Liam Twomey (Wexford, Fine Gael)

——I would not like to have that sort of a power because absolute power is always abused. I do not mind if the Medical Council has a lay majority, but it must not have direct linkage with Government which is bad for patient care in the long term.

The Minister has been long enough in politics to know that we need a strong independent Medical Council. It does not matter whether the council has a lay majority, but it must be independent. When one looks at the proposed membership of the Medical Council, which the Minister sees to some degree as a proxy for the patient safety authority of which I speak, it includes a representative from the Health Service Executive; the Higher Education Authority, who could even be Mr. Kelly, the man the Minister sacked; An Bord Altranais; the health and social care profession; the Health Information and Quality Authority; and the Independent Hospitals Associations of Ireland. The representation will be quite broad and in some respects will take up a proxy role for a patient safety authority. Therefore, it is very important that future Ministers should not have such strong control.

I am sure the same concerns have been made known to the Minister in the context of training. According to the Minister, the training of specialist doctors in the future will be handed over to the HSE. If I have learned anything over the past two years it is that I would be slow to hand over responsibility for the future training of doctors and specialists to the HSE.

The Minister must take a long look at what is happening with the HSE. Recently, I picked up a press release from the middle of 2004 when I was clearing through some papers in my office. The press release announced with great fanfare the individuals in charge of the financial directorate, the human resources directorate, the primary care and continuous care directorate, the National Hospitals Office, the IT directorate and the shared services directorate. Not one of those individuals remains in his or her job, and one of the directorates seems to have been effectively abolished. With an organisation that is obviously either in a state of flux after two years or slowly imploding, it is dangerous to hand over medical post-graduate training of doctors and dentists, the training of specialists and consultants, to a body that might not know where it is going.

The IT directorate, for instance, which is a simple one to view, was given €80 million from one year's budget to spend on small projects and by November last they had not spent one cent of it. That was the same directorate which was telling us that PPARS would be a fantastic addition to the health care services, whereas the Minister is waiting until after the election to switch it off. It is not for fun that we say this. There are great consequences to a Minister having control over the health service, especially the training of doctors.

Consider the contention that the Minister must have control over general policy. Can the Minister set standards for general policy on who can be registered with the Medical Council and the specialist training doctors can claim to have received? By implementing general policy, the Minister could implement the recommendations of the Hanly report by stealth, which report is still Government policy. She could restrict doctors' training by way of issuing a general policy to the Medical Council, thereby effectively closing small hospitals right across the country. This issue has been touched on. In this regard, one should consider the way the Royal College of Surgeons and the Royal College of Physicians have been setting harsh guidelines for accident and emergency units. These guidelines could have closed small units around the country in the past three years.

The Minister's setting of standards for trainee doctors will be dressed up as protecting the patient but it is actually the implementation of Government policy to suit politicians. It is to prevent politicians from getting it in the neck at election time from members of the public who do not want to see their local hospital closed down and do not believe one should have to travel 100 miles to visit the nearest accident and emergency department because some expert told the Minister doing so was a great idea when she was in the United States or Canada.

State control is to be exercised over the training of doctors, to which both patients and doctors will object strongly. If I were Minister for Health and Children, I would not like to have this power. I would like to believe I would be obliged to talk to those for whom I would be responsible, rather than having to issue a diktat to the Medical Council that would in some way restrict doctors' training, the knock-on effect of which would be that they would not be able to work in small hospitals. In this manner small hospitals could be closed, thus implementing Government policy by stealth.

What if the future Minister for Health and Children were Deputy Martin who seems to have a special interest in stem cell research? What would stop him if he decided to implement general Government policy to the effect that stem cell research could go ahead in Ireland? Where does this leave the Medical Council in terms of medical guidelines and doctors' rights? I will not stretch my point further and refer to the introduction of termination by ministerial directive.

See this speech in context