and social care professionals are regulated by CORU. A new register for social care workers will open in November. The Minister for Health has also designated five further professions for CORU to regulate. Once all 17 professions are regulated, some 40,000 professionals will be registered. Many of the professions in question had not been regulated previously. The work undertaken to introduce regulation should not be underestimated.

Many of these professions had not been regulated previously and the work undertaken to introduce regulation should not be underestimated. Our success can be seen in the increasing demand from other profession to be considered for regulation.

Education approval is one of the most important ways we protect the public. We ensure that the education bodies deliver qualifications that prepare professionals to provide safe and appropriate care. CORU has a statutory role to approve and monitor education and training programmes, which has a separate purpose to academic validation. Our approval ensures graduates have the knowledge, skills, and competence to provide safe care. For each profession, we draft education and training standards. This establishes the minimum standards of education required to ensure a graduate will be able to provide safe and appropriate care. Our process is robust. It is a strong lever to ensure compliance with the threshold standards. We hold a public consultation giving all stakeholders, including educators, opportunities to give feedback on the proposed standards developed by the registration boards. Once these standards are finalised, the education providers apply to CORU for approval.

Our process is to assess and monitor how programmes are actually delivering. We do not rely on what is set out in a prospectus. We examine the reality of what the programme is and establish whether the graduates will be skilled to provide safe care to the public. The assessment by an expert panel includes meeting with educators, placement providers and students, to confirm that the standards are being delivered. Where a programme meets the standards, it is approved and a new bylaw is made. Graduates from that programme are then eligible to apply for entry to the CORU register. Where deficits are identified we work with the education provider to assist them in addressed these. I understand the desire of education providers to have certainty from the outset but this is contrary to public safety. To approve courses based on a proposal rather than reality, transfers the risk from the education provider to patients and service users. It is the responsibility of each education provider to ensure its programmes meet the minimum standards. It is its responsibility to ensure the students get the required training. Above all else, it has a responsibility to the patients and service users who will be in the care of their graduates. Education providers also have an opportunity to be transparent and to keep students informed of the status of their programmes, include before students enrol.

CORU has approved 73 education and training programmes. Thirty of these of these have been for the social care workers, whose register will open in November. Due to the collaborative approach we take with education providers, we have never refused to approve a programme. Our health system in Ireland needs more health and social care professionals. In the last two years, CORU has approved 12 new programmes and received expressions of interest relating to 11 others. Our approval processes confirms that each new programme delivers desperately-needed graduates with suitable qualifications to safely provide care. Where concerns arise, and it becomes apparent there are serious deficits which cannot be rectified, we engage with the educator providers, Quality and Qualifications Ireland, QQI, and others in their duties to ensure the students are protected.

I was appointed CEO of CORU in 2008. I have dedicated my professional life to establishing a system of multi-profession regulation networks. Today is my final day; I officially retire from CORU this evening. I am immensely proud of what the organisation has achieved to date since our establishment to protect the public. What has become very apparent to me is the importance of providing access to training and education for all members of our society. Our health and social care professionals should reflect the communities they serve. Inequities regarding access to education and training impacts those from diverse backgrounds the most. The growth in post-education programmes is a concern given their cost which puts them outside the reach of many. Our educators have an opportunity to change this and I respectfully suggest that it is important they do so. I thank the committee members for their time and look forward to their questions.

Paul Kehoe (Wexford, Fine Gael)
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I thank Ms Hanrahan very much for that, and what better way to spend her last day than before an Oireachtas committee. How exciting it is. If we had known, we would have had a bouquet of flowers.

Professor Orla Sheils:

I thank the Chair and members of the committee for the opportunity to contribute to their discussion today. I represent the Irish Universities Association, IUA, the eight members of which play a key role in educating and training students for the full range of healthcare and social care professions in Ireland. We work closely with the providers in clinical and community settings and we rely on them for the essential practical patient-focused training of our students. We also work closely with the relevant professional and regulatory bodies, which are our partners in ensuring the quality of education and standards in health and social care professions meet national and international requirements. Education in the clinical and healthcare setting is quite different from other forms of education insofar as the costs incurred are high as the curricula are costly to deliver; require low staff-student ratios, specialised infrastructure; and substantial running costs which are not incurred by non-clinical programmes.

The IUA believes there are opportunities to address skill shortages within the sector but also to streamline processes within. The alignment among relevant Departments that fund education and training in class and in practice settings and that control the numbers of entrants to healthcare courses could be better. We need a more cohesive system for long-term planning for sustainable growth among health and social care practitioners. Transforming healthcare education requires a stronger alignment between the institutions and systems that are responsible for service delivery to ensure there is more joined-up thinking across policy and funding mechanisms. More streamlining and efficiencies can be made within the regulatory and accreditation bodies which ensure that the education and healthcare standards are being met.

There are efficiencies to be made regarding accreditation of new courses. My colleague from QQI already referred to the fact that in some instances, accrediting bodies will only review a programme when it is actually running. This means accreditation is not secured for the first intake of students to a course. We would suggest, as Dr. Walsh has done, that temporary or additional approval based on a review of the planned curriculum and site for the year 1 intake could be considered with a full review then when the programme is up and running. The same quality standards could be maintained that way but there is less risk to that first cohort.

Notwithstanding the principles for professional engagements with education statement that QQI published in 2021, we also believe there still remain some efficiencies that could be made in areas where duplication occurs. For some professions, monitoring and accreditation is undertaken by both the regulatory body and relevant professional body. In these settings, the remits often overlap but the quite distinct and separate processes place a very heavy burden on the programme providers. Moreover, CORU’s remit whereby each profession has a separate board can be troublesome because each board runs its own full accreditation process. This results in some schools within institutions preparing duplicate material, thereby requiring the same staff to attend up to three accreditation visits per year. This has a high hidden cost for HEIs.

Another issue I would like to highlight is the tension between the health and social care providers that rely on a steady supply of qualified graduates, and the lack of engagement or perhaps difficulty in securing clinical placements. Institutions typically establish long-term commitments with partner healthcare providers to provide meaningful, practical training to students. However, there is not a unified network or national framework for practice education. That can lead to ad hocor competitive environments in which HEIs negotiate with service providers to secure student placements. Some more thinking in that area would be helpful.

The universities can be more flexible, particularly for people who wish to change career midstream or students from other disciplines who wish to transfer towards health professional careers. We in the institutions need to be alive and create more flexible pathways to make that happen. Further flexibility could also be achieved be expanding the role our universities play in supporting continual professional development through new courses, masterclasses or micro-credentials. These are meant to meet the needs of practitioners who want to upskill, reskill or change direction.

We believe much can be done to ensure better alignment, co-ordination and effectiveness, including in the regulation and accreditation of higher education courses, to meet the country’s skills needs across health and social care provision. The IUA and partner universities are committed to playing their part in ensuring long-term sustainable solutions that are planned and can be sustained. I thank members of the IUA and a number of relevant ministerial appointments to CORU, the NMBI, the Medical Council of Ireland, etc., who have contributed their thoughts to this paper.

Paul Kehoe (Wexford, Fine Gael)
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I thank Professor Sheils very much and call Ms McHugh.

Ms Mary McHugh:

I wish the Chair and members of the committee a good morning. My name is Mary McHugh. I am a social care lecturer and programme director in the Technological University of the Shannon, TUS, Athlone. On behalf of THEA, we welcome the opportunity to make the submission regarding professional accreditation of higher education courses.

We welcome the opportunity to make a submission regarding professional accreditation of higher education courses, from my point of view with specific reference to social care. THEA members, educational providers, social care staff and students have welcomed and embraced CORU’s process over the past five years.

