Séamus Healy (Tipperary South, Workers and Unemployed Action Group)

I welcome the Bill and the opportunity to speak to it. I understand its importance and appreciate the necessity for its being fast-tracked through the Dáil. The Minister will be aware that all sides of the House understand the position and are keen to have the Bill passed today.

It appears we are in a situation similar to the one we were in some years ago with temporary registration which in my experience, having worked in hospital for years, worked rather well. I am not sure why that system was changed, but I imagine there were good reasons for it at the time.

It is important to acknowledge the contribution foreign or non-national doctors have made to the health service over a long period. In my experience, there has been a considerable number of excellent, well trained doctors and trainee doctors who have given excellent service throughout the years.

Given the problem with which the Minister has to deal, the Bill is both urgent and welcome. This measure should have been taken before now. It should have been introduced during the time of the previous Government.

I have wondered about the role of the HSE since the shortage of doctors was identified. The problem did not arise overnight; it was brewing for some time. Therefore, I would have expected the HSE to have dealt with it long before now.

I share the Minister's view on the HSE. I never believed its establishment was a good development. I opposed its formation in this House because I believed at the time - it has turned out to be true - that effectively it would be an unaccountable body. Certainly, it is unaccountable to this House. It has became centralised and is out of touch. With its establishment, local input and the input of locally elected members representing the public were curtailed. Local representation disappeared and, effectively, the HSE became an unaccountable body. In my experience, the idea of consultation is merely an afterthought for it. Effectively, it decides what it wants to do in a given case and the consultation process is either non-existent, incomplete or a rubber-stamping exercise in respect of a decision already made by senior HSE managers who have little or no knowledge of local circumstances.

The formation of the HSE allowed the Minister of the day to wash his or her hands of matters. There was such an occasion in the previous Dáil when parliamentary questions were refused on the basis that the Minister had no responsibility for the day-to-day running of services. I welcome the indication from the Minister that he will initiate reform in that regard. His initial dealings with the board and the appointment of new members are welcome.

Several speakers have raised the matter of language proficiency and the standard of doctors to be appointed using the new procedures. The detail set out by the Minister is welcome. He refers to proficiency in the English language. On occasion, this has presented a difficulty for patients, colleagues and other professionals in hospitals. What the Minister has said appears to cover the matter. One possible reason the HSE did not address this issue in the past is that it somehow thought the shortage of junior doctors might be used for the purposes of the forced reconfiguration of hospital services. While I hope I am wrong in this regard, one worries that everything the HSE does with regard to hospital services is motivated by its so-called goal of reconfiguration or, in other words, the stripping of services from local hospitals and their centralisation in larger regional hospitals. I absolutely oppose this process as the normal range of health services at hospital level should be available locally with easy access for local users.

While the shortage of non-consultant hospital doctors should not be used in such a manner, it also should not put at a disadvantage those hospitals which have built links during the years with medical schools both in Ireland and abroad. I refer to hospitals with proven records of provision of high quality care which have been able to attract doctors on this basis during the years and which continue to so do. Such hospitals which have good in-hospital training services for doctors and through their links with medical schools in Ireland and elsewhere been successful in recruiting non-consultant hospital doctors should not be placed at a disadvantage. I have heard suggestions from time to time that the HSE might wish to relocate doctors from such hospitals to regional hospitals. However, the point has been made in the media more than once that this problem affects both small hospitals and many of the regional hospitals.

I welcome the two-year registration period and believe there should be long-term manpower planning. New career paths and strategies, as well as planning on a long-term basis, should be put in place to ensure this problem does not recur every six or 12 months.

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