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The theme of sustainability was writ large in the pages of the recently-published Health and Social Care Professionals Council Statement of Strategy 2017-2021, and this was little surprise.
Over the next five years, the number of professionals regulated by CORU will expand to around 30,000, making it the second-largest regulator of healthcare professionals in Ireland.
Currently, it regulates more than 9,000 professionals, including dietitians, occupational therapists, optometrists and dispensing opticians, physiotherapists, radiographers and radiation therapists, social workers and speech and language therapists.
Minister for Health Simon Harris launching CORU’s Statement of Strategy 2017-2021. At the strategy launch with Minister Harris were Ms Ginny Hanrahan, CEO and Registrar, CORU, and MrBernard mcCartan, Chair, CORU
Work has commenced on opening registration for social care workers and medical scientists, while the registration and regulation of the remaining designated professions — psychologists, podiatrists, clinical biochemists and orthoptists — will begin when the Minister for Health appoints their registration boards.
The proposed regulation of counsellors and psychotherapists under the Health and Social Care Professionals Act 2005 was subject to public consultation by the Department of Health until late 2016, and will lead to further demands on CORU. Moreover, the future of the Pre-Hospital Emergency Care Council (PHECC) in relation to CORU will be subject to Government policy.
Various other professions have been mentioned in public discourse as potential candidates for regulation, including healthcare assistants, phlebotomists and physician associates. CORU could be their home too.
In this context, building a sustainable model of regulation is a matter of ongoing concern and attention for the regulator.
“Let’s face it, regulation is not cheap,” CORU CEO Ms Ginny Hanrahan told the Medical Independent (MI). She said the principal consideration is the level of risk posed to the public, adding that the power to designate a profession under the Act sits with the Minister for Health.
“We have a list of 22 aspirant groups who want to be regulated — everything from medical physicists, clinical engineers, play therapists, creative art therapists… there is a really broad range of people,” she commented.
CORU is very serious about its role in patient safety, underlined Ms Hanrahan. “Vulnerable people are going to counsellors and psychotherapists and not all are up to the standards required… We have the 15 (designated professions) and I think counsellors and psychotherapists will be definitely heading in our direction. With the other groups, a risk assessment will have to be done to see what sort of risk they pose to the public.”
Asked about the possible future regulation of physician associates, Ms Hanrahan said the question of whether they should be regulated by the same body as their supervisors, ie, doctors, would need to be explored. In 2015, a pilot with four physician associates was commenced by the RCSI at Beaumont Hospital, Dublin. It is due to conclude later this year.
“I know Prof Arnie Hill has been very involved in that in the RCSI. They haven’t talked to us,” explained Ms Hanrahan of the current situation. “We are keeping an eye on it because it is an issue that is coming up in the UK but it has also been [arising] in Canada and other places… If I was asked to look at it, I would look at it in the broadest sense of where it would work. It is an interesting one, about whether people want to be regulated with the professions who are supervising them. I don’t have an answer to that; I think that is something that has to be explored.”
An ongoing focus for CORU is planning “what regulation is going to look like in the future”, outlined Ms Hanrahan, who worked as an occupational therapist and as head of clinical services at Beaumont Hospital. She said CORU and the Department will work together closely in this respect.
Ms Hanrahan noted that the Department, in 2012, stated its intention to review the Act to allow CORU to work towards a model of regulation that will rationalise the individual registration boards into three inter-disciplinary registration boards, broadly encompassing Diagnosis, Therapy and Social Care (to be known as ‘Psychosocial’) to provide a less bureaucratic operating mode.
One of the intriguing details in CORU’s expressive statement of strategy concerned potential collaborations with other regulators, including in the fitness to practise realm.
The document stated that CORU was open to “listening to and indeed creating dialogue around how regulation could evolve to represent greater value for money, eg, shared services, shared ICT, or the concept of a shared fitness to practise forum across professional regulators in the health and social care arena. The model of regulation we adopt and activities we undertake need to be sustainable in this economic environment”.
Ms Hanrahan told MI that regular meetings take place between the regulators of healthcare professions and a variety of issues of shared concern are discussed.
“We, the regulators, also wrote to the Department about looking at our legislation because we feel the legislation should be the same across all of the regulators…We work very closely with the regulators. We are all there doing the same thing; we are all there to protect the public, we are regulating the professions that are under our remit. We feel there should be a similar mechanism for fitness to practise for all, whether you are a social worker, or a doctor, or a nurse, or a pharmacist.”