THEA represents four educational providers, which collectively have ten full-time and one part-time social care courses approved by CORU. TUS Athlone has two full-time courses and one part-time course and TUS midwest delivers one course over three different campuses. Atlantic Technological University delivers courses in Sligo and Castlebar. South East Technological University has courses in Waterford, Wexford and Carlow. Finally, Dundalk IT has received CORU approval to deliver one social care course. Each educational provider has actively engaged with CORU throughout the process. We will continue to collaborate with the social care sector, statutory, voluntary and private organisations, representative bodies like Social Care Ireland and the Irish Association of Social Care Educators to ensure graduates have the necessary skills and knowledge to meet CORU’s standards of proficiency, which are required to register as a social care worker.

Our members have had a long history in the provision of social care education in Ireland. Courses were born out of the need to address serious deficits in the provision of residential care and other social care services. Social Care Ireland and the Irish Association of Social Care Educators have worked tirelessly throughout this process advocating for recognition for the social care profession and supporting social care workers and educators navigating this new landscape.

As educators and social care workers, we have embraced CORU’s programme approval journey. Our values are fully aligned with CORU’s overall mission of creating quality standards with the sole aim of ensuring safety to the public. The journey began 20 years ago with the initial Health and Social Care Bill, followed by the Health and Social Care Act 2005. It will culminate, on 30 November 2023, with the opening of CORU’s register for social care workers. From 2025, “social care worker” will become a legally protected title in Ireland. This has proven a dynamic journey for both regulators and providers and we have learned much in recent years.

The title “social care worker” is likely to be truly transformative for the sector. First, it will inspire greater confidence in the public and individuals and families who need to access social care services. In addition, independent verification by the regulatory body, CORU, will help shape the emerging identity of the entire profession of social care workers.

The opening of CORU’s register this November launches a two-year transition period for the existing diverse sector of social care practitioners to apply to join the register. Once that two-year grandparenting process ends in late 2025, access to the register will be restricted to graduates who successfully complete one of CORU’s listed approved social care courses mentioned.

There are a number of considerations or issues to reflect upon. Practice placement is an integral part of social care programmes with every student requiring to complete a minimum of two placements spanning 800 hours during their social care programme. We appreciate that individuals and groups that avail of social care services allow social care students to engage and experience social care practice under supervision in their social care settings. This practice experience allows students to demonstrate they are meeting CORU’s standards of proficiency. Quality placements require resources to support students and their practice educators. These requirements demand significant investment by the placement agencies, which provide learning opportunities for students. This requires careful planning, preparing students for placement, investing time to find suitable agencies and build capacity, liaising with agencies during placements, monitoring student progress and providing training and supports for supervisors and agencies.

Another consideration is ensuring wider access to social care education. Government-led initiatives and individual college initiatives have ensured that underrepresented populations secure access to third level education and this in very evident in social care. Current initiative like DARE and HEAR and various bursaries and initiatives support students in gaining access to social care education. For example, the University of Sanctuary has supported those in direct provision to access third level education and social care in particular. Other supports such as the 1916 Bursary provides opportunities for applicants who have experienced disadvantage to become social care workers. Further development and funding of those initiatives are vital in ensuring successful completion of social care courses, therefore ensuring equality and access to social care programmes for all, and to ensure that all of our citizens are represented in social care.

Part-time provision is another consideration, which is lacking in Ireland. TUS Athlone offers one out of a total of two CORU-approved part-time social care courses aimed at those applicants wishing to pursue a qualification or longer term career pathway in social care, culminating in joining the social care register. Most of these applicants for part-time study are working full time in the social care sector. The majority are self-funded.

This demonstrates their commitment to social care and represents a significant challenge as they balance study, work and family. This is worthy of consideration in terms of financial support or tax breaks to support those students. Part-time courses are meeting the demands of social care practice. CPD and postgraduate education students who go through accredited programmes will have met the threshold standards to enter the register and profession. There also needs to be consideration given to post-qualification CPD and postgraduate qualifications that further develop skills of social care workers who may go on to work in a diverse range of areas within social care and may require more specialised skills and knowledge.

On balancing academic and professional requirements, like other professions in the health and social care area, we have experienced challenges aligning professional accreditation bodies’ requirements and academic requirements. This is something that can be a challenge for some students on social care programmes.

To conclude, there have been positive developments in social care education in response to the changing practice landscape. We are now at the cusp of the next phase of growth and progress, as well as achieving the recognition social care educators and the profession have been striving for since the initiation of social care education. I thank the members for their attention and time. I am happy to any answer questions they may have.

Ms Patricia O'Sullivan:

On behalf of the HECA, I thank the Chair and members for the opportunity to speak with them. The attainment of high-quality graduate outcomes stands as the central purpose of professional accreditation and approval. It is a goal towards which HECA member higher education providers are absolutely committed, supported by the robust regulation of both QQI and CORU. All strive for high-quality education provision and professional training that needs to be responsive to changing societal needs and shifts in professional practice. We are very supportive of the valuable work that CORU undertakes on public protection and QQI undertakes to underpin the quality of educational awards offered.

In 2022, one private higher education institution, HEI, a member of HECA, and one public HEI withdrew their applications from the CORU approval process for their social care programmes. In the case of the private provider the withdrawal prompted diverse stakeholder responses, student disruption and HEI uncertainty and risk. It also highlighted the need for significant improvement in the current system overseen by professional, statutory and regulatory bodies, PSRBs, and educational awarding bodies. Given the shared responsibilities of all parties to produce graduates who are qualified to work in health and social care settings and given the high demand in Ireland for such workers, it is crucial to anticipate and avert future failures in the implementation of regulations. This foresight involves adopting proactive measures to avert severe outcomes such as withholding recognition, strengthening the existing regulatory mechanisms and interagency collaboration as well as maintaining clear, open communication lines.

HECA believes the shared responsibilities referred to can be best achieved through structures that might ensure a confluence of validation and professional recognition processes. Providers engage in complex academic and professional approval processes that are currently undertaken as separate processes. This leads to a lack of cohesion and potentially contradictory outcomes. To address this, the integration of the academic awarding body validation and CORU professional accreditation processes should be considered. This integration could take the form of a single panel undertaking a unified process, ensuring programmes are fit for shared purposes. This approach could also mitigate unnecessary duplication, thus reducing the administrative load on providers, QQI and CORU without compromising the rigour and protective essence of both processes.

We advise the committee to consider recommending the establishment of a national working group. The working group could comprise key stakeholders and include representation from private providers, independent providers, or both, to support the improved cohesion of these separate legislative processes. This would serve the best interests of students, clients and the public and prevent future contradictory outcomes.

The public's best protection is ensured when every student reaching the end of his or her course achieves the qualifying proficiency standard. This outcome is best attained through continuous consultation and early accreditation by CORU.

A specific instance of policy divergence between CORU and QQI arises with social care programmes. Here, the recognition of prior learning does not appear to be endorsed by CORU, conflicting with national access, transfer and progression policies outlined by QQI.

Such inconsistency may not serve the best interests of all students, especially those considering a transfer during their studies due to diverse reasons. It may also provide impediments to academic bonding arrangements for protection of enrolled learners involving course transfer.

In general, we would stress the need for enhanced clarity, transparency and timely information from CORU to all providers to improve common understanding. Current uncertainties in the areas of counselling, psychotherapy and psychology have caused anxiety among students and deterred potential applicants, which could lead to future professional shortages. Clear precise information and timelines for statutory regulation could help students make informed decisions regarding their courses. Additionally, providers should be enabled to deliver accurate information to students about progression routes and programme accreditation status.

