Global Differences in Regulatory Models

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Global Differences in Regulatory Models

• A European Perspective

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Address by Eugene Donoghue Chief Executive O
fficer and Registrar An Bord Altranais (Nursing
Board), Ireland at CLEAR (Council for Licen
sure, Enforcement and Regulation) Conference,
San Antonio, Texas. January 11th 2002
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Thank you for the invitation to address this
conference . I hope that my contribution will a
dd to your knowledge of regulation in Ireland,
which I propose to present in the context of
regulations governing the movement of health
professions in Europe.
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Original regulatory legislation in Ireland was
derived from United Kingdom judicial systems.
From the 19th century and the beginning of the t
wentieth century laws were enacted in Ireland
regulating health care professions, and such
legislation focused primarily on the
establishment of standards in the education and
training and the establishment of a register of
practitioners. Boards were appointed by the go
vernment which included representation from the
professions.
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After independence was established in 1921 these
regulatory laws for nurses and midwives continued
until in 1950 the Irish Government passed a
Nurses Act which established An Bord Altranais
and put in place systems regulating Education and
Training, the Maintenance of a Register, Fitness
to Practice Procedures and Guidance to the
Profession.
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This Nurses Act was further revised in 1985 when
for the first time elected nurses and midwives
held a majority on the Regulatory Board.
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History of RegulationMedical Act,1858 Medical
Act, 1886 Medical Act, 1927Medical
Practitioners Act, 1978.Pharmacy Act
(Ireland)1875Pharmacy act,1951 Pharmacy Act,
1962Dentists Act, 1878 Dentists Act, 1921
Dentists Act1928 Dentists Act, 1985. Nurses
Act,1917, Midwives Act, 1919 Midwives Act 1944
Nurses Act,1950 Nurses Act 1985.
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The general role of the Nursing Board is to
Promote high standards of professional education
and training and professional conduct among
nurses.
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• Various models of regulation exist in the member
  states of the European Union.
  
• Each country has a designated Competent Authority
  for a profession
  
• The Competent Authority is an independent
  regulatory body in some states.
  
• Some are incorporated into Government Health
  Departments and some are administered by Local
  Authorities.

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The Irish Nursing Board consists of 29 members
(17 elected by the profession and 12 appointed by
the Minister for Health and Children) and holds
office for five years. Included in the Ministe
rial appointments are two representatives of the
public, and medical, educational and service
interests.
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The Board is self financing from annual fees
charged to nurses to have their name retained on
the Register. This accounts for approximately 90
of the Boards income. Currently there are 62,000
nurses names on the register (50,000active,
12,000 inactive). The Act provides for the rem
oval from the Register of names of nurses who do
not pay fees.
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The Act provides for the establishment of a
Statutory Fitness to Practice Committee which
requires the committee to enquire into
allegations of professional misconduct or
unfitness to practice because of physical or
mental disability.
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• Findings of the committee are reported to the
  Board whose role it is to administer sanctions.
  These range as follows
  
• Removal from the Register,
• Suspension from the Register,
• Attachment of conditions,
• Advise, Admonish or Censure.
• Decisions of the Board effecting a nurses
  employment are not effective until confirmed by
  the High Court.
  
• A nurse has right of appeal against decisions for
  up to 21 days after the Court has confirmed the
  decisions of the Board.
  

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Inquiries are held in camera, and appeals are
heard in open court. In general the Irish const
itution provides that only the High Court can
impose sanctions which effect a citizens right
to earn a living. Regulatory Bodies operate
within the limits of the constitution.
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A nurse may apply to the Board at any time to
have her/his name restored to the register
and The board may at any time remove in whol
e or in part the conditions attached to the
retention of the name of any person on the
register.
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In providing guidance to the profession the Board
publishes a Code of Professional Conduct for each
Nurse and Midwife The Board has also published
a Scope of Practice Framework which empowers
nurses and midwives to practice in accordance
with their education and training, experience and
competence. Currently the Board is examining i
n consultation with others the regulation of
Nurse and Midwife Prescribing.
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Ireland is obliged by virtue of membership of the
European Union and Directives enacted by the
Union to put in place systems for the mutual
recognition of diplomas, certificates, and other
evidence of formal qualifications of nurses and
midwives, doctors, pharmacists and dentists.
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European Union Member States Austria, Belgium,
Denmark, Finland,France, Germany, Greece,
Ireland, Italy, Luxembourg, Netherlands,
Portugal, Spain, Sweden, United Kingdom.
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Countries at immanent Pre-accession stage
Cyprus, Czech Republic, Estonia, Hungary,
Poland, and Slovenia.
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Other Pre-accession countries Bulgaria,
Latvia, Lithuania, Malta, Romania, and Slovakia
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Member States are obliged to apply Directives
Sectoral Directives (No.80/154/EEC and
No.77/452/EEC)which stipulate for particular
professions the duration and content of
programmes leading to Registration throughout
member states andGeneral Systems Directives
which provide member states with legal
requirements which must be satisfied in
processing applications of professionals from
other member countries in accordance with their
own national standards
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The Irish Government is currently proposing to
introduce legislation regulating a range of other
ancillary professionals, e.g. Psychologists,
Physiotherapists,Occupational Therapists etc. and
these in time will come under a regulatory system
controlling the movement of professionals.
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Process for Registration

