Mary Harney (Dublin Mid West, Progressive Democrats)

I am not as fit as some at running from my office to the Seanad.

I am pleased to have the opportunity to address the House today on Second Stage of the Health and Social Care Professionals Bill 2004, which provides for the establishment of a system of statutory registration for certain health and social care professionals. Statutory registration is best described as a system whereby individual members of a profession are recognised by a specified body as being competent to practise within that profession under a formal mechanism provided for by law.

Unlike systems of voluntary registration, it is a legally binding process with a mechanism for the prosecution of offences. The Bill is integral to the delivery of the commitment in the health strategy to strengthen and expand provisions for the statutory registration of health professionals. This is the first of three Bills to reform the regulatory environment for health professionals, with legislation for medical practitioners and nurses to follow.

The 2001 health strategy was based on four key principles, namely, equity, people-centredness, quality and accountability. As outlined in the health strategy, gaining people's trust in a health system is about guaranteeing quality. People want to know that the service they are receiving is based on best-practice evidence and meets approved and certified standards. Improving quality in the health care system requires implementation of internationally recognised evidence-based guidelines and protocols and ongoing education and commitment from health care institutions and professionals. Trust requires that deficiencies in the system be identified, corrective actions taken and future progress monitored. The principle of people-centredness includes ensuring that consumers are given greater control and greater responsibility for their own health and increased involvement of consumers as partners in planning and evaluation.

The vision adopted in the health strategy for the future health system places great store on treating people with dignity and respect. The health strategy envisaged that action would be taken to strengthen the customer focus of service providers. While acknowledging the need for freedom in exercising clinical judgment, the Government also accepts the need for a stronger framework for questioning and investigating clinical decisions in specific circumstances. Accordingly, the legislation on statutory registration of health and social care professionals contains a comprehensive legal process for the investigation of complaints against individual professionals.

The health strategy also stated that measuring the costs and quality of services and managing human resources have become increasingly complex at all levels in modern health care organisations. Strengthening and clarifying accountability and measurement mechanisms is a priority. Professionals now practise in a more demanding environment. Evidence-based guidelines, tighter professional standards, the requirements of health care organisations, and patient rights and expectations all add to those demands. That is another aspect of accountability strengthened by these legislative proposals. The establishment of a system of statutory registration for certain health and social care professionals is therefore considered essential to the delivery of the quality and accountability objectives of the health strategy. It will ensure that members of the public are guided, protected and informed so they can be confident that health and social care professionals providing services are properly qualified, competent and fit to practise.

The proposed system will ensure professional conduct and the maintenance of high standards of professional education and training among those professionals. It is estimated that 14,000 health and social care professionals will be subject to regulation from the outset, some 15% of whom are employed in the private sector. The 12 professions to be subject to the provisions of the Bill in the first instance were selected because they are long-established providers of health and social care within the health service and in most instances have experience of self-regulation. In addition, the qualifications of the majority of those professions are currently regulated within the public health service.

While the proposed system of statutory registration applies in the first instance to 12 health and social care professions, the legislation empowers the Minister for Health and Children to include additional health and social care professions in the regulatory system by regulation on the basis of specific criteria. Such criteria include, in particular, the potential for harm to the public, as well as the existence of a defined scope of practice, the degree to which the profession has established itself, has defined routes of entry and is committed to continuous professional development.

Legal registration constitutes a demanding standard of competence for each registered practitioner, including comprehensive fitness to practise structures. A central feature of the Bill is, therefore, the adoption of a contemporary approach to fitness to practise issues. In that context, the Bill provides for a mediation process and other informal means of resolution for less serious complaints by agreement of both parties concerned. It also includes a mechanism for a practitioner to accept a complaint and the sanction proposed to pre-empt the requirement for a full hearing where the complaint is considered to be less serious. A health committee is also being established to investigate, with appropriate input from a medical practitioner, complaints which arise from the health status of a registered practitioner.

The design of the proposed regulatory system was strongly informed by the principle that regulation in the health and social care sphere involves the balancing of a range of objectives and interests. These relate primarily to quality standards of service provision, protection of the public against harm, accountability and economic impacts.

While all regulation imposes economic costs, these costs will be offset in the case of the proposed system of statutory registration by such benefits as quality assuring the competence of practitioners; addressing information deficits for the public; bridging shortfalls in education and training levels; maintaining an incentive to invest in education and training; and the introduction of a statutory disciplinary process and strong consumer representation.

In developing the system of statutory registration for health and social care professionals, there was regard to the principles underlying effective regulation as set out in the various initiatives on regulatory reform, including the OECD report on regulatory reform in Ireland and the White Paper, Regulating Better, which highlighted the requirement that consumers should be placed at the top of the policy agenda. In this regard, while the present system of voluntary self-regulation is operating efficiently in many instances, it is considered that it does not provide adequate protection to the public who have a right to be confident that the person providing a service is properly qualified, of good standing and competent to practise in his or her profession.

The system of statutory registration proposed in the Bill is open and transparent, with strong public interest representation which will serve to enhance the quality of service to patients. Strong emphasis is placed on ensuring quality and safety while facilitating appropriate competition. Representative bodies of the professions concerned have long advocated the introduction of a system of statutory registration. The key features of the system reflect the outcome of consultations undertaken with relevant professional bodies and these bodies have been kept abreast of the development of the proposals. In order to ensure quality and safety while facilitating appropriate competition, consultations also took place between my Department and the Competition Authority.