With respect to psychology, some further clarity on the fields within psychology that will be regulated is required and how this may affect higher education programmes such as work and organisational, educational, clinical and sports psychology.

In conclusion, to support professional training and education provision, safeguard students, and maintain public confidence, it is crucial to streamline validation and accreditation processes, establish a national working group, harmonise policies, and address uncertainties in the fields of counselling, psychotherapy, and psychology. I thank the committee very much.

Paul Kehoe (Wexford, Fine Gael)
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That completes the witness statements. I now call on our first committee member to ask questions. Deputy Mairéad Farrell will be followed by Deputy Jim O'Callaghan.

Mairead Farrell (Galway West, Sinn Fein)
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Gabhaim buíochas leis an gCathaoirleach agus lenár n-aíonna as teacht os comhair an choiste. I specifically welcome Ms Hanrahan on her final day and it could not be a nicer day. It is lovely to be in a basement on such a sunny day. I thank her very much for having come in here today despite it being her final day. I wish her all of the very best for the future and I am sure that if she is anything like my mother, she has found that she is busier now in retirement than she ever was when working.

Ms Ginny Hanrahan:

That is often the case.

Mairead Farrell (Galway West, Sinn Fein)
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She does not know how she ever found the time to work.

The issue that is coming out clearly from everybody is accreditation and people going into courses. I am new to this committee so I have a number of questions on that issue specifically. I can hear what people are saying, which is that there needs to be that national body which has that kind of oversight but at this point in time, do we know how many courses or people who have been affected? Is it very clear to people before they go into the course that there might not be the accreditation at the end of it? I will leave it open to our guest speakers as to who wants to start off with replies to these questions.

Ms Ginny Hanrahan:

I will start then. We have approved 73 courses. We have had three courses which have withdrawn and two have reapplied. We work very closely with the education providers. The best way we can protect the students is to ensure the standards required and that the graduates will come off these courses with the right level of skills, confidence and knowledge.

This is not paying lip service. We have one course where we have had 107 individual contacts, meetings and emails, whatever, with the institution to help get that course over the line. From a CORU point of view, that is the best way we can protect the students, that is, to work very closely with the providers.

I talk about our setting minimum thresholds. Most of the courses we regulate are beyond those courses and I have great confidence in the students coming off those courses. The best way we can satisfy students coming on to these courses is by working with the providers to ensure the courses are approved. To date, we have not unapproved any course.

Mairead Farrell (Galway West, Sinn Fein)
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I thank Ms Hanrahan. For clarity, Ms Hanrahan said CORU has approved 73 courses. Three courses have been approved over time.

Ms Ginny Hanrahan:

Three colleges withdrew and two have reapplied and we are working with them to get them to-----

Mairead Farrell (Galway West, Sinn Fein)
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At this moment in time these colleges are not approved. Am I correct in saying that?

Ms Ginny Hanrahan:

That is correct, yes.

Mairead Farrell (Galway West, Sinn Fein)
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How many students are affected by that or have been affected to date?

Ms Ginny Hanrahan:

I am unsure. I do not know the numbers. All I can say to the Deputy is that our way of protecting those students is by getting those colleges over the line.

Mairead Farrell (Galway West, Sinn Fein)
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I believe we are all on the same page where we want everyone to be educated to the standard that is needed but the question here is how many students are being affected by this. Does anybody present have those figures and wish to contribute with those figures?

Dr. Padraig Walsh:

I can come in with a response here. This was the case of the programme which has been withdrawn by the private higher education institution.

A total of 84 learners were affected. When that happens in a private institution, it triggers what is called a protection for enrolled learners. QQI would have validated the original academic programme and looked at that. Our responsibility then is to work with other providers to see if the students can be transferred on or to see what accommodation can be come to with the colleges. Of those 84 students, 50 accepted a refund of their fees; eight transferred to another private college, which is one of the only ones that offered a part-time programme; ten transferred to a full-time course that offers the same qualification, and both this and the part-time programme have been approved by CORU; eight transferred to other programmes which would not allow them to become social care workers but in many cases people are happy to receive a degree, which can allow them to do other things; and six had been offered a refund and we are waiting to see what they will do. We work carefully with the college and all of that to ensure many of those people were able to go on and we hope they will be able to complete programmes.

Mairead Farrell (Galway West, Sinn Fein)
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On those 84 students, how much time had they done on the course at that point?

Dr. Padraig Walsh:

It varied. Some of them had one year done and some had two years done. It was a three-year programme. There were a number of people who would have graduated from the previous year. The grant parenting arrangement will allow people who have worked as social care workers for a two-year period up until 2025 to go on the register, so those students and graduates will have the facility to transfer onto the register.

Mairead Farrell (Galway West, Sinn Fein)
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That is very good. Professor Sheils indicated she wanted to come in.

Professor Orla Sheils:

I wanted to draw attention to the fact the following issue will become live. The HEA has an expression of interest out to institutions to develop new veterinary medicine, nursing, midwifery and pharmacy programmes, so those courses will be in colleges that do not currently have them. The same issues will arise for them in the coming months.

Mairead Farrell (Galway West, Sinn Fein)
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How clear was this to those 84 students before they started? There is an element of having to do your own research before you start a course, but when people have just come out of school, they are not used to doing that kind of research. How clear was it to those students before they started that it would not have been accredited?

Ms Ginny Hanrahan:

One of my concerns is that we have career guidance teachers for people coming out of school who give them ideas. We would often talk to them and we have found issues with the UK colleges for speech and language therapies. For example, they do not teach swallowing protection, so that is an issue if they come back to Ireland and have to do it, so we talk to them about that. There is no such system for adult learners and we need to look at where adult learners can go and get centralised information on what courses they are applying for.

Mairead Farrell (Galway West, Sinn Fein)
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When I did my leaving certificate, I did not get much career guidance at all, but most people coming out of school or most adult learners would assume that you are going to pay so many thousands of euro for something, you will be accredited at the end of it. Ms Hanrahan is saying that needs to be clearer. Could that be done legislatively to make it so that those private providers must tell people if they have not been accredited?

Ms Mary McHugh:

From CORU's point of view, we had to inform students. We were given a particular line to use in our documentation stating a course was not currently accredited. That was clearly stated on all of the publications on the course so that students were aware of that prior to coming onto a programme. We got approval this year so our new prospectus has all the information on that.

I wholeheartedly agree with the point on career guidance. We would have a concern about students coming onto a programme. When we interview students, particularly mature students, we would inform them of the requirements and how stringent they are in attendance and failed elements. All of those things will be outlined to a student, especially a mature student. Those coming through the CAO have a different experience as they are younger and they are depending on other things.

There is a perception that social care is a lovely course to come onto. It is a lovely and wonderful career but there are strict requirements and clear guidelines on the protection of the public. We did a lot of work with first-year students in particular on that area of informing students of the requirements. Some students choose to opt out of the course because of that, and that might be a choice they make for different reasons, but there is definitely an awareness, particularly among undergraduates and those coming in through the CAO, around social care that it is a wonderful programme to come onto but that there are particular requirements. I mentioned DARE and HEAR and all those initiatives for students and the diverse range of populations.

Offering students places on programmes is fantastic. However, the supports required to get those students through, and the awareness and supports they need to get them through are the important thing, otherwise you are going to have students who are not going to make it through those social care programmes. That is really important, and something we need to consider going down the line. We need to put more supports into those courses to ensure that students are able to go through it. That is a resource issue. That comes down to resources, at the end of the day. I do not know whether that answers the Deputy's question or not.

