Billy Kelleher (Cork North Central, Fianna Fail)

I welcome the opportunity to speak on the Bill. I thank the Minister's officials for their offer to brief us on the Bill owing to the timeframe between publication and today's debate. The shortage of non-consultant hospital doctors has been a problem for some years because of structural issues with the provision of health care here. We have been slow to address the issue over the years. Those doctors have been the workhorses in the provision of health care for many years. Obviously the problem has been exacerbated by changes in economic circumstances, new opportunities, and people willing to travel outside the country for career purposes and self-advancement in their profession, resulting in the problems we face on 11 July.

The Bill will obviously assist in recruitment efforts. I know the Minister and the HSE are making tremendous recruitment efforts in India and Pakistan, which it is hoped will bring enough non-consultant hospital doctors into the system to address the deficiencies that exist. The Minister referred to the importance of proficiency in the English language. When we pass the legislation, it is important that there is confidence and integrity in the system of registration of doctors under the supervised division. The last thing we need is a perception permeating that somehow these people, who are registered for two years, are yellow pack, so to speak, non-consultant hospital doctors. It is critical the public and other medical practitioners have confidence in these non-consultant hospital doctors. We all know there is quite a hierarchical structure in the higher echelons of health care and we do not want to be seen to have different grades and standards. I am satisfied the Bill makes sufficient provision for assessments prior to registration, registration itself and supervision thereafter to ensure the public and their peers will have confidence that the people who arrive here to provide much needed services are people of high quality.

In most societies there can be a sinister undertone of racism. In previous general elections I contested in my constituency of Cork North-Central it has been something that has cropped up now and again. The last thing we need is the perception that a doctor of a different skin colour is somehow less qualified than other doctors, which can have a very damaging impact on those who come here to provide the services we badly need. I hope the Bill will give everyone the confidence that the people who come here are here because of their ability, knowledge and expertise as opposed to people filling posts because of a shortage here.

The shortage of non-consultant hospital doctors is a structural issue that needs to be addressed. Given the Minister's knowledge of the health services, I know he will make strides in this area. Non-consultant hospital doctors need to have career paths and training opportunities and need to be able to see they can advance their knowledge, skills, expertise and career. I would welcome any changes to allow specified training programmes in order that when they leave, they do so after both giving and gaining. It would be positive to have a movement of doctors into the country and some of our own going outside, gathering experience and coming back again. That would be welcome provided we have the legislative basis to ensure the registration system has the confidence of the applicants' peers and the public.

Surveys have been carried out by various organisations and health representatives into the lack of non-consultant hospital doctors in accident and emergency units. There is disquiet and concern in many communities that they might lose accident and emergency services come 11 July. I would like to get clarity on the issue. For example, there is grave concern that the accident and emergency unit in the Mid-Western Regional Hospital will operate from 8 a.m. to 8 p.m. and close at night-time, requiring patients to be transferred to Galway or Cork. We need clarity as to how many non-consultant hospital doctors the Minister expects to have in place on 11 July. Where there are deficiencies, we will need continued recruitment in the months ahead to fill those pests. In the meantime, if services must be withdrawn on a temporary basis to ensure quality of care and that professionalism remains high, we need an assurance that these services will be reinstated when the non-consultant hospital doctors required are recruited in the months ahead.

There is a concern, perhaps even a suspicion, that the HIQA report is one element being used to downgrade services throughout the country and, equally, that the shortage of non-consultant hospital doctors will be used as a mechanism to temporarily withdraw services and, by stealth, to announce in the months ahead that they are to be withdrawn on a permanent basis. We need clarity as to the hospitals which may have services withdrawn temporarily in the weeks ahead because of the shortage of non-consultant hospital doctors and when the HSE anticipates the services to be reinstated as non-consultant hospital doctors are recruited.

On the broader issue, the Bill is welcome and will have a major impact on recruitment. There is no doubt that the two-year provision and the putting in place of training programmes for self-advancement and career advancement will attract many doctors from India and Pakistan to come here.

