sou · GYB365 · 2010-10-13 00:00:00 — Genom att tydliggöra vilken kunskap och vilka färdigheter som behövs för detta arbete, ökar förutsättningarna för att brukaren får insatser av god kvalitet. Vi delar bedömning att socionomexamen är den utbildning som ger den bästa grunden för socialt arbete. Men om endast socionomexamen skulle godtas som kompetens, kom- mer det att uppstå icke önskvärda inlåsningseffekter, där personer med annan utbildning utestängs från dessa tjänster. Vi menar där- för att huvudmannen bör ha möjlighet att även anställa personer med annan relevant högskoleutbildning för dessa arbetsuppgifter. Det kan till exempel vara en person med en högskoleutbildning inom andra områden och med påbyggnad i framför allt socialt arbete och /eller förvaltningsrätt och social rätt. Enligt statistik från Kommuner och Landsting (SKL) har ca 18 000 personer inom sådana uppgifter som skulle omfattas av behörighetsregleringen. Av dessa saknar drygt 7 000 socionomexamen. Av dessa har drygt 4 000 en eftergymnasial utbildning och drygt 2 000 en sådan utbildning . Det finns ett stort antal varianter av socionomutbildning. En stu- dent har 37 olika alternativ att välja bland. För att socionom- examen ska vara ett krav för behörighet, när det gäller viss myndig- hetsutövning inom hela , måste grundutbildningen bli mer likvärdig och ge den kompetens som behövs för dessa reglerade Vi menar att om de behörighetskrav vi föreslår in- förs, är det troligt att socionomutbildningen kommer att bli mer lik- värdig. Former bör också utvecklas för en kontinuerlig dialog mellan utbildningsanordnare och om utbildningens innehåll och framtida utveckling. En övergångstid bör införas. Det ger de som önskar möjlighet att komplettera sin utbildning och huvudmännen ges tid att planera verksamheten. En modell för hur detta kompetenslyft kan åstadkommas är att staten erbjuder utbildningsplatser, medan huvudmännen möjliggör studier, helt eller delvis inom ramen för respektive socialsekreterares tjänst. Våra förslag kommer att öka efterfrågan på socionomer. Enligt en rapport från (2009:5R Högskoleutbildningarna och arbetsmarknaden) kommer tillgången på socionomer att öka med mellan , givet att det utbildas lika många som . Någon risk för att behörighetskravet skulle vara svårt att uppnå på grund av brist på personer med rätt utbild- ning finns därför inte. I likhet med föreslår vi också en lagstift- ning om introduktion och stöd i yrket för dem som saknar tidigare erfarenheter av de arbetsuppgifter som är reglerade. Krav ska ställas i lag på socionomexamen, eller annan relevant examen på minst grundnivå i högskolan, för följande arbetsupp- gifter inom : 1.bedömning av om utredning ska inledas, 2.utredning och bedömning av behovet av insatser eller andra åtgärder och 3.uppföljning av beslutade insatser. För arbete inom verksamhet enligt LSS ska arbetsuppgift 2 och bör få i uppdrag att i samarbete med Högskole- verket ta fram underlag för en närmare beskrivning av vad som avses med annan relevant examen på minst grundnivå i högskolan inom området. Befintlig personal ska er- bjudas kompetenshöjande utbildning. Den som saknar tidigare erfarenheter av de arbetsuppgifter som är reglerade ska få en lämplig introduktion och stöd i yrket under . En uppföljning och utvärdering ska genomföras efter att behörighetsregleringen till fullo genomförts. The remit of the Qualification Requirements Inquiry On , the Swedish Government appointed an inquiry chair with a remit to investigate a number of issues relating to the regulation of qualification requirements in health care and social ser- vices. The Inquiry was directed to: -assess whether additional professional groups should be regu- lated in the health-care sector, -consider changes in the duties of opticians, -examine whether the system of special appointment to practise a profession in health care is appropriate, -present proposals leading to more nurses receiving specialist training, -review the provisions on restrictions on the right to take certain health-care measures, -make it clearer to the general public what is regarded as health care and what is classified as health-care-related activity, -present proposals on ways in which specialty training program- mes for dentists should be regulated, -review the content and scope of training for dental hygienists and -examine and analyse the for regulation of qualifi- cation requirements for certain tasks in the social services. In presenting our proposals, we are asked to be mindful of high patient safety and the high level of trust among the public in both health care and the social services. Our proposals should also take account of the constitutional principle of freedom of trade. We are asked to base ourselves on the principles which today underpin quali- fication requirements and licence to practise, and our proposals should create good conditions for the application of specific skills which distinguish the various professional groups in the health-care sector in an effective and flexible way. Some parts of the remit require us to consider whether the present-day provisions are appropriate. Should further professional groups in the health-care sector be regulated? Provisions on licence to practise, exclusive right to practise a pro- fession, protected title and protected specialist designation are con- tained in the Professional Activities in the Health and Care Field Act (LYHS). With effect from 1 January 2011, these pro- visions are contained in the new Patient . The principal function of licence to practise is to guarantee that staff have a certain level of knowledge and certain personal characteristics. Patient safety is the overarching criterion in assessing which professional groups are to be regulated. Other criteria that may be of great significance are: -the content of the professional role – which should have a certain breadth and contain a certain degree of independence, -the training programme – which should be of