Ms Patricia O'Sullivan:

Regarding Deputy Farrell's question on whether there was sufficient communication to students, with regard to the private provider, there was communication that this course was not approved by CORU. In fact, to my knowledge-----

Mairead Farrell (Galway West, Sinn Fein)
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Was it to the provider rather than the students?

Ms Patricia O'Sullivan:

Sorry, to the students. To my knowledge, QQI has commissioned a focused independent panel report on this aspect. Even though I have not seen the report - it is due to be published next month - I believe this will show that this particular provider did actually provide the students with the information that the course was not approved by CORU at that stage, and was under accreditation.

Mairead Farrell (Galway West, Sinn Fein)
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I would like to ask a quick question on CORU's complaints mechanism, which I have been asked to raise. Could the witnesses please detail their complaints mechanism?

Ms Ginny Hanrahan:

We receive approximately 55 complaints a year across all the professions. About 85% are against social workers, which is not surprising when one looks at the areas in which social workers are working, with families in very difficult situations. A very small number of those go forward to what we call a preliminary proceedings committee. This is a review to see if there is a complaint to answer or not. Then we progress to dealing with the full fitness to practise process, which usually means that if someone is really not working for the patient's safety, or if there is a concern, we can actually take them off the register. We have done so on a couple of occasions. We do that through the High Court. We recently had an optometrist, which was a quite well-known case. Again, these are very small numbers: 25,000 registrants and 55 complaints, and probably about ten to 12 of them go into further hearings. Does that answer the Deputy's question?

Mairead Farrell (Galway West, Sinn Fein)
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It does. Is it simply that people can just easily get in contact with CORU on that?

Ms Ginny Hanrahan:

Yes. We get complaints from individuals, but also complaints from employers.

Dr. Padraig Walsh:

I would like to answer the Deputy's question with regard to the legislation. Currently, the QQI establishment legislation requires a provider to say whether a programme is at a particular level on the national framework of qualifications, or whether it is in the national framework of qualifications. It also requires a provider to say if it is not because we do not completely regulate education and training. People can run programmes. We have all probably attended programmes that were good, but were not necessarily accredited. There is nothing wrong with that.

There is no legislation, however, to say whether a programme is subject to approval for regulatory purposes, and that is something that might be helpful. CORU provides guidance to providers on wording for that, to say, for instance, that this programme is currently in submission to CORU for approval, but that does not mean it will be approved. It is just like saying one is going to sit one's driving test, but that does not mean one is going to pass.

Mairead Farrell (Galway West, Sinn Fein)
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Unfortunately. That is good for us to know. It is important for us to hear what we can-----

Dr. Padraig Walsh:

I would also like to come in on the review which Ms O'Sullivan talked about. For that particular review which QQI conducted with an independent panel, which will bring up a number of these points, the report was concluded on 12 May. The provider submitted the response to us last week, and it will go before our approvals and reviews committee on 20 June. It will be approved thereafter, and I can provide the link for members if they want after that, so they will be able to see the report.

Mairead Farrell (Galway West, Sinn Fein)
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Brilliant. Yes, that would be very helpful. Do I have time for another question?

Paul Kehoe (Wexford, Fine Gael)
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Yes, the Deputy can go ahead.

Mairead Farrell (Galway West, Sinn Fein)
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I am not wearing my glasses, unfortunately I left them upstairs. My question is about the ask. We have the Department coming in for the next session, and the witnesses are saying that there needs to be an oversight body. Is that an ask of theirs from the Department or how do they feel that will need to be structured?

Dr. Padraig Walsh:

Perhaps I can answer that. CORU is here. There are other bodies like the Dental Council of Ireland, the Irish Medical Council and the Nursing and Midwifery Board of Ireland. The relevant Department for them is the Department of Health. That is the body that controls their legislation. One reason there are differences in the way that the professional bodies practise is history. We have bodies like the Royal Institute of the Architects of Ireland, which predates the State, and relatively new bodies like CORU, which were set up in this century. There are also differences in the form of legislation.

As set out in our submission, QQI commissioned a report that looked at the way the different bodies accredit. They do things differently, with some publishing their accreditation reports and others not. It is a matter of history and practice. That report from 2019 is included in our submission. Since then, we have facilitated a finding common ground programme. We have 30 professional, statutory and regulatory bodies, PSRBs, engaging in a programme of quarterly events, which involves a dedicated communications hub. We have worked on high-level accreditation principles, which are aimed at finding a method of updating the academic validation and professional accreditation process. To date, 16 professional bodies, 15 public higher education institutions and eight private higher education institutions have endorsed those principles. Getting people around the table has helped. People will be in a position to look at Ms McHugh's suggestion of a steering group. That proposal could progress.

Ms Ginny Hanrahan:

A new working group has just been put in place in the past few months, which includes representatives from the Departments of Health and Education, Further and Higher Education, Research, Innovation and Science, CORU and other regulators. It is looking at what we can do to improve things like placement provision. The number of students attending courses must be guided by the number of placements that can be provided. Some colleges have run into problems whereby they have taken on far too many students and do not have enough placements for them. Bodies like Tusla often work very hard to try to provide those placements. The national health and social care professionals office in the HSE is very actively involved in trying to provide placements. We must acknowledge the issues in this regard. Professor Sheils outlined really well that when people are being trained to go into health and social care, whether that is medicine, occupational therapy or whatever, there must be placements to ensure they have the right training when they come out. That is very challenging, particularly in the aftermath of the Covid period, when all front-line staff are under great pressure. There is some work going on to improve access to placements.

Mairead Farrell (Galway West, Sinn Fein)
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My next question is about the streamlining of that process. My understanding is that with nurses, doctors and so on, it is done on something of an ad hocbasis. That is probably not the correct term but it seems that rather than having a fully streamlined process, there is a need to get people on board with bringing trainees in on placement. I am aware that everybody in the healthcare sector is under massive pressure. People are working even harder than before and have less time to train others. However, such training is for the long-term benefit of the service. Do the witnesses feel there needs to be more streamlining of that process? We know we need more doctors and nurses over the coming years because the system is already under pressure. If we are increasing places on courses, we must ensure the corresponding placements can be offered.

Ms Ginny Hanrahan:

Trainee physiotherapists, occupational therapists, speech and language therapists and social workers all need to do a training placement. I trained as an occupational therapist 40 years ago, which included having to do a placement of 1,000 hours. That is absolutely crucial. People coming out of courses must be able to work independently. As we move to deliver Sláintecare, we must have professionals coming through who can get to work straight away. Placements are absolutely critical. I acknowledge it is very tricky for the providers at this time, when they are under such pressure. Working in the profession of occupational therapist, I have taken students in because we know it is the only way they will learn. Another factor is that there is a very small cohort of academically brilliant students who think they want to work in one of these professions. However, when they go out to placements, they realise it is not for them. It is crucial for all these professionals to have placement training.

Professor Orla Sheils:

Pharmacy is an example of where people got together and devised a national network to facilitate placements. It means they can make use of a wider geographic area. If one is depending on an individual partner institution, one is limited by the amount of capacity that institution has within its system, unless the Department of Health funds a clinical tutor at the site. Having more joined-up thinking might be a way of alleviating some of those geographical issues.

Ms Patricia O'Sullivan:

We already have a template whereby we had stakeholders from a wide section of society working together in the national Covid-19 steering group on further and higher education. The Chairman was a member of that group, which also included student representatives. It successfully steered the further and higher education sector through the Covid period. It was a really good template, not just in regard to recruitment but also in having that confluence of views on validation and accreditation. We need all these experts working together, along with learner representatives. We would be very supportive of that kind of national steering or working group.

