Liam Twomey (Wexford, Fine Gael)

While we are revisiting some old ground with these amendments, it is no harm to emphasise the point we wish to make once more. The Minister said she has met some young doctors who welcome this legislation. I do not really believe that is true, although it does not matter very much. My instinct tells me that most doctors do not care about the legislation or are not aware of it. Like the rest of the public, doctors tend to pay little heed to what happens in the Dáil until the implications of legislation become apparent. Very little has been said about the debates we have had on this legislation. If one polled this country's 9,000 doctors to ascertain whether they have any idea of what we are talking about in this instance, one would find that most of them know little about it.

Most of this Bill is quite technical. The sections of the Bill providing for ministerial direction will change the Medical Council quite fundamentally. I am not sure that it should be called the Medical Council any more. Its role is being broadened so that it will not just involve keeping doctors in check. The council will also be charged with examining the role of medicine throughout the health service, for example. Last week, we considered legislation on the Health Information and Quality Authority, which is being established because the HSE currently both purchases and provides nursing home services. It also sets standards in the nursing home sector and checks that those standards are being upheld. Nothing or very little was done over many years — certainly, patients were not protected. When the problems at Leas Cross, for example, hit the headlines, there was a slow movement to protect nursing home patients. I recently read an article which mentioned that Professor Des O'Neill's initial report on Leas Cross was half the size of the report that was eventually published by the HSE. Various officials in the HSE had to include various appendices to make clear they did not really do anything wrong, they should not be blamed, they did everything they could and somebody else was at fault. It was the patients who ultimately suffered.

This House decided last week to take the HSE out of the nursing home sector. We agreed to establish an independent organisation, the Health Information and Quality Authority, to set standards. We also gave the Social Services Inspectorate the responsibility for protecting patients in the nursing home sector. The Minister has also introduced the Medical Practitioners Bill 2007, under which HSE officials will be put on the board of the Medical Council. She has decided to subsume the Postgraduate Medical and Dental Board, which is responsible for specialist training of doctors and dentists and postgraduate research, into the HSE so that it is no longer an independent organisation. It appears that the Medical Council will have a role in the training and specialisation of doctors, thereby affecting the way in which they can register as specialists. It seems that this measure is being taken on foot of proposals from the HSE. I understand that the HSE will have a bearing on what will happen with regard to the competence assurance of doctors. The Minister has proposed that it will depend on resources being made available to the HSE. The Minister has taken from the HSE the power to simultaneously decide on standards and govern what happens within a certain part of the health service — the nursing homes sector. However, she has also introduced a Bill regarding medicine to put the HSE in charge of doctors, more or less.

I was a little surprised by the manner in which the Minister spoke about the HSE this morning. I refer to her comment that co-location is an issue for the HSE and has nothing to do with her. I find it fascinating that the HSE is now like "Big Brother", or like a computer that is more or less running itself. As a result of this legislation, the HSE is now in charge of the health services. Some people do not give a hoot about self-regulation and lay majorities. Most doctors are not engaging in this debate at all. They seldom get engaged in debates of this nature, other than when problems like those encountered at Leas Cross emerge. When something goes seriously wrong in the health services — Leas Cross was not the only example of such a difficulty — we should stand back and question how it was allowed to happen. In this day and age, how in God's name did those who were responsible for the inspection of nursing homes, including administrators who were being very well paid to protect elderly patients, not only fail to notice what was going on in such homes but also seem to allow it to happen without doing anything about it?

In 20 years' time, people will probably ask how in God's name we allowed legislation of this nature, which seems to give more powers to the Minister, to be passed in 2007. The Minister knows that such powers can easily be abused. Policy directions can easily be issued to quieten things down. The Minister has given herself the ultimate sanction of being able to threaten privately or publicly to remove some or all of the members of the Medical Council if they do not play ball. She has given incredible power to the HSE, which will be represented on the board of the Medical Council, and some other organisations that are linked to the Government, rather than to the protection of patients. The HSE is not about protecting patients. Many of the organisations and individuals which will be represented on the new Medical Council, such as the Royal Irish Academy, the Minister for Education and Science, the Health Information and Quality Authority and the Independent Hospital Association of Ireland, have nothing to do with patient safety. They are part of the mechanism of government.

The HSE and its Government allies will control things quite significantly. That is why I want to take the provision relating to ministerial responsibility out of the Bill. I have said that if I were the Minister for Health and Children, I would hate to have so much control over the Medical Council directly, which is what the ministerial responsibility provisions give the Minister, or indirectly, by means of the authority of the HSE and some of the other organisations which will now be part of the Medical Council. The ministerial appointment provisions could be bad for patient safety. I do not think it is a good idea to appoint to boards four or five people who usually have some connection with the Government. The Taoiseach has said that he puts his friends, rather than donors, on State bodies. That is what happens — it is a fact of life.

I do not think what we are doing has occurred to the Minister or to the majority of people. The general public is not engaged in this debate at all, but it will be interested in it in years to come when a report is published on what went wrong in the case of some serious disaster. I am not sure we have protected patients in the right way. I have asked the Minister previously to point out where the huge problems of which she has been made aware arise within the Medical Council, as it currently exists, or in the context of the Medical Practitioners Act 1978. It is important that some sort of critique be done on the effect on the Medical Council of the legislation before the House. I do not think the sort of ministerial authority that is being copper-fastened by this Bill was envisaged by anybody. It was envisaged that we would have proper systems of registration and competence assurance of doctors. It was intended to leave training to the training bodies. The Medical Council was supposed to have a specific role in maintaining standards and ensuring that bad doctors are rooted out of the system. The Minister has taken it a step too far.

We might rue the day that we brought this legislation through the House. The provisions contradict what the Minister is doing in other legislation, including the legislation we voted on last week. None of it is based on patient safety. Those who drafted the Bill in respect of HIQA had a different mind set to those who drafted the Medical Practitioners Bill. I do not know what will happen with the Pharmacy Bill and whether further amendments will be tabled before I read it tonight. That changed dramatically between Tuesday and Thursday. This is confused thinking. I am confused by it and, after 20 years in the health service, I am interested in this area.

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