Third International Congress on Professional and Occupational Regulation Presentation Handouts

Edinburgh, Scotland  |  June 27-28, 2013

(clicking on a session title will link to the 3 slides per page handout)

Thursday 27 June, 2013

9:00 – 9:15 a.m.  Welcome
Attendees will be welcomed to Edinburgh and the Congress by CLEAR's President, Michelle Z. Pedersen

9:15  - 10:15 a.m.  How Competent Are We at Assessing Competency? (Keynote Presentation)

Competency assessment is thought to be critical to ensuring “safe” and “effective” professional practice.  Regulators, educators, payers and – most importantly – clients – have great faith in the reliability, validity, and generalizability of traditional forms of competency assessment to ensure professionals have the requisite knowledge, skills, attitudes and behaviors to undertake important and complex work and decision making.

From where does this faith in the adequacy of competency assessment tools arise?  How certain should we be that any tool built upon a construct of “competency” can actually do all things we expect (or hope) it ought to do?  And while it is easy to criticize and deconstruct – what realistic options exist for safeguarding the public from harm?  In this presentation, we will review current literature and thinking related to competency, competency assessment, and its role in regulation, education, and professional practice.

Speaker: Zubin Austin is Professor and inaugural holder of the Ontario College of Pharmacists’ Research Professorship at the Leslie Dan Faculty of Pharmacy, University of Toronto, Canada.  His research interests focus on health professionals’ education and development.  He has published over 75 peer reviewed manuscripts and three textbooks and has received numerous awards for his research.  He is also an award winning educator, having received teaching awards from the Association of Faculties of Pharmacy of Canada, the American Association of College of Pharmacy, the province of Ontario, and he has been named undergraduate professor of the year at the University of Toronto on 13 separate occasions.

10:45 – 12 noon Establishing Priorities, Challenges and Opportunities in Occupational Regulation (Discussion Groups)
Roundtable Discussion Groups will provide attendees from a variety of professions and international jurisdictions with an opportunity to share challenges and best practices related to the most current and pressing issues in occupational and professional regulation.

1:30 – 3:00 p.m.  Global Mobility and Entry to Practice

Professional Regulation and the Economy: Why countries regulate services differently – and how it matters

Services markets were largely considered non-tradable in the past, but globalization has opened new opportunities for services providers, including regulated professions, as well as exposing them to foreign competition. Professional services are to various degrees regulated with the purpose of protecting consumers. However, the way regulation is designed, implemented and by whom it is enforced, differs substantially across countries.

To better grasp this complex reality, OECD is working on a Services Trade Regulatory Database that will provide unique internationally comparable current information on regulatory policies. Information from the Regulatory Database will ultimately be translated in a measurement of the impact of regulation under a new Services Trade Restrictiveness Index (STRI).

Already, OECD work shows that differences in regulation impede internationalization of professional services significantly – and in some cases differences in regulation matter more than the restrictiveness of regulation. Furthermore, it was found that strict regulation at home reduces the competitiveness of local services suppliers abroad. Nevertheless, OECD work also shows that the role of services providers and the services market structure differ across countries. Trade in services may not be an objective in itself and harmonization or regulation may not always be feasible or desirable when regulation, or lack thereof, is deeply embedded in the fabric of society. But, for OECD, where open markets generate foreign business opportunities to the benefit of consumers or clients, regulatory reforms aiming at removing unnecessary obstacles to foreign services providers should be considered.

The presentation will highlight new findings from the work on the Regulatory Database and the Restrictiveness Index. It will also present how, and discuss hypotheses on why, regulation differs across OECD countries, and some empirical results as to how differences in regulation affect trade in services. The presentation will provide regulators with unique and valuable insights on the complex relationship between professional regulation and economic policies.

Speaker: Hildegunn Kyvik Nordas, Senior Trade Policy Analyst, OECD, Responsible for the Services Trade Restrictiveness Index (STRI) Project

Streamlining Health and Social Care Regulation in the United Kingdom

The Law Commission for England and Wales is undertaking a comprehensive review of the legal framework for health and social care professional regulation in the UK. The aim is to produce a single statute which would govern all the professional regulators including the General Medical Council, General Social Care Council, Health Professions Council and Nursing and Midwifery Council.  The framework would give the regulators greater autonomy in making their own rules while also providing a commensurate strengthening of their public and parliamentary accountability. The regulators would also be given similar powers to establish streamlined, transparent and responsive systems of regulation overseen by the Professional Standards Authority.  A public consultation was held in 2012 and the Commission aims to publish its final report and a draft Bill in early 2014. Frances Patterson QC will provide an update on the review and set out the key messages from consultation.

