A New Professional Horizon
There’s a new law of the land for health professionals in BC. The ink has yet to dry on the recently enacted Bill-36 – the Health Professions and Occupations Act – but in the meantime nurses and others have many questions about how the implementation of forthcoming regulations could affect their working lives.
There are many aspects to the new legislation. Some of the changes address past concerns nurses have brought to the government, while others have prompted new questions over issues like nurses’ professional autonomy, their ability to effectively advocate for patients and the health-care system they depend on, and an overhauled disciplinary process that could jeopardize nurses’ privacy rights.
A multi-party committee tabled the legislation last October and it passed into law a month later. It replaces the Health Professions Act, a law that dates back to 1979, and which was amended several times over the years, most recently in 2006.
The government has yet to release an implementation schedule and in-force date for the Health Professions and Occupations Act and, in the meantime, the current rules under the old Health Professions Act remain in place. But, the new law is certain to bring significant changes to the oversight and regulation of health professionals.
BCNU President Aman Grewal says the timing of the legislation is less than ideal, and questions the wisdom of embarking on major changes when the health-care system is in the midst of a global pandemic and an unprecedented staffing crisis.
The new law is informed by recommendations contained in a 2018 report published by Harry Cayton, the former chief executive of the UK’s Professional Standards Authority for Health and Social Care.
Earlier that year, BC’s health minister Adrian Dix commissioned Cayton, a leading expert in the field of professional regulation, to conduct an inquiry into the operational and administrative practices of the BC College of Dental Surgeons as well as the Health Professions Act.
The review was prompted by a series of complaints made against the dental college in addition to controversies surrounding the BC College of Chiropractors and the College of Naturopathic Physicians which the government claimed had eroded public trust in all of the province’s professional regulatory bodies.
Following the release of the Cayton Report, Dix established the Steering Committee on Modernization of Health Professional Regulation to make recommendations on how the Health Professions Act should be amended, with the stated intent of improving governance and regulatory performance in the interest of safety of patients and the public.
This committee sought public engagement between November 2019 and January 2020 and released its own report in August 2020, with a number of recommendations that are now part of the new legislation. These include reducing the number of colleges from 20 to six, changing the composition, size and board appointments process for colleges, creating a new oversight body, updating the complaints and adjudication process, and facilitating better sharing of information between colleges.
BCNU was among the health-care unions and community organizations that submitted feedback to the committee.
“We stated that health regulation must strike a balance between the public interest and the rights of regulated professionals,” says Grewal. “Regulation must be effective, efficient and protect the public while ensuring licensed professionals are free to practice their chosen profession.”
A new complaints and adjudication process is one of the changes that’s most concerning, says Grewal.
The Health Professions and Occupations Act will allow the publication of discipline agreements between health-care professionals and their regulatory colleges, and all disciplinary measures will be made public. It’s a move the government says will improve transparency around complaints.
Grewal is unhappy with the change. “Publication of disciplinary measures and processes must weigh the right of the public to know the outcome and the privacy rights of the individual registrants,” she argues. Grewal says these privacy rights must outweigh the right of the public to know details about a registrant, warning that a “name and shame” culture will only discourage people from entering the profession at a time when the health-care sector is already critically short staffed.
The new legislation will consolidate the number of BC health regulators from 15 to six. It’s a move that is consistent with the amalgamation of BC’s three nursing regulators in 2018 to form the BC College of Nursing Professionals, and which further amalgamated with the College of Midwives of BC in 2020 to form the BC College of Nurses and Midwives (BCCNM).
These changes are intended to create administrative efficiencies. However, in its 2020 submission to the province’s steering committee, BCNU reported that the amalgamation of colleges has so far done little to decrease regulatory fees. In fact, the opposite has been true.
“Health regulation must strike a balance between the public interest and the rights of regulated professionals.”
- BCNU President Aman Grewal
“The nursing college has increased licensing fees by 15 percent this year alone and the costs have significantly gone up since the first 2018 amalgamation,” said Grewal at the time. She also told the committee that BCNU heard from its members that regular fee increases deter the continuation of practice. “The BC government should be concerned about nurses leaving the province for other parts of Canada or choosing to leave the profession entirely,” Grewal added. “These continued practice costs could exacerbate our province-wide nurse shortage.”
Not all of the changes in the Health Professions and Occupations Act need be regarded as detrimental.
Regulatory board governance will see a significant overhaul, most notably with the planned creation of a college superintendent, a new professional oversight body that the government argues will promote accountability, transparency and consistency across colleges. The Office of the Superintendent will conduct routine audits, set college standards on policy and practice, investigate colleges when necessary and investigate complaints about colleges’ actions and policies. It will also have the ability to change or overrule college board decisions.
When the new law is fully implemented, the health minister will appoint all regulatory board members based on the recommendations of an independent competency-based selection process, which will consider diversity and be grounded in clearly specified criteria. College boards will also have an equal number of registrant and public members.
The enactment of the Health Professions and Occupations Act will also see the establishment of an independent disciplinary tribunal as part of a new two-step process for managing complaints. An initial investigative stage will remain the responsibility of the regulatory colleges, while a separate independent disciplinary stage will be conducted by a panel appointed by the Office of the Superintendent. This panel will contain at least one member licensed in the same health profession as the person who is the subject of a hearing.
Notwithstanding the privacy concerns surrounding the new disciplinary process, Grewal says nurses should welcome changes that would see disciplinary matters determined independently of the regulator, which can instead focus on the protection of the public.
The new law also supports a commitment to cultural safety and humility, and could be a significant step forward in the effort to eliminate discrimination in BC’s health-care system. Regulated health professionals and occupations under the law will be required to embed anti-discrimination measures in the delivery of services. Discrimination will be deemed a form of professional misconduct or actionable conduct, and will require colleges to take action when registrants discriminate against others.
These changes reflect key recommendations on the province’s 2020 report In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in BC Health Care and help further implement the province’s Declaration on the Rights of Indigenous Peoples Action Plan.
Grewal welcomes these particular changes, but says her concern for nurses’ privacy remains, and she worries that the new legislation means nurses will be under even greater pressure to maintain their practice standards at a moment in history when they are struggling the most.
She also reminds members that it is an employer’s responsibility to adequately staff health-care facilities and programs to ensure the provision of safe patient care and practice conditions.
“I can’t tell you the number of times the union hears from members about overcapacity units – there simply aren’t enough nurses to go around,” she says. “Our professional voice has never been more important, and nurses must always be free to advocate for the practice conditions they and their patients deserve.” •
For more information on all of the changes in the Health Professions and Occupations Act, visit www.bchealthregulators.ca.
GOVERNANCE OVERHAUL
The new Health Professions and Occupations Act will bring significant changes to the regulatory environment in BC, most notably with the creation of the Office of the Superintendent, a new professional oversight body.
UPDATE (Spring 2023)