Second Reading of Allied Health Professions Bill

10 Jan 2011

By Khaw Boon Wan

Venue: Parliament

Mr Speaker, Sir, I beg to move that the Bill be now read a second time.

2. The Allied Health Professions Bill establishes a regulatory body, the Allied Health Professions Council, to register and regulate the allied health professionals, and prohibits false representation of these professionals.

Background

3. The Allied Health Professions comprise diverse groups of healthcare professionals providing a wide range of health services. They include radiographers, physiotherapists, occupational therapists, psychologists, speech therapists, and many others.

4. With a rapidly ageing population, demand for healthcare will rise as the sick elderly are more likely to present with many diseases and more complex conditions. We are reforming our healthcare system to cope with the challenges in two major areas. First, we are strengthening the community and step-down care sector so that patients can be treated there competently instead of in costly acute hospitals. Second, doctors will increasingly be assisted by multi-disciplinary healthcare teams with allied health professionals as key partners. Success of these reforms relies on well trained allied health professionals.

5. These health professionals, with their specialized know-how, can contribute to better health outcomes and lower healthcare costs through effective rehabilitation, health promotion, and prevention. For example, a physiotherapist is skilled in the physical rehabilitation of stroke patients or those who had undergone hip replacement, helping them to walk again. An occupational therapist is best placed to train the patient to perform self-care activities safely and independently, such as dressing himself, toileting, and bathing. These rehabilitative activities are essential in helping the elderly regain an active and meaningful life.

6. For a long time, we have left the allied health professions to regulate themselves. This was somewhat adequate in the past as most of them worked in the public sector and the professional bodies had diligently taken on a voluntary regulatory role. However, as the demand for their services grows and as we try to build up the long term care sector, the voluntary approach to regulation will become less effective.Voluntary self-regulation is also not the international norm. All developed countries have legislations to regulate their allied health professions and they have been doing so for years. Singapore is an outlier.

7. I signalled this intent to regulate the allied health professions in 2007 when I came to this House to move the Optometrists and Opticians Bill. The experience to regulate the optometrists and opticians has been positive. We are now better assured that these eye care practitioners have the competencies to provide safe and effective eye care services. Since then, the Optometrists and Opticians Board has registered more than 2300 optometrists and opticians and will be implementing mandatory continuing professional education. This is a significant improvement from the past where untrained persons could easily set up shop and provide optometry services with questionable standards.

Our Approach to Regulation

8. The next major group are the therapy professions: physiotherapists, occupational therapists and speech therapists. MOH could establish another legislation to target this group but there are many more allied health professions, like the dietitians, radiographers, psychologists. Such a piece-meal approach will take a long time. Instead, we recommend the more efficient option of an umbrella legislation that will allow for the regulation of many Allied Health groups, with subsidiary legislations covering individual professions. The United Kingdom, New Zealand and Hong Kong have taken such an approach. This is the approach which is incorporated in this Bill. Let me now elaborate on the key features.

Main Features of Bill

Part I – Preliminary

9. Part I lays out the scope of application for the Bill where Clause 4 clarifies that the Bill applies only to Allied Health Professions listed in the Second Schedule. As a start, only the occupational therapists, physiotherapists, and speech therapists will be regulated. Clause 5 empowers the Minister for Health to amend the Schedule to regulate other allied health professions in future.

Part II – Allied Health Professions Council

10. Part II of the Bill sets up the Allied Health Professions Council, provides for members of the Council to be appointed by the Minister for Health, and to include representatives from each of the regulated allied health professions. The Council’s functions are set out in clause 7, and include registration, issuing of practicing certificates to registered professionals, and setting of standards for training, conduct and practice.

11. There have been concerns raised regarding adequate representation of the different professions, and the effectiveness of a single regulator regulating many different professions. Clause 12 empowers the Council to appoint committees, and professional boards. These committees and professional boards play a key role in advising and making recommendations to the Council with regard to the standards and issues arising in particular professions, and will comprise mainly members of the specific profession. Coupled with a representative Council, such a structure would ensure that each profession is adequately represented, and the unique issues faced by specific professions can be addressed. However, for operational efficiency, the Council is expected to maintain oversight and management of the committees and boards, complaints, investigations and disciplinary processes.

PART III – Registration of Allied Health Professionals

12. Part III of the Bill sets out the registration framework to recognise appropriately trained and qualified professionals for practice in Singapore, and empowers the Council to impose conditions and restrictions on registration, require mandatory continuing education, refuse registration, remove and restore names under specified circumstances. Clause 14 sets up the 4 registers, corresponding to the 4 types of registration under the Bill. These are: Full, Restricted, Conditional, and Temporary registration.Clauses 16 to 19 set out the general criteria, conditions and restrictions that may be imposed in the 4 registration categories. The tiered registration framework enables the Council flexibility to register individuals according to their training, and practice experience, whilst providing safeguards to protect the public.

13. Let me now elaborate on the different tiers of registration. An allied health professional with full registration may practice generally and without supervision in the profession in which he is registered. There will be a list of approved qualifications. These qualifications will be determined by the Council, and established for each regulated profession in the regulations. Anyone who holds an approved qualification or passed the local qualifying examination in a regulated profession would be eligible for Full registration.

