Closing speech for Allied Health Professions Bill

10 Jan 2011

By Khaw Boon Wan

Venue: Parliament

Mr Speaker, Sir, I thank the Members who have spoken on this Bill for their support. Let me address their various comments and valuable suggestions.

Comparison with Other Health Professional Registration laws

1. Dr Lam noted that the Bill is different from the other health professional registration laws as its scope is wide and varied. A/Prof Straughan asked if we could draw useful lessons from the regulation of traditional Chinese medicine (TCM).

2. Actually, the registration laws for the different healthcare professions are generally similar as they all seek to protect the public from unqualified practitioners or those who are unethical. Not surprisingly, there are great similarities in approach. In drafting this Bill, we have taken references from several countries, including Australia, Canada and New Zealand. The omnibus approach to this Bill, resulting in it being wide and varied, is for a practical consideration as noted by a few Members, including Dr Lam. But the strategic intent of raising professional standard, safeguarding consumer interest and promoting high ethical practices is similar to how we regulate doctors, dentists, pharmacists or TCM physicians.

Council Composition & Role

3. However as the range of allied health professions is wide, adequate representation on the Council is a valid concern. I have addressed this earlier in my 2nd reading speech. A/Prof Fatimah Lateef suggested some sort of a proportionate representation of each profession on the Council. The Bill allows us to appoint more than one member of each profession on the Council. Where a profession has more than, say 500 registrants, I suppose we can appoint two Council members. For now, we will start with one representative each, and see how it goes. The first Council will start off with the Director of Medical Services or his representative; the Director-General of Education or his representative; the Registrar; one physiotherapist, one occupational therapist, and one speech therapist, all of whom have at least 10 years of practice experience. We will add new members as needed.

4. Dr Lam asked if we would put a cap on the size of the Council. We propose to keep it within 25 members so that it doesn’t become too big.

5. Let me also add that the Allied Health Professions Council is, first and foremost, a regulator. Its primary duty is to ensure the safety and welfare of the public. It is not set up to promote or advocate the different professions’ interest. In regulating these professions, the Council needs to ensure that the standards and regulatory policies are relevant to the different groups, and can effectively address any regulatory issues unique to the profession. The Council will have to consult extensively with the different professions and stakeholders as it further develops and implements the regulatory policies and standards. It will be supported by advisory committees and boards, comprising experienced practitioners from the professions. It should also learn from other allied health regulators overseas.

Scope of Practice

6. A/Prof Fatimah Lateef felt it important to define clearly what each profession can and cannot do. We will define the knowledge, skills, and training required for each specific allied health profession. We will set standards on practice, conduct and ethics. But in defining what the professionals can or cannot do, we must be careful not to hinder other legitimate service providers from providing services which they are competent to do.

7. Ms Ellen Lee noted some overlap in the scope of practice between chiropractors and physiotherapists. She wondered if chiropractors would lose their right to practice what they are trained for. They will not. This Bill does not grant monopoly power to a particular profession. For example, both voice coaches and speech therapists provide voice training. If you are a teacher, and want to control and project your voice better, a voice coach could well do the job. However, if you have just had a stroke and need help to regain your speech, you will need a speech therapist.

8. Even amongst the allied health professions, there are overlapping areas of practice as noted by Ms Ellen Lee. For example, hand therapy may be carried out by both physiotherapists and occupational therapists; and difficulties in swallowing may be managed by both occupational therapists and speech therapists. As healthcare becomes increasingly team-based and integrated, it is more important that a profession is allowed to practice what they have been trained to do so long as they can demonstrate competence in doing so.

9. We do not want to reduce access to services, or reduce choices for consumers because that will push up cost. However, it is important to help consumers make an informed choice. Therefore, we have to protect the titles and the practice of the profession under the title, and not the scope of practice. In so doing, when patients need an allied health professional’s expertise, the professional titles used will serve as a guide for them, as will the register of practitioners which will be readily accessible on the Internet.

Registration Framework

10. A/Prof Fatimah Lateef, Ms Cynthia Phua and Ms Ellen Lee commented on the registration framework.

11. We have adopted a tiered registration framework as we have found it useful in regulating the other health professions. A tiered system allows practitioners of diverse background and training continued access to our system for the provision of care without compromising public safety.

12. Let me briefly explain how the registration framework will work. Full and Conditional registration will apply to most practitioners. All practitioners who have approved qualifications or have passed the local qualifying examinations will be eligible for registration in either one of these two categories. For those who have been practising as an allied health professional in Singapore, they will be directly eligible for Full registration. New graduates, or those who have little or no experience of practising in Singapore will first be conditionally registered and required to work under supervision. After completing their supervised practice period with no adverse performance reports, they will be able to convert to Full registration.

13. Dr Lam asked if supervised practice during conditional registration can be done in private institutions. We can allow it if the private organisations have the capabilities and standards to supervise such professionals.

14. Among those who are currently practising in Singapore, there is a small number whose basic professional qualifications are not recognised. However, they have been serving patients for many years in their jobs. They should be allowed to continue in their practice, and serving the patient groups they are familiar with. Restricted registration will apply to this group of practitioners, where they will only be allowed to work with client groups they are familiar with, or only in specified employment or places of practice.

15. There will also be practitioners whose basic professional qualifications are not recognised, but have had good quality post-graduate training and practice experience in a particular area of the profession; or others who may have practiced exclusively in a particular area of practice, such as sports physiotherapy, or paediatric occupational therapy, for a long period of time. Restricted registration may also be applicable to these individuals.

16. Allied health professionals employed for the purpose of teaching, training or research, must also be registered. Competence and conduct issues remain relevant. When they are here for a short stint of a few weeks or months or do not have qualifications that are on the list of approved qualifications, temporary registration is needed. In areas of critical manpower shortages, temporary registration can also be applied as a stop-gap measure. Such a practitioner must work under supervision at all times.

