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

I am pleased to have this opportunity to address the House on Second Stage of the Health (Miscellaneous Provisions) Bill 2014. This is quite a technical Bill, with 44 sections in total. The Bill has three main objectives. It will provide for the subsuming of the Opticians Board into the Health and Social Care Professionals Council; it will make certain efficiency amendments to the Health and Social Care Professionals Act 2005 and ensure consistency with the legislation governing other health regulators; and it will amend the Health Act 1970 to ensure 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, is to subsume the Opticians Board into the Health and Social Care Professionals Council. This is in furtherance of the ongoing programme of State agency rationalisation. The intention is to effect the amalgamation by transferring the regulation of the professions of optometrist and dispensing optician from the Opticians Act 1956 to the Health and Social Care Professionals Act 2005.

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, however, continue to be on the protection of the public.

I pay tribute to the Opticians Board's outgoing president, its members, its registrar and their predecessors who have been regulating the optical professions in Ireland for almost 60 years. The advice and assistance of the professional bodies, the Irish Association of Dispensing Opticians and the Association of Optometrists Ireland, over many years and, in particular, leading up to and during the current transitional phase has also been much appreciated.

The interim Optical Registration Board, which was established earlier this year and whose members will be appointed to the new statutory board when this Bill is enacted, is currently preparing the necessary by-laws to be made by the new statutory board. When these by-laws have been made the Opticians Act 1956 will be repealed and the regulation of the optical profession will pass to the new board under the Health and Social Care Professionals Act 2005.

I will provide the House with some background to the Health and Social Care Professionals Act 2005 which will apply to the optical professions on the enactment of this Bill. I will also update the House on the implementation of the Act to date. The Act currently provides for the statutory regulation of 12 designated health and social care professions. 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 regulation comprises a registration board for each profession, 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.

The Act provides for a two-year transitional or grand-parenting period 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 the optical professions 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, 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.

The registers for the professions of speech and language therapist and dietitian were established by their registration boards last Friday, 31 October. The occupational therapists register is expected to be open for applications for registration very early next year. The remaining professions are following close behind and I expect that the registration boards of all 12 professions will be established by the end of next year.

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 the 2005 Act's fitness to practise 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 the cancellation of registration, may be imposed. This fitness to practise 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 to practise regime to be implemented. Arrangements are in train for the making of the necessary commencement order before the end of this year.

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 regimes for the 12 professions already designated and to transfer the regulation of the optical professions to the 2005 Act. The Minister also needs to make final decisions in 2015 on the details of bringing the regulation of counsellors and psychotherapists within the ambit of the Act. The first stage of the required consultation process is currently under way.

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.

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. The Bill will also permit a registration board to regulate two or more designated professions. Under this objective, the Bill will 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. The 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.

The Bill also proposes to introduce uniformity between the Health and Social Care Professionals Act 2005 and certain provisions of other Acts which regulate medical practitioners, nurses and midwives. 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 - in particular 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 will now 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 sections 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 practise regime to allow for the following: 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 parte basis; 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. 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 67A 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 address 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 the following: reducing contribution amounts automatically for those maintained but not accommodated by, or on behalf of, the HSE; and varying contribution amounts based on service users' income levels and-or levels of dependence or independence, and making appropriate transitional arrangements in relation to the new contributions framework if deemed necessary.
This Bill will modernise the regulation of the optical professions, it will ensure that 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. It will also 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.