sou · GYB365 · 2010-10-13 00:00:00 — -odontological radiology (X-ray examinations of teeth, jaw and adjacent areas in the face including mandibular joints) -bite physiology (functional impairments in the mandibular system). The number of specialities vary between EU Member States. Some countries do not have any specialties at all, while others have a rela- tively large number. , with its eight specialties, belongs to the latter category. In several of those countries which have few or no specialties dentists do, however, undergo several years of training pro- grammes after their basic training and in practice operate as specia- lists. Only two specialties – orthodontics and oral surgery – can lead to automatic recognition of the professional qualification in the EU. Recognition for the other six specialties that exist in can be obtained under what is known as the general scheme. Demand for dental care is affected by a number of factors such as the need of the population for dental care, availability of staff, support for dental care, national guidelines and so on. Dental health has improved dramatically in recent decades, particularly among children and adolescents. However, dental health does not automa- tically lead to lower demand for dental care. The number of children and adolescents with a great need for care has not decreased. An increased number elderly people with serious diseases and impaired general condition also makes increased demands, as does the fact that many elderly people retain their own teeth, supplemented by various types of implants. We consider there to be a need for collective responsibility for specialist registrar training of dentists to enable efforts made to be continuously followed up and for changes to be made to the spe- ciality training necessitated by developments in dental health. Respon- sibility should rest with a government agency. is at present responsible for the regulations and general guidelines on what knowledge, skills and approaches are to apply to each area of specialist expertise. This agency is also tasked with drawing up national guidelines for adult dental care, devising indicators by which to analyse and follow up the quality of dental care, taking responsibility for the dental health register which is to be used to monitor how dental care develops, prescribing how duties may be delegated in dental care and compiling and dissemi- nating scientifically based knowledge on the properties and use of dental materials. In addition, is the competent authority under the Professional Qualifi- cations Directive and monitors dental care issues in the initial work currently in progress in the 2012 review of the Directive by Commission. This, taken together, makes the Board well suited to also issuing regulations on the and designa- tion of the specialty training of dentists. has been responsible for the and designation of the specialist skills of doctors since 2010. A national council has been established to assist the Board. We propose that this national council should be expanded to also include skills in the area of dental care. The council should be appointed by the Government. Our hope is that a joint council can lead to the possibility of efficiency gains in administration and to allowing lessons to be drawn between the professions during the continuous monitoring of the development of specialty training. When the council considers issues concerning the specialty training of dentists, it should consist of one chair and five members. The members should be appointed on the proposal of , representatives of the dental pro- fession, the Authorities and Regions and the for Higher Education. The regulations and general guidelines on the specialist training programme for dentists need to be reviewed. In this review, it is important to take account of the changes in fields of work and opportunities for cooperation in the dental care teams that may be a consequence of the reduced number of dentists and the increased number of dental hygienists, and of the strengthening of the training of dental nurses which has taken place. Mobility within the EU, and to and from countries outside the EU, may also have an impact. the review leads to requirements for mandatory courses in spe- cialist skills to be included in the specialist training programme, consideration should be given to whether these should be funded by central government, as happens at present in the specialist training of doctors. Responsibility for providing places for the specialty training pro- gramme for dentists has been understood to rest with the county councils. The county councils have fulfilled this responsibility. We propose that a provision be introduced into the Dental Care Act stating that the county councils are obliged to provide places for the specialty training programme for dentists to an extent equivalent to the planned future need for dentists with specialist skills in clinical work. A wish has been expressed at meetings and hearings that the specialist training programme for dentists should be a university programme and that the training should be funded by central government. The specialist training of both doctors and dentists was deregulated as long ago as 1992. This deregulation has meant the abolition of detailed control of specialty training. In our view, the arguments that lay behind this deregulation should continue to apply, and the same system should be applied to doctors as for dentists. should be tasked with issuing regulations on the and designation of the specialty training programme for dentists. The national council for the specialty training of doctors, which is located at , should be expanded and tasked with also assisting specialty training programme for dentists. should conduct a review of the descriptions of goals for training and of the regula- tions and general guidelines on the specialty training