James Browne (Wexford, Fianna Fail) | Oireachtas source

I welcome the opportunity to raise the issue of unqualified non-specialist doctors working as consultants in our mental health services. The President of the High Court, Mr. Justice Peter Kelly, has been extremely critical of this practice. He has described as scandalous the HSE practice of permitting non-specialist doctors to be appointed as consultants in hospitals and mental health services. He said that the HSE appears to be a law unto itself in this regard. These comments came from the President of the High Court. He also highlighted the disparity and distribution of sub-standard consultants, which is considerably higher in one CHO area and in regional hospitals. All 20 acute hospitals are affected. Mr. Justice Kelly was so perturbed that he directed that his judgment be sent to the Attorney General, the Minister for Health, the Secretary General of the Department of Health, the HSE chief executive, HIQA and the State Claims Agency. He made these worrisome criticisms in a decision to cancel the registration of an individual consultant who had made a series of medical errors.

The Medical Council, HIQA and the Irish Hospital Consultants Association are all reported as having expressed serious concerns about this practice. The College of Psychiatrists of Ireland recently stated that it holds that a doctor should not be a consultant if the doctor is not a specialist in the appropriate area of medical practice, yet unqualified doctors are being appointed as psychiatric consultants. These doctors have not undergone higher training, only basic training. They are not subject to the usual rules and oversight to which a qualified psychiatrist consultant is subject. They are not trained in leadership or management, but they are being paid the consultant rate. Indeed, if they are working for an agency, they may even be paid more. One week such a doctor may be a junior trainee and the next week he or she may be running the place. One week the senior registrar may be holding the hand of such a trainee and the next week the trainee may be giving senior registrar orders.

Let us consider for a moment what this means for patients. It means that someone who is not qualified is making orders to the effect that a person should be deprived of liberty or detained under the Mental Health Act against his or her will. Surely, this is a clear breach of human rights. It means that doctors are prescribing mediations and courses of treatment without the appropriate training, continuous upskilling or oversight. It means patient safety is being seriously compromised.

One of the regular excuses is that there is a shortage of consultants, but only some weeks ago the College of Psychiatrists of Ireland stated that it had enough quality candidates to increase the number of training places by at least 10%. Inexplicably, the HSE only approved a 5% increase in training places. Nothing adds up in this regard. It is clear that the practice of permitting non-specialist doctors to be appointed as consultants places the lives, health and welfare of patients at risk. This is a real patient safety issue. It is another example of the dysfunctionality at the heart of the HSE and it demands to be addressed immediately.

Will the scandalous practice of permitting non-specialist doctors from being appointed as consultants stop? Are people who have been the subject of medical errors by non-qualified consultants notified of these errors? Will the Minister undertake to increase the number of training places for those who actually want to be properly trained and who wish to properly qualify as psychiatric consultants?

See this speech in context