Ms Mary McHugh:

From a social care point of view, the area is so diverse and students go into such a diverse range of areas that sometimes it is very difficult to co-ordinate. Tusla has been very proactive in setting up and co-ordinating nationally in relation to social care and social work. It is unfortunate that it may be more focused on social work and those being co-ordinated are in social work and they are placing social care students. Maybe there needs to be more of a social care perspective on it but it has been excellent and very successful.

However, there needs to be more recognition of the practice educators who are providing the placements. It may be that many of them are Government funded in different areas such as disability and family support. Maybe there needs to be some recognition in payment or time off or whatever. They are working in hugely stressful environments. They have to provide placements which, as Ms Hanrahan said, are hugely valuable to our students and they need to be recognised. Perhaps a steering committee could get involved in that. Placements are vitally important to us.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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I thank everyone for their opening statements and for coming before the committee, especially Ms Hanrahan. Not many people would wish to spend their last day in work appearing before an Oireachtas committee, but as Oireachtas committees go, we are not too bad.

There appears to be an issue around whether a course should be approved and validated in advance of it starting - ex anteas Dr. Walsh put it - or whether we should wait until it is up and running, ex post. I can see the arguments in favour of and against both. Am I correct in stating that Dr. Walsh thinks that ex anteprogramme approval appears to be safer? Is that from the students’ perspective?

Dr. Padraig Walsh:

QQI can only approve ex ante. It is the same with all validating bodies, like universities. The programme must be approved before people are recruited to it. There is a sense in accreditation or approval that it is either pass or fail whereas in fact there can be a process of having conditions. QQI, when it validates a programme, can do so with conditions that must be fulfilled by the provider within a period of time. A number of the professional bodies, including the Nursing and Midwifery Board of Ireland and the Irish Medical Council, actually operateex anteprocesses but they have a follow-up procedure system. For instance, in areas such as medicine where new programmes are approved, they can approve the programme ex antebut they require a come-back for the first set of graduates.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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It is like a conditional approval.

Dr. Padraig Walsh:

It is, yes. It is a conditional approval process or approval with conditions. That is standard in many areas.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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Are there examples where conditions have not been met and what the consequences have been for the course?

Dr. Padraig Walsh:

There have been cases, not only in regulated professions but in any higher education area, where conditions have had to be met. There is usually a process whereby people are given a further chance to fix those, but then there is a process of having to transfer people onto other programmes. All programmes that are approved are periodically re-accredited, so it is always possible to lose accreditation. In some cases, it is not a bad thing there is a chance this can happen. During the financial crisis, for instance, there were programmes where academic staff numbers had run down. It provides a form of protection to make sure there is a periodic accreditation process. It happens with all professions.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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In her opening statement, Ms Hanrahan said she understood the desire for education providers to have this ex anteapproval but that it is risky, and to approve courses based on the proposal rather than the reality transfers the risk from the education provider to patients or service users. Will she elaborate on that?

Ms Ginny Hanrahan:

In our work, we need to make sure the graduates coming off are actually fully formed and fit to practise. Our legislation only allows us to approve or not approve. As I said, to date we cannot approve of conditions. That is what our legislation says. We have approved all our courses and we work really hard to get the courses across the line. For me, that is the most important thing we do and, from a student safety perspective, that is the best thing we can do.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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What is the potential risk with ex anteapproval?

Ms Ginny Hanrahan:

It is because it is looking at a perspective. It is interesting, because I spoke to the nursing board before I came in here. We have professions that are very small. The biggest group we have is 5,300 social workers and we have 800 dispensing opticians, so the numbers are very small.

With a bigger group, a memorandum of understanding could be issued in the case of a hospital or whatever. However, that is not always possible because we need placements in smaller locations. Placements are, in many cases, where issues arise. That is why we feel safer in saying we should look at how we approve the course, make sure we get in the approval review and meet the students and practice placement providers to ensure the standards are being met. In that way, we can be reassured the graduates coming off the course are meeting the requirements.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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Professor Sheils stated that a more logical approach might be to allow a temporary approval based on a review of the planned curriculum, possibly for one intake, and then to review it when the programme is running to make an assessment for the final approval. Would that be a fair way of doing it?

Professor Orla Sheils:

It is a possibility. I take the point that for classes or courses where there are very small numbers but where we are relying on what are effectively sole traders to supervise, that becomes difficult and it would be easier not to do it, but I do not think it is an insurmountable challenge. The list of potential placement supervisors could also be vetted as part of that pre-approval in order that there would be a good sense of the ecosystem into which the students would be placed.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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Does dealing with that issue require legislative intervention or is it something the bodies involved can introduce?

Ms Ginny Hanrahan:

As I said earlier, the legislation that governs us is clear. We can either approve or not approve. We cannot approve of the conditions. That is the legislation I am working to. It is why our system has been developed in the manner in which it has.

Professor Orla Sheils:

Yes, and that varies throughout the sector.

Dr. Padraig Walsh:

Some legislation allows for approval or refusal and some allows for the approval of conditions. There is different legislation for different bodies.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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In the context of the social care profession, Ms McHugh spoke about CORU's register, which will launch a two-year transition period for the existing diverse sector of social care practitioners to apply within. In order for people to apply to that now, do they need qualifications or is it only after the two-year period that qualifications will become mandatory?

Ms Mary McHugh:

Ms Hanrahan might be in a better position to answer this than I am, but it is open to people who have been working in social care for a long time and wish to apply to get onto the register. They may have a diverse range of qualifications or, like me, they may have an historical social care qualification. I intend to apply to the register in November. The two-year period will be their only opportunity. I they do not get onto the register within that period, the only opportunity thereafter will be through an approved qualification. In that regard, there needs to be a public awareness campaign. CORU is involved in that. I attended the social care conference this year, as did Ms Hanrahan, and some people were saying they would wait and see. There is no waiting and seeing. Applicants can either get onto the register within the two years, if they wish to grandparent, or they will be required to have one of the approved courses, which will mean they will have to return to college and undertake a course from the start. When I was in college, people graduated with a higher certificate-----

Ms Ginny Hanrahan:

If I could come in there, we have regulated ten professions for the first time. Grandparenting allows people with older qualifications to be included. For example, we really have to take into consideration the 40 years of people having been working. Forty years ago, the qualification in my case was a diploma, whereas it is now a degree. An allowance has to be made for that where people have the experience to work, and that is what grandparenting is about.

We have made a change in the legislation that is going through the Oireachtas to allow us to include two years of grandparenting. In most cases, on the day on which the register opens, the grandparenting provision applies only where the applicant has worked for two of the previous five years and we can take into account the older qualification because the gate is coming down. For social care, however, because of the challenges and because this is the first time there is regulation and the first time the courses have been reviewed, the grandparenting period will be extended to 30 November 2025, which means that where graduates come off courses that, as Dr. Walsh mentioned, might not have gone through the review, those graduates will be nonetheless able to apply to get onto the register.

It is a very fair system. In summary, we are putting in the new standard, the gate is coming down and courses will have to meet the new standard, but we are making an allowance for older qualifications and acknowledging people’s experience in working as social care workers.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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Any social care providers who are currently in place will need to register under the scheme.

Ms Ginny Hanrahan:

Yes, the individuals will have to register.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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Ms O'Sullivan stated it was crucial to streamline validation and accreditation processes. What did she mean by that?

