John Crown (Independent) | Oireachtas source

I also make a disclosure; I am a doctor. It was a real shock for me when I came back in 1993 from New York, which is often considered the medical litigation capital of the world, to find that Ireland, where we had a certain set of prejudices about the perception of doctors in our society and a non-confrontational nature, was at the time third in the world for medical claims, and I believe we are now second. People do not really understand this. This is a uniquely dangerous environment in which to practise medicine in terms of the risk of litigation.

A major contributory reason is that the medicine is not that good. It is not that the doctors are not that good but there are far too few of them and they are given incredibly unrealistic workloads. The eyes of my colleagues in this committee start to glaze over when they hear me say this. For most specialties we have approximately one fifth or one sixth the number of specialists per head of population when compared with countries in continental Europe. We tend to have about 70% of the number that the UK has and the UK is pretty much second worst in the world for the number of doctors per head of population for most specialties as well. As a result we have people who are seeing vastly larger numbers of patients than doctors will in other countries. As a result, even with all things being equal and even if the quality of the care, systems and backup were exactly the same, statistically an Irish doctor is more likely to be sued because he or she has far more interactions.

Of course, there is another factor. If doctors are having far more interactions, the chances are that the quality of those interactions is suffering. They have a real problem, given that they are practising in an environment with a unique set of risks, such as a tiny number of CT scanners, an inadequate number of operating theatres, and waiting lists which would be hilarious if they were not so tragic and are only surpassed in the OECD countries by the UK. The British must thank God every day that the Irish health system exists because we keep them off the bottom of the charts for international public systems. This was the problem I came back to 20 years ago and it is not a whole lot better now. We can then throw in the perfect storm of the economic meltdown which meant that suddenly there were cutbacks to an already constrained system. There is a failure to appoint replacements in positions that were already desperately overworked and underprovided for.

I do not want to put too much of the blame for this on lawyers, but certainly a contributory factor was that a lot of lawyers had a lot of free time on their hands and were suddenly looking for other opportunities when conveyancing became no longer possible.

When I came back to Ireland I took a lot of criticism for saying this. The system was so poor, the way the health system was structured so poor and the outcomes were so poor, there was the potential that medical litigation could be in some senses creative. It could help to fix problems and highlight problems. However, I do not think that is the primary reason for having it.

We desperately need to fix the health system if we want to reduce the risky environment in which doctors practise. I believe the cohort of doctors and nurses we have is unsurpassed. I can obviously speak with a greater degree of expertise on oncology than I can on other areas. The kind of training Irish doctors get, because so many of them train abroad in unbelievable centres of excellence, tends to mean that we have people of extraordinary quality in posts here being asked to do impossible jobs, and we need to fix that.

I will not talk about specifics. However, obviously in the aftermath of the Galway obstetrical tragedy a few years ago, there was much discussion about the possibility of individual liability. The central problem in Galway and elsewhere is that Galway is at the bottom of the charts for the number of obstetricians per head of population in Ireland and Ireland is at the bottom of the charts for the number of obstetricians per head of population in the world. Until we fix those problems we will not fix the crisis.

Deputy Ó Caoláin asked about the culture of transparency. I have got two minutes. If you want me to leave, Chairman, I will leave.