Áine Brady (Kildare North, Fianna Fail)

I am happy to have the opportunity on behalf of the Government to participate in this debate on Deputy Reilly's Bill, which proposes the introduction of mandatory professional indemnity cover for medical practitioners by way of an amendment to the Medical Practitioners Act 2007. The Government accepts that systems must be in place that minimise to the greatest extent possible the need for patients to initiate civil litigation and thereby avail of the cover which professional indemnity provides. All Members have a shared wish to ensure that patients are protected from harm in so far as humanly possible. Progressive policies implemented by the Government have underlined its commitment to this issue. Indeed, the very Act which this Bill proposes to amend contains a large number of significant measures which at their heart intend to promote the protection of patients.

I wish to take this opportunity to outline some of the significant advances in the area of the reform of professional regulation. As Members are aware, the Minister for Health and Children has undertaken an ambitious legislative programme in recent years as part of the health reform programme. While the Health Act 2004 was the primary focus of this programme, significant importance has been placed on bringing forward legislation relating to modernising professional regulation. The new Health and Social Care Professionals Act 2005, the Medical Practitioners Act 2007 and the Pharmacy Act 2007 are now law. I am pleased to note that work also is at an advanced stage on the preparations for the publication of the nurses and midwives Bill.

The main purpose and aim of the Medical Practitioners Act 2007 is not to provide in detail for redress after an adverse clinical event, but to shift the focus entirely to a more proactive system of robust registration and regulation of the medical profession before any such event occurs. The Act, which repealed legislation that was almost 30 years old, was signed into law in May 2007 following a wide-ranging consultation and serious consideration of the matters which needed to be addressed. The Act is being commenced on a phased basis to allow for a smooth transition to the new procedures which the Medical Council must introduce. The main objective of the Act is to provide for a modern, efficient, transparent and accountable system for the regulation of the medical profession, which will 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.

Key areas addressed in the Medical Practitioners Act include governance, membership of the Medical Council, registration, fitness to practise procedures, education and training and maintenance of professional competence. Strengthening and clarifying accountability is a priority under this Act. Modern governance arrangements applicable to other statutory bodies in the health service and across the wider public service now apply to the Medical Council.

For the first time ever, the new Medical Council now has a majority of members who are not medical practitioners. This principle now applies to the regulation of the medical profession, as to other health professionals and non-health professionals. It is important for public confidence that members of a profession themselves do not have majority control in the governance of their regulatory body. This is paramount to the ongoing development of openness and transparency in the work of the Medical Council.

The Medical Practitioners Act places significant emphasis on the responsibilities that come with the privilege of registration with the Medical Council. It is now an offence for a medical practitioner to practise medicine in the State unless he or she is first registered. Significant penalties are attached for breaches of these requirements. The establishment of a new register of medical practitioners consisting of four divisions, which came into effect on 16 March 2009, is particularly important. Most doctors will be registered in one of the following three divisions: specialist division, trainee specialist division or general division if they are neither a specialist nor in an approved internship or specialist training post. The remaining division is for visiting medical practitioners from the European economic area providing temporary and occasional services.

Under the Act, doctors with suitable non-EU specialist qualifications are able to gain direct access to specialist registration. Provisions are also included to help doctors holding refugee status to become registered. The Act provides for a number of routes for complaints and concerns to be addressed. A mediation process for dealing with less serious complaints by agreement of the parties concerned is provided for. The Act also includes means for a complaint to be referred to the statutory complaints process established under the Health Act 2004, or to the procedures of another body or authority, or for the referral of a matter to competence assurance procedures, where appropriate. Openness and transparency in procedures must be demonstrated. Over the years, it has been of significant concern that fitness to practise procedures were conducted behind closed doors and that the Medical Council was precluded by legislation from disclosing any details regarding the conduct of inquiries. Arising from these concerns, the Medical Practitioners Act provides that, in general, fitness to practise inquiries are to be heard in public. The council held its first public fitness to practise inquiry hearing on 4 March 2009.

