Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

Fianna Fáil will be supporting this Bill and welcomes the fact that it is before the House for debate. This has been a long time in gestation. It has been discussed for a long time in various Dáleanna over the years and there have been Private Members' Bills on it as far back as 2007, if memory serves me right. We are now in a position where we can move this legislation through the parliamentary process. It is important that the public has full confidence when it avails of medical services in the State, be they in the public hospital or health care system or the private health care sector. This Bill will address those issues. The fact that people must register with the Medical Council and show they have adequate indemnity cover is very welcome.

The Minister of State said that the State Claims Agency will assess what the required indemnity threshold will be for the various specialties and sub-specialties in the private sector. This is something we welcome. However, we do not want too much delay or prevarication on the part of the State Claims Agency in assessing what is considered acceptable cover and then referring it to the Medical Council for to be included in the criteria for the registration of clinicians, physicians and others. It is alarming that there is no legal requirement for indemnity in the private sector. This has caused difficulties for individuals who have had to take cases and find that there is no cover available to them in the normal process when harm is done to them.

That is certainly of grave concern. We have seen that in certain areas and cosmetic surgery, in particular, has caused considerable difficulty for certain people in recent times, leading to class actions, etc.

Of course, this is just one of a suite of measures to be introduced. The issue of open disclosure and duty of candour is another key area in ensuring that there is confidence in the system and that it is not as adversarial as at present. If damage is done to an individual we need to have a system in place. While accepting that clinicians have an entitlement to defend their professional integrity, dragging people through a very onerous and confrontational legal system is distasteful, to say the least, particularly when harm has been done to them.

While we must all come to the pre-legislative scrutiny with open minds on open disclosure, it is something that needs to be not just written in legislation but also instilled in the culture. If there is an adverse effect on an individual who has had interactions with the health system- public or private - there should be an onus to accept, inform and make redress without the usual delay, prevarication and, sometimes, a very hard-headed legal process for people to overcome in order to seek redress. I welcome that aspect of the provisions that are coming.

It is alarming - the Minister of State referred to this in his speech - that medical indemnity insurance costs have increased by 42% in the private health care sector. Under the clinical indemnity scheme, payments have doubled in two years, from €106 million in 2014 to an estimated €220 million in 2016. Of course, that has an impact all the way back to people who are taking out private health insurance. It impacts on people who are trying to maintain private health cover because these costs are ultimately borne by people who take out private insurance and use private health care facilities.

We need to look at this area very quickly to understand the reasons behind it. Over the years in various Oireachtas health committees we have had discussions about the indemnity, the costs of the awards and all that flows from that. If damage is done, obviously there must be redress, but we need to ensure that our payments systems are in line with best international standards and practices in similar legal systems to ours.

Damage was done to people in Our Lady of Lourdes Hospital in Drogheda and in some other areas over a number of years. When discussing issues like this we must acknowledge that some people have been treated very poorly by the system, in the first place when they interacted with the health services. Subsequently it sometimes takes the State a very long time with huge resistance to redress. That applies not only to the health area, but also to institutional abuse where the State has put up huge resistance where by and large it is accepted that a wrong was perpetrated to an individual or a group of people.

At times the State does itself a disservice by being too entrenched by trying to defend a position that is no longer defensible. If we expect open disclosure and a duty of candour from individuals working in the health system, then the State should equally be obliged to have an open disclosure and a duty of candour to ensure that individuals are not put through onerous processes. I accept that the State has to defend its position, but the State for many years has defended positions that were wholly indefensible. With almost infinite resources and taxpayers' money available to it, the State has fought citizens tooth and nail to the steps of the Supreme Court, knowing full well that at the end of the day that it would lose. It was simply a policy of prevarication and obfuscation. We need to change that if we are to have a true republic where citizens have an entitlement to at least due process and equal opportunity in trying to seek redress as opposed to taking on a state that has and uses very heavy-handed tactics from time to time.

While not wanting to delay the House too much, I wish to broaden the debate. We welcome the Bill, which is significant in many ways. There is, of course, an issue with the number of clinicians, doctors, physicians and other medical professionals coming into the country. We need integrity in the process. We are doing not just ourselves but global health a disservice by not training enough of our own doctors and nurses. We have a dearth of highly trained professionals in this country, while some of our best and brightest are leaving. At the same time we are going to the poorest countries to pillage their best and brightest, who are needed in their own countries.

There is a moral imperative here. As the First World country we claim to be, we are consistently trawling the world looking for nurses and doctors from elsewhere. At the same time we will not train enough in our own system and many of those we train are leaving. From a moral and ethical point of view that needs to be addressed. If people want to come here and feel they have something to offer, they are more than welcome. However, we need to address the moral and ethical issue of a First World country going out and basically taking people from countries that need them badly. We are targeting countries with a series of recruitment advertisements, while nurses and doctors trained here are going elsewhere - primarily to other First World countries obviously. We then leave a dearth in the countries from which we get them with no obligation on us to assist them in any way. As a country, we should think long and hard about that. I am very liberal when it comes to opening up our labour market to people from outside and I have always welcomed that. I believe we need to discuss the medical area because it has an impact on their home countries.

In looking at the suite of measures, we need to ensure that the State Claims Agency robustly, efficiently, effectively and quickly assesses the type of indemnity required for the various specialties and sub-specialties. Equally we need to assess the impact the clinical indemnity scheme and the pay-outs is having on the cost of health cover and the provision of private health care in the country. In the overall health service - public and private - open disclosure and a duty of candour needs to be not only addressed statutorily but also embraced as a cultural shift in thinking.

Overall I welcome the concepts behind the Bill. We need to move quickly to assess what is required to implement it, ensuring that the resources are available to the State Claims Agency. We often pass legislation here without providing the agency that has to make the assessments and implement it with the resources to do its job effectively. It is critically important that whatever measures are required are available in supports for the State Claims Agency to make these assessments to ensure the Medical Council has full knowledge of what indemnity is required.

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