Liz McManus (Wicklow, Labour)

However, I felt for them. It is not good political management or governance to leave in that position people who work in extremely stressful conditions with children who have suffered considerable abuse. People will not perform such stressful duties unless they believe they have the support of the organisation in which they work. The people I met had no sense of such support or of engagement or understanding from within. This is a form of atomisation and demoralisation that leads to vacancies and to people leaving their jobs because they cannot take any more.

The fact that this state of affairs is the direct result of ministerial and Government decisions as to how to manage the health service must inform Members in respect of the Bill under discussion. Members should learn from experience. While there is a view that experience merely constitutes the repetition of the same mistake with ever-increasing certainty, I hope Members can change and improve the Bill during its passage and that the Minister will learn from experience, rather than simply repeating previous mistakes.

Partnership is the key to a good working relationship. This applies within the HSE and between the Government and the Medical Council. It is important to recognise that, within the confines of existing legislation, in general the Medical Council has done its job well. It has the support of doctors and has regulated the profession in a way that, in general, has lived up to its task. Undoubtedly, however, the processes are both slow and secretive. The law is archaic and the manner in which the system operates is alienating to the public who may wish to complain to the Medical Council.

Recent events have undermined confidence in the Medical Council. To its credit, it published the reports relating to the so-called investigation by three consultant obstetricians. However, to its discredit, no explanation has been given as to why the Medical Council chose not to discipline the consultants for their failure to act properly in respect of their role in investigating the work of Dr. Neary. Although the fitness to practise committee recommended that sanctions be imposed, the medical council rejected this recommendation without any explanation, which simply is unacceptable. I support the Minister in asserting that transparency should be as fully enforced as possible. The Labour Party wants such enforcement to be included in this Bill.

Members must consider the issue of the lay majority. The Minister's argument has not been explained fully and I intend to table amendments on Committee Stage because the issues raised deserve to be considered. It is important to have a good debate on such issues.

There is a logic to separating the fitness to practise committee from the Medical Council itself. Fitness to practise is of direct concern to patients and it is appropriate to have a strong lay presence on that committee. However, one must recognise that this tends to slow down matters. While the process in courts with juries is slower than would otherwise be the case, such a step is logical and I welcome the openness of inquires, when appropriate. However, I am not yet convinced as to the necessity for, or desirability of, having a dominance of lay people on the Medical Council itself. Regulation, training, education and competence assurance all require expertise to make the correct decisions.

I read with great interest an article in The Irish Times on the experience of one lay person, namely, the journalist Ms Mary Raftery. She has concerns regarding the Government's approach, which is to view a lay majority as a panacea and wrote about how it is vital that clinical audits and peer review should become mandatory for all doctors. However, she then makes the point:

While there is a role here for non-medical people, particularly in ensuring complete transparency, this process is more appropriately driven by doctors themselves. Lay people, by definition, lack the detailed knowledge necessary to judge the increasingly specialised nature of medical practice.

The second strand, which is currently also the responsibility of the Medical Council, is the investigation of complaints against doctors [in respect of fitness to practise]. It is here that the process of self-regulation has been exposed as being most seriously flawed.

She then noted she has heard complaints about the Medical Council and went on to state:

I have some small experience in this area. For five years during the 1990s, I was one of two lay members appointed to the board of the Dublin Dental Hospital. With no specialist knowledge of dentistry, I felt that my ability to have any significant impact was extremely limited.

This is not to criticise either the board or the hospital — far from it. It is merely to point out that it has been my direct experience that the influence of lay people, serving in a voluntary capacity in complex areas of which they have no expert knowledge, is in danger of being seriously exaggerated.

Other jurisdictions have confronted this problem. New Zealand, for [example], has split the two strands mentioned above.

She refers to that country's separation of clinical order and competence assurance from fitness to practise

. . . under the aegis of its medical council, which remains doctor-dominated. However, the investigation of complaints and concerns was removed from the council in 1994. It is now the responsibility of the Health and Disability Commissioner. His office is [fully] independent and is staffed by professional investigators who are not doctors, but can call on specialist knowledge as required.

There is active encouragement of complaints being made. She continues:

The commissioner also has the power himself to initiate an investigation into any matter of public concern in the health area. This ability to be proactive, rather than simply waiting for complaints to come in, is a key strength. Another is the entire separation from the medical profession.

New Zealand established this independent, stand-alone complaints body after a number of serious scandals

She goes on to observe:

It is simply not enough to throw a few more lay volunteers onto a medical council board. This kind of tinkering around the edges of a system which is fundamentally flawed will do nothing to restore our seriously shaken confidence in the medical profession. Neither will it provide an adequate remedy for those who are damaged by doctors' errors.

It is interesting to hear about the experience and case made by somebody who was a lay member of the board of a medical facility. We must listen to it. She made an extremely strong case for the establishment of a patient safety authority, the position both the Labour Party and Fine Gael fleshed out in detail. We have not heard from the Minister the case for lay people having a majority. As I understand it, none of the training schools is represented on the Medical Council. This raises issues——

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