programme for dentists. A provision should be introduced into the Dental Care Act on the obligation of county councils to provide places for the spe- cialty training programme for dentists. The specialty training programme for dentists should continue in future to be in-service training. The question of whether this in-service training should be a university-based training programme should be investigated in a wider context, with the specialty training programme or specialist training of several professions being examined simultaneously. Training of dental hygienists We have been asked to investigate the content and scope of the dental hygienist training programme. Licence to practise for dental hygienists was introduced in 1991. Two years of studies in higher education leading to a professional qualification are required to obtain a licence to practise. The pro- fession of dental hygienist is the only one among 21 professions sub- ject to licence to practise in health and care to have a two- year programme of training. The dental hygienist training program- me is now available at eight institutions of higher education, all of which offer a third, elective year. Of those who study to become a dental hygienist, 58 per cent at present opt for a third year. During the third year, the students receive expanded training in the areas of paediatric and adolescent dental care, dental care of the elderly, dental care for groups with diseases affecting oral health, scientific methodology, cooperation in dental-care teams etc. The supply of dental hygienists is good and is expected to in- crease by 47 per cent by 2023. Most projections also predict that the demand for dental hygienists will increase. Good dental health in large groups is leading to dental hygienists acquiring a greater role. A greater share of paediatric dental care could, for example, be per- formed by dental hygienists. Outreach activity among the elderly and disabled also means that demand for dental hygienists is in- creasing. for Higher Education pointed out fifteen years ago that is it difficult for present-day training to achieve university level and that it should be reviewed. The profession of dental hygienist has undergone great changes. The requirements set for a dental hygienist with a licence to practise cannot be satisfied in the framework of two years of study. We share this view. We are also of the view that existing curricula for the three-year training programmes which all the institutions of higher education today offer can serve as basis for deciding what a new qualification de- scriptor should contain. The training programme for dental hygienists should be extended to 180 higher education credits, that is to say from two years to three. for Higher Education should be tasked with drawing up proposals for a new qualification descrip- tor. Qualification requirements in the social services Our task has been to survey and analyse the need for, and of, regulation of qualification requirements for a number of tasks in the social services. This applies to certain types of administration, including investigation and decisions, which relate to individuals and which are carried out on behalf of the social welfare committee. We have been asked to pay special attention to political decision- making in the social services and what consequences regulating qualification requirements would have with regard to the supply of personnel with suitable training and experience. What is the current situation? Regulation of qualification requirements means that requirements are set for certain skills in order to be allowed to use a particular title or to carry out particular tasks. The two types of regulation can also be used simultaneously. There are already requirements in the Act today for staff to have suitable training and experience. But it is not stated what type of training and experience is to be required. has issued general guidelines on the skills of staff in several different areas in the social services. Such guidelines exist for the administration and follow-up of cases relating to children and adolescents, cases concerning the elderly and people with disabilities. It is common to these general guidelines that they indicate qualification as social worker or qualifi- cation in social care according to a previous study scheme as suitable training. The general guidelines also specify a number of areas in which staff should have theoretical knowledge and practical skills, such as investigation, action, follow-up, evaluation etc. has also issued regula- tions and general guidelines on management systems for quality in social services. The management system should also cover supply of staff and skills. There should be routines for continuously checking that staff have the skills required to carry out their tasks. The Child Protection Inquiry The Child Protection Inquiry (SOU 2009:68), which presented its proposals in 2009, was tasked, among other things, with investi- gating how a high level of skill can be ensured for social welfare officers who work on the investigation, planning and follow-up of cases relating to children and adolescents. The inquiry was also asked to comment on whether there was a need for separate regulation of skills requirements. The Inquiry proposed that the Bachelor of Science degree in social work and public administration should be required to assess whether an investigation should be initiated, to investigate and assess the need for intervention or for other measures and to follow up interventions decided upon. The social welfare committee should offer suitable induction and support in the profession for social welfare officers who do not have any previous experience of these duties. The qualification requirements should start to apply after a transitional period of five years. The Inquiry additionally proposed that a specialist training programme of at