John Lahart (Dublin South West, Fianna Fail)
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Amendments Nos. 1 to 3, inclusive, 8 to 10, inclusive, 20 to 22, inclusive, 28 to 30, inclusive, 35 and 37 to 45, inclusive, 53 and 54 shall be taken together by agreement.

Mary Butler (Waterford, Fianna Fail)
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I am pleased to report these final amendments to the House. The Bill contains important patient safety measures and I know from the earlier Dáil and Seanad debates that there is strong support across the House for this legislation and a common desire to support its progression. The Bill makes significant changes to the five health profession regulatory Acts, particularly in the areas of fitness to practise and registration, and is keenly awaited by stakeholders.

I propose to take amendments Nos. 1 to 3, inclusive, 8 to 10, inclusive, 20 to 22, inclusive, 28 to 30, inclusive, 35, 37 to 45, inclusive, 53 and 54 together. These are minor typographical and drafting errors which were identified during the Bill's progress through the Seanad. I appreciate that this is a large number of amendments but the Bill introduces complex changes across multiple Acts. Deputies will agree that it is important to be as thorough as possible and to take the opportunity to make corrections where needed.

This group of amendments do not make any substantive changes to the Bill. They include: the correction of a drafting error in the Nursing and Midwives Act 2011, which makes reference to the wrong section; removal of a reference to a section in the Medical Practitioners Act 2007 which is incorrect; correction of a minor drafting error in the Bill which relates to the internal numbering of section 71A of the Medicinal Practitioners Act 2007; and correction of the spelling of the word "specialty". Several sections of the Bill are also being renumbered following the addition of sections to the end of the Dentists Act 1985, the Health and Social Care Professionals Act 2005, the Pharmacy Act 2007 and the Medical Practitioners Act 2007 by the Emergency Measures in the Public Interest (Covid-19) Act 2020 which was enacted in March this year.

Mary Butler (Waterford, Fianna Fail)
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I propose to take Seanad amendments Nos. 4 to 6, inclusive, 17 and 18, 24 to 26, inclusive, 46 to 49, inclusive, 59 and 60 together. Regulators can impose a range of sanctions on a practitioner following a fitness to practise inquiry. The most serious of these include cancelling a person's registration, suspending the registration for a period of time or attachment of conditions to a person's practice. Before these sanctions take effect they must be confirmed by the High Court. Regulators can also choose to impose minor sanctions such as advice, admonish and censure. Currently, these minor sanctions do not require a High Court confirmation but cannot be appealed to the court. The Bill changes this such that any sanction can now be appealed to the courts. The Bill, as initiated, introduced amendments to the five Acts to provide that the minor sanctions would in future require High Court confirmation before taking effect. Concerns were expressed in this House at the earlier Stages of the Bill that this measure would impose an unnecessary additional cost, would delay the finalisation of proceedings and may bring an additional degree of publicity to registrants on whom the most minor of sanctions were being imposed. Having reviewed the matter and consulted with stakeholders, the Minister introduced these Seanad amendments to the Bill, which remove the proposed requirement for a High Court confirmation of the minor sanctions. This was welcomed by Senators across the House. The Bill, of course, continues to provide the new right of appeal for minor sanctions.

Mary Butler (Waterford, Fianna Fail)
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I propose to take amendments Nos. 7, 19, 27, 50 and 61 together.

As with the previous amendments, these relate to the treatment of the minor sanctions of advice, admonish and censure. The Bill initially provided that regulators would in future be required to publish information in all cases where these sanctions were imposed. Colleagues in both Houses expressed concern that this measure would have a disproportionate impact on those receiving minor sanctions. Following consultation with the regulators and representative bodies, it was agreed that the publication of minor sanctions will instead be subject to a public interest test to be applied by the regulator. This will allow regulators to exercise discretion and only publish information relating to minor sanctions where they are satisfied that it is in the public interest to do so. These amendments were warmly welcomed by stakeholders and by Senators on all sides of the House when introduced.

