John Cregan (Limerick West, Fianna Fail)

I do not, as Deputy Naughten knows. Due to his profession, Deputy Reilly is au fait with what is required.

The main provisions of the Bill are that medical indemnity cover is to be compulsory for all medical practitioners specified by the Medical Council as requiring such cover; the Medical Council will make the rules specifying the categories of practitioners required to hold medical indemnity cover, the form and level of such indemnity cover including the minimum sum of medical indemnity cover for each class of practitioner, and the bodies recognised by the council for the purpose of providing such cover; written evidence of appropriate indemnity cover is to be a requirement for the Medical Council to issue a registration certificate, which is the main thrust of the Bill; and it is to be an offence to practice without medical indemnity cover or to falsely represent having medical indemnity cover with penalties for summary convictions or convictions on indictment. We have had cases where members of the profession from other countries have practised here and they were not always insured to do so. This is highly dangerous.

In recent years we have moved to a far 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, gynaecologists and those in obstetric units who 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 case of birth related cerebral injuries.

The scheme was established in July 2002 and is managed by the State Claims Agency. One of the main advantages of the scheme is that it has rationalised the myriad of medical indemnity arrangements which had applied up to that point. Under the clinical indemnity scheme each hospital or HSE area assumes legal liability for its employees' alleged clinical negligence.

The Commission on Patient Safety and Quality Assurance was established in January 2007 to develop clear and practical recommendations to ensure the safety and quality of care for patients is paramount throughout the entire health care system. Its report, Building a Culture of Patient Safety, was published in 2008 and approved by the Government in January. The report contains 134 recommendations including proposals for legislation; licensing of all public and private health care providers; developing standards on patient safety and quality that will apply across the entire service; and the introduction of systems of credentialing and privileging for health care professionals.

Measures taken by the Minister and the Department to restore public confidence in the health service include the establishment and continued strengthening of HIQA and the Office of the Chief Inspector of Social Services, the assignment of executive responsibility for all matters relating to patient safety to the Office of the Chief Medical Officer and the commencement on 1 March of the provisions of the Health Act 2007 on protected disclosures.

I welcome the Government's position on the Bill. It recognises that some of the issues in the draft Bill may be worthy of further consideration and I believe they are. However, a number of matters require further research and reflection and these include, but are not limited to, the competence of the Medical Council to determine what is an appropriate minimum sum of indemnity coverage for each class of practitioner and EU issues regarding freedom of mobility. These will need to be considered and will require further investigation and legal advice. The Minister has given a commitment to put in place a review group and to report back by January. I welcome that commitment. The Minister is taking the right approach and I commend Deputy Reilly on bringing the Bill to the House.

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