Speaker: Frances Patterson, Commissioner Responsible for Public Law, Law Commission for England and Wales, speaking about the work to streamline healthcare regulation legislation in the United Kingdom.

3:30 – 5:00 p.m. Global Mobility and Entry to Practice (Discussion Groups)

Innovation in Facilitating International Mobility: The Québec-France Agreement on the Mutual Recognition of Professional Qualifications

additional handout - common procedure

additional handout - common procedure examples

International mobility in the regulated professions, trades and occupations, is a phenomenon in need of more understanding and adaptation by countries looking to welcome a specialized workforce. Receiving countries have to review their immigration and integration policies and programs, to adjust and facilitate, while keeping in mind the legitimate concerns of public protection and quality of services. Some jurisdictions with steady migration flows have devised mechanisms to further standardise and facilitate the movement of people.

In this context, The Québec-France Agreement on the Mutual Recognition of Professional Qualifications, signed in 2008, is an innovative agreement that marks a first between Europe and America. It is a comprehensive agreement between two jurisdictions introducing a mutual, structured, government-supervised process for all regulated professions and trades. It provides for an holistic look at a profession or trade in each jurisdiction. In a mainly self-regulated environment, the Agreement included a validation by government authorities of public interest issues in the mutual recognition arrangements between regulators of both jurisdictions.

The presentation will highlight and discuss the implications of this professional mobility agreement for regulators and the lessons learned after a few years of its implementation. It will also address the next steps with regards to other potential agreements, especially with a view toward the Comprehensive Economic and Trade Agreement between Canada and the European Union (CETA) which is presently negotiated and wherein the influence of the Quebec-France Agreement appears to be of a significant importance.

Éric Théroux, Assistant Deputy-Minister for Policy, Francophone and Multilateral Affairs, Ministry of International Relations, La Francophonie and External Trade, Government of Québec
Following the presentation, attendees will break into roundtable discussion groups for focused discussion related to the key points from the afternoon presentations.

Friday 28 June, 2013

9:00 - 10:15 a.m.  The Regulatory Continuum and the Role of the Regulator

Lessons from Health Care Regulation in England: The Mid Staffordshire Public Inquiry, Its Findings, Recommendations and Impact

This year, the Mid Staffordshire Public Inquiry, set up by the UK Government, reported on the failings at this hospital trust, and analysed why it was that the hospital failed, without regulatory intervention. The report offers a critique of the complex and confusing UK system of healthcare regulation, and all those who are involved in it, from Government and the Department of Health at the top end, to failures of regulation of the activities of the Trust’s board. The release of the report has sent shock waves throughout those involved in healthcare regulation, and is likely to lead to widespread reform of healthcare regulation of the NHS and private healthcare, and the introduction of criminal sanctions on organisations and possibly individuals who fail in their regulatory duties.

Peter Watkin Jones of Eversheds LLP was Solicitor to the Inquiry, leading a team of 30 lawyers who were responsible for obtaining and analysing the evidence. Peter will present on the dynamics that led to the setting up of the Government Inquiry, what it discovered, the recommendations that have been made for reform, and likely implementation by the UK Government.

Speaker: Peter Watkin Jones, Solicitor to the United Kingdom Mid-Staffordshire Foundation Trust Inquiry discussing implications of the Francis report for regulators.

Ontario’s Health Regulatory College Supervisor Appointment Process

The Regulated Health Professions Act, 1991 (RHPA) is an umbrella piece of legislation that applies to all regulated health professions in Ontario, Canada.  The RHPA permits the government of Ontario to appoint a College supervisor on the recommendation of the Minister of Health and Long-Term Care, where the Minister considers it appropriate or necessary.  In Spring 2012 a College supervisor was appointed by Ontario’s Lieutenant Governor in Council  for one of Ontario’s Health Regulatory Colleges.   The College supervisor is provided with the exclusive right to exercise all of the powers of the Council of the College and every person employed, retained or appointed for the purposes of administering the RHPA.   The decision to appoint a supervisor was made in response to a number of complaints regarding the College’s operations and an operational review and audit of the College’s regulatory practises.   This presentation will provide an overview of Ontario’s experience in appointing a supervisor to a Health Regulatory College including the requirements under the RHPA for proceeding with an appointment, lessons learned through the process of appointing its first supervisor and the outcome of this appointment. 