Mary Butler (Waterford, Fianna Fail)
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I propose to take amendments Nos. 11 to 15, inclusive, together.

These amendments are consequent on Dáil amendments on Committee Stage. They relate to section 29 of the Bill, which amends the Health and Social Care Professionals Act 2005 to allow a small cohort of practitioners to apply for registration with the Physiotherapists Registration Board. The Bill as passed by the Dáil amends the 2005 Act in two ways. It deletes a restrictive date requirement for receipt of a particular qualification and, consequently, extends the time allowed for persons to apply for registration with this board from 31 December 2019 to 31 December 2021. However, as currently drafted, extending the registration window from 31 December 2019 to 31 December 2021 was dependent on the Bill being enacted before the end of 2019. This did not happen and the registration window closed on 31 December 2019.

If the Bill is enacted as currently drafted, it will incorrectly imply that the registration window has remained open. Accordingly, the amendment proposed here is a corrective measure. It addresses the fact that there is now a period when a cohort of applicants is unable to apply for registration with the Physiotherapists Registration Board. It also allows applications which were received by Health and Social Care Professionals Council, CORU, prior to 31 December 2019 but where no decision has been reached by the board on them to be considered as valid applications, removing the need for an applicant to make a second application. Furthermore, it extends the window of registration for qualifying applicants from the date of the commencement of the Bill until 30 June 2022, which I trust will provide adequate time for these applicants to avail themselves of these registration provisions.

The amendment also clarifies that any application received during the current period when the application window is closed, that is, between 31 December 2019 and the commencement of the relevant section in the Bill, is not to be considered by the registration board, although it is open to any applicant to reapply when the application window reopens. Finally, the amendment also provides that applicants seeking registration under this provision will be required to comply with return-to-practise by-laws in the same way as is required for other applicants for registration on the Physiotherapists Registration Board.

Mary Butler (Waterford, Fianna Fail)
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This amendment relates to pharmaceutical assistants and was proposed and supported by a number of Senators. It will amend the Pharmacy Act 2007 to provide two new functions for the Pharmaceutical Society of Ireland. Specifically, the Pharmaceutical Society of Ireland will be required to ensure that pharmaceutical assistants undertake continuous professional development and that they comply with specific legislation related to enactments for which it supervises compliance. Officials continue to engage with the Pharmaceutical Society of Ireland to ensure that the voted amendments can be carried into practise in a safe and effective manner that serves the public interest. This amendment will enhance patient safety by promoting continuous professional development by pharmaceutical assistants and will be welcomed by those in the profession. They have played an important role in supporting pharmacies over many years and I wish to acknowledge the service they provide to the public and our health services overall.

Mary Butler (Waterford, Fianna Fail)
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I propose to take amendments Nos. 31 and 55 together.

These amendments are technical in nature and relate to the sections of the Medical Practitioners Act 2007 and the Nurses and Midwives Act 2011 that enable the respective regulators to make rules. The Bill inserts a new subsection (15)(c) into section 20 of the Medical Practitioners Act 2007. This section deals with the membership, functions and procedures of committees of council and subcommittees of committees. The new subsection (15)(c) provides that subcommittees of the fitness to practise committee may perform any of the functions of that committee as if it were the fitness to practise committee. However, section 11 of the Medical Practitioners Act 2007, which sets out the power of the Medical Council to make rules, does not reflect the breadth of functions intended by the new subsection (15)(c). The Committee Stage amendment in the Seanad replaces the wording "different grounds founding a complaint" with "complaints referred to that Committee", which ensures that the regulator's powers to make rules for committee are consistent with the functions that are assigned to those committees. An identical amendment is being made to section 13 of the Nurses and Midwives Act 2011.

Mary Butler (Waterford, Fianna Fail)
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I propose to take amendments Nos. 32 to 34, inclusive, and 56 to 58, inclusive, together.

