1. What is Statutory Registration?
A system whereby each individual member of a profession is recognised by a specified body as competent to practice within that profession under a formal mechanism that is provided for by law. Unlike systems of voluntary registration it is a legally binding process: all persons wishing to practice must be registered.
At present, only five professions are subject to statutory registration in Ireland: doctors, dentists, nurses, opticians and pharmacists. A number of other professions have informal or voluntary systems of registration organised by their respective professional body, but such a system has no basis in law.
2. Why introduce Statutory Registration?
Protection of the public: professional providing the service must be properly qualified and competent.
Protection of the profession: to exclude unqualified or insufficiently qualifed persons and to provide a mechanism for sanctioning professional misconduct among the small minority of problem cases.
Mechanism to deal appropriately with practitioners compromised by ill-health or addiction.
Structure for appraising and approving training courses, examinations, qualifications and institutions.
EU Directives on the Mutual Recognition of Third level Qualifications in EU: forum for better information and greater consistency in implementation.
Overall: statutory registration offers the ‘teeth’ that voluntary codes of registration cannot.
3. Consultation process on Registration Scheme
Minister for Health and Children launched the consultation process with the professional bodies in Cork on 14 April 2000.
Discussion Document by Department of Health and Children formed the basis for subsequent discussions.
There followed a serieson one-day workshops facilitated by Institute of Public Administration, at which all of the major issues raised by the Discussion Document, and others raised by the professional bodies, were considered in some detail.
Minister emphasised importance of seeking to build consensus using a highly consultative process with the professions involved. Minister and Department acknowledge the vital input of all of the professions involved in the consultation process.
Professional Bodies which Participated
- Academy for Medical Laboratory Science
- Association of Occupational Therapists of Ireland
- Association of Clinical Biochemists of Ireland
- Environmental Health Officers Association
- Psychological Society of Ireland
- Institute of Chiropodists and Podiatrists
- Irish Association of Care Workers
- Irish Nutrition & Dietetic Institute
- Irish Association of Speech and Language Therapist
- Irish Association of Social Workers
- Irish Association of Orthoptists
- Irish Chiropodists/Podiatrists Organisation
- Irish Institute of Radiographers
- Irish Society of Chartered Physiotherapy
- Resident Managers Association
- Society of Chiropodists and Podiatrists
4. Key Elements of a Statutory Registration Scheme
However designed, the registration system must ensure we deliver the best possible service to patients and clients.
Registration system to be designed with the full development of the professional bodies in mind. Far from diluting their influence or membership, statutory registration should provide a vehicle for enabling professional bodies to build upon their existing role.
Integrated, mutually supportive system of registration across professions, but with significant autonomy within each Registration Board on issues affecting that profession.
Self-financing system of registration, i.e. funded from contributions of all registered members. No scope for entirely separately-funded registration systems: if we try this the scheme would not be viable.
Legislation will be drafted to allow maximum possible flexibility. Should be enabling/empowering rather than very rigid.
The professions and all others involved must have ownership of the registration system. Department will prepare the legislation, but the detailed operation the scheme would be a matter for those running it – in line of course with the legislation.
5. Main Structures proposed for Registration
- Co-ordinate and assist activities of Committees and Boards
- Ensure common approach without compromising autonomy
- Policy-making and overall supervisory, rather than executive functions
- Promote and develop common ground between professions
- Registrar of Council to be Registrar of each Board also
- Supply administrative support to Committees and Boards
- Enabled to establish committees for specific functions if required
- Certain appeal functions in Fitness to Practice Cases
Statutory Committee Preliminary Proceedings
- Preliminary hearing of complaints
- Decision to refer or not to proceed
- Independent chair; 1 legal 2 from profession; 1 from another profession (panel system)
Statutory Committee Health
- Cases involving health, addiction or serious illness
- Recommendation to relevant Registration board
- Independent chair; employer + consumer rep; 2 from profession
Statutory Committee Fitness to Practice
- Formal hearing of case involving e.g. professional competence, practice or related matter
- Recommendation to relevant Registration Board
- Independent chair; employer + consumer rep; 2 from profession
Registration Boards 1 per Profession
- Maintain a register of all members deemed eligible to practice
- Determine criteria for registration, in consultation with professional bodies, e.g. qualifications, training and practical experience and system of ‘grandparenting’
- Maintain record of all post-registration qualifications held by each registrant
- Prepare Code of Conduct and Ethics in conjunction with professional bodies
- Nominate titles to be protected under the legislation
- Remove practitioners from register as a result of e.g. Fitness to Practice case
- Final decision on any other sanctions recommended by FPC or HC
- Membership: Majority of professionals – 5 – 7 members; reps of health, education as appropriate and 1 consumer rep, not being a current/former member of profession
6. Registration Requirements: how would the work?
Statutory Registration would:
- be compulsory for all practitioners in each registered profession;
- extend to practitioners in all forms of practice, whether public or private;
- apply to all sectors in which a profession operates (e.g. health, social services, education, industry)
Standard, efficient registration scheme needed for ‘standard’ cases
No ‘automatic’ registration for any group – in public or private sector relevant qualifications and experience needs to be established, plus sign-up to Code of Ethics of profession
For those not meeting qualifications criteria, assessment mechanism needed
Some professions will need a ‘grand parenting’ system for assessing those not immediately qualified for registration: to be worked out with those professions which need it. Importantly:
- specific criteria to establish individual eligibility for assessment (e.g. working for at least 5 years)
- specific time limits within which practitioners may apply for assessment ( e.g. 18 months of introduction of assessment scheme) Grand parenting arrangement cannot be indefinite.