On the notion of a shared fitness to practise forum, Ms Hanrahan said this was an idea raised during a meeting of the regulators and was “at very early discussion”.
In describing the broader context to this dialogue, Ms Hanrahan said that “if you look in the UK, with the bigger regulators, they have actually pulled out fitness to practise from their regulation; they separate them”. She also noted that healthcare is very much delivered on a multidisciplinary team basis.
“I suppose we are starting at the early piece, which we feel is to get the legislation the same for all the regulators, as a starting point.”
The regulators are also looking at “very practical ways of how we can reduce our costs as groups”, with the area of IT as an example.
In 2014, CORU received €2,193,614 in exchequer funding, while registration fees totalled €450,381.
Asked about future funding sources and registration fees, Ms Hanrahan said: “I suppose a political decision has been made, in that our fees ended up in the middle of the Lansdowne Road Agreement and they have been set to €100 until 2018. I should say that our council set the fees but essentially, our fees go towards our cost but we also get funding from the Department as well.”
Last year, CORU had 94 statutory meetings, when most bodies would have 10 or 12, outlined Ms Hanrahan. “We had 94 because we have all the [registration] boards, and the council, and that is not sustainable, so you will see in the statement of strategy we are talking about how we are going to review and tighten that but make sure we meet the standards. The most important thing, no matter what you do with the structure, is you have to be satisfied that the public are protected by ensuring that the right standards are being set for the professions, and being monitored.”
CORU’s fitness to practise function was launched on 31 December 2014. To date, almost 80 complaints have been received, mostly relating to social workers. Ms Hanrahan said this was expected, based on international evidence and the inherent nature of that role. One person has had their registration cancelled since initiation of fitness to practise.
As with the Medical Council, CORU’s Preliminary Proceedings Committee (PPC) considers the merits or otherwise of each complaint about any of the regulated professions.
The PPC has a crucial function in this respect. “It is important they get the right information; and also, to take out the vexatious complaints or frivolous ones… The challenge is trying to streamline the timelines on it. We have a couple of things we would like to seek legislative amendments on, so that you could take a couple of steps out of the process to reduce the time.
“We are very mindful that any complaints we are dealing with, it is really important that we can say ‘this needs to be answered or it doesn’t’ and that is a critical decision to make, and I don’t apologise for the time it takes to get that. But obviously if there is anything we can do to speed it up, that is one of the things we are doing and as a group of regulators it is something we have submitted, looking to try and streamline all of our legislation in relation to fitness to practise.”
This year, CORU will be developing a report examining learnings from complaints.
“Even in the ones that have come in and haven’t made cases, there are learnings: Is it around a communication issue or is it around rudeness? These are important things for people who are usually feeling very vulnerable going to meet any of our professions.”
CORU also ensures that the relevant educational bodies deliver qualifications that prepare professionals to provide safe and appropriate care; monitors and promotes continuing professional development; and has set standards of proficiency in respect of those applying to the relevant register.
“To get onto the register is a tough enough journey because we do Garda vetting, we also get a health declaration, we get evidence from their employer… ” outlined Ms Hanrahan.
“We have had a number of people apply who have been struck off other registers [abroad] but because we have been so diligent, they didn’t get on… The other thing we are also doing is, we deal with international qualifications — that is very complicated, we have to do it on a one-by-one basis, and again it is about ensuring that if somebody is coming with an international qualification that it is meeting the standards required, and if it is not, then we have to offer them a way to get it up to that standard through… an assessment or to do a period of adaptation.”
Ms Hanrahan also pointed out that CORU’s registers are important tools for doctors, who often refer to members of the designated professions.
Recent news reports have highlighted the issue of outdated medical equipment in HSE facilities. Where such deficits impact on registrants (radiographers, for example), does CORU have a place in raising concerns with the HSE?
“There is an element of ‘we must act within our powers’. But as a regulator, there are times we can use our influence and we have done it on a few things. Ultimately, the responsibility has to be with the HSE and how that is funded,” responded Ms Hanrahan.
“As an occupational therapist, I remember the frustrations of a wheelchair not being up to scratch or trying to get wheelchairs for patients… and for the people on the ground it is very difficult; you literally have to go advocating. I know the professions we regulate are dealing with all of those issues and we are mindful of it, and where we can influence, we do.”
This year looks set to be another eventful one for CORU and its over 40 staff, as well as members of council, committees and registration boards. CORU is especially keen to develop a heightened profile through public meetings and media/social media engagement in 2017.
“I have a very dedicated staff, who absolutely get what this is about,” concluded Ms Hanrahan.