Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I move: "That the Bill be now read a Second Time."

I am pleased to have an opportunity to address the House on Second Stage of the Health (Miscellaneous Provisions) Bill 2014. This is quite a technical Bill, with a total of 44 sections. It has three main objectives, the first of which is to provide for the subsuming of the Opticians Board into the Health and Social Care Professionals Council. The Bill also makes certain amendments to the Health and Social Care Professionals Act 2005 in the interests of efficiency and to ensure consistency with the legislation governing other health regulators.

The Bill also amends the Health Act 1970 to ensure that statutory contributions are payable by recipients of residential support services who, while maintained, are not directly accommodated by or on behalf of the Health Service Executive.

The first objective and the original main purpose of the Bill, which is to subsume the Opticians Board into the Health and Social Care Professionals Council, is in furtherance of the ongoing programme of State agency rationalisation. The intention is to transfer the regulation of the professions of optometrist and dispensing optician from the Opticians Act 1956 to the Health and Social Care Professionals Act 2005. I would like to pay tribute, at this stage, to the Opticians Board's outgoing president, members, its registrar and their predecessors who have been regulating the optical professions for almost 60 years. The amalgamation of the Opticians Board with a more broad-based, multi-profession regulator will move the regulation of these professions into a modern regulatory regime where the primary and overriding focus will continue to be on the protection of the public. I know that the professional bodies representing optometrists and ophthalmologists have concerns regarding the transition to a new regulatory regime under the Health and Social Care Professionals Act 2005 and, in particular, with the proposed composition of the new optical registration board and I would like to provide some assurances on these points. I note, however, that a statement was issued today welcoming the new regime, for which I am thankful.

The Opticians Act 1956 provides for an eleven-member board comprising five optometrists, one dispensing optician, four medical practitioners and one other person who may also be a medical practitioner. In contrast, the thirteen-member registration boards established under the 2005 Act have a lay majority of one, in line with modern legislation governing other health professionals such as doctors and nurses. The interim optical registration board, whose members will be appointed to the new statutory board when this Bill is enacted, includes four optometrists and two dispensing opticians. It also includes two medical practitioners, one of which is a consultant ophthalmologist, who were appointed to represent the public interest on this occasion. The Act allows a degree of flexibility to cater for the particular skill needs of the board at particular times. Accordingly, the public interest representation of future boards may differ from the current board. Also, on the same basis, the ratio of optometrists to dispensing opticians may be varied in the future, subject to the appointment of at least one member of each profession. The lay-majority model is working well for the other six registration boards and I would urge the professional bodies to work constructively with the new board.

Similarly, the approach to regulating professionals is somewhat different under the amended 2005 Act. It is less prescriptive but, I would argue, more effective than the 1956 Act which currently regulates opticians. The focus is on the protection of the public by confining the use of professional titles solely to registrants who are obliged to comply with their profession's code of professional conduct and ethics. If, as in the 1956 Act, the Bill provided for the inclusion, in primary legislation, of a specific prohibition on the treatment of eye diseases by opticians and an explicit requirement to inform patients of suspected eye diseases or conditions, it would result in optometrists and dispensing opticians being treated differently to the other professions registered under the 2005 Act. These are matters that are more appropriate to the code of professional conduct and ethics that will be adopted by the optical registration board. The code will require registrants to act within the limits of their knowledge, skills, competence and experience in the interest of public protection. Any breach of the code is defined in the Act as professional misconduct which would be liable to investigation and sanctions under the 2005 Act's fitness to practice provisions.

I would now like to provide the House with some background to the Health and Social Care Professionals Act 2005, which will apply to optometrists and dispensing opticians on the enactment of this Bill and with an update on its implementation to date. The Act currently provides for the statutory regulation of 12 other designated health and social care professions, namely the professions of clinical biochemist, dietitian, medical scientist, occupational therapist, orthoptist, physiotherapist, podiatrist, psychologist, radiographer, social care worker, social worker and speech and language therapist. Regulation under the Act is primarily by way of the statutory protection of professional titles by confining their use solely to persons granted registration. The structure of the system of statutory registration comprises registration boards, a committee structure to deal with disciplinary matters and a Health and Social Care Professionals Council with overall responsibility for the regulatory system. These bodies are collectively known as CORU and are responsible for protecting the public by regulating health and social care professionals in Ireland. CORU is also charged with the promotion of high standards of professional conduct and professional education, training and competence among the registrants.

The Act provides for "grand-parenting" which is a transitional period of two years during which existing practitioners must register on the basis of specified qualifications. After this period, only registrants of a registration board, who will be subject to the Act's regulatory regime, will be entitled to use the relevant designated title. As optometrists and dispensing opticians are already regulated under the 1956 Act, no transitional period will apply to them and their transfer to the 2005 Act will be seamless.