high quality, well defined and lead to a particular profession and -international relations – including the EU rules has under- taken to apply on mutual recognition of formal qualifications for activity in the health-care sector and the Nordic agreement on a common labour market for certain health-care staff. It is not necessary for all the criteria to be met for a professional group to be granted licence to practise. How much should be re- quired for a professional group to be eligible for a licence to prac- tise has to be decided by striking a balance. Patient safety overrides other criteria. There may be less need for a licence to practise if the profession is only practised in public employment than if there are opportunities to undertake the activity privately. Under our terms of reference, we are asked to avoid creating a system of duplicate licences to practice. We are free to propose changes to the principles which today dictate which professional groups are to be regulated. Our assess- ment is, however, that the present-day principles are well established and appropriate. We therefore do not propose any changes. In our view it is reasonable that a licence to practise should pri- marily be considered for professional groups who have qualifica- tions from Swedish higher education. The reason for this is that their education is consequently covered by the for Higher Educations regular review and evaluation and that under the Higher Education Act it has to be founded on a scientific basis and proven experience. We wish to emphasise the regulation of a profession cannot re- place the responsibility of the health-care provider to plan, direct and check activity. There is a need for systematic work on patient safety, treatment based on science and proven experience, as well as competent and skilled practitioners to achieve good patient safety. The following groups have expressed a wish for regulation of their profession in written communications and at meetings: cyto- diagnosticians, social workers in the health-care sector, massage therapists, chiropodists, podiatrists, orthoptists, osteopaths, perfusionists, dental technicians and urotherapists. The principal task of cytodiagnosticians is to use microscopy to diagnose whether there are cell changes in smears from patients. It is most common to diagnose smears in order to identify precursor stages of cervical cancer. This professional group receives thorough higher education and performs highly skilled tasks. Most are quali- fied as biomedical analysts and have received supplementary training in diagnostic cytology. This means that those who work as cyto- diagnosticians, with a few exceptions, are licensed to practise as bio- analysts. Cytodiagnosticians have a relatively narrow profes- sional role with a limited number of tasks. They are principally employed in laboratories in the public health service, and as health- care staff are supervised by . If a special licence to practise was introduced for this professional group, it would lead to duplicate licences to practise. We therefore do not consider the conditions for proposing a licence to practise for cytodiagnosticians to be met. Social workers in the health-care sector Social workers in the health-care sector operate on the basis of a psychological and social perspective and work in many different areas of health care. These social workers have an independent profes- sional role with clear responsibility for patients. In providing health care, they are under the supervision of . Those who act as social workers hold a Bachelor of Science degree in social work and public administration, supple- mented by various advanced training courses. There is no separate training intended specifically for the profession of social worker in the health-care sector. The Bachelor of Science degree in social work and public administration is a programme which is intended to meet the need for general skills in social work throughout the social field. If a licence to practise for social workers in the health- care sector was introduced, it would have to be differentiated from others who hold the Bachelor of Science degree in social work and public administration. Licence to practise would therefore need to be linked to work tasks rather than to the training received. We there- fore do not propose that licence to practise should be introduced for social workers in the health-care sector. Both these professional groups work in the area of foot care. Chiro- podists are primarily private practitioners. Training in chiropody has been arranged for a few years in the form of qualified professional training (KY). The type of training does not satisfy the require- ments for licence to practice which we have established. It is also our impression that among chiropodists currently there is a wide variety of educational backgrounds, where the level of skill is in large part the result of the chiropodists own development efforts and continuing professional education through various private courses. Podiatrists are a limited professional group, whose training in is being phased out. The last annual intakes will graduate in 2011. There will then be no Swedish higher education for podiatrists. We therefore do not make any proposals for the regulation of chiro- podists and podiatrists. massage therapists use massage and muscle stretching for well-being and preventive purposes and for the treatment of specific injuries and complaints in the locomotor system. The vast majority of them work as private practitioners. Our assessment is that their training does not fulfil the requirements for a licence to practise. We therefore do not make any such proposal. Orthoptists examine, diagnose and treat unilateral visual impairments. They mainly work at eye clinics in hospitals. Orthoptists have a back- ground of training in nursing, and the majority of them are trained ophthalmic nurses. They then undergo supplementary training