Registration nation: giving healthcare professions legal protection

Do you know the difference between a nutritional therapist and a dietitian, or between a physiotherapist and a physical therapist? Many people don’t, which is why there is a long-running campaign within certain healthcare professionals to have their professions placed on a legal footing, thus preventing unqualified or underqualified people from practising under the same professional title.

"We've been waiting for 20 years for the registration of our profession," says Richelle Flanagan, dietitian and member of the Irish Nutrition and Dietetics Institute (INDI). The professional register for dietitians will open on October 31st, after which dietitians have up to two years to register with Coru, the new State organisation that manages the registers of healthcare professionals (see panel).

While practising dietitians are happy to have legal protection for the work of dietitians, whose title is also protected, they didn’t get as much as they wanted.

“We sought to have the title ‘clinical nutritionist’ protected too, because we use that term in hospital settings, but it was turned down by Coru.”

Public health nutritionists work mainly in industry and public health, but they cannot do one-to-one consultations with the public because they do not have a degree in dietetics.

“Dietitians are the only ones recognised to work directly with patients in the public health service,” says Flanagan.

But while “dietitian” will now become a protected title, many people continue to turn to nutritional therapists for advice. “Nutritional therapists can have anything between a two-week online course and a four-year degree course, and there is often a misunderstanding among GPs about their experience.

“It would be good to see proper regulation of nutritional therapists too,” says Flanagan.

A similar confusion arises between the professional titles of physiotherapists and physical therapists. The problem is that in most other countries the terms physiotherapist and physical therapist are interchangeable, whereas in Ireland they refer to two different levels of qualification and clinical expertise.

“All chartered physiotherapists have a four-year full-time degree and 1,000 hours of clinical placement in public health services as part of that degree. They have expertise in musculoskeletal, cardio-respiratory and neurological conditions,” says Ruaidhri O’Connor, chief executive of the Irish Society of Chartered Physiotherapists. “We are affiliated to the World Confederation of Physical Therapists.

“One of the dangers is that people look up information about a neurological condition and find international references to physical therapists, and then they seek intervention from a physical therapist here who doesn’t have training in neurological conditions,” says O’Connor.

Before it sets up the register for physiotherapists in Ireland, the Health and Social Care Professional Council of Coru will have to decide whether both physiotherapists and physical therapists will be included and, if so, what the minimum educational qualifications and clinical experience for the profession will be.

In Ireland, physical therapists have varied levels of training and work outside the public health system. Generally speaking, their clinical practice is limited to musculoskeletal conditions. Many are members of the Irish Association of Physical Therapists which has previously campaigned for inclusion on the register.

Other professions such as psychologists, counsellors and psychotherapists awaiting the formation of their registration boards will, no doubt, be watching what Coru decides in relation to physiotherapists and physical therapists.

Meanwhile, nutritional therapists are in the category of complementary therapists, most of whom work outside the public health system.

The 2005 Department of Health report on the Regulation of Complementary Therapists required complementary therapy groups to develop self-regulation with practitioner registers with minimum educational and training standards, codes of conduct, complaints mechanisms, and so on.

Many complementary therapies have since established self-regulatory standards. And a review of the academic qualifications of a small number of complementary therapies – osteopathy, chiropractice, acupuncture, herbal medicine and Traditional Chinese Medicine – was published in 2012.

However, the lack of an overseeing body such as Coru on the whole process of self-regulation leaves many question marks over whether professional standards can be maintained within the sector.