Ms Patricia O'Sullivan:

It is not helpful when there are contradictory outcomes. In validation, a course is approved, but accreditation limits us to a kind of a "Yes" or "No" answer.

Going to part of the suggestion given, there needs to be some kind of middle ground. I understand that people are restricted on the basis of legislation, but this is why the working group and getting all the experts together could come up with a solution. If the only solution is legislation, then so be it. There needs to be some kind of middle ground because the processes have faults. Going forward, many more professions are to be accredited. If a person is going into psychology, counselling and psychotherapy, that is a wide, complex group that has many different parts. We need to get our ducks in a row, as it were.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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Professor Sheils mentioned that CORU requires that each profession has a separate board and that this is problematic. Why is that? Is she suggesting there should just be one board for all professions?

Professor Orla Sheils:

The accreditation process involves an assessment of the governance within the institutions. In other words, how things are run. That does not change whether it is occupational therapy, physiotherapy or radiation therapy. An example from my home institution is that the school of medicine had three accreditation visits. People who can speak to the governance are rolled out to say the same thing to three different boards in an academic year.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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That is repetitive.

Professor Orla Sheils:

It is repetitive. It is not an efficient way to do things. That bit does not change. If the bits that stay the same could be agreed, surely they can be accredited but once and the board might then focus on the specific course in question and the curriculum there.

Ms Ginny Hanrahan:

Essentially, as I said, we regulate all these professions for the first time. We are now reviewing what we call the criteria, which is what the college needs. We will come up with a solution in respect of that issue. There are 12 separate boards within our organisation for the various professions. We are looking at a more sustainable regulation model whereby we will consider how we can simplify matters and be more efficient in how we deliver this. It is in the context of the criteria that governance is looked at. We will be looking at a model where we hear once from a college and then progress. It just takes time. When you are starting off with a new profession, you have to be satisfied that everything is okay. Professor Sheils is in Trinity, where a lot is established. However, for many of the colleges, the first time they have had a regulatory review has been through CORU. It is looking at getting that balance right.

Paul Kehoe (Wexford, Fine Gael)
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I have a question for Ms Hanrahan. Does CORU have any processes in place for students who have trained and graduated from Northern Ireland or farther afield who then want to come to Ireland to work? Is that an issue? Does CORU recognise their qualifications?

Ms Ginny Hanrahan:

Yes.

Paul Kehoe (Wexford, Fine Gael)
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Does anyone else on the panel wish to reply to my question as well?

Ms Ginny Hanrahan:

We have a recognition process. Anybody who qualifies in Ireland and comes off a course that has been approved can apply to register. For people from Northern Ireland or any other part of the world, there is a process whereby we have to go through a review of their courses. We apply the EU legislation across the board. Once they get their applications in, we have up to four months to make that decision, but we get it done within about ten weeks. We have an initiative with what we call frequently seen qualifications. For example, at the moment, we do not have to review social workers from the Ulster University, UU, because so many have come through. We are saying we will just get them through, so they are getting through much quicker. We are trying to roll that out to more courses. We looked at radiography as well with Queen Margaret University in Edinburgh and UU. At the last registration board meeting, there were about six applicants who basically we did not have to go through this process for because the courses have got through. We are trying to improve that as much as possible. We have up to four months to do a full review and we usually get them through within ten weeks.

Paul Kehoe (Wexford, Fine Gael)
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I refer to the crisis in recruitment. We all know what is happening out there. It comes to my office as a public representative and everything like that and I go to the HSE and it is like a circle. Has CORU been equipped with enough resources as an organisation to meet the demand? What additional help, assistance or resources does CORU need?

Ms Ginny Hanrahan:

We have had an increase and we are working away. In a ten-week turnaround there is a balance to be struck in making sure the proper checks are done. There is therefore a safety issue there. The other side we are working on is working very closely with the HSE and Tusla, where they are looking at overseas recruitment, based on our knowledge and experience of which countries are more likely to be successful if you are going recruiting.

Professor Orla Sheils:

One of the biggest issues with regard to recruiting the numbers we need in a sustainable way is the fact we rely on funding from different Departments. The Higher Education Authority, HEA, or the Department of Further and Higher Education, Research, Innovation and Science, DFHERIS, can fund academic spaces in institutions, but we are dependent on the HSE to fund clinical tutors. The pressures on it may mean it is not going to do that, which limits the number of students we can process, because they have to be in a safe clinical environment. There is not that joined-up thinking whereby to resource the provision of healthcare practitioners, we need both the right hand and the left hand to work together.

Paul Kehoe (Wexford, Fine Gael)
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Have any Ukrainian people who have come in had any qualifications to work the Ukrainian community? What about the refugee community?

Ms Ginny Hanrahan:

Yes. There have been a small number who have gone through the process and who have been successful. It is a very small number. That is a result of the hand-holding from our team working very closely with them as well working with the human rights organisations. Again, we really are working very hard to allow that to happen.

The language is the other issue. I was delighted to see in St. Vincent's University Hospital that they have just done a programme for 28 doctors, looking at language. There are some innovations we need to be looking at to try to improve that.

Carol Nolan (Laois-Offaly, Independent)
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I thank the representatives. I have read through the briefing notes and it is good we are having this discussion here. We know we have a crisis with recruitment and retention in our health services. Has CORU been properly equipped with enough resources to make sure assessments are carried out in a timely fashion? There have been a couple of instances where healthcare professionals have been in touch with my office, wondering where their documentation was and where they had been waiting. Does CORU need more resources? This is not a criticism of any kind; just being pragmatic. Are there gaps? Does CORU feel its services are stretched and it needs more?

Ms Ginny Hanrahan:

There is no doubt we have had more applicants. There has been a 100% increase in applicants this year and there were 900 international applicants. This relates to anybody who has trained outside Ireland, including many from the UK. We will hit at least 1,800 this year, so it is a large number.

In fairness to the Department of Health, we have been working very closely with it from a resources point of view. Yet, as I was just saying, under the EU legislation, which is what we apply across the whole lot, we have four months to get somebody through that process once we have all the papers. We are actually getting there in about ten weeks.

We are also looking at alternative routes. I have mentioned that we are looking at frequently seen qualifications. Therefore, if a radiographer comes from Queen Margaret University in Edinburgh, they will get through more quickly because we have seen those qualifications. Therefore, it is a case of the frequency of colleges with frequently seen qualifications. We are looking to roll that out. Physiotherapy is one of those areas as well. I hope that answers Deputy Nolan's query.

Paul Kehoe (Wexford, Fine Gael)
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I thank the witnesses for coming before the committee today. The discussion has been both very productive and beneficial to the work of the committee. I specifically welcome Ms Hanrahan and I wish her the very best of luck. I hope her staff are doing something nice for her this evening. I hope the next part of her life or her career after her retirement will be happy and, most importantly, full of good health. I hope the staff thank her for the work she has done in the organisation. I thank her very much again. We will suspend for a few minutes.

Paul Kehoe (Wexford, Fine Gael)
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On behalf of the committee, I welcome Ms Tanya Kenny, principal officer, and Ms Fiona O'Byrne, principal officer, Department of Further and Higher Education, Research, Innovation and Science. The officials are here to brief the committee on the professional accreditation of higher education, HE, courses with specific reference to the health and social care professions.

The format of the meeting is that Ms O'Byrne will make a brief opening statement that lasts five minutes. This will be followed by questions by committee members and each of them will have a five-minute slot. As the witnesses are probably aware, the committee will publish the opening statement on the website following the meeting.

The officials are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction by the Chair.