spe- cialising in orthoptics. Introducing a licence to practice for orthoptists would therefore mean that they have duplicate licenses to practise. We therefore do not make any proposal for a licence to practise for this professional group. There is no specialised programme today for nurses wishing to specialise in orthoptics. In Chapter 12 we argue that specialist nurse training should be made more flexible. Within the framework of such a more flexible system it might be possible for orthoptists to gain protected specialist designation. Osteopathy is a form of treatment based on the body being a unit, all the parts of which are related and dependent on one another. The most important task for an osteopath is to find the cause of what is preventing the body from healing itself. Osteopaths in prin- ciple work exclusively as private practitioners outside the health ser- vice. The two osteopath training programmes held in are not higher education programmes under the Higher Education Act. We therefore do not propose a licence to practise for this profes- sional group. The principal task of perfusionists is to control the heart-lung in connection with heart surgery. They work almost ex- clusively as employees in the public health service and not as private practitioners. They are therefore covered by supervision. There is no Swedish higher education pro- gramme for perfusionists at present. We therefore do not propose a licence to practise for this professional group. Dental technicians design and make individually fitted replace- ments for lost teeth. They do fulfil the requirements for licence to practise with regard to education. They additionally carry out advanced tasks and to an ever increasing degree have contact with patients. In our view it is, however, the dentist who is responsible for the treatment as a whole, even though it is the dental technician who makes the replacements for lost teeth. Our impression is that dental technicians primarily work with the material and that the con- tacts with patients that take place mostly relate to aesthetic issues. The replacements made by dental technicians are covered by the legislation on devices. This means that there are detailed provisions which in various ways regulate the activity and which among other things contain requirements on monitoring how the devices work in practical use. Dental technicians therefore have to register their activity with the , which also supervises this activity. Taking all aspects into consideration, we therefore do not make any proposal for a licence to practise for dental technicians. Urotherapists investigate and treat people with urinary leakage or other bladder disorders. At present they are nurses, midwives, physio- therapists or doctors with a licence to practise who have received advanced training in urotherapy. As we are asked not to create dupli- cate licences to practise, we do not make any proposal on regulation for this professional group. Further regulation of qualifications for professional groups with licence to practise A number of professional groups which have a licence to practise have expressed a wish for further regulation of qualification require- ments. The Specialist wishes to be granted a protected title. The Therapists would like 12 months of full-time practical experience to be a requirement for licence to practise as an occupa- tional therapist. The same request has been made by the with regard to audiologists. The Physiotherapists wishes to have a specialist training programme, and the considers there to be an urgent need for state regulation of the spe- cialist skills of psychologists to be investigated more closely. also wants psychologists to have exclusive right to practise their profession. The Physio- therapists has argued that the Swedish title sjukgymnast should be replaced by fysioterapeut. The Government has also forwarded a re- quest form amendment to the provisions concerning licence to practise as an orthopaedic engineer. Nurses in diabetic care In our view, it should be possible for diabetes nurses to be regarded as nurses with specialist training. If this training becomes more flexible, it may be possible for diabetes nurses to gain a protected specialist title (see Chapter 12). Our assessment is that a protected title for diabetes nurses should not be introduced at present. Practical experience – a requirement for licence to practise? We consider that the practical experience required for licence to practise should form part of the training and that passing an exami- nation should be the criterion that has to be met for a licence to practise to be issued. The employer would then be responsible for employees having the skills required. An important aspect of this responsibility is to give new employees the induction necessary to carry out the work in a way that is satisfactory and safe for patients. We therefore do not consider that practical experience should be a requirement for licence to practise for occupational therapists or audiologists. Should more groups have a protected specialist title and a regulated specialist scheme? There are specialist schemes today for physiotherapists and psycho- logists which are organised by the Physiotherapists and the . It is also possible for physiotherapists and psychologists with a licence to practice to state that they have continuing professional education and specialist training. The training on which licence to practise for these groups is based is also relatively extensive and of good quality. We do not consider there to be reason, from the point of view of patient safety, to introduce a regulated specialist scheme and pro- tected specialist title for these two professional groups. Should psychologists have exclusive right to practise their profession? For a professional group to have exclusive right to practise a parti- cular profession, the need to improve patient safety must be so great that freedom of trade