Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

I am pleased to have the opportunity to address the House on the Health and Social Care Professionals (Amendment) Bill 2017. This is a short Bill, containing only nine sections, that amends the provisions of the Health and Social Care Professionals Act 2005 in three main areas. First, the Bill will address the gaps that have been identified in the Act’s provisions relating to the appointment of professional members to the Health and Social Care Professionals Council and the registration boards. Second, it will permit a registration board to apply criteria or conditions in respect of further education, training and experience to applicants for registration who, although qualified, have not yet practised their profession. Third, the Bill will make necessary amendments to the Act in advance of draft regulations to protect the title of "physical therapist" being brought forward. The 2005 Act already provides for the protection of the title of "physiotherapist" for the exclusive use of those granted registration by the Physiotherapists Registration Board.

Before explaining the Bill's provisions in more detail, I will provide some background to the Health and Social Care Professionals Act 2005 - which the Bill seeks to amend - and with a brief update on its implementation to date. The Act currently provides for the statutory regulation of 14 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 the registration boards, a committee structure to deal with disciplinary matters and the Health and Social Care Professionals Council, which has overall responsibility for the regulatory system. These bodies are collectively known as CORU and they 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 a transitional period of two years during which existing practitioners may register on the basis of specified qualifications. After this period, only registrants of a registration board who are subject to the Act’s regulatory regime or those who applied during the transitional period and whose applications are still being determined or are under appeal will be entitled to use the relevant protected title or titles. Title protection is the key to public protection under the Act and is central to the Bill’s provisions relating to the physiotherapists registers. I will provide more detail on this aspect later.

To date, the registration boards of 11 of the designated professions have been established. The professional titles of seven of these professions are now fully protected under law. The physiotherapists register was established in September of last year and the registration boards for the professions of social care worker, medical scientist and psychologist are working hard towards establishing their registers. Registration boards for the remaining professions will follow close behind and it is expected that the boards for all 14 professions will be operating by the end of 2018. From a public protection viewpoint, a crucial milestone in the regulation of the Act's designated professions was the introduction of the its fitness-to-practise regime two years ago. This involved 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 is similar to that applicable to medical practitioners, nurses and midwives. While a number of complaints have so far been investigated by CORU's preliminary proceedings committees, none has yet been referred for full investigation.

I would also like to take this opportunity to update the House on the proposals to regulate counsellors and psychotherapists.The Act provides that the Minister for Health may designate health or social care professions not currently designated if he or she considers it is in the public interest to do so and if the specified criteria have been met. Towards the end of last year, following consultations with the Health and Social Care Professionals Council, the Minister undertook a detailed public consultation on the question of regulating counsellors and psychotherapists. The consultation process yielded information that has been of considerable assistance to the Minister and officials. The 80 submissions received showed majority support for statutory regulation of the professions and for it to be undertaken in the context of the Health and Social Care Professionals Act 2005.

Having considered the submissions carefully, I decided last May to proceed with the designation of two distinct professions under the Act, that of counsellor and psychotherapist. Each will have its own register under one registration board. This decision was communicated to the council, the relevant professional bodies and all the respondents to the public consultation process. The regulations to designate the professions and to establish their registration board have now been drafted by the Office of the Parliamentary Counsel and have recently been submitted to this House and to Dáil Éireann for their approval. Subject to the approval of the regulations by the Houses, the next step will be the appointment of the 13-member registration board.

Following the submission of suitable candidates for my consideration, 12 members will be selected by the Public Appointments Service; the 13th will be nominated by the Minister for Education and Skills. I expect the registration board will be in a position early next year to begin its workload. It will be tasked with advising me and the Health and Social Care Professionals Council on some of the outstanding issues to be decided. These include the professional titles to be protected by regulation under the Act and the qualifications that ought to be required of existing practitioners in order to register.

In tandem, the registration board will begin the process of drafting the various by-laws needed to establish its registers and to commence each register’s two-year transitional period. Title protection will come into effect after these transitional periods when only those granted registration by the board will be entitled to use the protected professional titles.

I am aware of other professions seeking designation under the Act. Creative arts therapists, play 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 14 professions already designated and to make progress on the regulation of counsellors and psychotherapists. Next year, when all the registration boards have been established and the professions of counsellor and psychotherapist have been designated under the Act, the Department will turn its attention to the question of how best to treat the unregulated professions. As a first step, I 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.

I now propose to outline the main provisions of the Bill in more detail. The Bill has 9 sections. Section 1 provides for definitions. Sections 2, 3 and 4 of the Bill deal with appointments to the Health and Social Care Professionals Council and to registration boards. These three sections address gaps that have been identified in the Act relating to the appointment of professional members to these State boards.

Section 2 amends the Act to allow the Minister for Health to make the initial appointment of a professional member to the council when a new profession is designated by amendment of the Act. At present, the Act provides for such appointments only when a profession is designated by regulation. The professions of optometrist and dispensing optician were designated when the Act was amended by the Health (Miscellaneous Provisions) Act 2014. Representatives of these two professions are currently attending the council in an observer capacity. This amendment will allow me to formally appoint these professional members. This section also permits the Minister to appoint professional members to the council to fill casual vacancies where the relevant registration board has not yet established its register or has not conducted an election and is therefore not in a position to nominate elected members for appointment to the council.

