I would like to thank Deputy Howlin for raising this timely issue. I am supporting the reading of this Bill for a second time. I am fully supportive of the objective behind this Bill which is to protect the public.
The people requiring protection in this case are women who are experiencing a crisis pregnancy and are seeking support at a time of extreme distress and vulnerability. Instances have come to light where services purporting to provide objective advice and support were in fact serving their own agenda with little regard for women, their health or their welfare. Health information should be just that, not an opportunity to push an agenda, mislead and scaremonger.
My Department has assessed the Bill as drafted and we do have some concerns that it needs re-working to achieve our shared objectives.
However, we are engaging constructively with the Bill and I want to work with the Deputy and the Members of this House to come up with appropriate solutions. Subject to the Bill passing Second Stage I will make available the resources of my Department for this purpose and I hope we can work with Deputy Howlin to achieve the best result for women.
I know that Deputy Howlin as a former Minister for Health is very much alive to the duty to protect the public when availing of health or social care services. As I have said this concern is shared by the Government, especially when it comes to pregnancy counselling services. A crisis pregnancy is perhaps one of the most stressful events in a woman’s life and can place her in a very vulnerable position. Positive Options, the crisis pregnancy service that is funded and overseen by the Health Service Executive, provides counselling in 50 locations nationwide and provides women with free, non-judgemental counselling.
We are all aware, however, that some other bodies providing counselling to pregnant women may not adhere to the same standards. There have been media reports of such bodies providing information that is not truthful or objective and this is a cause of concern.
To address this concern Deputy Howlin has put forward this Bill. The Bill seeks to address the matter by regulating crisis pregnancy counsellors. I have some legal and practical difficulties with the detail of these proposals but I do agree that there is an important role for the regulation of relevant professionals in this area. I hope we can find a means of achieving such regulation and I will outline developments for the House that I believe are very relevant in doing so.
Existing Regulation of Information
However, before I do so, I am announcing tonight that in tandem with our consideration of this Bill, my Department is commencing a review of the Regulation of Information (Services Outside the State for Termination of Pregnancies) Act 1995 as part of our response to addressing the concerns that have arisen. This is an issue which has been raised with me by the Terminations for Medical Reasons Group at our meetings and by individual women I have met. The 1995 Act provides that it is an offence for bodies or counsellors to provide information on termination of pregnancy that is not truthful or objective. Allegations of providing such information may be referred to the Gardaí for investigation.
These provisions are already on the statute books and it is important that people with concerns about the veracity of information given out by service providers are aware that there is an existing basis for having their concerns investigated. The review that my Department is undertaking can establish if these provisions need to be strengthened and examine other relevant issues and concerns which have been raised.
Progress in Professional Regulation
Turning to the issue of professional regulation I think it might be useful for Deputies if I outline the progress that has been made in implementing the Health and Social Care Professionals Act 2005 and provide some information on how it operates in practice. The Act currently provides for the statutory regulation of fourteen designated health and social care professions, namely the professions of clinical biochemist, dietitian, dispensing optician, medical scientist, occupational therapist, optometrist, orthoptist, physiotherapist, podiatrist, psychologist, radiographer, social care worker, social worker and speech and language therapist.
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 registration boards, 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, collectively known as CORU, 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 “grandfathering” which is a transitional period of 2 years during which existing practitioners must 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, are entitled to use the relevant protected title.
To date, the registers of eight of the designated professions have been established. The remaining professions are following close behind and I expect that the registers of all fourteen professions will be open by the end of 2017. It has been a long and difficult journey for all involved but much valuable learning has been gained along the way.
From a public protection viewpoint, a crucial milestone in the regulation of the Act’s designated health and social care professions was the introduction of the Act’s fitness to practice regime at the end of 2014. This allows 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.
Central to CORU’s fitness to practice regime is a Code of Professional Conduct and Ethics which sets out the standards of conduct, performance and ethics which a registrant must adhere to throughout the course of their work. Each profession registered has its own Code. As part of an application to join a register all registrants will have signed a statutory declaration stating that they have read, understood and agree to abide by the Code for their profession. Failure to adhere to the relevant Code is grounds for a fitness to practice complaint.
