Dara Calleary (Mayo, Fianna Fail)

I welcome the chance to speak on this legislation. When I read some background information on the Bill, it struck me that it is accepted this problem is not just found in Ireland - it is a Europe-wide problem. I understand it is particularly acute in the UK. Is it time to examine this issue at EU level? Why are the health systems in Ireland, the UK and Europe as a whole insufficiently attractive to the graduates who, as taxpayers, we have put through our education systems? Many medical professionals from this country are going to New Zealand and Australia. It seems to be a Europe-wide problem. Rather than accept it as the norm that this challenge will arise here, in the UK or across Europe every six months, perhaps it is time for us to examine the matter collectively at EU level.

When the results of the leaving certificate and the points race are published in four or five weeks, we will find once again that there is a huge demand for medicine degrees. Those who are maintaining that level of demand are being lost to our system at some point along the way. We are being forced to pass rushed legislation of this nature to deal with that problem. Deputy Twomey - it is relevant to note he is a doctor - said that as users of the health service, we have accepted being dealt with by international doctors while at the same time wondering where the Irish graduates have gone. Perhaps patients accept that things often happen to junior doctors. I might return to the question of whether many incidents are not being reported or dealt with.

We need to be careful about a couple of aspects of this legislation. I understand Cathal Magee told the Committee of Public Accounts this morning that 158 junior doctor posts are vacant. In the rush to fill those vacancies, we have to make sure we retain the checks and balances that are normally in place when medical personnel are being recruited. They need to be as robust as ever. As a professional, Deputy Twomey understands the sanctity of the doctor-patient relationship. We do not need to start reciting examples of that sanctity being broken. If that were to happen under the new approach proposed in this legislation, it would undermine the whole system. We need to make sure, in the rush that is under way, that the requisite standards are maintained.

It is probably a given, subject to what Deputy Twomey was saying, that those being recruited should have proficiency in their medical skills. They need to have proficiency in many other areas as well. I am not just talking about non-consultant hospital doctors - this applies right across the system. In recent years, I have had personal experience of dealing with consultants on behalf of family members. Some of them are absolutely fantastic at treating patients and communicating messages to patients. Others are just horrendous, frankly. Some consultants in the system want to have a lord-tenant relationship with their patients. They treat people who are paying to use their services with utter disgust. They see patients as something to get out of the way very quickly. A patient with a range of conditions is fragile enough without having to deal with such a scenario.

As we review educational standards, we also need to consider standards of civility and treatment. I am reluctant to use the term "customer service" because I hate looking at the health service as if it were a business with customer relationships. I am sure every Member of this House has experienced a difficult relationship with a consultant. Thousands of people have had similar experiences. It can be difficult to get some consultants to understand messages or to show respect. Perhaps the process of opening the examination of standards of education will give us a chance to examine these problems formally.

Deputy Twomey spoke about the approaches of general practitioners. We do not use our GPs enough. They are contacted when things go wrong but they should also have a role in health promotion and illness prevention. The Deputy has spoken previously about such matters, which are absolutely crucial. We tend to rush to accident and emergency departments when minor problems develop. If we had a primary care system that was properly managed, resourced and facilitated throughout the country - such a system is beginning to take hold - it would take much of the pressure from accident and emergency units.

I was intrigued to hear Deputy Twomey refer to geographical models within the health system. The House debated that matter last night in the context of the hospital network, which is a huge issue. I often wonder whether the bean counters and accountants in the HSE fully understand the insecurity people can feel when hospital services are geographically distant from them. It is grand in this city because people can hop on a DART or get on the motorway and get to hospital relatively quickly. There is a necklace of hospitals around the city of Dublin. It is a big worry that people in rural areas who suffer heart attacks or strokes may be an hour away from the main hospital in Galway or elsewhere. It strikes me that we might need to examine the models to which Deputy Twomey referred. Not only do we need to use our GPs to a greater extent, but we also need to scale up on our local senior nurses. We need to ascertain what skills are held by district nurses and examine whether it is possible for them to use such skills in emergency situations as they arise. That would alleviate the pressure on accident and emergency units, which is driving the problem we are discussing.

I would like to speak about the recruitment of doctors by private clinics. I often wonder whether we are looking at a timebomb in that regard. In recent years, the Medical Council has taken cases against some private clinics. Deputy Twomey spoke about luck. Unfortunately, some patients in private clinics have not been lucky. Will the standards put in place by the Minister and enforced by the Health Information and Quality Authority apply in private clinics as well as HSE-run hospitals? I understand the Medial Council has dealt with cases in Galway in which patient care was compromised considerably. That is on the public record. We need to make sure such cases are not replicated.

I wish to refer to the approach of the HSE to hospital management and reconfiguration. The HSE's attitude to Members of this House was laid bare during last night's debate. Deputies were given assurances by the HSE only for it to sanction a complete reversal within minutes. Those who are involved in hospital reconfiguration and in the running and management of the HSE need to understand we have a mandate. We have put ourselves in front of the people. We try to present problems, cases and scenarios to the HSE and many other bodies. We are talking about the HSE in this instance. I ask Minister to instil within the HSE a culture of respect for Deputies and Senators, and public representatives in general, as part of the process of reforming that organisation. These processes need to be improved so we can carry messages and make representations on behalf of people.

I understand the Minister is committed to the introduction of the Dutch model of care. I have not had a chance to check whether the problem we are discussing arises in the Netherlands. As I have said, it is a Europe-wide problem. How does the Dutch equivalent of our six-month training rotation work? Our system has probably not changed since the Minister's time and that of Deputy Twomey. One does six months and then one moves on. Although our training mechanism has served the country well, is it the proper one for these times? I am sure Deputy Twomey will agree that the parts of the health service that work - quite a number of them do - are working well. At a time when we are examining everything, it is time to examine whether our training system works for 21st century Ireland. Does it deliver a good experience for students who are becoming doctors? Does it help to make them as proficient as possible? Are we using it to cover gaps in our system? If so, it needs to be addressed.

I wish the Minister well in this portfolio. As a former Opposition spokesman on health and as a medical practitioner, he knows what he is taking on. This is a system. We do not want to have to return to deal with the same problem six or 12 months from now. We have to look at it now. The time has come, and perhaps the Minister can lead this effort in the context of Ireland's upcoming Presidency of the Council, for a European-wide effort to identify why there is a problem in Europe attracting medical practitioners into hospitals.

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