Ms O'Byrne has five minutes.

Ms Fiona O'Byrne:

I thank the Cathaoirleach and members of the committee for the invitation to discuss the topic of professional accreditation of higher education courses with specific reference to health and social care professions. I am the principal officer with responsibility for higher education policy and reform in the Department of Further and Higher Education, Research, Innovation and Science. I am joined by my colleague, Ms Tanya Kenny, principal officer, who has responsibility for quality, qualifications and governance.

My Department is responsible for the policy, funding and governance framework for the tertiary education, research and innovation system, which includes higher education and further education providers. Higher education institutions provide a supply of graduates into health and social care professions. They have demonstrated that they are keen to work with relevant regulators to accredit their programmes and enable the registration of graduates with regulators upon completion of their programmes.

In line with their legislatively underpinned autonomy, higher education institutions are responsible for their own day-to-day management and operational affairs. That includes the management of academic affairs and course provision. The accreditation of courses with the relevant regulatory authorities is a matter for individual institutions in line with this autonomy.

The Department of Health has responsibility for the development of regulatory policy for healthcare professionals as well as the governance of CORU, and the professions designated under the Health and Social Care Professionals Act 2005. The Department of Health is also responsible for developing policy approaches for the future regulation of those health and social care professions, which are currently unregulated. Governance and oversight of the health regulators, such as the Irish Medical Council, the Nursing and Midwifery Board of Ireland, and the Health and Social Care Professionals Council, CORU, are under the remit of the Minister for Health.

CORU is Ireland's independent health regulator. It has a distinct statutory remit to protect the public by promoting high standards of professional conduct, education, training and competence through statutory registration of health and social care professionals. CORU sets the standards and competences that health and social care professionals must meet. CORU is also responsible for ensuring that the relevant educational bodies deliver qualifications that prepare professionals to provide safe and appropriate care.

The Department of Further and Higher Education, Research, Innovation and Science fully supports the regulation of professions as regulation gives confidence to the public, and the profession, that there is an appropriate mechanism to ensure fitness to practice and the protection of the most vulnerable in society. The issues resulting from a withdrawn accreditation application in summer 2022 have brought a renewed focus on professional accreditation processes. In addition, areas have been highlighted where processes must be strengthened, where greater engagement and co-ordination are required, and where more transparency must be provided for students.

Through strengthened engagement between the Department of Health, the Department of Further and Higher Education, Research, Innovation and Science, CORU, Quality and Qualifications Ireland, and higher education institutions, these matters have been taken forward over the intervening period and remain a focus of engagement. Higher education institutions have a responsibility to communicate clearly and transparently with their students on the accreditation status of their programmes. In September 2022, Department officials wrote to providers of social care programmes in publicly-funded institutions reiterating the need for institutions to communicate their position regarding their accreditation status to all students. Institutions were also asked to ensure that anywhere information on these courses is presented, including on websites, clearly reflects the accreditation status so that students are aware of what their position would be in terms of professional registration in advance of applying to and at the end of any course.

The Department understands that a significant majority of social care programmes have now completed the CORU process and are successfully accredited.

The remaining small number of programmes are continuing through the process. The Department also understands that these remaining programme providers are actively engaging with CORU around their applications and are moving through the process in a timely way. The Department continues to engage with the Department of Health and the higher education sector as these final programmes move through the accreditation process. I thank members, and I am happy to assist the committee with its considerations.

Paul Kehoe (Wexford, Fine Gael)
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Okay. First we have Deputy Jim O'Callaghan.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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I thank the Chair, and I thank Ms O'Byrne and Ms Kenny for coming before the committee. I do not know if they heard the earlier session,

Ms Fiona O'Byrne:

We heard some of it.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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One of the proposals put forward was by Ms Patricia O'Sullivan. She was talking about the fields of counselling, psychotherapy and psychology, and she thought it would assist public confidence if validation and accreditation processes could be streamlined, and a national working group established to harmonise policies. Obviously, I am conscious that Ms O'Byrne is not a politician and it is an executive decision. Does she have any views on that? Would that be something feasible, if ministerial approval was behind it?

Ms Fiona O'Byrne:

The accreditation of programmes by regulators such as CORU is a matter which falls under the remit of the Department of Health. It is not a process the Department of or Minister for Further and Higher Education, Research, Innovation and Science has a role in. There are probably two separate pieces around the forming of clearly enhanced engagement between the stakeholders involved, and this includes CORU, QQI, the Department of Health, the Department of Further and Higher Education, Research, Innovation and Science, and the higher education institutions. It is something which has increased in recent months, and has the potential to enhance the outcomes from these processes.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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I am not suggesting that the establishment of the Department of Further and Higher Education, Research, Innovation and Science has confused it, but is there any proposal or merit to the suggestion that perhaps we should move departmental responsibility away from the Department of Health for those issues, and over to the Department of Further and Higher Education, Research, Innovation and Science? I think that is, perhaps, part of the harmonisation Ms O'Sullivan was talking about.

Ms Fiona O'Byrne:

Regarding the role of professional accreditation bodies such as CORU, the Nursing and Midwifery Board of Ireland and the Irish Medical Council, the span of issues under the control of such bodies is so wide that I would imagine a proposal like that would need significant consideration. There is substantially more beyond the education dimension.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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There was also mention of care providers, and the fact that they now have to register within the next two years. I do not know if Ms O'Byrne was aware of that, or if she was here for that contribution.

Ms Fiona O'Byrne:

I was not here for that. The process, as I understand it, for regulations being introduced for the first time includes grandparenting provisions to enable new social care workers to register on the basis of experience.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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In Ms O'Byrne's and the Department's assessment, how is CORU developing as the independent health regulator since it was established?

Ms Fiona O'Byrne:

As higher education institutions apply for regulation, the Department is not party to those processes. However, we do have a role in engaging with colleagues in the Department of Health, CORU and the institutions to support that engagement, and to ensure that processes are progressing in the event of any issues emerging. We are not actually party to the individual accreditation applications.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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One of the other issues which was raised was the issue of approving and accrediting a course before it is up and running. Does one wait for the course to be up and running, and then give it approval after one sees how it is performing? Obviously, CORU and QQI are limited with regard to what they can do by the legislation which has been set down.

From the point of view of the student, one could appreciate the concern and maybe the apparent unfairness which arises if one has a student who starts a course which has not been accredited, and then a while into the course, they are told that it is not going to be accredited. I know this is predominantly a question for politicians but is there anything that can be done to try to protect students who find themselves in that position?

Ms Fiona O'Byrne:

The crux of the issue is the balance between the need to protect the public, which is CORU's remit, and the protection of students, and how we get the balance right in that regard. Key to managing it under the legislation underpinning the regulatory bodies is enhanced engagement between all stakeholders. It is a case of managing that balance.

Jim O'Callaghan (Dublin Bay South, Fianna Fail)
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Does that enhanced engagement happen in practical terms?

Ms Fiona O'Byrne:

It does. I engage directly with my counterpart in the Department of Health's professional regulation unit and with CORU.

Mairead Farrell (Galway West, Sinn Fein)
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One of the things we heard clearly in the previous session was about the oversight of the supervisory body. I ask for the views of the witnesses on that, both in terms of the accreditation of courses and about the other thing that came out towards the end of the last session, namely, placements and the streamlining of same. The witnesses in the previous session said that Tusla organise it quite well but that the way the Irish Pharmacy Union does it through the union itself, which means it is more spread out on a national level.

Ms Fiona O'Byrne:

On the first point, the accreditation of programmes by CORU or other professional regulators is a matter for the Department of Health. CORU is an independent regulator, so we do not have a role in that process.