least one year should be introduced at the advanced level. The Inquiry has presented thorough arguments for a need for such regulation for child protection cases. Virtually no objections were raised against this proposal during the consultation period following the report of the Child Protection Inquiry. The duties concerned here are what are known as exercise of autho- rity. This means decisions or other measures which ultimately are an expression of the powers of society in relation to its citizens. It concerns decisions on assistance, actions taken under the on Services for Persons with Certain Functional Impairments (LSS), on immediate taking into care etc. The handling of a case involves all measures taken, from initiation of a case until it is concluded through a final decision. It is the social welfare committee that takes the decisions, but whole groups of cases or a single case may also be delegated to officials. Case handling is very often concerned with taking difficult decisions which are of crucial importance to the client, and the individual official has great scope in taking such decisions. There are already statutory requirements today for the quality and quality of activities in the social services and in the on Services for Persons with Certain Functional Impairments, but they have not had a sufficient impact. We therefore judge there to be a need for further regulation. The of the user receiving good-quality intervention are improved by clarifying what know- ledge and skills are needed for this work. We share the assessment of the Child Protection Inquiry that the Bachelor of Science degree in social work and public administration is the training that provides the best basis for social work. But if only the Bachelor of Science degree were to be accepted as provi- ding the required skills, undesirable lock-in effects would arise, where people with different training are excluded from these posts. We therefore take the view that the responsible authority should have the option of also employing people with different relevant higher education for these duties. This may, for example, be a person with higher education in other areas and with advanced studies in particular in social work and/or administrative law and social law. According to statistics from the Authorities and Regions (SKL), around 18 000 people in the social services have duties that would be covered by the regulation on qualification requirements. Just over 7 000 of these do not hold a Bachelor of degree in social work and public administration. Of these, just over 4 000 have had post-secondary education lasting three years or more and just over 2 000 have undergone such education lasting two years. There are a large number of variants of training for social workers. A student today has 37 different alternatives to choose from. If the Bachelor of Science in social work and public administration is to be a qualification requirement for certain exercise of authority throughout the social services, the basic training must become more equivalent and provide the skills required for these regulated duties. In our view, if the qualification requirements we propose are introduced, it is likely that the training of social workers will become more equivalent. Procedures should also be developed for continuous dialogue between training organisers and the social ser- vices on the content and future development of training. A transitional period of five years should be introduced. This provides those who wish to have the option of supplementing their training and the responsible authorities with time to plan the acti- vity. A model of how this boost in skills can be accomplished is for central government to offer training places, while the responsible authorities make studies possible, or partly in the framework of the post of the social welfare officer concerned. Our proposals will increase the demand for social workers. Accor- ding to a report from the for Higher Education (2009:5R Higher Education Programmes and the Labour Market), the supply of social workers will increase by between 40 and 50 per cent by 2025, given that the same number are trained per year as at present. There is therefore no risk of the qualification requirements being difficult to achieve due to a lack of people with the right training. Like the Child Protection Inquiry, we also propose legislation on induction and support in the profession for those who do not have previous experience of the duties that are regulated. Requirements should be laid down in law for the Bachelor of Science degree in social work and public administration, or other relevant qualification of at least first-degree level in higher educa- tion, for the following tasks in social services: 1.assessment of whether an investigation should be initiated, 2.investigation and assessment of the need for intervention and other measures and 3.follow-up of interventions decided upon. Duties 2 and 3 should be regulated for work related to the on Services for Persons with Certain Functional Impairments. should be tasked with cooperating with the for Higher Educa- tion to produce a basis for a more detailed description of what is meant by other relevant qualification of at least first-degree level in higher education in the area. Existing staff should be offered skills-raising training during a transitional period of five years. Anyone who lacks previous experience of the duties that are regulated should be given suitable induction and support in the profession for at least one year. Follow-up and evaluation should be conducted within two years after the regulation of qualification requirements has been fully implemented. lag om alternativa behandlingsformer Härigenom föreskrivs följande. 