Liam Twomey (Wexford, Fine Gael)

There are doctors who should not be practising medicine and it is important we remove them from involvement in the care of patients. I hoped to hear the Minister indicate in her contribution the number of doctors she feels should not be practising medicine and the number of complaints received by the Medical Council that have had serious consequences for patients. Many of the complaints dealt with by the council do not go much further than the discussion and mediation type process mentioned by the Minister, but a small number of cases are incredibly significant. These concern negligence, incompetence and abuse of power. These cases are the ones we must root out and the ones with which we are concerned in this legislation.

There are currently approximately 9,000 doctors caring for patients. We have 2,500 consultants, 2,500 general practitioners, 4,000 junior doctors, more than 500 public health doctors and doctors involved in training students and young doctors in our universities. These doctors need the support of strong, robust legislation which will help in rooting out the type of bad doctors mentioned by the Minister.

In the past 20 years I have worked in the areas of both accident and emergency and care of the elderly where I have seen my fair share of people dying and of hairy moments. I have had to make life and death decisions, especially in the accident and emergency area with patients arriving in after road traffic accidents. One always sits back afterwards and asks whether one did the right thing.

Some areas of my training as a junior doctor left a lot to be desired. One occasion always stands out in this regard. On my first day in the job as a paediatric doctor I was asked to administer chemotherapy to young children under the age of 12. I was expected to insert a needle into the lower base of the child's spine and set up a drip as the nurse held down the child. The consultant in charge at the time showed me how to do one and then put on his coat to leave. Although I had never done the procedure before, he was going to walk away after showing me once how to do it. This legislation will not stop people acting in this manner, but it will stop junior doctors from being stupid enough to proceed with a procedure without supervision where something might go wrong.

We must focus on this type of bad practice and ensure our doctors are trained properly. If I had been stupid enough to go ahead and try the procedure on the second child without supervision and it went wrong, I would have been the person brought before the Medical Council and the High Court and the consultant could wash his hands and say he expected I should have been competent enough to do it or should have asked him to show me again. As the Minister knows well, some consultants can be overbearing and junior doctors may be afraid to ask them questions.

I worked with the same consultant in the accident and emergency department on another occasion when a young child was brought in with suspected meningitis. As we both rushed to beat the clock, we could see the meningitis rash growing on his leg. Then I saw the other side of that consultant. I saw the fantastic expertise he could apply in seconds to save the child's life. These are the sort of issues we should consider when examining the practice of medicine which is an extremely difficult profession. Nobody in the House, unless he or she has worked as a doctor, nurse or health care professional, can realise the life and death decisions that must be made or how a single decision can have disastrous consequences for the patient.

Doctors cannot use the excuse of systems failure, that something did not work or someone did not do his or her job, because of the high standards they set for themselves, whether looking after children with cancer, someone who has been mangled in a road traffic accident, or providing dignity and care to elderly people who may suffer from pneumonia or are about to die. As the Minister knows, there are more than 1 million discharges from our hospitals each year, up to 12 million outpatient interactions and 22 million GP consultations a year. We should also take into account the millions of interactions that happen with doctors, nurses, nurses and patients, domestic staff and other allied health care professions and consider how they all help to make the system work.

The Minister spoke about trust. The Government needs to wake up to its responsibilities in this regard. Leas Cross has been described by Ministers as a systems failure. The Government had 18 months notice of the issue before the "Prime Time" programme put it in the public domain. I believe the Government knew well in advance what was happening there but refused to do anything about it.

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