To date, the registers of two professions, namely social workers and radiographers, have been established. The Social Workers Registration Board's two-year transitional period ended in May of last year. This means that all persons using the title of social worker are now obliged to be registered and are subject to the provisions of the Act. The transitional period for the profession of radiographer will end in October of next year. Meanwhile, the registers for the professions of speech and language therapist, dietitian and occupational therapist will be established by their registration boards before the end of this year. The remaining professions are following close behind and I expect that the registers of all 12 professions will be open by the end of 2016.

From a public protection viewpoint, a crucial milestone in the regulation of the Act's designated health and social care professions will be the introduction of a robust fitness to practice regime. This will involve the commencement of Part 6 of the Act to allow complaints about the conduct or competence of registrants to be investigated. Disciplinary sanctions, where complaints are substantiated, up to and including cancellation of registration, may be imposed. The regime will be similar to that applicable to medical practitioners, nurses and midwives. CORU is currently putting in place the necessary legal and administrative arrangements to allow the new fitness practice regime to be implemented and I hope to be in a position to make the necessary commencement order before the end of this year.

I would also like to update the House on proposals to regulate the professions of counsellor and psychotherapist which are not currently designated under the Act. This issue has been the subject of many Topical Issues debates in the House in the recent past. The Minister for Health may designate health or social care professions not currently designated if he or she considers that it is in the public interest to do so and if the specified criteria have been met. The previous Minister for Health, Deputy James Reilly, wrote to the Health and Social Care Professionals Council in May of this year advising it of his intention, in the public interest, to designate by regulation the profession or professions of counsellor and psychotherapist under section 4(2) of the Act. The Act provides that the Minister for Health is obliged to consult with the council in the first instance concerning a proposed designation and to give interested persons, organisation and bodies an opportunity to make representations to the Minister. The council has been asked to advise on a number of issues concerning the proposed designation and to take into consideration the recently published report of Quality and Qualifications Ireland, QQI, on the academic standards necessary for the accreditation of courses in counselling and psychotherapy. This is an essential element as it will inform, for the purpose of registration, the assessment by the registration board, when established, of the qualifications of those currently in practice. This is the first stage in the consultation process under the Act and I expect t receive the council's report in the coming weeks. I will proceed to the next stage, which will involve a much wider consultation, when I have fully considered the council's report.

While a number of issues remain to be clarified including decisions on whether one or two professions are to be regulated, on the title or titles of the profession or professions, and on the minimum qualifications to be required of applicants for registration, the proposals to regulate counsellors and psychotherapists are being progressed as a priority. It is hoped the necessary designation regulations can be made early next year. Expressions of interest will then be sought from suitably qualified persons available for appointment to the new registration board that will be established to regulate counsellors and psychotherapists.

I am aware of other professions seeking designation under the Act. Creative arts therapists and audiologists, for example, have been making a case for regulation for some time. The immediate priority, however, is to establish the regulatory process for the 12 professions already designated and to come to final decisions, following the detailed consultation process, on the regulation of counsellors and psychotherapists. When all the registers have been established, towards the end of 2016, the Department will ask CORU to prepare a risk assessment, in terms of public protection, of the principal health and social care professions seeking designation, and to make recommendations concerning options for their possible future regulation.

The second objective of the Bill is to make certain amendments to the Health and Social Care Professionals Act 2005 in the interest of the efficient running of the regulatory system and to ensure consistency with the legislation governing other health regulators. In summary, under this objective, the Bill will divide, for the purposes of the Health and Social Care Professionals Act 2005, the designated profession of radiographer into the two designated professions of radiographer and radiation therapist, permit a registration board to regulate two or more designated professions, and introduce uniformity between the Act and certain provisions of other Acts which regulate medical practitioners, nurses and midwives. The division of the designated profession of radiographer into two designated professions of radiographer and radiation therapist, for the purposes of the 2005 Act, is in response to the evolution of the profession into two professions for all practical purposes. Over time, the training, qualifications and scopes of practice of diagnostic radiographers who take images and radiation therapists who apply radiation treatment have continued to diverge. This division for regulatory purposes has been recommended by the Radiographers Registration Board and the Health and Social Care Professionals Council.

The existing 13-member Radiographers Registration Board will regulate the professions of radiographer and radiation therapist and the Optical Registration Board will regulate the professions of optometrist and dispensing optician. This is a new departure as up to now each profession had its own registration board. The Bill also provides that newly designated professions may, in the future, be regulated by an existing registration board. These measures will limit the number of new registration boards to be established as new professions are designated. Registration boards with two or more professions would still have 13 members, the existing balance between the number of lay and professional members would be maintained, and each of the board's professions would have at least one professional member on the board. In time, in order that CORU can operate as efficiently as possible on a cost effective and self-funding basis, it is planned to rationalise the 12 existing registration boards listed in the Act, one for each profession, plus any other boards that may be established for newly designated professions, into a reduced number of inter-disciplinary registration boards. This will require separate primary legislation to be introduced when the registration boards and their registers for the existing designated professions are up and running successfully.

