Liam Twomey (Wexford, Fine Gael)

When the Minister presents amendments so late in the day, we are never quite sure whether they will make a difference or whether they will mean another land-mine that explodes on the next Minister when somebody challenges it in the courts. Cats and dogs remain better protected than patients in the Irish health care system, even after this debate. We still have a long way to travel before patients are properly protected.

The Minister seems to have got around some of the problems regarding beneficial interest. I am not 100% sure whether it is fully sorted out, but that is what happens when we are flying through legislation on what could possibly be the second last day of the Dáil. The discussion about market rates is still up in the air. I am not sure if the Pharmaceutical Society of Ireland believes it can regulate this market to decide what is a true market rate for a pharmacy. That may be impossible, but time will tell.

We should have a joint council between the PSI and the Medical Council. There is a great need for all these regulatory bodies to start talking to each other. There is also a need for the Minister to correct much of the legislation involved. She has done little to get the bodies talking to each other. She will be aware of the international reports which show the percentage of pharmacists, doctors and health care professionals who have ended up with substance abuse habits. They may abuse the drugs for sale themselves, or they may abuse their privilege and sell on those drugs to others. I am not sure if the Minister has covered those issues in this Bill. That is why I was hoping she would accept our view that there should be a joint council between the two bodies.

Ultimately, a patient safety authority is needed to protect patients, and when Fine Gael and the Labour Party published a policy document last year on a patient safety authority, I think the Minister recognised what we were talking about. All of the regulatory bodies must talk to each other and some body must direct that, which should be the patient safety authority. The Pharmaceutical Society of Ireland must come up with ethical guidelines on how doctors and pharmacists interact and work together.

Let me focus on something in which the Minister believes and on which I support her to some extent, namely, prescribing by nurses. I still have concerns about it and we must be careful on how we move on it. We never defined quite clearly whether a nurse working in the health spa of a five-star hotel could prescribe drugs. At what level can nurses prescribe? Can they prescribe in a hospital or in a GP surgery? The Minister wants the fitness to practise hearings in the Medical Council to take place in public, but the fitness to practise hearings for nurses at An Bord Altranais are never held in public. We raised concerns about the structure of Health Information and Quality Authority and whether it will protect patients. The Leas Cross scandal occurred relatively recently and I think time will tell how well known it was among senior management of the HSE and how nothing happened for quite some time. The inquiry into Our Lady of Lourdes Hospital showed what can go wrong when the structures are not in place.

Has the Bill taken the UK Shipman report into account? That was far more comprehensive than anything we have ever done in this country. There are concerns about what seems to be unusual prescribing of cyclomorph, which is a form of morphine that Harold Shipman used to murder his own patients. Has the Minister taken the recommendations of this report on board? We want to balance things. We do not want to regulate excessively, but the Minister should have taken on board everything in that report when she was framing the Bill. So much takes place that the potential for abuse is huge.

The Minister and her colleagues in Fianna Fáil are pushing a private model that is not like the competitive private model of the Blackrock Clinic or the Beacon Clinic. They are pushing a private model where the State takes up many services from the private sector. Many of the abuses that have occurred worldwide are cases where the State has contracted a great number of services from the private sector. When the Minister talks about abuses in the public system, she is actually talking about abuses that occur when the private model is mixed with the public model.

Some public clinics have been closed down and the work has been transferred to private clinics. It is quite possible that those private clinics will be pushing doctors and other health professionals to increase the work they do on patients from the public system because the public system is paying for it. The same checks and balances in regard to whether these investigations are even needed are often not in place in the public system. VHI or BUPA, because they are private companies, will generally be careful about making sure they do not find themselves in a Deloitte & Touche situation. It would never happen that a private company would pay out €165 million to consultants without having the foggiest notion what is going on. This is what happened in regard to PPARS, however, with consultants being paid €30 million or €40 million without anybody knowing what was happening. That would not happen in the private system because it has better checks and balances in place.

The Minister's drive towards using the private system to pay for public services is not ideal. The same difficulties may arise in respect of her co-location plan if effective governance structures are not in place and procedures are not properly defined. Nothing about the HSE inspires confidence that this will happen. The Minister has talked a good talk in rushing through this legislation. However, for those of us who may have more intimate knowledge of how the health services work and who think the issues through more thoroughly, significant concerns remain which the Minister has not confronted.

I am sure the Minister read the recent report in the Irish Medical Times on the mental health tribunals that were set up under the auspices of the Mental Health Commission according to the provisions of the Mental Health Act 2001. I pointed out on Committee Stage that it is a good idea, of which I remain a strong supporter, that anybody who is admitted to hospital involuntarily should have an opportunity to have that involuntary admission independently reviewed by the Mental Health Commission. Although the system has been operating for only six or seven months, however, the HSE has already raised major concerns with the Minister that it is not working well.

One of the main problems is that it is turning into something of an adversarial system, in which lawyers are involved, rather than the advocacy process that was envisaged to allow patients have their involuntary admissions reviewed. It was not established to provide an opportunity to sue doctors and blame people. Rather, its purpose was to offer a second opinion and to advocate on behalf of these vulnerable patients. Although it was only set up on 1 November 2006, it is already the subject of concern on the part of the Irish Medical Organisation and the HSE. This was something that was planned for five years.

The Minister can dismiss the points I have made but there is no denying the concerns that exist on this issue. One of the best ways forward is to be found through my party's proposal to establish a patient safety organisation. The Minister must kick into touch on these issues by offering her full support to our position. Health services are taking a strange direction. Where there is potential for abuse, it usually occurs. A small minority of people engage in such abuse and it is our duty to protect the majority. We have a particular duty to protect patients in the public health care system.

I expect the Minister will not accept many of the Opposition amendments. I will withdraw my amendment.

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