The Bill as passed by the House amends the Medical Practitioners Act 2007 and the Nurses and Midwives Act 2011 to provide that where subcommittees of the preliminary proceedings committee, PPC, and the fitness to practise committee, FPC, are established pursuant to rules, these subcommittees can perform any of the functions of the respective committees as if they were the committees. This was aimed at better utilising the time of both the PPC and the FPC and facilitating the more expeditious processing of complaints. This will be of benefit to all those involved, patients, their families and practitioners. The amendments provide additional clarity regarding the procedures for the establishment of those subcommittees. Specifically, they provide that, in accordance with the rules, the chairperson or such other committee members as may be designated by rules can establish a subcommittee of the respective committee.

As drafted, the provision could be interpreted as meaning that the entire committee is required to establish a sub-committee. These amendments remove any risk of ambiguity or uncertainty around the mechanism for establishing sub-committees.

Mary Butler (Waterford, Fianna Fail)
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Section 36 of the Medical Practitioners Act addresses areas of overlap between the practice of medicine and other health professions. Under existing legislation, where a person holds a dual qualification in medicine and another health professions, for example, dentistry, this section allows them to lawfully practice those areas of dentistry which overlap with medicine without having to be on the register of medical practitioners.

Section 37 provides that a person must be registered with the Medical Council in order to practice medicine in the State. The amendment clarifies that the requirements of section 37 do not apply to a person registered as a dentist, nurse or so on who was practising medicine when carrying out tasks in the context of the other specified health profession. This amendment, recommended by the Office of the Attorney General, makes clear that a person, irrespective of whether they are a medical practitioner, is not unlawfully practising medicine when carrying out tasks in the context of the other specified health profession and so they are not contravening section 37 of the Medical Practitioners Act.

Mary Butler (Waterford, Fianna Fail)
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I propose to discuss Seanad amendments Nos. 51, 52 and 62 together.

Sections 88 and 89 of the Medical Practitioners Act set out the duty of the Medical Council in respect of education and training for medical qualifications. They require the Medical Council to approve programmes of training and the bodies which deliver the training. However, while the Act is explicit that the council may refuse to approve a body as a body which may deliver undergraduate or postgraduate training programmes, the Act does not explicitly provide for the council to refuse to approve an individual training programme. A similar issue arises in section 85 of the Nurses and Midwives Act in respect of the training of nurses and midwives. This is problematic for both regulators in that while they can attach conditions to a programme, they do not have the express power to refuse to approve a training programme which does not meet the required standard. Both the Medical Council and the Nursing and Midwifery Board of Ireland have identified this as a weakness to their respective Acts and accordingly these technical amendments give both regulators the express power to refuse to approve training programmes.

Mary Butler (Waterford, Fianna Fail)
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The Bill, as passed by this House, amends the Health Act 2004 to give the Minister for Health the power to designate the HSE as the competent authority to compare the equivalence of non-Irish qualifications with the qualifications assessed for certain health professions. These are professions which are not regulated on a statutory basis but which are regulated for the purpose of the EU professional qualification directive and for which the Minister is currently the competent authority. Concerns were raised on Committee Stage in the Seanad on behalf of the Environmental Health Association of Ireland regarding the HSE being the competent authority for environmental health officers, EHOs, one of the professions for which the HSE would become competent authority if so designated. I understand that the Environmental Health Association of Ireland believes this would be a conflict of interest if the HSE were to act as both employer and deciding body in respect of qualification recognition. The association is also concerned about the appropriateness of the HSE acting as competent authority for environmental health officers when the executive is not the exclusive employer of the EHOs, with many employed outside the health sector including, for example, by local authorities.

The Department received advice from the Office of the Attorney General on how to eliminate any potential conflict of interest arising in respect of the HSE undertaking the dual role of employer and competent authority. However, the Minister recognises the concerns raised by the Environmental Health Association of Ireland and these will need to be reviewed and fully considered by officials. Until such time as these can be fully considered, the Minister is satisfied that it is appropriate and safe for the status quo to remain and it is proposed, therefore, to remove this provision from the Bill.

John Lahart (Dublin South West, Fianna Fail)
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Agreement to the Seanad amendments is reported to the Houses and a message will be sent to Seanad Éireann acquainting it accordingly.