Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

On behalf of my colleague, the Minister, Deputy Stephen Donnelly, I thank those who contributed to the Second Stage debate today and two weeks ago with the Minister of State, Deputy Butler. The fundamental objective of this Bill is to improve patient safety. The overwhelming support of Deputies for the Bill's provisions reflects the importance of patient safety and reflects our shared goal of constantly working to improve our health and social care services. I understand that the issues which were raised with the Minister of State, Deputy Butler, have already been brought to the attention of the officials of the Minister, Deputy Stephen Donnelly. I will be happy to update the Minister on further issues speakers have raised with me today. The officials are taking notes of everything, even including Deputy Ó Murchú on the issue of the medical card which he raised before on the floor of the Dáil. Deputies raised a very wide range of important matters and I hope to address the majority of these in the time available to me before I make some concluding remarks.

I understand there was much discussion of the issue of regulation of the homecare sector. This is clearly a matter of concern to many Deputies. I am pleased to advise that the Department of Health is currently developing a regulatory framework for the licensing of homecare support providers to deliver services for adults aged 18 years and over. This will comprise primary legislation for the licensing of providers, secondary legislation consisting of regulations to set minimum requirements and the HIQA national standards. A public consultation on the draft regulation was concluded in early August and this will inform further development, together with ongoing engagement with key stakeholders including HIQA, the HSE, private and voluntary providers and service users' representative groups. I can also report that my colleague, the Minister of State, Deputy Butler, has established a cross-departmental strategic workforce group to examine current challenges associated with the recruitment and retention of home support workers and front-line carers in nursing homes. Arising from the completion of an evidence-based review and targeted consultations, a report for the consideration of the Minister of State, Deputy Butler, is currently being prepared. This will set out key recommendations.

The regulation of counsellors and psychotherapists with CORU was also raised by several speakers. The work of the counsellors' and psychotherapists' registration board is significantly more challenging than for other CORU professions. This is due mainly to the many different educational pathways into the profession and the variety of specialties and titles used. The initial stages of regulating a profession can be very complex as there is an obligation to balance the right of existing practitioners to practice their profession while ensuring that those who are placed on the register are safe to practice. Much progress has been made by the board, including the verification and assessment of historical qualifications as well as international research into regulatory norms in other jurisdictions. The drafting of separate and distinct standards of proficiency for counsellors and psychotherapists has also begun. However, a substantial body of work remains to be undertaken before that register is opened. I want to assure the House that CORU fully appreciates the importance and urgency of this work.

Another CORU matter which I will respond to and which was raised by a number of speakers is the issue affecting students of social care work attending Dublin Business School. All Deputies will know the register for social care workers is to open in November 2023. The social care workers' registration board has engaged extensively with colleges over a number of years on the standards required for educational programmes to ensure that the graduates are trained to an appropriate level to deliver their service safely to the public. In July 2022, Dublin Business School withdrew its application for approval by CORU of its social care work programme. This effectively means that graduates of the Dublin Business School programmes will not be automatically eligible for registration with CORU. The Minister is aware that this is deeply distressing for the students affected. I want to assure Deputies that the concerns of students are very much understood. The issue is being carefully considered by officials from both the Department of Health and the Department of Further and Higher Education, Research, Innovation and Science with significant support being provided by CORU.

Medical workforce planning is another area on which several speakers raised concerns. The Department of Health is currently developing a health and social care workforce planning strategy and workforce planning project model based on international best practice. A key outcome of this project, which is being technically supported by the European Commission, is to equip the Department with the necessary tools, processes and technical capacity to produce rolling action plans on workforce planning. These will help to implement targeted policy measures for health and social care workforce reform. Extensive work has been completed to date, with the project team currently focused on the document of the strategy and the action plans. It is expected that the project will be completed in 2023.

I will now respond to some specific workforce planning issues raised by various Deputies. On the issue of intern places for medical graduates, following an increase in intern places over several years, we no longer have a shortage of these places. An additional 120 permanent intern places have been created, which represents a 16% increase compared with pre-Covid levels. I confirm that for the 2022-23 interim year, an additional 90 graduates were appointed to intern posts and a supplementary reserve list was created to fill the remaining posts. Resolving the historic shortfall in placements is a significant development and will help to support our efforts to retain doctors who have trained to remain in Ireland.

