Seán Fleming (Laois-Offaly, Fianna Fail)

I welcome the opportunity to speak. I thank Deputy Reilly for publishing the legislation. The Government is pleased with the principle of the legislation and Members will resolve that the Bill be read a second time tomorrow evening, in line with what the Deputy proposed. It can be considered in January 2010. It is good to see general agreement on this issue, notwithstanding that a number of details must be worked out.

The Bill seeks to regulate doctors so they have the appropriate insurance in order to practise medicine in Ireland. We live in a litigious society and insurance is important. Nobody could engage in medical activities without such cover because it would be an enormous risk to himself or herself and to his or her patients if something went wrong. As was pointed out, medical indemnity cover is to be compulsory for medical practitioners who are specified by the Medical Council as requiring such cover. I agree with the principle of this but I wonder whether the Medical Council is the best arbiter of these issues. Many of these cases can end up in court and judges may take a different view to the Medical Council as to the level of cover required. Some of these issues will have to be put on a statutory footing to ensure the courts have clear guidelines.

I do not normally mention courts when discussing legislation but inevitably when things go wrong some of these cases end up in court. This is one of the main points I want to discuss with regard to education and training and risk assessment and analysis by the HSE. I also want to draw attention to differentiating between the role of the Department, which will pass the legislation, and the HSE, which will be involved in its implementation through its employment of doctors, consultants and other professionals in the health services and ensuring that the taxpayers' interest is well-covered.

When considering much of the legislation which comes before us in the Dáil one's personal experience as a TD in a constituency can be invaluable in contributing to a debate such as this. I have seen a significant change of emphasis in the HSE with regard to risk assessment and analysis. In my early days as a TD I was aware of many cases that went to court because something went seriously wrong and people ended up with a difficulty for the rest of their lives - or it might have been a temporary situation where something went wrong for example in the delivery of a child where the mother was not satisfied with the outcome - and people sought information and there was a clam-up. People then sought information under the Freedom of Information Act but still could not get all of the answers they sought. Bitterness crept in because they felt something was covered up or hidden. They then engaged solicitors and once solicitors get involved an issue takes on a life of its own and the possibility of good communication and talks stops at that stage. I know the State Claims Agency now deals with all of these cases but historically it did not and many difficulties were created.

I have been impressed by some cases of which I am aware because of local people approaching me as a TD when they were not satisfied with a situation. Often, all people want is an explanation of what happened and what went wrong. There has been a reluctance in the system to provide that information because of fears that it will lead to admissions of guilt or negligence which will open the floodgates. It is a vicious circle because this fear prevents those in the HSE assessing the case from providing information to a patient and the lack of this information provokes the patient to step up activity. One of the most important things we need to do is break this vicious circle.

We must improve the communication skills of doctors. Notwithstanding the significant improvements made in this area in recent years, many people going to a doctor are numbed if they receive bad news and when they go home and try to explain it to their families they do not remember exactly what was said. It is a very basic point but people should write down their questions before they visit a doctor because they will forget to ask the very obvious questions. I know it sounds strange to state this but everybody knows it from his or her own experience. One will ring a consultant's secretary the following day and explain that one meant to ask a particular question and ask the consultant to phone back. However, he or she is busy and the treadmill goes on.

I agree with the principle of the legislation before us. It is important that there is proper indemnity and insurance and I accept the role being outlined in the Bill. The establishment of the implementation steering group this year to drive implementation of the recommendations of the report of the Commission on Patient Safety and Quality Assurance, many of which will require legislative change, is to be welcomed and I look forward to that happening in due course.

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