Mary Harney (Dublin Mid West, Independent)

I move amendment No. 1:

To delete all words after "That" and substitute the following:

"Dáil Éireann:

1. Supporting the important role of the State Claims Agency in its administration of the clinical indemnity scheme, whereby the State has assumed responsibility for the indemnification and management of clinical negligence claims arising from the diagnosis, treatment and care of patients;

2. Welcoming the recommendations contained in the report of the Commission on Patient Safety and Quality Assurance to ensure that safety and quality of care for patients is paramount within the health care system;

3. Acknowledging the establishment of an implementation steering group this year to drive implementation of the commission's recommendations;

4. Noting with satisfaction the passing by the Oireachtas of the Medical Practitioners Act 2007, the main objective of which is to provide for a modern, efficient, transparent and accountable system for the regulation of the medical profession and to satisfy the public and the profession that all medical practitioners are appropriately qualified and competent to practise in a safe manner on an ongoing basis;

5. Welcoming the ongoing commencement of provisions of the Medical Practitioners Act regarding registration, fitness to practise procedures and for supervising medical education and training at basic and specialist level;

6. Endorsing the work of the Medical Council in preparing for the commencement of provisions in relation to the maintenance of professional competence of all medical practitioners;

resolves that the Medical Practitioners (Professional Indemnity) (Amendment) Bill 2009 be deemed to be Read a Second Time, on 31 January 2010.".

It is now two and a half years since the House enacted the medical practitioners legislation of 2007. This was a comprehensive modernisation of legislation governing the medical profession that then dated back 30 years. It was a good debate and an important moment in legislating for patient safety and standards in health. It was clear from all contributions in that debate that at the heart of the doctor-patient relationship is trust. When one is a patient or when one's family members are patients, one wants to have the utmost confidence and trust in one's doctor not from the perspective of blind faith or deference, but for good reason. However, I do not believe that people want a bevy of lawyers, legislators or insurers metaphorically sitting in on confidential discussions with their doctors.

A system characterised by trust, patient involvement in feedback, no-fault reporting, responsiveness to complaints, fair processes and continuous learning is much preferable to one based on suspicion, defensiveness, opaque procedures, blame and litigation. I believe the clear sense of the House two years ago and subsequently is that Members want health care to be built on the first model and not the second, by supporting trust and confidence rather than relying on blame, litigation and compensation. I believe Members also share the view that to achieve the highest quality of medical care and trust in the relationship between doctor and patient, it is essential that it is supported by a modern infrastructure that exists outside the relationship itself. Just as Members no longer believe it sufficient for professions to monitor and regulate themselves on their own, they also do not think it appropriate to rely solely on personal traits and training to achieve a high level of care and trust in the doctor-patient relationship. Consequently, the Government is supporting and reinforcing quality care and trust through an infrastructure.

First and most important in this infrastructure is medical competence assurance. This means the initial rigorous training of doctors, followed by a continual process of competence assurance. The Government has provided and supported key institutions with authority and public confidence to ensure medical competence, principally, the new Medical Council and the professional colleges. Another part of the supporting infrastructure for the doctor-patient relationship comprises clear processes to deal with cases in which things go wrong, ranging from negligence at one extreme to honest mistakes and plain accidents or coincidences of small events. Even if they are never used, the existence of full professional indemnity insurance, fair and open complaints procedures, fair and thorough fitness to practise hearings, whistleblower protections and so on is critical to engendering confidence on the part of patients in both each doctor and in the practice of medicine itself.

I believe great progress has been made on these fronts in a variety of legislation and initiatives as part of the health reform programme. In addition to the innovations in the Medical Practitioners Act 2007 and the new Medical Council, the Government has established the Health Information and Quality Authority, HIQA, as the body that will set standards for health care providers beyond the personal and professional competence of individual clinicians. The clinical indemnity scheme is working well to provide assurance for patients and doctors alike on medical claims. My colleague, the Minister of State, Deputy Áine Brady, will set out some important provisions of the Medical Practitioners Act and features of the clinical indemnity scheme.

This year, I commenced provisions relating to whistleblower protection in the Health Act 2004. The Oireachtas also enacted the Pharmacy Act 2007, which provides for a complete overhaul of the regulation of pharmacy and which updates legislation that went back to the 19th century. Again, patient safety, continuing competence assurance and the achievement of quality services is at the heart of that legislation. It is evident from the work of the Pharmaceutical Society of Ireland in the past two years that this new and modernised regulation is working better for patients and the public interest. The same is true for HIQA, which in just a few years has made tangible progress towards higher standards of care and higher public confidence in the services received. Furthermore, the Department set up the patient safety commission, which also gave its backing to the commission's report. An implementation process is now under way under the direction of the chief medical officer and his team. A key part of the thinking behind the patient safety commission is to involve patients and their perspectives in the achievement of higher standards. This idea is based on the insight that, in the 21st century, a grounded, trusting doctor-patient relationship is based on mutual respect and two-way feedback.

It is in the overall context of the infrastructure supporting patient safety and the doctor-patient relationship that I perceive and welcome the motivation behind Deputy Reilly's Bill. As Deputy Reilly has well articulated this evening, the motivation is that patients would be assured that professional indemnity insurance is, in fact, in place for every doctor who practises in the State and in whom they place their trust. I agree fully with the objective behind this Bill. Patients need the assurance of the competence and professional insurance of their doctors. The question is how does one most effectively achieve such assurance.

Given the complexities and sensitivities of medical indemnity insurance, the method deserves detailed reflection from the legal, administrative and practical points of view. This is the reason the Government has tabled an amendment this evening to the effect that the Second Reading of the Bill will be deferred until the end of January next at the latest. In the meantime, I will ensure that the draft legislation receives full analysis and consideration from all the relevant policy and legal expertise available to me. I will revert to Deputy Reilly and the Fine Gael Party before the end of next January. I also intend to keep him informed and fully consult him on particular aspects as I proceed. I also am happy to include Deputy Jan O'Sullivan in this process.

More generally, I welcome this opportunity to work together with other parties on improving assurance for patients in potential legislation. Our legislative system is designed to be deliberative but our politics are adversarial, often excessively so. This can lessen the occasions for collaborative, deliberative work on legislation driven by shared objectives or certainly can drown it out in public communications so the public too seldom sees Members as legislators working together on common objectives. This Bill provides Members with such an opportunity. I thank Deputy Reilly for introducing this Bill in his party's Private Members' time. I acknowledge the constructive spirit in which it has been offered and I undertake to examine it honestly and fully in consultation with him and to revert to this House before the end of January.

See this speech in context