Seán Connick (Wexford, Fianna Fail)

I welcome the Bill. The main thrust of Deputy Reilly's Bill is to provide for insurance requirements for medical practitioners in Ireland. The clinical indemnity scheme, which was established in 2002, plays an important role in the provision of professional indemnity in the public health care system. Through the clinical indemnity scheme, the State is responsible for negligence claims arising from the care and treatment of patients in public health care. Up to the establishment of the clinical indemnity scheme, each defendant in a clinical negligence case, such as the hospital, doctor, nurse, consultant and health board, had separate legal representation. This was due to the diverse insurance and indemnity schemes of which each was part. This significantly increased legal costs, added to the time it took to process a case and led to many insurance providers either refusing certain types of cover or offering it at vastly increased premiums. This was a particular concern for hospitals with obstetric units and for obstetricians and gynaecologists due to the increasing costs and amount of cases arising from birth-related cerebral dysfunction. Under the clinical indemnity scheme, each hospital or HSE area, depending on the circumstances, now assumes liability for its employees' alleged negligence. This has provided us with a far more cost-effective system of professional indemnity within the public health care system. The clinical indemnity scheme plays an important role in our public health care system and the House should recognise and support the State Claims Agency in implementing it. However, we have to recognise that the structure of the clinical indemnity scheme is based on enterprise liability and as such it is not an insurance based scheme. As a result, we need clarification as to whether the clinical indemnity scheme would fall foul of Deputy Reilly's Bill if it was passed into legislation by the House.

Deputy Reilly's Bill proposes that the Medical Council should regulate for the form and level of medical indemnity cover required by each medical practitioner practising in Ireland. As things stand, the Medical Council's guide to ethical conduct and behaviour states that, "Doctors must ensure that they have adequate professional indemnity for the work they perform". I have a concern about the ability of the Medical Council to adjudicate on what is the appropriate minimum sum of indemnity necessary for each class of medical practitioner, as it would be required to do under the Bill. A similar provision was passed in a Bill in Britain in 2006 which required medical practitioners to hold an adequate and appropriate indemnity arrangement. The General Medical Council, which is Britain's version of our Medical Council, has established an expert working group to advise on what constitutes an adequate and appropriate indemnity. After two years of deliberations, this expert working group has yet to resolve what looks like such a simple issue.

On reading the Bill I freely admit there is merit in a number of the proposals which have been put forward. The issue of medical indemnity is one which poses a serious challenge to medical practitioners throughout the world. We certainly do not want to find ourselves in a position where patients who suffer from the negligent acts of medical practitioners discover that the practitioners concerned do not have an adequate level of medical cover or even worse, no insurance at all.

Deputy Reilly's stated aim of ensuring that we do not allow practitioners, particularly those from abroad, to practise in this country without insurance is certainly admirable. However, I do not believe we should divorce the sole issue of medical indemnity from the wider issue of the general standards of patient care and quality assurance which we expect of medical practitioners in Ireland.

The Commission on Patient Safety and Quality Assurance has advanced a very clear strategy for the future direction of patient care in Ireland. This group has made 134 recommendations which it wants to see adopted. Among these recommendations are proposals on the licensing of public and private health care providers and proposals for the introduction of a system of privileging of health care professionals. An implementation steering group has been established to commence the implementation of the commission's recommendations and its first report is due to be published shortly. I welcome the recommendations of the commission and feel they will make a significant contribution to the standard of health care provided. I also acknowledge the work being done by the implementation review group, which is chaired by the chief medical officer of the Department of Health and Children. I look forward to seeing its first progress report and to seeing how it proposes to turn the commission's recommendations into practical solutions to our health care needs.

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