The issue of access to specialist training posts was also raised. Deputies will be interested to know that the Department has recently embarked on a broad programme of legislative reform, which includes addressing certain registration and access issues identified by the Medical Council. Included in this is the removal of a legislative barrier that prevented certain doctors who trained outside of the EEA from applying for specialist training in Ireland. This barrier was removed in November 2020. In addition, earlier this year, significant changes to working arrangements and immigration permission for most non-EEA doctors were announced. These changes reduced the administrative burden for effective doctors and make Ireland a more attractive place for these professions to relocate to.

It is important to recognise the strength of global competition for healthcare talent. The steps we have taken are welcome and positive developments that recognise that the Irish health service is supported by highly skilled and caring doctors from across the world. We will continue to work with doctors and other health professionals who wish to live and work in Ireland.

The final workforce issue I will address is non-consultant hospital doctors, NCHDs. As several Deputies highlighted, the NCHDs raised a very legitimate concern about their experiences working in Ireland and we know there is significant room for improvement. There is an urgent need to review the issues they have highlighted if we are to increase retention and continue to attract new doctors to join our medical workforce. The Minister for Health is fully committed to addressing the issues affecting the NCHDs. To this end, in the past few weeks, he established a national task force on the NCHD workforce. This task force will develop policy initiatives that will result in improved on-site facilities, structures and training supports for all NCHDs working in Irish hospitals.

I regret that I do not have time to directly address all of the issues raised by colleagues across the House. However, I hope Deputies will have found this information somewhat helpful.

Turning now to the specifics of the Bill, I will briefly recap its main provisions. First, it will amend the Medical Practitioners Act to ensure the holders of UK medical degrees can access intern training posts in Ireland. Citizens of both jurisdictions have long benefited from the freedom to work and study in each other’s country – a freedom that is enshrined in the common travel area agreement. This amendment will ensure that, once again, holders of UK medical degrees can benefit from those rights and apply for intern placements here.

The next issue addressed by the Bill is the continued provision of a route to registration on the general division of the Medical Council’s register for certain cohorts of internationally trained doctors. The amendments essentially correct a small number of errors in the Regulated Professions (Health and Social Care) (Amendment) Act 2020, which were detected prior to commencement.

The Bill makes a number of amendments to the Health and Social Care Professionals Act, the legislation under which CORU operates. First, it will allow the Minister to prescribe and vary by order transitional period qualifications listed in Schedule 3 of the Act. This Schedule was drafted in 2005 and needs to be amended to reflect passage-of-time changes.

The Bill also makes changes to the Act’s transitional period registration route for social care workers to provide that applicants meet the same standards as other CORU professions. As Deputies will appreciate, social care workers are in contact with some of the most vulnerable members of society. It is vital that CORU is satisfied that these workers have the skills and experience to deliver safe and high-quality care.

Two amendments will deliver these changes. First, existing practitioners will be required to attain their work experience in the State. For social care workers, this can currently be in any jurisdiction. Second, applicants will be required to undergo an assessment of professional competence, rather than have their competence attested to by way of the employer reference, which is the current requirement. The existing provisions are considered to pose an unacceptable risk to patient safety and these amendments mitigate that risk and align the registration process for social care workers with other CORU professions.

The remaining significant provision in the Bill is related to the Medical Practitioners Act. The Bill proposes to make a number of amendments to support the Medical Council in its triage investigation and adjudication of complaints function. This will support changes introduced under the 2020 Regulated Professions (Health and Social Care) (Amendment) Act and will lead to a more efficient examination of complaints.

Finally, the Bill will introduce immunity for certain persons operating under the provision of the Medical Practitioners Act. Deputies will appreciate that where a serious complaint is being investigated, experts and others appointed to assist must be free to participate without fear of litigation.

On behalf of the Minister, Deputy Stephen Donnelly, I thank all the Deputies for their input in recent days.

I regret that the topics the Leas-Cheann Comhairle raised are not addressed in my response. However, my colleagues indicated they will convey them to the Minister.

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