The introduction of uniformity between the Health and Social Care Professionals Act 2005 and certain provisions of other Acts which regulate medical practitioners, nurses and midwives is driven by the desirability to ensure consistency in the various registration regimes. The Bill will amend the Act in a number of respects to bring its provisions into line with those of the Medical Practitioners Act 2007 and the Nursing and Midwives Act 2011.

The final objective of this Bill is to address an unintended lacuna in section 19 of the Health (Amendment) Act 2013, which came to light during the implementation planning phase. That Act modernised the contributions regimes in a wide range of residential settings so as to better reflect current models of residential care service provision in the disability, mental health and care of older people sectors. Under the National Disability Strategy and A Vision for Change, there is an ongoing drive towards community-based living in the disability and mental health sectors. In line with this, the increasing trend, particularly in the disability sector, is for accommodation needs to be met by the agencies of the State, such as local authorities, responsible for addressing the accommodation needs of citizens generally. However, the 2013 Act unintentionally omitted situations where service users are maintained, although not accommodated, in specified settings by or on behalf of the HSE. The primary purpose of Part 3 is therefore to ensure that affordable contributions towards ongoing daily living costs will apply to those maintained in such settings, subject to appropriate safeguards. For example, the level of contribution will be reduced to reflect the extent to which service users meet their accommodation and-or maintenance costs themselves.

I now propose to outline the main provisions of the Bill. The Bill is divided into 3 Parts. Part 1 has three sections which provide for the repeal of the Opticians Act 1956 and for the standard provisions relating to Short Title, commencement and expenses.

Part 2 contains 37 sections relating to the amendment of the Health and Social Care Professionals Act 2005. It applies the Act to the professions of optometrist and dispensing optician. The primary sections in this regard are sections 6, 12, 17, 20, 22, 34 and 36. It also amends the Act, in sections 6, 12 and 21 of the Bill, to divide, for the purposes of that Act, the designated profession of radiographer into the two designated professions of radiographer and radiation therapist. Sections 6, 12, 13 and 16 will permit a registration board to regulate two or more designated professions.

Amendments to provide for the introduction of uniformity between the Health and Social Care Professionals Act 2005 and the Medical Practitioners Act 2007 and the Nursing and Midwives Act 2011, and consequential and other technical amendments, comprise the remaining section of the Bill. The amendments required to align the 2005 Act with the 2007 and 2011 Acts may be broken down into the four main areas of governance, fitness to practice, registration and offences. The principal governance amendments relate to the election of a deputy chairperson of the Health and Social Care Professionals Council, the role of the council's chief executive officer, quorums and the holding of certain meetings of the council and registration boards by video link or the circulation of papers. The Bill amends CORU's fitness to practice regime to allow for: the cancellation of the registration of a registrant convicted of an indictable offence if it is in the public interest to do so, the appointment of persons to assist in investigating complaints against a registrant, the application for immediate suspension of the registration of a registrant on an ex partebasis, and the publication of the transcript of the proceedings of a committee of inquiry. In regard to registration, the Bill provides for the charging of fees for approving education and training programmes and for attaching conditions to the registration of a registrant with a relevant medical disability. Finally, the Bill modernises the Act's provisions relating to the prosecution of offences and provides the Health and Social Care Professionals Council with new investigation powers similar to those of the Medical Council and the Nursing and Midwifery Board of Ireland.

Part 3 has four sections which, under subsection 1(3) of the Bill, will come into operation in tandem with section 19 of the Health (Amendment) Act 2013. The Bill provides, in section 42, for amending section 61A of the Health Act 1970 to define or redefine key terms. The thrust of the amended definitions provision is to ensure that the statutory contributions regime will cover ongoing essential daily living costs such as food and utility bills where these are met by or on behalf of the HSE, irrespective of whether the service user is accommodated by or on behalf of the HSE.

The Bill also provides for a number of amendments to section 67C of the 1970 Act, including provision for reducing contribution amounts automatically for those maintained but not accommodated by or on behalf of the HSE, Health Service Executive; varying contribution amounts based on service users' income levels and-or levels of dependence or independence; and making appropriate transitional arrangements for the new contributions framework if deemed necessary.

This Bill will modernise the regulation of the optical professions, will ensure all those maintained by the HSE and its agents in specified settings contribute within their means towards their daily living expenses while retaining a reasonable amount of income for personal use, and will enable the Health and Social Care Professionals Council to continue to fulfil, in a more effective way, its objective to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions.

I commend the Bill to the House.

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