Jimmy Devins (Sligo-Leitrim, Fianna Fail)

I am delighted to have an opportunity to speak on this Bill. I wish to refer briefly to an issue Deputy Durkan raised in the course of his contribution. He mentioned the fact that doctors, particularly consultants, worked very long hours. It is the Government's objective to provide a consultant-provided rather than a consultant-led service. Unfortunately, as the Deputy and I are well aware, there are some regional or general hospitals in which consultants are on call for up to 48 hours at a time. That is certainly not conducive to good patient care. Therefore, the Government is to be commended for moving as quickly as possible to increase consultant numbers.

The need for the current arrangements to be updated is obvious, particularly when we consider that the existing legislation has been on the Statute Book for over 30 years. A new, modern, efficient and accountable system of regulation is patently required. It is agreed by all that changes to the 1978 Act are not enough — we need new legislation such as that before the House. In that regard, I welcome the input by the Medical Council which has made it clear that it supports the Bill. The council, together with other interested bodies, made numerous submissions to the Minister while the Bill was in gestation. From what the Minister said, I understand a total of 58 submissions were received. I was glad to hear that patients and patient advocacy groups were among those who had made submissions. As is patently obvious, the Government is committed to ensuring patient safety in legislation. That is the purpose of the Bill.

The main purpose of the Medical Council is to regulate the medical profession to ensure the public interest is safeguarded. This can be done in many ways: from ensuring the training of medical students is of the right quality to supervising ongoing education and training of doctors once they have qualified. If there is a problem with a doctor concerning health or fitness to practise, the appropriate committees of the council are utilised. Recently, we all saw the investigation by the council of Dr. Neary and the subsequent report by Judge Harding Clark. While for many this type of case may be their only source of knowledge of the council's workings, it is only fair to state an enormous amount of the council's time is taken up in supervising the training and subsequent qualifications of doctors.

The Medical Council is entrusted with maintaining the highest possible standards of medical care. It is an onerous task and one for which we need a modern, well resourced council which must be fully equipped to do such work. If enough resources are made available to the council to maintain the highest possible standards in training and supervision of qualifications, one hopes the need for fitness to practise investigations will be kept to a minimum. We must be realistic, however, and realise that even with the best standards applied, there will always be cases where the level of care by a doctor will not meet the requisite standard.

One of the remarkable facts about medicine in this and many other countries is that once doctors have qualified, they do not need to undergo any further training or education if they do not want to. Medicine is a complex and, thanks to the explosion of knowledge, rapidly changing profession. It is constantly evolving and new investigations and treatments are becoming available all the time. Speaking as a former practising general practitioner in Sligo, it is obvious that to practise safely and to the highest possible standards continuing education is essential. Most medics of whom I am aware do this either by further study, attending lectures or courses, or keeping up to date by reading medical journals. All these activities are part and parcel of continuing medical education.

At this juncture, I pay tribute to the County Sligo GP Society which can lay claim to being the first clinical society in Ireland to be devoted solely to general practice. It is run by GPs for GPs and engages in a wide spectrum of medical education activities. It also hosts a successful annual seminar which is attended by doctors, not just from Ireland but also from abroad, who discuss the latest investigations, treatments and ideas. In recent years this group of GPs in the north west has established connections with doctors in many European countries to the mutual benefit of all. Last weekend I had occasion to visit the society's annual seminar which was a stimulating experience. I have mentioned this society because it is an example of a body which promotes continuing medical education of which I am personally aware. All over the country doctors in hospitals or general practice are engaging in similar educational programmes. The fact remains, however, that there is no compulsion for any doctor to undertake further study. Unfortunately, I am sure there are some doctors who have not engaged in any such further education programmes from the time they qualified from medical school.

The Medical Council has an important role to play in this regard, as prevention is infinitely better than cure. I welcome the steps the council is taking in terms of continuous medical assessment and competence assurance. For the public to have faith in doctors, it must know that there is continuous assessment of a doctor's knowledge and skills. I welcome the fact that the Health Service Executive and other employers are required to facilitate competence assurance but I am aware of some concern that too much time may have to be spent on form filling. At a recent meeting of world medical regulators in New Zealand the issue of competence assurance was discussed. It was suggested the average doctor would have to spend between six and nine hours per week dealing with such issues, which in many cases could account for 20% of their working week. It is essential that competence assurance and continuing medical education are developed. We must also ensure the system does not develop in such a way that it becomes an end in itself, rather than a means to an end. I hope the new Medical Council will take these concerns on board because nobody wants to see a situation where perhaps 25% of a doctor's working week is devoted to competence assurance to the detriment of patient care.

On a separate issue, I note that the Our Lady of Lourdes Hospital inquiry report by Judge Harding Clark states, at page 345:

The Department of Health and Children should introduce legislation to protect clinical governance records and risk management clinical incident forms from the application of the FoI Act. Unless these documents are protected from FoI or discovery they are unlikely to be created and opportunities for learning from mistakes will be lost.

The absence of such an exemption will undermine any prospect of creating an open environment in which adverse incidents will be reported and, I hope, lessons learned. A balance should be stuck on this issue.

Until now, the Medical Council has had a majority of medical members but under the proposed legislation, there will be a majority of lay members. This is a huge step forward and constitutes a first for any medical council or its equivalent in Europe. There has been much discussion concerning this change in the council's composition and it is an issue which I am sure will be debated more fully on Committee Stage. Suffice it to say that some of the nominating bodies could potentially have a conflict of interest. For example, the HSE is the employing body of most doctors and the body which runs all our public hospitals. Is it an appropriate body to have the right to nominate somebody or, under this legislation, two persons who may have to adjudicate on an employee, or visit or report on the facilities of a hospital under its care? Concern has been expressed to me and other Members of the Oireachtas that the independence of the Medical Council and, more importantly, the perception of its independence may be compromised by having council members nominated by such a body. There are also some concerns with regard to the relevance of some of the other nominating bodies, specifically the Royal Irish Academy. These are issues which can be discussed more fully on Committee Stage.

Competence assurance and regulation of training facilities will take up an increasing amount of the work of the new council. The workload of all members will increase dramatically, but the workload of medical members, in particular those from an academic background, will be enormous. This issue will be dissected and analysed on Committee Stage. Having heard the Minister's speech, I am sure she is well aware of this issue and I welcome the fact that members may be co-opted to various committees to help carry out the work.

I would like to discuss one of the most important aspects of the council's work, namely, the composition and workings of its fitness to practise committee. This committee hears allegations, conducts inquiries and makes judgments as to whether a doctor's conduct falls below the appropriate standard. This is the aspect of the Medical Council's work with which the public is most familiar, but it takes up relatively little of the overall work of the council.

There has been much discussion on the composition of this important body which operates in a quasi-judicial way. There is a strong case to be made for its having a chairperson from a non-medical background. Such is the importance of the committee's work that having a person with a legal background as chair, whether senior counsel or an established solicitor, might be the best way forward. It is also worth discussing whether such hearings should be in public or private. That decision is difficult because of the sensitive nature of the issues. Some patients might prefer to have their complaint held in camera. There is a case to be made for allowing people the right to decide whether to opt for public or private hearing.

I welcome the Bill which has been a long time in coming. I look forward to discussing the issues in more detail on Committee Stage. I congratulate the Minister and the Government for driving forward this much needed change in the regulation of the medical profession. As the Minister stated, patient safety is at the heart of the health reform agenda. The Bill has patient safety as its raison d'être.

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