14. Clause 16 deals with full registration, and requires an allied health professional to complete a period of supervised practice under conditional registration before being eligible for full registration. This allows the Council to make a more comprehensive assessment of the practitioner instead of relying only on his qualifications and credentials. Clause 16 also allows the Council to apply exceptions and give Full registration directly to an individual who is clearly well trained and competent. Where a person is not eligible for full registration, his application will be assessed for other registration categories.

15. Clause 17 deals with restricted registration. A practitioner who does not have an approved qualification but have been practicing in Singapore; or who may have a post-graduate qualification in specific area of professional practice but do not have an approved basic qualification, are among those who will be eligible for restricted registration. Like full registration, an allied health professional on restricted registration can practice independently. However, restrictions are imposed on his scope, place of practice, or employment because of his qualifications, practice experience, or health issues. Before an individual is granted restricted registration, his abilities may also have to be assessed through conditional registration.

16. Clause 18 deals with conditional registration. Conditional registration will generally be applied to all new registrants who have approved qualifications or have passed the local qualifying exams. While under conditional registration, the practitioner will be supervised and subject to performance review. This enables the Council to make an assessment on the ability to practice safely and competently. The supervision requirement also ensures that new practitioners are adequately supported when they start working in Singapore.

17. Temporary registration is set out in Clause 19, and applies to an allied health professional who is in Singapore for the purpose of teaching, research or postgraduate study; or deemed to have knowledge, experience and skill of value to Singapore, to function in any healthcare capacity, including the provision of health services, but is not otherwise entitled to be registered. To safeguard the public, a practitioner on temporary registration will require supervision at all times, and additional conditions and restrictions may also be imposed.

Part IV – Offences

18. Part IV of the Bill sets out the various offences and a penalty of a fine not exceeding $25,000 and/or prison term not exceeding 6 months for a first offence. This Part protects the public by prohibiting false representation of the regulated allied health professionals. There are inherent difficulties in regulating every aspect of practice in any profession as naturally, overlaps occur in normal life and work. For example, both exercise trainers and physiotherapists prescribe exercises, but for different purposes and to different types of clients.

19. However, we recognise that allied health professionals are trained and qualified to deal with healthcare and patients; and the expectations from the public is with regard to such expertise and its expected treatment outcomes. With a register of such professionals, and laws against false representation, patients are assured that they are receiving treatment from bona fide practitioners.

20. Thus Clause 29 and 30 makes it an offence for a person who is not registered to imply that he is a qualified professional from the way he provides services, or use any title set out in the Second Schedule. Clause 31 to 33 sets out various offences to prohibit business owners and employers from making false claims that their employee is so qualified, and also holds the employee and his co-workers liable for such false claims.

Part V – Disciplinary Proceedings

21. Part V of the Bill deals with disciplinary proceedings before a complaints committee (CC), disciplinary tribunal (DT), health committee and interim orders committee inquiries. It provides for the Council to take action against the registered allied health professional on conduct, and fitness to practice issues set out in Clause 39; and also has in place appeals mechanisms for aggrieved parties. The clauses in this Part are substantially similar to the new Part VII of the Medical Registration Act.

22. To support professional self regulation, the Complaints Committee (CC) and Disciplinary Tribunals (DT) set out in clause 40 and 50 will have a majority of members from the profession registered in the same profession as the person being complained against. As some of the smaller professions may not have members of sufficient experience and expertise, Clause 50 also provides for the Minister to make exceptions to the DT members’ appointment where it is expedient to do so. Senior legal professionals may also be appointed to the DT.

23. The CC and DT are empowered to make a wide range of orders to deal with matters. These include dismissing frivolous complaints; issuing letters of advice or warning; ordering the registered person to undergo treatment, or suspending his practice. These powers are set out in Clause 42, 49 and 53. In addition, the DT is empowered to impose a penalty of up to $50,000 on a registrant.

Part VI - Micellaneous

24. Part VI provides for miscellaneous clauses to support the Council in meeting its mandate, such as setting out the powers of the investigators, appointment of legal and medical assessors, and allowing for composition of offences.

Schedules

25. Lastly, the First Schedule sets out the occupational groups defined as Allied Health Professions, and the Second Schedule lists and describes the allied health professions to which the Bill applies to.

Consultation and implementation

26. In preparing this Bill, the Ministry has consulted the public, allied health professionals and their associations, as well as employers. There is strong support for the Bill. We will continue to consult them as we refine the implementation plans and subsidiary legislation that will follow.

Conclusion

27. Mr Speaker, Sir: we need highly skilled allied health professionals to beef up our healthcare teams so that Singaporeans can continue to enjoy a high level of health, even as they grow old. Our allied health professionals have rendered a high level of care, despite not being regulated. However, going forward my Ministry believes that the allied health professionals can play an even larger and more effective role, through statutory regulation as prescribed in this Bill. This will be good for the professions which have unanimously supported this Bill. This will be good for patients who can then be assured of competent and safe services. I seek the House’s strong support for this Bill to ensure that the public continues to enjoy high standards of healthcare.

28. Mr Speaker, Sir, I beg to move.