Section 11 reads, "In the case of a medical practitioner whose name was previously registered in the Supervised Division and that practitioner's name is not registered in any other division of the register, the Council may make an ex parte application to the Court for an order prohibiting that practitioner from applying for registration in any of the divisions of the register". To clarify, I presume the purpose of this provision is that if a non-consultant hospital doctor arrives and is registered in the supervised division and a complaint is brought against him or her which is followed by an investigation that takes place after the expiry of the two-year period, that doctor will not be free to apply for full registration. This is a very safe and significant mechanism to include in the Bill, as it provides for clarity that doctors coming to Ireland will have the required qualifications, expertise, capabilities and language proficiency. In the event of anyone slipping through the examination process net, it is good that there will be a mechanism in place to deal with the matter.

The Minister knows as well as I do that the primary concern is the provision of services in local hospitals. It is a bone of contention, in particular, given the situation at Roscommon County Hospital in recent days, where people believed the Government had made a commitment which was breached. They had supported political parties in good faith, assuming that the services would be retained and even upgraded, as stated. While I do not want to make a strong political point in the context of the Bill, it is critical that we do not arrive at a situation where in the coming weeks communities will accept in good faith the withdrawal of services as being only a temporary measure, while an attempt is made to fill non-consultant hospital doctor posts, only to find in the coming months that a decision has been made to withdraw the services completely. The Minister must state clearly in the House that this will not happen, which will put many communities at ease in the coming months when they hear about the temporary suspension of services.

There were many people outside the gates of this Parliament yesterday protesting on behalf of Roscommon County Hospital and there is genuine disquiet throughout the country on the issue. Hearing that one of the largest hospitals in the country may have to suspend accident and emergency services on a 24-hour basis puts fear into people in smaller communities and hospitals. The Minister said some time ago on the "The Frontline" programme that he could not guarantee that all services would be maintained and that there could be temporary closure of services in smaller hospitals. However, when we hear there could be temporary closure of services in larger hospitals, this causes much disquiet.

Will the Minister outline the hospitals which will have a full complement of non-consultant hospital doctors on 11 July, the hospitals which will have enough non-consultant hospital doctors to retain all services but at a reduced capacity, and the hospitals which will have to suspend accident and emergency services and other specialties in the coming weeks? If there was clarity on this question, we could take in good faith that the Minister, with the HSE and those recruiting doctors, were making every effort to fill these posts quickly as applicants were assessed, deemed suitable and registered in the supervised division.

With regard to the hierarchical structure in the medical profession, there is no doubt non-consultant hospital doctors are the backbone of front-line services. At times, they are overworked and work exceptionally long hours, with strange rostering times that put huge pressure on an individual. This issue was debated some years ago in the context of exemptions to the EU working time directive. It is critical that not only there be opportunities in the context of training and career advancement but that we try to change the attitude that has permeated the health system, namely, that non-consultant hospital doctors and junior doctors can be worked for excessively long hours and treated badly or with disdain in some cases, as I witnessed as a hospital patient. It will take a long time to change attitudes and the perceptions some consultants may have of other medical professionals. I know this causes difficulties in hospitals, even in trying to recruit non-consultant hospital doctors, because they hear through the system that certain hospitals may not be a great place in which to work. If there is that perception, it will obviously be more difficult to attract non-consultant hospital doctors to these posts.

I wish the recruitment process well. The Bill's focus on the Medical Council, the recruitment process and the registration process will help to instil the confidence the public should have in the quality and professionalism of the doctors who come to work in this country. Equally, whatever happens, we must not end up in a situation where there is a perception that the people concerned are in some way less qualified. The issue of racism can be used in very sinister ways at times, as I have witnessed in my area. When doctors have a different skin colour or speak with a different tone, there can be an idea that somehow they are less qualified and less capable of providing the good quality care we expect from those who have taken the oath. I hope it will become clear in the course of the debate that this legislation will ensure no one will slip through the net and that the integrity of the process will be retained.

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