Joe O'Reilly (Cavan-Monaghan, Fine Gael) | Oireachtas source

Before I get into the specific remarks I want to make about this legislation, I want to record my complete support for the words of my colleague, Deputy Ó Caoláin, regarding the four women who are not yet included in the scheme of compensation for the Dr. Neary scandal. I ask the Minister of State, Deputy Kathleen Lynch, and her colleague, the Minister, Deputy Varadkar, to look at the material that will be brought forward. I know a couple of the women reasonably well. I know one of them very well. I met one of them with Deputy Ó Caoláin some months ago. Neither of us wants to put their names on the record. While I do not wish to repeat the sound case Deputy Ó Caoláin has made, I want to ensure I leave no ambiguity by making it clear that I support him on this important matter and I congratulate him on his lucid presentation of this complex case.

I welcome the opportunity to speak on this Bill, which seeks to ensure it is mandatory for all medical practitioners to have an adequate level of medical indemnity insurance. This is a very important protection for all patients. It goes without saying that this vital protection has to be accompanied by continuing regulation and scrutiny of the insurance sector and of the cost of insurance. Nevertheless, the purpose of this legislation should be unambiguously supported. It is startling enough that medical practitioners are not required to have professional indemnity cover in order to be registered with the Medical Council. Under current legislation, any medical doctor - Irish or otherwise - can carry out cosmetic surgery without needing to have any specialist training or qualification or the requisite insurance. I find this very alarming because it is common practice for surgeons from other countries to spend short periods of time in Ireland carrying out procedures before leaving again. Many of these surgeons are not covered with indemnity. This poses a real threat to unsuspecting patients who may suffer damage if work is carried out by a non-specialist surgeon. Dr. Peter Meagher of the Irish Association of Plastic Surgeons has raised concerns about the level of aftercare service offered at some plastic surgery clinics that have limited opening hours and lack of availability of surgeons. It is clear that a great deal of regulation is needed in this area. I am glad to see that this Bill addresses many of these issues and protects the patients.

It is interesting to make the point, as the Minister of State did in her speech, that there are 57 specialties on the medical registers. Section 6 of this Bill places a duty on registered medical practitioners to have an adequate level of indemnity in place to cover his or her class of practice. This must be in place at the time of his or her registration. Section 9 includes a provision that would make the Medical Council unable to register somebody unless he or she has adequate insurance. Section 11 provides for the power to remove somebody who does not have such insurance. Obviously, insurance is otherwise provided in the cases of lecturers and others working in the State system. All of that is provided for in this legislation.

The work of any medical professional within the health service is both challenging and rewarding. It is important that provisions are in place to protect the safety of every patient and to support our medical professionals. The vast majority of our surgeons, doctors and general practitioners operate in a very safe and responsible way. Sadly, there are exceptions for which we have to legislate. This country has a team of excellent medical personnel who are very highly qualified. There is no implicit suggestion that anything other than this is the case. The Government has acknowledged this by making a great investment in the health service. Some €13.19 billion will be invested in the health service in 2013. This represents an increase of €900 million on last year's figure. That is a very important vote of confidence in our health professionals and is a reflection of the importance of health care.

I would to make a point about primary care, which is germane to this legislation in so far as it relates to doctors, surgeons and specifically general practitioners. Although immense things are being done in this area of health delivery, there is room for more development and more supports here. I am very proud of the new primary health care centres in my constituency. I refer, for example, to the refurbished facility in Kingscourt and to the centres in Bailieborough, Cootehill, Drumalee and Townhall Street in Cavan town and Virginia. This Government has a good record of providing a number of health care centres throughout counties Cavan and Monaghan in the worst of times. While I am happy about that fact, I think we need more. I would like to see a primary health centre in Ballyjamesduff because there is a vital need in that part of my constituency.

GPs are of central importance in our primary health centres. We should be very supportive of our GPs in that role. It was great that we reached agreement with the GPs on the progressive reforming legislation that provides GP cards to people under the age of six and over the age of 70. We should work with our GPs in a co-operative manner. We should be sensitive to their needs and fully respectful of their traditions and their work. They provided our primary health centres for generations. Indeed, their services were often provided intergenerationally in families. We should support our GPs practically and proactively in the development of primary care centres. I think we need more public health nurses. As the country starts to be in a position to afford it, we should begin to augment the numbers of such nurses to get better cover there. We need home care assistants. The home care packages are vital as a cost-effective way of keeping people out of institutional care at a low level of cost. They provide meaningful, good and fulfilling jobs for people. They allow people to stay in their own homes and they allow the primary care centres to function. It is very important for this service to be augmented. We need to put more money directly into care assistance and home care packages.

The people on carer's allowance who provide care in their own homes should be feted and very highly valued in our community. The means-testing system that applies to them is relatively benign. We provide a half-rate of carer's allowance to people who are getting a second payment. There are many good aspects to it as it is. We have restored the respite care grants. While all of that is in place, I think more needs to be done. I think all possible secondary benefits, including those that relate particularly to older people, should be applied to carers to make it a very attractive option to be a carer. I think we should increase the rate of carer's allowance constantly, incrementally and annually as the country can afford it.

It is a no-brainer in two regards. One is because institutional care is so expensive, and in cold, clinical economics it makes sense to support our carers. Second, it is good for the carer and for the person being cared for, so there is a huge amount at stake and very practical and real supports are needed. I suggest to the Minister that more needs to be done in the area of the primary carer at home with carer's allowance, secondary benefits and a gradual further relaxation of the means test. It should be attractive for somebody who wants to care for a relative and practical for them to leave employment and get an income which replaces their employment. They are freeing up a job for somebody else and doing a very important job in the home, allowing people to stay there where they want to be. That is very important and this Bill provides an opportunity to address it. I hope and intend that this speech to the Chamber is not my last. In one of my latter speeches I am delighted to get the chance to speak on the carer's allowance because I feel very strongly about it.

I also think this Bill protects patients and can only be supportive of our GPs. Proper practitioners have no difficulty in being compliant in these areas and this stops the wrong people coming into the market. A point was well made earlier about insurance, about people needing regulation and the cost of insurance regulation, as well as the need not to have exploitative rates of insurance. There is a need to stress test the insurance industry when it seeks increases in insurance costs, and this idea merits support. The legislation is excellent, it is very reassuring for patients and is a further reform of our health system that is to be welcomed and commended.

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