Speakers: Suzanne McGurn, Assistant Deputy Minister, Health Human Resources Strategy Division, Ontario Ministry of Health
Deanna Williams, Supervisor, College of Denturists of Ontario

10:30 - 12 noon  The Regulatory Continuum and the Role of the Regulator (Discussion Groups)

Change in Oversight of Self-Regulated Professions : A New Look at the Registration of Foreign-Trained Professionals

Professional regulation is often considered by social and economic leaders as lacking sensitivity towards foreign trained professionals, and as being an impediment towards economic development. Particularly in the case of self-regulated professions some argue, the need for public protection is at risk of diversion by the members of the profession for their own interests.

The admission to practice of foreign trained professionals is a social and economic issue shared by many countries at the receiving end of the migration process. For these countries, foreign trained professionals are a crucial influx to overcome demographic and economic challenges. With increased global mobility, the role and behaviour of regulators are being questioned by many observers, and by the immigrant professionals themselves.

In the past few years governments were pressured to intervene in facilitating the process of immigration and professional integration. In Canada, some provincial governments created specialized oversight mechanisms (Commissioners) to improve registration processes and hold the regulators accountable to their duty - first and foremost the duty of fairness. The extensive powers vested with these public offices and the obligations brought by new fairness laws and codes, mean a significant change for the regulators.

The presentation will highlight and discuss these new approaches of ‘check and balance’ between governments and self-regulated professions through the very recent examples in Canada. It will present some features of the new oversight mechanisms and lessons learned from their work.

André Gariépy, Commissioner for Complaints concerning the Recognition of Professional Competence, Office of the Professions, Government of Québec  

Following the presentation, attendees will break into roundtable discussion groups for focused discussion related to the key points from the morning presentations.

1:30 - 3:00 p.m.  Demonstrating Continuing Competence

Assessment of Continuing Competency and its Impact on Continuing Professional Development

For the past 15 years, the Ontario College of Pharmacists has assessed the continuing competency of its members in response to fulfilling its mandate of public protection and as a catalyst for encouraging its members to engage in continuing professional development. This presentation reports on the performance of pharmacists selected to undergo a practice review from a number of perspectives. First, the results identify specific groups who consistently experience a greater degree of difficulty in successfully completing the practice review.  Second, the nature and impact of strategies to assist these individuals are explored.  Finally, opportunities in which competency assessment can serve as a catalyst for professionals to engage in continuing professional development are discussed.

Speaker: Anthony Marini, Educational Development Centre, Senior Teaching Development Associate, Carleton University, Ottawa, Ontario, speaking about research into pharmacy continuing competence programs.

Demonstrating continuing competence, demonstrating continuing trustworthiness – the doctor’s dilemma

The Medical Council of Ireland regulates doctors in Ireland.  It protects the public and promotes patient safety by ensuring good professional practice among doctors.  The cornerstone of its role is the maintenance of a register.  While entry to the register was controlled by a requirement by the applicant to demonstrate competence, there has traditionally been no requirement for registered doctors to demonstrate continuing competence.  In the last 5 years, regulation of the medical profession in Ireland has undergone significant reform.  One of these changes is a new duty on registered doctors to demonstrate their continuing competence to the Medical Council.  This was a necessary, well-supported and apparently straightforward development in the role of the Medical Council as a professional regulator but it brings with it a range of strategic and operational challenges and choices.  This talk will share the Medical Council of Ireland’s perspective on how demonstration of continuing competence changes the role of the professional regulator and will offer reflections on the implications of this agenda for the maintenance of trust in the profession. 

Speaker: Paul Kavanagh, Director of Professional Development and Practice, Medical Council of Ireland speaking about the challenges and choices which professional regulators face in taking on the continuing competence agenda.

3:15 - 4:00 p.m.  Demonstrating Continuing Competence (Discussion Groups)

4:00 - 4:10 p.m.  Concluding Remarks
CLEAR's President, Michelle Z. Pedersen, will outline some of the key points and learnings from the Congress presentations and discussions.

Summary document - Discussion Group sessions

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