17. In this way, the tiered registration framework allows us flexibility to manage workforce challenges and at the same time, protecting public safety and consumer interest.

Restore Names to Register

18. Dr Lam asked about the process for renewal of registration for practitioners whose registration has lapsed. The practitioner can apply, or the Council can restore the name to a register on its own motion. The name will be restored to the same register if there is no reason not to do so. Otherwise, the Council can place the person on conditional or restricted registration as well. The details are in Clauses 27, 56, and 59.

Continuing Professional Education

19. Dr Lam and A/Prof Fatimah Lateef asked if compulsory continuing professional education will be required. The Bill does provide for the Council to mandate continuing professional education to grant or renew practicing certificates. When implemented, this will better assure the public that registered professionals will be up-to-date in their knowledge and practice. As Ms Ellen Lee pointed out, this will strengthen the quality of care provided. The Council will consider this after completing the registration of existing practitioners. Given the wide range of the professions, the Council will set up committees to set the policies, standards and requirements for continuing professional education. The committees will comprise the relevant allied health professionals. Continuing professional education activities will be co-ordinated by the professional bodies, healthcare institutions, and other education providers as is the case with other health care professions.

Disciplinary matters

20. Ms Ellen Lee asked if there were safeguards to protect registrants against frivolous complaints. These are provided for in the Bill. The complaint must be made in writing and supported by a statutory declaration. The professional will be given the opportunity to present his case. The Complaints Committee will review and investigate the complaints thoroughly, and only serious complaints will be directed for formal inquiries.

21. Ms Ellen Lee asked who could represent the allied health professional when he is called to answer a case against him. When the complaint is reviewed by the Complaints Committee, the allied health professional will not generally be required to appear before the Committee. Instead, he may be asked to provide a written exculpatory statement. It is only when the complaint is directed for further inquiry at the Disciplinary Tribunal or Health Committee, would his attendance at the proceedings be required. And at this stage, he can engage a legal counsel to represent him at the proceedings if he wants to. This follows the practice in other health professional regulatory Councils.

22. Mr Lam Pin Min sought clarification on the different roles of the Performance Assessment Panel (PAP), Fitness Assessment Panel (FAP) and Interim Orders Committee (IOC). The Performance Assessment Panel will be appointed by the Complaints Committee if there is an issue of the quality of professional services provided by the allied health professional. This is set out in Clause 45. The FAP will be appointed by the Complaints Committee where the Allied Health professional’s fitness to practice is in doubt by reason of his physical or mental condition. This is set out in Clause 46. The IOC will be invoked when immediate or urgent action is required for the protection of members of the public or it is otherwise in the public interest or in the interests of the allied health professional concerned. The IOC may order that his registration be suspended or be made subject to conditions or restrictions. Division 7 of Part V of the Bill deals with the IOC procedures and it follows what is provided for doctors under the Medical Registration Act.

Advertising Guidelines

23. Dr Lam asked if there would be guidelines on advertisements of practitioners. We will set these guidelines in the ethical codes for the allied health professions, similar to the medical profession.

Cost Implication

24. A/Prof Straughan expressed concerns on the cost of regulation. Any regulation will come with a cost. The key is to minimise the cost of regulation. Indeed, one reason for taking an omnibus approach to this legislation is to reduce the overhead cost of regulation. Our sense is that any cost impact will not be significant for as long as the market is sufficiently competitive and functioning. This was our experience when we started regulating the optometrists and opticians. The Bill will not affect the choices available to consumers and patients regarding the type of services they seek.

Insurance

25. A/Prof Straughan wondered if regulation would impact reimbursement decisions by insurers. This is really something for the insurers to decide. Currently some insurance policies do reimburse for some allied health professional services and price it into the premiums.

26. Ms Ellen Lee was concerned of the burden on the allied health professionals if they are subject to costly indemnity insurance. I agree with Ms Ellen Lee that it will be prudent for practitioners to have arrangements either through their employers for some sort of indemnity, or if they are self employed, to have their own indemnity insurance. Many already do. In the public healthcare sector, we employ quite a large number of allied health professionals. In our experience, the cost of such insurance is not prohibitive.

Care via the Internet

27. Ms Ellen Lee asked how the quality of care provided over the internet will be dealt with. This problem is an emerging issue and challenging as well. For allied health services, this is not yet a significant issue. But I agree that the Internet will open up new possibilities and challenges. Some of the other regulatory Councils are currently looking into this issue, and it will be appropriate to develop this as a policy across all health care professionals.

Implementation timeline

28. Several members asked about the implementation timeline. If the Bill is passed, we will set up the regulatory framework and get it operational for the 3 professions within a year.

29. We have listed 10 groups in the First Schedule. I scanned the range of allied health professions regulated in other countries. By and large, it is these 10 professions that are regulated. We will start with the 3 therapy professions in the first phase. This will be followed by another 3 professions: clinical psychologists, diagnostic radiographers and radiation therapists. These are the 6 professions which we already have local education and training programmes in place. My estimate is that we should be able to complete these 10 professions within the next term of government.

Chiropractors

30. Dr Lam and Ms Ellen Lee asked if chiropractors would be included in this Bill. My Ministry is studying the regulation of chiropractors in some countries as “complementary and alternative health practitioners”. We are also studying the need for such a legislation in our workplan. We should get this study through within the next term of government.

Conclusion

31. Mr Speaker, Sir, the allied health professionals form an important pillar of our healthcare system. It is time for us to go beyond self-regulation. By setting and enforcing standards, this Bill will raise the quality of the allied health sector, thus serving the public better. I seek the House full support for this Bill.

Mr Speaker Sir, I beg to move.