Liz McManus (Wicklow, Labour)

I welcome the publication of this Bill which represents an important and long overdue reform of the system of regulation and standard setting for doctors. Medical practice is rapidly becoming more complex and challenging. It is important, therefore, that the structures to protect patients and support doctors are up to date and appropriate to meet those changes. However, it is not clear that the Minister has found the correct balance to protect the public good, while retaining the confidence of medical practitioners in the ability of the system to regulate and police their profession.

It would be a great pity if the changes proposed led to a deterioration in either confidence or competence in health care. We should remember this is the Minister who forced through the establishment of the HSE without proper planning, preparation or accountability, with the result that the management structure of the health service lost the public's confidence and alienated those working within it to the point where a major trade union representing health workers recently passed a motion of no confidence in the executive. We cannot allow the same alienation to be extended to the Medical Council. A streamlined, effective, modern and accountable system is required to regulate and assure competence in best medical practice.

For the most part, we are fortunate to have in Ireland a high level of professionalism and ethical standards in our doctors, although there are rare and frightening exceptions. For almost 20 years women in the north east were left at risk of extreme trauma and injury because no system was in place to protect them. The most striking element about that case is that it took a young midwife to speak out bravely and end this reign of terror. To this day that midwife has maintained her anonymity. The praise heaped on her by the Minister sounded hollow because words of praise are no substitute for robust protection of whistleblowers legislation. Unfortunately, the Government has run away from that important reform. The Labour Party published a Bill to protect whistleblowers which the Government accepted before behaving dishonourably by abandoning it quietly instead of putting it into law. This has meant that other health workers within the health service who see a wrong being done are prevented by fear of retribution from speaking out. It would have been a better tribute to the aforementioned midwife had the Minister introduced a protection of whistleblowers Bill instead of offering empty words of praise.

This Bill to reform the Medical Council has been long awaited. The 1978 Act has outlived its usefulness. It has been obvious for many years that new legislation is required. It is a great pity, however, that the debate on this long awaited Bill is being cut short. Two and a half hours is simply not good enough and shows the cavalier attitude which, regrettably, is the hallmark of the Government's tenure. In the past decade the main driving force for change has not come from the Government but from within the Medical Council. Under the presidency of Professor Gerard Bury, there was a distinct shift of policy towards reform and, in particular, the principle of competence assurance. That work has been continued during the tenure of Dr. John Hillery. Given these efforts, it is a pity that the Bill being presented to the House has led to much contention and anxiety among doctors.

The reasons for the controversy are obvious and have been analysed thoroughly by the various medical organisations, including the IMO. Critical positions have been presented and supported with evidence. It is not clear, however, why the Minister has chosen to insert certain provisions in the Bill. She needs to justify these provisions, with evidence to support her case. Evidence based practice is embedded in medical practice and provides a robust and accurate methodology for arriving at conclusions. It is not clear why she is choosing to give herself and future Ministers for Health and Children such extraordinary powers over the Medical Council. It seems she is confusing ministerial authority with democratic accountability but the two are not necessarily the same. Her proposals are an invitation for ministerial meddling, which is neither healthy nor necessary. I fully support the principle of democratic accountability but a safer and more accountable balance could be achieved by having a formalised link to the Oireachtas rather than the Minister.

It is clear that the concerns expressed by the public relate largely to the protection of patient safety and the right to seek redress and be heard when something goes wrong. I have described the inadequate response from the Government to the whistleblower legislation introduced by the Labour Party.

The Neary case exposed the limitations of current structures, showed a terrible failure to monitor and expose malpractice and revealed an urgent and pressing need to reform and improve the way medical professionals work. The Harding Clark report which outlined in detail the road map for the future stated in regard to the Medical Council:

The Inquiry is acutely aware of the sense of frustration felt by members of the Medical Council and the medical professional bodies at the lack of a new Statute giving the Council statutory powers to oblige doctors to engage in continuous medical education and to present for skills assessment. The Medical Council needs these powers urgently so that it can delegate those duties to those professional bodies to regulate the training and continuous assessment of their members.

The needs of the general public require that the professional bodies have the power and effective means at their disposal to monitor the competence of their members in order to ensure optimum patient care. In the past and perhaps at this present some doctors are engaging in procedures beyond their skills and some are failing to apply current practice. There is currently no legal obligation to keep their skills updated. This must change.

Competence assurance is not met solely by attendance at continuing professional development courses. Skills must be certified or validated. The public must have faith in an independent regulating body within the State.

At no stage does the report recommend ministerial authority over an independent regulating body; neither does it argue for a lay majority on the Medical Council. These issues seem immaterial to the concerns which arose in the Neary case.

We are dealing with issues of public concern. Most people will sooner or later fall ill, at which time they are entitled to protection from malpractice and, as far as is practicable, errors in their treatment. While oversight over those who regulate practitioners is needed, it must to be exercised at the highest level of authority, that is, the Oireachtas. I do not believe an individual Minister should be able to act at will over the Medical Council. The independence of the council is an important protection from political interference or direction for reasons other than patient safety but it is clear that there must be accountability. It is a better and safer option, for example, to vest the supreme power to close down the council solely in the Oireachtas. Such a decision would have extremely serious implications for the medical profession and patients and would have to be subject to rigorous and open scrutiny before being taken. Only the Oireachtas could guarantee the necessary safeguards. While I do not think the Minister would be culpable in this regard, leaving that power in the hands of a Minister is an invitation to occlude instead of expose. As the Minister says, she will not always be here.

Since the Minister for Health and Children, Deputy Harney, took office, Members have witnessed a worrying withdrawal of openness and accountability throughout the health service. The establishment of the Health Service Executive, HSE, has led to a loss of access to information to a disturbing degree. The Minister's legacy will be that there are no health boards, no media access, no effective system of parliamentary questions and no justification for the clamp down on accountability. Members' experience must make them deeply uneasy regarding the failure to provide the important checks and balances that only can be guaranteed by open scrutiny in these Chambers.

Members must recall, as the Minister never does, that the most significant adviser employed by the Government on health care reform, Professor Niamh Brennan, actually argued against getting rid of health boards. While she argued for their reformation, she came to the conclusion that they should not be abandoned. She acknowledged with some reluctance that accountability could be maintained only by including public representatives at a local level. However, her wise words were ignored and, consequently, we now have the most bureaucratic and impenetrable system of health care management imaginable. The public has no faith in the HSE structures as set up by the Minister and even those who work in it have declared a vote of no confidence in the organisation.

Yesterday, I met some front line workers who were completely frustrated by the difficulties they confront in their work. After hearing their myriad of complaints, I suggested they should make a presentation on their concerns to the overall director of the relevant directorate within the HSE. I was staggered to discover that not one of these highly qualified people was able to name the director of the directorate in which they operate. Their inability to name their departmental head constituted a telling indication to me of the HSE's poor state.

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