• Applications are appraised on an individual basis
  and verification of compliance with European Law
  is sought independently from the Competent
  Authority in the country of origin
• Applications from outside the European Union are
  assessed individually and applicants must supply
  to the competent authority a current
  registration certificate(license), employment
  history, two character references and passport
  number.

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Process for Registration (contd)

• Nurse applicants from some countries who are
  otherwise qualified to enter the Register are
  required to undertake a period of orientation and
  assessment in a hospital approved by the Board
  and a recommendation is required from the
  Director of Nursing before full registration is
  granted.

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Current Developments

• Currently serious questions are been raised in
  relation to sectoral regulation of professions in
  the European Union. The accession of at least
  thirteen new Eastern European states is immanent
  which will substantially pressurise
  administrative systems operating sectoral
  directives in the European Union. Consultation
  proposals recommend the introduction of national
  systems of regulating the movement of
  professionals (General Systems Directive).

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• Irish and UK Professionals Bodies and some
  professional bodies in other European countries
  are concerned about the administrative and legal
  implications of this. They are satisfied that the
  current systems provide for a common standard for
  public protection throughout the Union and the
  requirement on each member state to ensure that
  such standards are applied.
• In the United Kingdom major changes are been
  implemented in reforming regulatory systems for
  health professionals following public concerns
  raised in recent years concerning the
  effectiveness of these systems.

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Government in the UK is clearly stating that pub
lic confidence in professional self regulation
has been dented and that for regulation to be
effective it must be open, responsive and
accountable, focussed on protecting patients and
the public rather than solely on professional
staff. They state that regulation also needs t
o be flexible to take account of changes to the
way in which staff work and care is delivered in
the future. (Ref. Modernising Regulation- the
New Nursing and Midwifery Council, A
Consultative Document, August 2001)
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A new United Kingdom Nursing and Midwifery
Council will come into being this April 2002 and
will replace the United Kingdom Central Council
for Nursing, Midwifery and Health Visiting.
It will have a membership of 23 ( 12 elected and
11 lay members appointed by the Government).
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• The central aims of the legislation are to
• treat the health and welfare of patients as
  paramount
  
• collaborate with and consult with
  stakeholders
  
• be open and proactive in accounting to the
  public and
  
• the professions for its work
• and

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• to reform structure and functions by
• giving wider powers to deal effectively with
  individuals who pose unacceptable risks to
  patients
  
• creating a smaller Council, comprising directly
  elected practitioners and a strong lay input,
  charged with strategic responsibility for setting
  and monitoring standards of professional
  training, performance and conduct
• streamlining the professional register providing
  explicit powers to link registration with
  evidence of continuing professional development.
  
• (Ref. Establishing the New Nursing and Midwifery
  Council, April 2001)

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There is a strong influence of United Kingdom
legislation in relation to regulation of
professions throughout the world.
In Ireland the government proposes to review leg
islative regulatory instruments by 2003 and
during the following five years to examine the
principle of self regulation. (Health Strategy,
Quality and Fairness- A Health System for You,
Department of Health and Children, Ireland,
2001).
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In conclusion, I question
whether we as regulators are as pro-active as we
should be in leading the modernisation of
regulation. Governments who have the ultimate
responsibility for public protection react with
legislative changes when systems fail. If we as
regulators have not considered likely weaknesses,
problems and trends and reported on them then we
will be less likely to be in a position to
influence developments in professional regulation.
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References for further Information See web
pages nursingboard.ie doh.ie
doh_at_prolog.uk.com europa.eu.int/comm/index_en.ht
m