Seán Crowe (Dublin South West, Sinn Fein)

One of the most significant matters affecting the health services in recent years concerns the accountability and training of health professionals. Such legislation should be designed to protect patients and to help ensure that they receive care of the highest standard, but I am as disappointed as others by the guillotining of this debate after three hours. It is equally unacceptable that we needed to wait so long for the Bill. Those commitments in the Government's 2001 health strategy that have not been abandoned altogether have been repeatedly delayed, such as this Bill.

The core of the Bill is the reform of the Irish Medical Council, the main regulating body for the medical profession. Section 6 describes the objective of the Medical Council as "to protect the public by promoting and better ensuring high standards of professional conduct and professional education, training and competence among registered medical practitioners". The Medical Council as established has failed to protect the public, as seen in the scandal concerning the obstetrics and gynaecology unit at Our Lady of Lourdes Hospital in Drogheda where dozens of women were mutilated by Dr. Michael Neary. The Neary scandal is the background to the Bill and one of the main purposes of the legislation should be to ensure that such appalling treatment of vulnerable people within our health service is not allowed to recur.

The victims of Michael Neary were betrayed by the Our Lady of Lourdes Hospital authorities, which turned a blind eye to what was happening, Neary's professional body, the Irish Hospital Consultants Association, which carried out a bogus investigation that actually praised Neary, a surgeon who butchered women, and the Irish Medical Council, which proved incapable of dealing with this outrage speedily, openly and fairly. These betrayals reinforced the opinion held by many that when it comes to the crunch, some doctors and consultants will not report the inadequacies of their colleagues.

The report of Judge Maureen Harding Clark into the obstetrics and gynaecology unit of Our Lady of Lourdes Hospital was a damning indictment not just of one consultant, but of a conspiracy involving a number of people who participated in gross medical malpractice, turned a blind eye or took part in a cover-up involving the unlawful removal of the charts and birth registers of many of the victims with a view to concealing the details of the operations performed and the treatment given. In other words, this was theft to facilitate a cover-up, which was allowed to happen in a climate where consultants were seen to be above reproach and where elitism led to a total lack of accountability.

We are still waiting for a scheme of redress to deal with all claims of medical negligence made by the women who were in the care of the consultants and staff of the maternity unit of Our Lady of Lourdes Hospital between 1974 and 1998. The Minister for Health and Children owes a solemn obligation to the victims to establish a scheme of redress to provide them with a forum to state their cases and recompense, if possible, for the physical injury and personal grief and trauma they have suffered. The Government also needs to clarify the position of the Garda investigation and whether prosecutions will be pursued in respect of those who stole medical records.

The purpose of the Bill is to address the profound questions about the regulation of the medical profession raised by the Harding Clark report. The sad reality is that self-regulation by the professionals in this case did not work and led to a grave injustice being done to patients. Its failure showed up major weaknesses in the system.

The explanatory memorandum to the Bill states that the balance between self-regulation and public accountability needs to be adjusted. That is definitely the case in the wake of the Neary scandal. One of the main ways the Bill seeks to redress the balance is through changing the composition of the Medical Council to give it a lay majority. Both the IMO and the IHCA object to this measure, as they want to maintain a majority of medical professional representatives on the council. This argument will go back and forth during Committee and Report Stages, but self-regulation failed miserably in the Neary case and other cases. That has weakened the argument for maintaining the council as it is.

The Bill gives extensive powers to the Minister regarding the council. She will appoint the members nominated by professional bodies and statutory agencies and the lay members who have such qualifications, expertise, interests or experience as, in the opinion of the Minister, would enable them to make a contribution to the performance of the Council's functions. The key question for us as public representatives is who in the new Medical Council will represent the interests of patients, the users of the services provided by medical professions. The answer is far from clear in the Bill. Citizens will be more interested in the answer to that question than in arguments about how many representatives from which professional bodies should be on the council. The public has the right to know whether the council will serve it better.

Section 7 states that the Medical Council shall "perform its functions in the public interest", which is the key point of the Bill. The council has to act not in the interest of the Government of the day or of this or that professional body, but in the public interest. The majority of medical professionals act in the public interest and carry out health-giving and life-saving work everyday and often against the odds in our health services, which are crippled by the disastrous policies of this and previous Governments.

The Government's policies are undermining the ethos of public service, which should guide everyone working in our health service. The Government is pursuing a policy of privatisation that puts profit before people. It is providing land on public hospital sites and significant tax breaks to developers and speculators who see health care as a lucrative business. Once these private for-profit hospitals are in place, they will suck the life-blood out of the public health service. As the public system deteriorates, health professionals will be drawn into the private for-profit system. It is already happening. This week, a primary care specialist hired on a large salary to advise the HSE CEO, Professor Brendan Drumm, left for a top post and a seat on the board of directors of the private primary care company, Touchstone.

For years, the public service ethos has been undermined by contracts that allow hospital consultants to profit simultaneously from the public system and private practices. The Government claims to be trying to change that in the negotiations with the consultants, but the Minister has undermined her case. She claims to be serving the public system while bringing in the privateers. The Government is reinforcing the two-tier system. Public service is playing second fiddle to private profit.

The large bureaucratic backlog in the filling of posts and the appointment of health professionals in our public health services must be addressed. I am told by people working in the health services that since the establishment of the HSE, the bureaucracy has worsened. It is a nightmare and the massive bureaucratic bottleneck is denying patients the professional care they need, which must be addressed as a matter of urgency.

See this speech in context