On the wider issue of securing placements, in mid-2022, the Department of Further and Higher Education, Research, Innovation and Science established a working group with colleagues in the Department of Health, CORU, the HSE and the higher education sector to identify and address the barriers to expanded provision for the health and social care professions, HSCP. As part of that work, the group identified placements as the key issue constraining expansion. Since that work has commenced the HSCP office within the HSE has progressed significant work on an educational practice placement framework to oversee the governance of placements, with those kinds of issues in mind. I understand that in recent weeks the Department of Health has also appointed a HSCP officer to drive that forward so there is a renewed focus on coming to a more joined-up approach to placements.

Mairead Farrell (Galway West, Sinn Fein)
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When that was identified as a key barrier, was there an identification of the number of places that would have been impacted? Was it at that point that it was decided that we wanted to increase the numbers or was it just seen as constrained? Or was it seen as the case that at this point it was at maximum capacity?

Ms Fiona O'Byrne:

The Department of Health is undertaking work. It has funding from the European Commission to support it in its workforce planning to develop the tools and approaches to develop workforce plans for each of the subdisciplines that fall under the HSCP banner, as well as within medicine and nursing. That work is continuing. In parallel with that and in advance of final workforce plans beings arrived at, we are trying to ensure there are no constraints that would stop it.

Mairead Farrell (Galway West, Sinn Fein)
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A few things came up in the earlier session. More generally, when people are coming into nursing for example, it is points-focused. We see in other countries that it can be done in more of an apprenticeship-type programme. How is the analysis of that and of our international comparisons going?

Ms Fiona O'Byrne:

In nursing in particular, under the Funding the Future framework one of the priority areas is driving skills and engagement, with a particular focus on the skills required for the delivery of essential public services. A subgroup on nursing chaired by Professor Tom Collins was set up to explore both models of nursing.

In parallel, the Department of Health has set up new structures for nursing, which the Department of Further and Higher Education, Research, Innovation and Science feeds into. On apprenticeship, that is an employer driven model. It would be a matter for the employers of nurses, predominantly the HSE, to consider whether that is something they would like to take on. I understand the Nursing and Midwifery Board of Ireland is this week finalising standards relating to graduate entry programmes too.

Carol Nolan (Laois-Offaly, Independent)
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I thank both of the witnesses for being here. This has raised a number of important questions. I first want to ask if there is joined up thinking, and a lot of co-ordination between the Department of Further and Higher Education, Research, Innovation and Science, the Department of Health and CORU. What is the current level of collaboration? Engagement has been mentioned, but it often strikes me that when there are a lot of bodies and stakeholders involved it can pose problems and barriers. I would like to know what the current level of engagement is. Are there planned meetings every month, or what way is it structured?

Second, in terms of the binary nature of approval or fail decisions by CORU, is the approach currently utilised too inflexible? Could improvements be made? What improvements could be made to CORU's decision making?

Ms Fiona O'Byrne:

On the first question, there is a combination of formal engagement. The Department of Further and Higher Education, Research, Innovation and Science, the Department of Health and CORU are all represented on the health and social care professions working group. We engage formally through those structures. That is complemented by substantial informal engagement where the professional regulation unit in the Department of Health, CORU and my unit in the Department of Further and Higher Education, Research, Innovation and Science would be in frequent contact working through processes like this, and the couple of remaining applications waiting to be accredited. On the current binary nature of the approval process, I am not in a position to comment on the suitability of the legislation or the existing policy. As Department officials we are not here to give opinions on that.

Eileen Flynn (Independent)
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A lot of the time people from disadvantaged backgrounds and minority groups tend to take caring courses. That is not to stereotype, but a lot of people tend to take caring courses and nursing courses as well. A person might go down that route and be told they would have a qualification at the end of it, only for that course, no matter which, not to be accredited. What is being done to protect students who find out maybe after a year that their course is not accredited? Second, and this might be off the point for the witnesses, I have done some work with Ballyfermot College of Further Education. A lot of the post-leaving certificate, PLC, colleges in Inchicore, Ballyfermot and Crumlin provide good access for people from disadvantaged communities. In one sense, education is a way out for people from some economically disadvantaged backgrounds. I am trying to work with the board of management and the Department to get an accredited nursing course in Ballyfermot College of Further Education, for example. It would be a QQI level 6 and then people could go on to UCD or DCU to finish the rest of the course. Is that doable for some of the PLC colleges? It creates that access. People are not in big universities, and are not afraid then of stepping into a college like Ballyfermot College of Further Education. I would like to hear the witnesses' thoughts on that.

Ms Fiona O'Byrne:

I will deal first with the question about students joining a course.

It is the responsibility of higher education institutions to communicate the accreditation status clearly and transparently to students in advance of them joining courses. The particular challenge at the moment is because accreditation is being introduced for the first time. Higher education institutions need to communicate in advance of students joining and, through that process, to ensure students are fully aware of what is happening.

Regarding access routes, the Minister recently announced the establishment of the national tertiary office, NTO. This office will be managed between the Higher Education Authority and SOLAS. Dr. Fiona Maloney has been appointed director. The national tertiary office is driving out programmes that are co-developed and co-delivered between further education providers - the likes of Ballyfermot - and the higher education providers. The thinking here is if the programmes are developed together to make a smooth continuation pathway, students will be guaranteed progression on to the higher education piece of the programme. Students will be able to begin the programme, probably closer to home, in the further education and training, FET, provider and then have that guaranteed progression and the supports to go alongside it. The first batch of programmes from the NTO are due to commence in September 2023, but it is an area of particular focus for the Department and a priority.

Ms Tanya Kenny:

Regarding the protection of the learners when they enroll in particular courses, there are statutory provisions which are regulated by QQI, which we heard from earlier today. These are the protection of enrolled learners' provisions. They provide a statutory obligation to protect learners who are affected by any cessation or non-commencement of a programme. That is usually fulfilled either through academic bonding or financial bonding, so that they would be facilitated on another course or through a financial refund. There are legal provisions to protect learners in that way.

Regarding access and the recognition of prior learning, we are aware that, as part of the accreditation and approval process with our colleagues in CORU, a provider must set out in detail its admission procedures, which would include what is entailed by recognition of prior learning. That can include informal learning, formal learning and previous life experiences. The provider would then give clarity on what the requirements are.

Eileen Flynn (Independent)
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I have had experience where, say, ten or 12 Traveller women are doing a course in any area and then they are told that the provider is waiting to hear back from the Department if it can be accredited at the end of the year. Women are taking part in courses and then finding out at the very end that it is not accredited. Obviously it is still educational but they do not have the credits. We need to look at changing this because I have seen it on the ground in community work around some of the courses on health, addiction and poverty. It is important we support people and that the Department is very clear. People should not have to live in hope that by the end of a course they will have an accredited qualification.

Paul Kehoe (Wexford, Fine Gael)
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The Senator can get back to me through the committee secretariat and we can-----

Ms Fiona O'Byrne:

If the Senator has a particular example of a course she wants us to have a look at, please send us the details. I am just not familiar with the specific example.

Eileen Flynn (Independent)
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There are many of them around the country, more so at community level, where organisations like NGOs would support women or men to do a course. It might be about addiction or education about poverty. However, when they finish the course they find they do not get the credits they were expecting. I will send on those details.

Paul Kehoe (Wexford, Fine Gael)
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I thank the officials for updating the committee today on this issue. It has clarified a number of areas for the members. I also thank the witnesses who appeared before us in session 1.