1 § Denna lag gäller den som yrkesmässigt undersöker någon annans hälsotillstånd eller behandlar någon annan för sjukdom eller där- med jämförligt tillstånd genom att vidta eller föreskriva åtgärder i förebyggande, botande eller lindrande syfte. Lagen gäller inte den som enligt 1 kap. 4 § patientsäkerhetslagen (2010:659) tillhör hälso- och sjukvårdspersonalen. 2 § Med alternativa behandlingsformer avses i denna lag åtgärder enligt 1 §. Inskränkningar i verksamhet på hälso- och sjukvårdens område 3 § Andra än hälso- och sjukvårdspersonal får inte yrkesmässigt undersöka någon annans hälsotillstånd eller behandla någon annan för sjukdom eller därmed jämförligt tillstånd genom att vidta eller föreskriva någon av följande åtgärder i förebyggande, botande eller lindrande syfte: 1.behandla sådana smittsamma sjukdomar som enligt smitt- skyddslagen (2004:168) är anmälningspliktiga sjukdomar, 2.behandla cancer och andra elakartade svulster, diabetes, epilepsi eller sjukliga tillstånd i samband med havandeskap eller förlossning, 3.undersöka eller behandla någon annan under allmän bedöv- ning eller under lokal bedövning genom injektion av bedöv- ningsmedel eller under hypnos, 4.behandla någon annan med radiologiska metoder, 5.utan personlig undersökning av den som sökt honom eller henne, lämna skriftliga råd eller anvisningar för behandling, 6.undersöka eller behandla barn , eller 7.prova ut kontaktlinser. 4 § Utövare av alternativa behandlingsformer ska kunna ingå i ett frivilligt register över sådana yrkesutövare. 5 § Regeringen får meddela ytterligare föreskrifter om hur registret ska administreras, vilka uppgifter det ska innehålla, villkoren för registrering, och avgift för godkännande och registrering. 6 § Till böter eller fängelse i högst döms den som 1.bryter mot någon av bestämmelserna i 3 § 1–7, eller 2.under utövning av verksamhet som sägs 3 § uppsåtligen eller av oaktsamhet a) tillfogar den undersökte eller behandlade en skada som inte är ringa, eller b) framkallar fara för en sådan skada. Första stycket 2 gäller oavsett om skadan eller faran orsakats av olämplig behandling eller genom avbrott i eller dröjsmål med läkar- vård. Den omständigheten att gärningsmannen på grund av brist i utbildning och erfarenhet inte kunnat inse sjukdomens natur eller förutse skadan eller faran befriar honom eller henne inte från an- svar. Om gärningen är belagd med straff enligt 10 kap. 3 eller 4 § pati- entsäkerhetslagen (2010:659) ska i stället dömas till ansvar enligt dessa bestämmelser. 7 § Till ansvar enligt bestämmelsen i 6 § ska inte dömas, om gär- ningen är belagd med strängare straff i annan lag. 8 § Har någon gjort sig skyldig till brott som anges i 6 §, får Social- styrelsen meddela förbud för honom eller henne att eller för alltid utöva verksamhet som avses i 5 kap. 1 §. Förbudet får förenas med vite. Den som överträtt ett sådant vitesförbud får inte dömas till straff för gärning som omfattas av vitesförbudet. Överklagande av beslut m.m. 9 § beslut om förbud att utöva verksamhet enligt 8 § första stycket får överklagas hos allmän förvaltningsdomstol. Prövningstillstånd krävs vid överklagande till kammarrätten. 10 § Beslut som meddelar enligt denna lag gäller , om inte annat anges i beslutet. Denna lag träder i kraft . lag om ändring i tandvårdslagen (1985:125) Härigenom föreskrivs att en ny paragraf, 13 §, ska införas i tand- vårdslagen (1985:125). I landstingen ska finnas möj- lighet till anställning för tand- (2010:659) i en omfattning som motsvarar det planerade framtida behovet av tandläkare med specia- listkompetens i klinisk verk- samhet. Denna lag träder i kraft . 1 upphävd genom 1996:788 lag om ändring i lagen (1993:387) om stöd och service till vissa funktionshindrade Härigenom föreskrivs att det i lagen (1993:387) om stöd och ser- vice till vissa funktionshindrade ska införas två nya paragrafer, 6 a § och 6 b §, av följande lydelse. För utförande av uppgifter en- ligt denna lag som innefattar 1.utredning och bedömning av behovet av insatser eller andra åtgärder, eller 2.uppföljning av beslutade in- är kommunen skyldig att an- vända socialsekreterare som har avlagt svensk socionomexamen eller annan relevant examen på grundnivå i högskolan eller som har sådan utbildning som erkänts av enligt 6 b §. ansvarar för att den socialsekreterare som själv- ständigt utför sådana arbetsupp- gifter som avses i denna paragraf har för uppgiften tillräcklig er- farenhet. Saknar socialsekreteraren tillräcklig erfarenhet ska nämnden erbjuda denne lämplig introduk- tion och stöd i yrket under . får använda en socialsekreterare med utländsk examen för utförande av de upp- gifter som anges i 6 a § om den utländska utbildningen ensam eller tillsammans med yrkeslivserfar- enhet kan jämställas med en svensk socionomexamen eller annan rele- vant examen på grundnivå i hög- skolan. bedömer om kraven enligt första stycket är uppfyllda. Regeringen meddelar de före- skrifter som behövs för verk- ställigheten av denna bestäm- melse. 1.Denna lag träder i kraft . 2.En socialsekreterare som före ikraftträdandet av denna lag an- ställts för att utföra de uppgifter som anges i 6 a § första stycket ska till och med anses behörig att utföra de angivna uppgifterna. lag om ändring i socialtjänstlagen (2001:453) Härigenom föreskrivs att det i socialtjänstlagen (2001:453) ska införas två nya paragrafer, 3 kap. 3 a § och 3 b §, av följande lydelse. För utförande av uppgifter inom som inne- fattar 1.bedömning av om utred- ning ska inledas, 2.utredning och bedömning av behovet av insatser eller andra åtgärder, eller 3.uppföljning av beslutade in- är kommunen skyldig att an- vända socialsekreterare som har avlagt svensk socionomexamen eller annan relevant examen på grundnivå i högskolan eller som har sådan utbildning som erkänts av enligt 3 b §. ansvarar för att den socialsekreterare som själv- ständigt utför sådana arbetsupp- gifter som avses i denna paragraf har för uppgiften tillräcklig erfar- enhet. Saknar socialsekreteraren tillräcklig erfarenhet ska nämnden erbjuda denne lämplig introduk- tion och stöd i yrket under .