Proposed Registration of Counsellors and Psychotherapists
I would also like to update the House on the very relevant proposals to regulate counsellors and psychotherapists. These professions are not currently designated under the Act. The Act provides that the Minister for Health may designate by Regulation health or social care professions not currently designated if he or she considers that it is in the public interest to do so and if the specified criteria have been met.
The previous Minister for Health, James Reilly, wrote to the Health and Social Care Professionals Council on the question of designating, in the public interest, the profession or professions of counsellor and psychotherapist under section 4(2) of the Act. The Act provides that the Minister for Health is obliged to consult with the Council in the first instance concerning a proposed designation and to give interested persons, organisation and bodies an opportunity to make representations to the Minister.
The Council was asked to consider a number of issues concerning the proposed designation and was requested to take into consideration the report of Quality and Qualifications Ireland on the academic standards necessary for the accreditation of courses in Counselling and Psychotherapy. This was the first stage in the consultation process under the Act.
On 31 August this year, having received and considered the report from Council, I proceeded to the next stage which involves a public consultation to include all interested parties. As mentioned earlier, I have asked that submissions be forwarded to my Department by 30 November 2016.
While a number of key issues remain to be clarified, including decisions on the title or titles of the profession or professions and on the minimum qualifications to be required of applicants for registration, I hope that the necessary designation regulations can be submitted to the Houses of the Oireachtas for their approval next year. Expressions of interest will then be sought, via the Public Appointments System, from suitably qualified persons available for appointment to the new registration board that will be established to regulate counsellors and psychotherapists.
Consideration of Crisis Pregnancy Counsellors and their Potential Regulation
These forthcoming developments with regard to the registration of counsellors under CORU are highly relevant in determining the best means of regulating pregnancy counselling (other than that provided by professionals such as doctors, nurses or social workers who are already regulated).
Deputy Howlin’s Bill proposes amending the Health and Social Care Professionals Act 2005 to designate crisis pregnancy counsellors as a profession. It would treat pregnancy counsellors separately to counsellors generally and would define their scope of practice. I am not convinced that this would be the best approach in practice.
Establishing crisis pregnancy counsellors as a profession separate and distinct from the profession of counsellor would give rise to difficulties. Pregnancy counselling does not meet the standard criteria for designation under the Act. In particular, it has not established itself as a separate profession with its own professional body, defined routes of entry, distinct entry qualifications, and so on. Also, unlike counsellors generally, its numbers would be very small as most providers of pregnancy counselling are members of other regulated professions such as counsellors, medical practitioners, nurses and social workers.
The Bill also seeks to regulate the profession by way of defining the activity engaged in by pregnancy crisis counsellors. The Health & Social Care Professionals Act, 2005 regulates professions by way of setting qualifications and protecting title. It does not regulate activity or define scope of practice.
As mentioned earlier, registrants are obliged to adhere to a Code of Conduct and Ethics specific to their profession and failure to do so is grounds for a fitness to practice complaint. The Act provides that only those who are registered can use the protected title. The ultimate sanction under the Act is the cancellation of registration and the consequent removal of entitlement to use the title.
Therefore, inclusion of references in the Bill to the activity of giving information, advice and counselling to pregnant women in relation to crisis pregnancies needs careful consideration. There are a range of professionals engaged in such activity which are regulated by CORU and other regulators such as the Medical Council. We want to retain the everyday contribution of such professionals to supporting women in crisis pregnancy situations and to do so in a way that relies upon their existing professional regulation which reflects their professional affiliation and standing.
In addition, the Bill does not take into account the difficult but key requirement of setting grandfathering qualifications, a requirement central to the registration of existing practitioners. There is also the matter of having to provide for the establishment of a registration board (each profession is regulated by a 13 person registration board) and a range of consequential amendments to the 2005 Act.
Conclusion
For these reasons, while I am supporting the Bill being read at second stage, I am also pointing to the additional work that needs to be done before the Bill proceeds further. I am committed to working with Deputy Howlin in this matter and I have asked officials in my Department to give timely consideration to ways of better protecting the public from certain crisis pregnancy agencies or counsellors providing information that is not truthful or objective.
The intention will be to make progress through utilising both the forthcoming registration of counsellors and the existing Regulation of Information Act 1995, including the review of this Act my Department will undertake. I look forward to keeping the House informed of developments in addressing our shared objectives.