Sections 3 and 4 will allow the Minister to appoint professional members to a registration board during the transitional period of the profession concerned when the boards do not have sufficient registrants to hold elections for these positions.

Section 5 of the Bill will permit a registration board to make by-laws to apply criteria or conditions on further education, training and experience to applicants for registration who, though qualified for a specified period of time, have never practised their profession. It will apply to all the designated professions. The Act already has such provisions in respect of applicants who wish to resume the practice of their profession.

Section 6 amends section 38 of the Act to provide for an amendment consequential to section 5. It also provides for the registration in the register of physiotherapists, on a once-off basis and for a limited period ending on 31 December 2019, of recent graduates of the Institute of Physical Therapy and Applied Science, Dublin, and of current students of the institute’s programme who will graduate in 2019 with the relevant qualifications.

Section 7 provides for the registration in the register of physiotherapists, on a once-off basis and for a limited one-year period, of existing users of the title of physical therapist who hold specified qualifications awarded by the institute or equivalent qualifications or who successfully complete an assessment of professional competence set by the physiotherapists registration board.

Section 8 provides for an amendment to the Act consequential to section 7. Section 9 provides for the Short Title of the Bill and for the commencement of its provisions.

I will now give the House some background to the amending provisions in the Bill relating to the register of physiotherapists. In other English-speaking countries, physiotherapists often use the title of physical therapist interchangeably with that of physiotherapist. In Ireland, however, for the past 25 years or so and in the absence of regulation and title protection, the title of physical therapist has been used by other providers of musculoskeletal therapies practising in the private sector. Those currently using the title of physical therapist are predominately the members of the Irish Association of Physical Therapists. They number about 300 and most of them are degree level graduates of the Institute of Physical Therapy and Applied Science in Dublin. These practitioners and physiotherapists, mostly the 3,000 members of the Irish Society of Chartered Physiotherapists, all provide musculoskeletal therapies. Physiotherapists, however, are also trained to provide cardiorespiratory and neurological therapies. The profession of physiotherapist is a designated profession under the Health and Social Care Professionals Act 2005.

Three years ago, in June 2014, the newly-established Physiotherapists Registration Board held its first meeting. One of the first items on its agenda was the protection of the title and how best to address the question of protecting the title of physical therapist. Early last year, the then Minister for Health, Deputy Leo Varadkar, concluded extensive consultations with the registration board and other relevant organisations. He came to the conclusion that protecting the title of physical therapist under the Act as a variant of the title of physiotherapist would be the best way to eliminate the risk of title confusion and the consequent risks to public safety. Protection of variant titles is done by regulations that require the prior approval of both Houses of the Oireachtas. The effect of prescribing the title of physical therapist as a variant of the title of physiotherapist will be to protect both titles under the Act by confining their use solely to registrants of the profession of physiotherapist. It was also decided to allow certain practitioners who are users of the title of physical therapist, and who hold qualifications of a certain standard, to continue to use the title. This requires the amendments to the Act, proposed in this Bill, to allow such practitioners to apply on a once-off basis and for a limited period to register in the physiotherapists register. These decisions took into account, appropriately and subject to ensuring public protection, the legitimate concerns of all the practitioners involved and of the other parties that will be affected by the regulations to protect the title of physical therapy.The decisions were welcomed by the two main professional bodies, the Irish Society of Chartered Physiotherapists and the Irish Association of Physical Therapists. Specifically, the Bill will permit the registration in the register of physiotherapists, on a one-off basis and for a limited period, of qualified existing practitioner-users of the title physical therapist by recent graduates of the Institute of Physical Therapy and Applied Science, Dublin, and of current students that graduate from the institute's final programme which commenced in 2016 and will end in 2019. It is intended that the regulations to protect the title of physical therapist will be made during the 12-month period provided for in the Bill.

As I mentioned earlier, the Physiotherapist Registration Board established its register on 30 September 2016. This means that all legislation necessary to protect the title of physiotherapist is now in place. When the register's two-year transitional period ends in September 2018, entitlement to use of that title will be confined to the members of that register. While the register has been open for receipt of applications since last September I am disappointed to hear that the rate of application has been slower than for other professions. It is important that CORU be given the opportunity to process as many applications as possible before the 30 September 2018 deadline, otherwise if the existing practitioners leave it to the last minute to apply for registration it is likely that a number of non-registrants will still be using the protected title of physiotherapist after that date and until such time as their applications are processed. This would be far from ideal from a public safety perspective.

I am keen to ensure that the Bill proceeds through this House as quickly as possible. As stated, the Bill will provide for the necessary amendments to the Health and Social Care Professionals Act 2005 to allow me to bring forward regulations to protect the title of physical therapist alongside that of physiotherapist and to make other technical amendments to the Act to enable the Health and Social Care Professionals Council to continue to fulfil its objective, which is 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.