Significant implications for those already working and not found eligible for registration: provision for temporary registration pending achievement of required standard
7. Fitness to Practice and Health Issues
Questions regarding fitness to practice arise only in a tiny minority of cases each year but it is vital to have a fair, consistent and transparent system for dealing with these. All procedures must adhere to the principles of fairness and natural justice.
Preliminary Proceedings Committee would:
- screen, investigate and deal with all initial complaints received (health, professional conduct or ethical issues)
- determine whether complaints should be referred to the Fitness to Practice Committee or Health Committee, back to professional body or
- judge there was any basis for investigating them further.
Fitness to Practice Committee would:
- investigate complaints referred to it by the Preliminary Proceedings Committee
- recommend a course of action to the relevant Registration Board.
Health Committee would:
- deal with lifestyle issues and
- cases of being compromised by physical or mental ill health.
- cases would be referred to it by the Preliminary Proceedings Committee.
Specified procedures for:
- initiating a complaint (statutory declaration)
- notification of allegations and complaints
- conducting of parallel investigations
- reference of cases by Preliminary Proceedings Committee
- types of sanctions (e.g. formal warning; fine; limiting scope of practice; working under supervision; course of training; temporary or permanent removal from register)
- appeals mechanism (to Registration Council or High Court, depending on basis of appeal)
- publication of sanctions
8. What would the role of Professional Bodies be?
- Already a wide range of functions including:
- Professional issues: views of the profession; code of ethics; standards of practice; voluntary (non statutory) registration; conferences; newsletters; academic journals; website; representation on other professional bodies; links with the European and International communities; student membership; links with the IMPACT Vocational Group; and negotiating professional indemnity insurance for members
- Education and training: Co-ordination of clinical placements; curriculum development; accreditation of undergraduate and post graduate courses; running certain post graduate courses; and running schemes of research awards.
- Continuing Professional Development (CPD): Running/arranging educational workshops; developing or already providing CPD.
- EU Directives on the Free Movement of Professionals: acting as the Designated Authority, with the approval of the Minister, re issues under the EU Directives; acting as the Competent Authority to advise the Minister on applications received under the Directives; and in most cases, acting as the Competent Authority to advise the Minister on non-EU cases on request.
- Links to Department of Health and Children: Responses to formal policy documents; and annual meeting with Department.
- Vast bulk of these functions would continue after Statutory Registration. Only areas of likely change are those directly affected by the statutory registration scheme itself. Even then, there is considerable scope for ‘subcontracting’ some of the functions (particularly in relation to education and accreditation) from the Registration Board to the relevant professional body
- Future role of professional body could include:
- Promoting the profession in the eyes of the public
- Acting as a learning society, publishing journals and promoting further expert understanding of developments in treatments;
- Defining what the profession is, including the question of whether a particular activity or treatment constitutes part of the work or treatment of that profession;
- Defending individual members in cases where appropriate;
- Contributing to debate on the future changes and scope of the profession;
- Developing a program of Continuous Professional Development in partnership with the Statutory Committees and the Registration Boards and, where appropriate, delivering this training;
- Participating in the appraisal and approval of training courses, examinations, qualifications and institutions in partnership with the Education Committee;
- Providing an important input to Curriculum development; and
- Promoting student membership so that the values and principles of the profession are imbued from the beginning of training.
9. Continuous Professional Development – (CPD)
What is CPD? It aims to ensure that professionals
- Maintain and update their skills and experience and
- Keep fully abreast of developments.
CPD can comprise:
- formal training and education,
- attendance at courses organised for the purpose,
- experiential learning,
- part-time ‘off-site’ training, and
- other structured methods of maintaining and updating skills.
- may or may not be formally examined.
- is normally recorded officially
- can be accredited by the professional body and
- can include a points system whereby professionals accumulate a specified number of points per period of time
Distinguish between two types of CPD:
- One maintains and updates clinical competence – usually specific to an individual profession.
- Other focuses on areas of personal development such as management and personal development skills – not profession – specific.
Under statutory registration, competence-based CPD would be a compulsory element and would be financially supported by the Department.
This would require detailed preparation, including the planning and implementation of appropriate CPD systems across all professions involved.
Aim would be to move to a system of compulsory CPD within five to seven year of introducing a statutory scheme of registration
10. Funding and Administration issues: who would pay?
- Operation of the registration scheme as a whole would be self-financing, i.e. funded from the registration fees of registered members.
- Department would provide seed funding to start off the operation.
- Fees could be subject to tax relief but this is for Revenue Commissioners to decide.
- Fees for each profession would be the same and would not be based on the size of any individual profession
- Fees for registration would be charged by the Registration Council and would, as such, form the Council’s income
- Out of this, Council would be required to pay all pay necessary costs such as accommodation, staff and other operational expenses, including those of the Registration Boards and Statutory Committees.
- Fee levels to be tailored by Council and Boards based on what sort of service they want to fund.
- Slim administration proposed, with common core services provided to each Registration Board and Statutory Committees. This gives economy of scale and improves efficiency and expertise.
- Registrar of Council would act as Registrar to each Board
- Non-core functions could be contracted out if costs justify this e.g. records management, legal work and mailing.
11. Next Steps and Timetable
- Consultation with professions between now and year-end
- If proposals accepted, draft legislation to be prepared. ‘Heads of a Bill’ by early to mid 2001.
- Registration Bill to be prepared as soon as possible thereafter, but depends on timetable of Attorney General’s Office.
- Oireachtas debate on Bill, followed by enactment: ideally within 18 months bud depends on Oireachtas timetable.