The support of doctors and the protection of patients require the modernisation of medical education and training processes. Provisions on medical education and training have been significantly developed over those included in the Medical Practitioners Act 1978. The new medical education and training functions for the Medical Council, which commenced on 16 March 2009, also cover the functions of the former postgraduate medical and dental board. The Department of Health and Children is currently focused on developing policy, evaluation and financial frameworks to ensure that there are sufficient numbers of highly competent doctors trained to deliver a patient centred, high performance service in Ireland. The Government policy to have a consultant-provided service requires that sufficient numbers of highly qualified doctors are trained in order to meet the needs of the health service into the future.

The Act provides in detail for the Medical Council to approve and monitor medical education and training at all levels. It deals extensively with the approval and monitoring by the council of education and training for medical students, interns and those undertaking specialist training. This includes the specification of guidelines and standards on curricula, training facilities and other matters. The Medical Council has an ongoing role in monitoring, inspecting and approving compliance by medical education and training stakeholders with these standards and guidelines.

The Medical Practitioners Act 2007 makes provision for a new statutory framework, to be operated by the Medical Council, for the maintenance of professional competence of registered medical practitioners. The intention of these provisions is to ensure that doctors remain highly competent throughout their careers. The council will be required to develop, establish and operate one or more schemes of competence assurance, to submit it to the Minister for consideration and to develop statutory rules regarding the operation of the scheme, which must be laid before the Houses of the Oireachtas. Provisions of the Medical Practitioners Act relating to the maintenance of professional competence are the only ones that remain to be commenced. This will be undertaken when the council has developed the relevant schemes. The council has indicated that it expects to be in a position to introduce the professional competence element of the Act in 2010.

The Medical Council's Guide to Ethical Conduct and Behaviour provides that doctors must ensure that they have adequate professional indemnity for the work they perform. I welcome the fact that the council recently completed a review of this important guide and I have been advised that it expects to be in a position to launch the latest version to the profession and the public by the end of November 2009.

I refer to the arrangements currently in place in the State regarding medical indemnity. In particular, I wish to highlight the progress the Government has made on improving the situation for health professionals, including doctors, working in the State. In recent years we have moved to a much more efficient system for providing for indemnity of professionals in our public health services. Under the clinical indemnity scheme, the State has assumed responsibility for the indemnification and management of clinical negligence claims arising from the diagnosis, treatment and care of patients. The clinical indemnity scheme was established because commercial insurers either withdrew from offering insurance cover to obstetricians and obstetric units or were not in a position to provide cover at affordable rates. This was due to the escalation in the size of court awards and associated costs in cases of birth-related cerebral injury.

The scheme is managed by the State Claims Agency and was established in July 2002. One of the main advantages of the scheme is that it rationalised the myriad of medical indemnity arrangements which had applied up to that point. The clinical indemnity scheme means that each enterprise, for example, each hospital or HSE area, assumes legal liability for its employees' alleged clinical negligence. Claims against consultants were brought within the scope of the scheme on 1 February 2004.

The clinical indemnity scheme has responsibility for developing and implementing a national clinical risk management strategy, including the development of clinical risk management standards. The clinical indemnity scheme advises and assists participating enterprises on the adoption of effective risk management. This includes assistance in the development of policies, procedures and guidelines that promote good clinical practice. Risk management advice is informed by analysis conducted on a central national database of adverse clinical incidents reported to the clinical indemnity scheme by health care enterprises. Health care enterprises record adverse clinical incidents and near misses, clinical negligence claims and anticipated claims, employer's liability and public liability incidents and claims. Clinical incidents are reported to the clinical indemnity scheme without patient identification details. The identity of patients and of any staff involved in incidents is revealed to the clinical indemnity scheme only if litigation ensues.

Clearly, the clinical indemnity scheme could not include private practice by consultants undertaken off the public hospital site. However, a number of years ago, in order to address a serious emerging issue whereby cover was either unavailable or withdrawn for obstetric services, the Government undertook measures to ensure that the cost of professional indemnity cover for consultants working in private practice remained available and affordable. This was done by capping the amount of cover that doctors need to purchase and providing a State-backed indemnity over and above that limit. This important system has worked extremely well in making professional indemnity insurance much more accessible and affordable for the medical profession. The level of these caps has been independently reviewed on two separate occasions and has been found to continue to achieve the Government's aims on its introduction.

I am pleased to have had the opportunity to speak on this important matter. I look forward to listening to the debate and the many views that will be put forward on this issue.

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