Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

I move: "That the Bill be now read a Second Time."

I am pleased to have the opportunity to address the House on the Second Stage of the Medical Practitioners (Amendment) Bill, as passed by Seanad Éireann. The purpose of this Bill is to make it mandatory for medical practitioners, who are engaged in medical practice, to provide evidence of minimum levels of indemnity insurance cover to the Medical Council. They will do this when they first register with the council and thereafter on annual renewal of registration.

There are currently approximately 20,000 medical practitioners on the Medical Council’s register. However, there is no legal obligation on a medical practitioner to have medical indemnity insurance cover. In some cases also medical practitioners may have indemnity cover, but this cover may be inadequate for the specialist area in which they practise. As a result, some patients and the users of medical practitioners' services may find they are unable to seek redress in the event of a medical mishap or negligent care from a medical practitioner. Given the high cost of litigation and the long-term consequences of some adverse events, this legislation is to be welcomed as patient-focused and progressive.

The main purpose of the original Medical Practitioners Act 2007 is to protect the public and to have a proactive system of robust registration and regulation of the medical profession in order to minimise the risk to the public and to safeguard the health and well-being of people accessing health services. Under the Medical Practitioners Act, the Medical Council must register every medical practitioner who practises in Ireland. In anticipation of the enactment of this Bill, the council already asks medical practitioners on

application for registration and on annual retention of registration, whether they have indemnity cover. On the enactment of the legislation, medical practitioners will not be registered to practise unless evidence of adequate indemnity cover is provided to the council. This development can only be to the benefit of patients.

The Bill, as originally published, put an onus on the Medical Council to specify minimum levels of indemnity on being advised by the State Claims Agency of what these levels should be. However, it was agreed on Committee Stage in the Seanad that the Bill should be amended to make it explicit that it would be the State Claims Agency which would specify minimum levels of indemnity. Currently, the State Claims Agency's functions relate to the management of clinical claims under the clinical indemnity scheme and so it has the expertise, knowledge and experience in this area. It also has close contacts with private medical indemnifiers, insurers and other experts in the area of clinical negligence and risk. It is, therefore, very well placed to assess and specify the minimum levels of indemnity which should be required by medical practitioners. This policy change required that a new function be given to the State Claims Agency under section 8 of the National Treasury Management Act 2000, as amended.

On 5 June 2015, Government approved the drafting of amendments to the Bill. In the current Bill, the State Claims Agency will link with relevant bodies in order to assess and specify what the minimum levels of indemnity should be for medical practitioners in different specialties on the Medical Council's register. There are currently 58 medical specialties on the register. Practising in some specialties has an inherently higher risk of a medical mishap than practising in others. Even within different specialties, some types of medical practice, by definition, will have a higher risk than others. The State Claims Agency will specify the indemnity levels to the Medical Council, which will check the indemnity cover held by each medical practitioner on the register. It is important to point out that all doctors who work in the public health system are provided with medical indemnity insurance under the State's clinical indemnity scheme. Likewise, private consultants who practise in public hospitals are also covered by this scheme.

However, doctors who are engaged in fully private practice in private facilities must purchase private indemnity insurance cover. There is a wide range in the cost of cover for consultants engaged in private practice. For example, a consultant practising dermatology, based on figures from medical indemnifiers, would be considered low risk. The annual premium for this practice could be around €16,000. However, a spinal surgeon may have to pay over €100,000 for annual medical indemnity insurance cover, reflecting the much higher risk involved in that practice. The Joint Committee on Health and Children heard last year how the cost of cover for medical indemnity in private practice has increased significantly in recent years. For example, the increase was around 42% in 2014. The reason given by the medical defence organisations for this increase is that it is mainly due to the high cost of awards for clinical negligence in Ireland. This is supported by the increasing cost of clinical claims under the clinical indemnity scheme. In 2014, the cost of the scheme was €106.2 million but in 2015 this had risen to €187.7 million. The cost in 2016 is expected to be over €220 million.

The legislation will not require medical practitioners to pay any more than would be the normal adequate cover for the type of medical practice in which they are engaged. A medical practitioner who is not engaged in medical practice does not pose a risk to another person relating to his or her medical practice and so does not need cover. For example, a practitioner who is a full-time lecturer and who is not lecturing in a clinical specialist area will have no legal obligation to have medical indemnity insurance cover.

The legislation is one element of a package of measures being introduced by Government relating to medical negligence. Other elements include legislation on pre-action protocols for clinical negligence cases. This forms part of the Legal Services Regulation Act 2015, which was enacted by the Minister for Justice and Equality. That legislation should help shorten the time that it takes for clinical negligence cases to go through the courts. In addition, the heads of Bill on periodic payment orders, which will form part of the civil liability (amendment) Bill, have been agreed by Government and this legislation will be published shortly. These tort reform measures are being accompanied by a range of patient safety measures aimed at reducing the risk of clinical incidents happening in the first place. Patient safety and quality must be at the heart of our health services and it is important to keep our patients and service users at the centre of everything we do. Delivery of health care is, however, inherently risky and while it is inevitable that things go wrong, there is much that can be done to prevent harm or error, identify the cause when it occurs and learn from this to improve services.

My Department is fully committed to progressing the programme of major patient safety reforms agreed by Government last November. These measures are focused on legislation, establishing a national patient advocacy service, introducing a patient safely surveillance system, extending the clinical effectiveness agenda, a national patient experience survey, a national patient safety office in the Department and setting up a national advisory council for patient safety. Within the programme of legislation, we intend to progress the licensing of our public and private hospitals, the health information and patient safety Bill and provisions for open disclosure.

I hope Deputies will support this important Bill. Given the trauma faced by patients and their families when things go wrong, there will at least be clarity that medical practitioners have adequate minimum levels of medical indemnity insurance cover. I thank Senators for approving the Bill and for checking on Committee Stage that the legislation was robust and fit for purpose. I commend this Bill to the House.

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