I will outline the key elements of the proposed system of statutory registration for health and social care professionals. Section 4 designates the 12 health and social care professions subject to the provisions of the Act, regardless of whether they work in the public or private sector or are self-employed. They are chiropodists, clinical biochemists, dieticians, medical scientists, occupational therapists, orthoptists, physiotherapists, psychologists, radiographers, social care workers, social workers and speech and language therapists. This section also provides for the designation of additional health and social care professions by regulation in the future.

Sections 6, 7 and 8 establish the health and social care professionals council; define the object of the council as being to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions; provide that the council must exercise its powers and perform its functions in the public interest; and set out the functions of the council. The health and social care professionals council will, through appropriate co-ordination and oversight, ensure the consistency and coherence of the system as a whole and promote uniformity of practice among registration boards.

The locus of control and direction in terms of the operation of the system of statutory registration lies firmly with the health and social care professionals council. The council will have a co-ordinating role ensuring there is uniformity of procedures throughout the system, particularly regarding disciplinary matters where a substantial legal and administrative burden is anticipated in line with current experience in the medical and nursing professions. It is considered that the individual registration boards would not have the capacity required to deal with the complex legal issues likely to arise on an ongoing basis or would not benefit from the expertise the council would build up handling these issues on a regular basis.

Section 9 lays down the membership of the council as comprising 25 members, 12 being members of the registered professions and 13 from outside the professions, representing the management of the public and voluntary health or social care sector, third level educational establishments and the interests of the general public to ensure an appropriate balance with public accountability.

In keeping with the regulatory system for other health professions, section 17 provides that the council must meet its expenses out of funds at its disposal, that is from fees paid by registrants. Section 22 enables the council to make rules providing for such matters as registration and the receiving and recording of evidence by committees of inquiry. Sections 26 and 27 provide for the establishment of a registration board for each of the 12 professions to be registered; define the object of each registration board as being to protect the public by fostering high standards of professional conduct and professional education, training and competence among registrants of that profession; and set out the functions of each registration board.

Section 28 lays down the membership of each registration board as being 13 persons, six from the particular profession elected by members of that profession and seven persons from outside the profession, representative of the management of the public and private health or social care sector, third level educational establishments and the interests of the general public.

Section 31 enables each registration board to make by-laws regarding such matters as qualifications attesting to the standard of proficiency required for registration. Where a proposed by-law might result in an additional burden being imposed on the Exchequer, both the council and the Minister must approve the draft by-law. Sections 35 to 37 provide for the establishment and maintenance of a register of members of that profession and the procedure to be followed by a person seeking registration. Section 45 requires each registration board to make the register available for inspection by members of the public. Sections 47 and 48 enable each registration board to approve or withdraw approval for education and training programmes for the education and training of candidates for registration and require a registration board to monitor the ongoing suitability of education and training programmes approved by the board.

Section 50 requires the council to establish a preliminary proceedings committee, a professional conduct committee and a health committee to perform functions and exercise powers in regard to complaints, inquiries and discipline and sets out the membership of these committees. Section 51 sets out the grounds under which a person may make a complaint to the council concerning a registrant, including professional misconduct, poor professional performance or where a registrant's ability to practise is impaired by his or her health status, including an addiction to alcohol or drugs. A complaint may also be made on the grounds of professional misconduct or poor professional performance even though the matter to which the complaint relates occurred outside the State.

Section 55 provides that where there is sufficient cause to warrant further action being taken regarding a complaint, the preliminary proceedings committee must refer the complaint either for resolution by mediation or other informal means or to a professional conduct committee or a health committee. Section 57 provides that a hearing before a professional conduct committee will generally be held in public while a hearing before a health committee will generally be held in private.

Section 59 enables the council to apply to the High Court for an order directing a registration board to suspend a registrant's registration pending the completion of an inquiry, if it considers that the action is necessary to protect the public. Sections 62 to 64 provide that if allegations have been substantiated the council must impose a disciplinary sanction on a registered practitioner, such as the attachment of conditions to registration, suspension or erasure from the register. Sections 67 to 69 provide that the imposition of a disciplinary sanction other than an admonishment or censure does not take effect unless it is confirmed by the High Court.

Sections 75 and 76 provide that the council may notify the Minister, employer and public as soon as any sanction imposed on a registered professional takes effect. This includes imposition of a sanction in another jurisdiction. Section 78 makes it an offence for an unregistered practitioner to use a protected title or to falsely represent himself as being a registered practitioner. Section 90 sets out grandparenting arrangements for those practitioners currently in practice. It is intended that all persons currently qualified to work in the public health service will meet the standard required for registration. Where practitioners do not possess the required qualification, they will be given an opportunity to undergo an assessment to demonstrate competence. Where a practitioner does not reach the standard of proficiency required for registration, he or she would not be entitled to continue to use a title that is protected under the legislation but would be entitled to continue working under a different title.

As I said at the outset, this Bill marks a further step in the process of strengthening and expanding provisions for the statutory registration of health professionals as set out in the health strategy. It is further confirmation of the Government's commitment to the delivery of a reformed health service which has as its core objective the maximisation of the level and quality of care provided to patients and clients in the years ahead.