The legislation which is the framework for the statutory professional registration framework for all health and social care professionals (except for those such as pharmacists which already had a statutory registration scheme) is the Health & Social Care Professionals Act 2005 (HSPA 2005). The legislation states that the Health and Social Care Professional Council’s main duty is “to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions” (Section 7). The legislation envisages that registration for specified professions will be put in place first and others will follow when recommended by the Minister for Health and Children. The professions identified as “first wave professions” are the largest professions based on numbers. These are:
- Clinical biochemists
- Dietitians
- Medical scientists
- Occupational therapists
- Orthoptists
- Physiotherapists
- Podiatrists
- Psychologists
- Radiographers
- Diagnostic and radiation therapists
- Social care workers
- Social workers
- Speech & language therapists
- Any further professions scheduled by the Minister of Health and Children
The membership of the Health and Social Care Profession (HSCP) council includes a representative from each of the above first wave professions and one representative of the management of the public health sector, the public social care sector or both sectors; one representative of the management of a voluntary or private sector organisation concerned with health or social care; and one representative of third level educational establishments involved in the education and training of persons with respect to the practice of the designated professions and is nominated by the Minster for Education and Science. Also included are six representatives of the interest of the general public and are appointed with the consent of the Minister for Enterprise, Trade and Employment; and three persons who have qualifications, interest and experience as in the opinion of the Minister, would be of value to the Council in performing its functions. The specific membership is listed on the website of the Health and Social Care Professions Council (CORU). The legislation allows for the Minister for Health “to designate a profession that falls within the definition of a health and social care profession. S/he will also have a duty to establish a registration board for that profession”. Coru’s council is responsible for ensuring processes are implemented within the terms of the legislation for each profession. This includes monitoring the registration of professionals; standards; education/performance/code of ethics and conduct; fitness to practice; and protected titles, where an individual whose name is entered in the register of members of that profession, for example, ‘clinical engineer’. The legislation allows for sub-divisions within a registered profession.
REGISTRATION BOARDS
Each profession will have a registration board. The structures put in place to define the management of statutory registration, require that registration boards are responsible for ensuring improvements in the quality of service user care; the setting of standards of competence for practice; the fostering of continuing education and development required for excellence over a lifetime of practice; the identification the competence of the individual practitioner; and to reassure service users and the public about competence of those belonging to the health/social care professions. Registrants from first wave professions must meet standards set by registration boards and endorsed by their relevant council. Each board will have 13 members to include seven lay members; six professional representatives; one from education; two managers; and three practitioners. ‘Grandparenting’ is a structure to validate competency of those already working within the profession who do not meet the stated Educational criteria. Processes must be put in place to validate an individual’s professional experience proficiency. Grandparenting procedures will be made available for two years after the register has been opened. Registration boards are obliged to ensure registrants have a high standard of professional education; competency in practice; and maintain high standards of professional conduct and ethics. Progress for health and social care professions The registers for social workers ares now open. Registration boards have been appointed for speech and language therapists, occupational therapists and dietitians. It is expected that registration boards for radiographers and physiotherapists will be appointed in the near future. Some professions developed voluntary registration schemes in anticipation of statutory registration. The clinical engineering profession developed such a scheme in line with the proposed legislation and later with the actual legislation. The Clinical Engineering Voluntary Registration Board (CEVRB) was established in February 2002. The scheme is described in a published protocol for clinical engineering voluntary registration. The scheme is based on profession pillars which have been developed over many years by Engineers Ireland (formerly the Institution of Engineers of Ireland), some of which already have legal standing. The scheme has undergone a legal review by Beauchamps solicitors. Since 2002, CEVRB representatives have met with members of the Department of Health dealing with registration and, in more recent years, CEO of the Health and Social Care Professions Council Ginny Hanrahan. The CEVRB has many strengths, including the fact that it is based on well-established professional engineering principals including grandparenting procedures. The challenges facing the CEVRB include the cost of registration. It is difficult to maintain momentum and enthusiasm when statutory legislation has taken much longer than expected to be implemented. Clinical engineering has a diverse nature, including people working in a range of roles from maintenance to research in the public and private sectors, and in the private sector supplying services to the public sector.
VOLUNTARY REGISTRATION REQUIREMENTS
The Clinical Engineering Voluntary Registration Scheme required a minimum standard of education, validation of professional competence and sign up to a code of ethics. Appropriate technical education and professional competence are assessed according to Engineers Ireland’s criteria for each of its three registered titles: Engineering Technician, Associate Engineer and Chartered Engineer. All three of these titles are acceptable indicators of educational and professional competence for the CEVRB. Specific experience in the clinical environment is confirmed by references of registered clinical engineers. Potential registrants must also sign up to the Engineers Ireland code of ethics. Engineers Ireland also offers structures to manage grandparenting – through its ‘alternative routes to membership’ procedures. In addition, Engineers Ireland offers a mentorship scheme where candidates are offered a mentor to support them in meeting the requirements of alternative routes to membership. Conformance with fitness to practice requirements and a code of ethics are very tricky areas to police. This issue was examined in detail by the CEVRB, but by utilising the Engineers Ireland ethics structures, the CEVRB was able to use well-developed structures which had already been tested. A continuing professional development scheme has also been established which registrants should follow. The CEVRB considers registration to be an inclusive process, where the profession works to raise standards and raise its professionals to meet these standards.
PROFESSIONAL FORMATION
In 2003-2004, a working group of the Biomedical Engineering Division of Engineers Ireland was established. This group, chaired by Bill Grimson from DIT, published a document which reviewed education relevant to the clinical engineering profession, career structures and possible future mapping of career structures to allow for progress between grades. The document also proposed a detailed curriculum for clinical engineering courses. This document was presented to the International Federation for Medical and Biological Engineering (IFMBE) and became a foundation document for IFMBE recommendations for education in clinical engineering. Clinical engineering in this context included rehabilitation engineering and health informatics. This document has not been implemented in Ireland at a formal level. However, it could still be a foundation for future clinical engineering courses. The clinical engineering profession must respond to the demands of statutory registration and engage with appropriate bodies in doing this. As professionals we should make it a common goal to support one another in this endeavour.
Meabh Smith graduated from TCD with a degree in Engineering and an MSc in Physical Sciences in Medicine. She is a founder member of the biomedical engineering division of Engineers Ireland and served many years on the Executive Committee of the Division. She works in Beaumont Hospital, Dublin