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

I thank Deputies Kelleher, O'Reilly, Kelly, Harty and Mattie McGrath for their support for the legislation. I also thank the Deputies for putting forward ideas and setting out some of the problems we have in the health service. That is what this debate should always be about. I welcome their contributions on Second Stage of the Medical Practitioners (Amendment) Bill and the fact the Deputies have expressed their broad support. Medical practitioners work tirelessly to protect public health and the vast majority do not engage in medical practice without adequate indemnity cover. This legislation will reassure patients that doctors are practising with appropriate levels of medical indemnity insurance cover. It should serve to weed out the very few, and I emphasise that it is a very few, who do not do the right thing, that is, those who do not have adequate levels of cover.

Deputy Kelleher referred to the possibility of delay. I do not expect the State Claims Agency to delay the process of specifying minimum levels of indemnity as adequate resources are available to the agency for this purpose. Proposals for open disclosure legislation will undergo pre-legislative scrutiny this Thursday. I agree with Deputy Kelleher that the legislation should be progressed as a matter of priority as part of the suite of measures relating to tort-reform, specifically the civil liability (amendment) Bill, which will introduce periodic payment orders. The legislation will allow for staged payments to those who have suffered catastrophic injuries.

Deputy O'Reilly raised very important issues in regard to Shannondoc, litigation and the working conditions of nurses. She also made a very important point about the Government constantly speaking about the €14.6 billion in the health budget that we secured this year. It is very important that the positive things are recognised too. We have €20 million for the National Treatment Purchase Fund to tackle waiting lists and 10,000 medical cards for children with disabilities are also coming on stream. We have also seen a reduction in prescription charges for people over 70 and supports and services for school-leavers with disabilities. We also had the €5 million to kick-start the Healthy Ireland fund. Things are happening and the money is being rolled out. I accept the Deputy's point that there are major issues of reform and efficiency. We must constantly invest in health services which have been neglected for many years. That is something we are trying to do. The last budget was a step and hopefully we can develop it further.

Issues were raised about the 58 specialties on the Medical Council register. Insurers must currently assess the levels of risk to offer insurance indemnity. The State Claims Agency will consult with the indemnifiers and insurers. It will also examine court awards and consult with risk assessors to agree the minimum levels required. How we are managing the increasing cost of insurance for private practitioners is a legitimate question. The Government approved the establishment of the capped scheme in 2004 which means that practitioners must only purchase indemnity cover to a certain level or cap. Over the cap the State pays the balance. The capped scheme was introduced by the Department of Health in 2004 to provide limits or caps in respect of clinical indemnity cover that consultants are required to purchase in respect of their whole-time off-site private practice. Under the capped scheme, consultants purchase indemnity up to certain limits or caps and the State's clinical indemnity scheme covers any claims arising in excess of these caps. Without the capped scheme, subscription rates for consultants in whole-time private practice would have been greatly increased. On disputes and their resolution, the Medical Council will publish on its website the minimum levels required for the different classes of doctors in the 58 specialties. The State Claims Agency will have worked out the minimum levels based on extensive consultations with the relevant stakeholders.

A number of Deputies referred to the GP contract. The development of the new, modernised contract for general practice to address the changing role of doctors in delivering chronic care within the community and allow general practice to play its part in addressing the challenges that face the health service is a priority. I emphasise that. The Department of Health, the HSE and the IMO are currently engaged in a comprehensive review of the GMS and other publicly funded health sector contracts involving GPs. Engagements to date have seen the Department, the HSE and the IMO agree a number of service developments, including the introduction of the diabetes cycle of care for adults and other patients with type 2 diabetes and a support framework for rural GPs which has increased the number of qualifying GPs to over 300. We have also seen a revised list of special items of service under the contract to encourage the provision of more services in the primary care setting.

When we are talking about these issues, it is important to remember that the whole ethos of the Department of Health and the HSE is a strong patient safety culture to minimise risks. Over the next two days, the Department will hold conferences on these issues and a strong patient safety culture will be top of the agenda. It is important to note that there will be no additional cost in the price of indemnity or insurance for medical practitioners as a result of the improved measures proposed in the Bill. The proposals will benefit patients should things go wrong with their medical care. It is important to reiterate that the Bill is one part of a wider package of other legislative proposals intended to benefit patients. Our focus must be on improving services for patients. Legislative proposals include the introduction of periodic payment orders for catastrophically injured people, pre-action protocols to streamline the legal process in medical negligence cases, the licensing of our public and private hospitals, the health information Bill and provisions for open disclosure. This wide range of legislative proposals is underpinned by the introduction of specific patient safety measures, including the establishment of the national patient safety office in the Department of Health and the national patient advisory council for patient safety. Patient safety is at the heart of everything we do in our health services.

Unfortunately, the reality is that providing health care is at times risky and under pressure mistakes sometimes happen. This Bill, together with all of the other measures I have mentioned, is a very significant step and is being actively progressed to ensure that the best possible care for patients is provided, even when things go wrong.

The Medical Council, which already does an excellent job as the regulator of the medical profession, will in the public interest create awareness among medical practitioners of the minimum levels of indemnity specified by the State Claims Agency. The Bill also give the council power to sanction those who do not comply with the law.

This is a welcome Bill and I urge Deputies to support its passage. Once again, I thank all of the Deputies for their contributions to the Second Stage debate and look forward to further constructive examination of the Bill on Committee Stage. I commend the Bill to the House.

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