should be restricted. We do not consider there to be reason to introduce such an exclusive right for any additional group. Such an exclusive right for psychologists would also cause difficulties with regard to defining what tasks would then be covered by the exclusive right. Should the Swedish title of physiotherapist be changed from sjukgymnast to fysioterapeut? Fysioterapeut is a title which today is used both by those who treat people and those who treat animals, for example horses and dogs. Internationally the term fysioterapeut is equivalent to sjukgymnast. Sjukgymnast today is a title which is used to significantly more people than the title fysioterapeut. A problem that many people consider to exist with regard to protected titles is that the title of therapist is often confused. We consider this risk of confusion to be a strong argument for not replacing the title sjukgymnast with fysioterapeut. Such a change would also mean that the title sjukgymnast, after a tran- sitional period, could be used by anyone. In view of how well established the title is, this would make it more difficult for patients/consumers to judge who is a health-care professional and who is not. What training provides entitlement to a licence to practise as an orthopaedic engineer? Licence to practice for orthopaedic engineers was introduced in 2006. To avoid excluding those who have followed older training pro- grammes, it was decided that it should also be possible for these training programmes to provide the basis for a licence to practise for this professional group. It is also possible for , in exceptional cases, to grant a licence to practise to those who have demonstrated satisfactory skills other than by gaining a degree. This possibility exists with regard to all professions with licence to practise. The rules on exemptions are, for obvious reasons, most relevant when a licence to practise is introduced. Nearly everyone who has followed an older training programme to become an orthopaedic engineer should now have had time to apply for a licence to practise. have we found that orthopaedic engineers, regardless of educational background, have been the subject of action by or () to any major extent. We therefore do not consider there to be grounds for changing the requirements for licence to practise as an orthopaedic engineer. Review of the duties of opticians We do not judge there to be a need to alter the duties of opticians in the health-care system – with one exception. We propose that opti- cians be allowed to use what are known as diagnostic drops. The use of such drops leads to better quality in sight tests. It provides a basis for the early detection of severe visual defects and suspected pathological changes in the eye. There are two groups of patients who can be expected to benefit most from the use of diagnostic drops. The first of these is children over the age of eight years, as some visual defects in this group can be detected significantly more reliably if drops are allowed to be used. The other group is the older part of the population, as it is important that eye diseases such as glaucoma are detected at an early stage. If opticians are allowed to use diagnostic drops, the number of incorrect referrals will also decrease. The risks associated with the drops are small, but only opticians who have received training in using such drops should be authorised to prescribe them. has organised continuing professional education courses in the use of diagnostic drops since the autumn of 2008. As these drops are only to be used in certain sight tests, authorisation should be limited so that it only relates to requesting those diagnostic medicines which are needed in such tests. and the should be the authorities which issue regulations on authorisation for opticians to use medicines. During our inquiry, representatives of the optician industry expressed a wish for the provisions on who is allowed to supply contact lenses to be tightened. When the new Patient comes into effect on 1 January 2011, the ban on people other than health-care professionals supplying contact lenses ceases to apply. We therefore do not consider this issue in our report. Opticians who meet certain skills requirements should be autho- rised to use diagnostic drops. and the Pro- ducts Agency should be the authorities which issue regulations on authorisation for opticians to prescribe medicines. Special appointment to practise a profession in the health-care sector We have been asked to consider whether the present-day system of special appointments to practise a profession in the health-care sector is appropriate. It is possible at present for the county councils to employ doctors who do not have a licence to practise, without applying for special appointment for the individual, in the following cases: -Doctors for pre-registration training, which is a condition for obtaining licence to practise. -Locum tenens doctors, if the person employed has a degree from or another Nordic country or has been trained abroad and has obtained a decision on a pre-registration training post from . -Doctors who have received training abroad and who have to take a probationary post for six months. -students who have completed studies up to and inclu- ding the ninth semester with approved courses, They may work as locum tenens doctors in the health service under supervision with the exception of posts in primary care. The county councils have been granted this option to facilitate the administration of employment. year around 2 200 Bachelors of Medicine (medicine kandidater) are employed as pre-registration doctors. The number of locum tenens doctors is estimated at around 1 000 per year. A problem to which attention was drawn as long ago as 2001 by the then Swedish is that it is not possible for those who operate private health care to employ doctors without licence to practise for pre-registration posts, locum tenens posts and probationary posts.