Dr. Gerard Crotty:

I will deal with a number of the questions asked. First, in response to the specific question asked by Deputy Seamus Healy on whether we supported a duty of candour, yes, we do support open disclosure and communication and honesty at all stages of the clinical process. In that regard, we highly commend the support and education provided by the Medical Protection Society which are very useful for our members in that respect. It has been shown that open disclosure and good honest communication reduce the likelihood of litigation. However, we echo the comments of other speakers that a legal duty of candour should be backed by appropriate protection and that an admission of untoward events should not in itself be used as evidence of culpability. This should be included in legislation, probably the promised health information Bill.

We also support the development of the various alternatives to litigation that have been mentioned and also, in so far as cases will continue to go through the legal system, the procedural reform and tort law reform to which reference have been made. However, we emphasise that all of these will take time to result in any change on the curve in terms of the cost of claims and the projected future cost of claims and, therefore, subscriptions to the Medical Protection Society. We emphasise that there is also a need for urgent action to deal with what is an unfolding crisis in terms of consultants who when their next premium falls due, may cease to practise and leave the country.

A question was asked about the age profile of those who were leaving. It is across the age spectrum. Some are older and approaching retirement, but those who do not show up in the statistics are those who have not commenced to practise in this country; whatever about someone with a mature practice with borrowings paid off being able to support the payment of such high premia, it is untenable for many that they commence to practise in a private hospital in this country. They are commencing to practise abroad and do not appear in the Irish statistics. As a result, it will be very difficult and perhaps impossible to replace those who have left and the provision of services in specialties in certain private hospitals may cease entirely. The major concern is the transfer of the workload to public hospitals which are already overburdened.