Dáil debates

Wednesday, 10 April 2019

Regulated Professions (Health and Social Care)(Amendment) Bill 2019: Second Stage

 

5:30 pm

Photo of Donnchadh Ó LaoghaireDonnchadh Ó Laoghaire (Cork South Central, Sinn Fein) | Oireachtas source

I welcome the opportunity to speak on this large and complex item of legislation. The Regulated Professions (Health and Social Care) (Amendment) Bill 2019 relates to transposition of Directive 2005/36/EC, as amended by Directive 2013/55/EU, on the recognition of professional qualifications, which it must be pointed out was agreed under the Irish Presidency of the European Union in 2013. It is quite important that we transpose these directives, especially with the looming prospect of Brexit, and that we provide the mechanisms for the recognition of professional qualifications.

This legislation affects a number of professions and, indeed, some more than others. I will structure my observations and questions by profession first and foremost. On the section pertaining to pharmacists, there are some welcome changes to outdated aspects of standing legislation. Part 4, which seeks to amend the Pharmacy Act 2007 is very important. The Irish Pharmacy Union has consistently called for the 2007 Act to be updated. In particular, it has vocally called for the removal of the prohibition of a pharmacist to be declared bankrupt from registering as a pharmacist, for a complete overhaul of the fitness to practice regime to a less formal and adversarial model, as recommended by the Pharmaceutical Society of Ireland’s review in 2015, and for the implementation of the Supreme Court recommendations following the Corbally case. We can and will agree or disagree with various calls the representative bodies have made regarding this Bill and I have no doubt it will be an interesting debate on Committee Stage. It is important, however, that we are aware of what the representative bodies are seeking and saying.

When Deputy Jan O'Sullivan was Minister for Education and Skills, her officials had meetings with representatives of unions on the issue of the Corbally case and concerns around public hearings, and what matters should be brought to a public hearing. In the Seanad in 2015, my former colleague, the then Senator Kathryn Reilly brought forward amendments to the Teaching Council (Amendment) Bill which invoked the Corbally judgment. We know these issues have been debated at the highest level, so it is important and interesting that changes are forthcoming. However, there are a few observations, and perhaps criticisms, that I will articulate. There are still many outstanding issues with which the legislation has not sought to deal. This is an all-encompassing item of legislation and the opportunity should be seized to use it to amend primary legislation as such an opportunity does not come about often.

The Minister of State should give clarification as regards the decision of the council of the Pharmaceutical Society of Ireland, PSI, to approve rules on the temporary absence of a pharmacist from a pharmacy which have been sent or are being sent to the Minister to be signed. First, those rules are unnecessarily restrictive in that they undermine and restrict the professionalism and the employment prospects of almost 300 pharmaceutical assistants, most of whom are women over 50 years of age. Perhaps more equitable rules could have been included here in primary legislation where we could have debated them and they could be fed into by stakeholders to ensure they delivered for all involved. The Pharmacy Act 2007 could have been amended to develop a core competency framework for pharmaceutical assistants. It could have had a requirement that all pharmaceutical assistants on the PSI register undergo a practice review with the Irish Institute of Pharmacy. There are many things which could have been done, and still can be done, so I would urge the Minister to not sign those PSI rules and instead use Committee Stage of this Bill to bring forward amendments to the 2007 Act which protect pharmaceutical assistants and the public and let us debate it fully here so that no adverse outcomes materialise.

I spoke with members of the pharmacy profession and they raised questions around the amendment to section 52 of the Act, which allows the High Court to direct how the costs of an application for confirmation of a sanction are borne. They stated that this opens the possibility that a pharmacist who has been through a fitness to practice inquiry would then be required to pay for the High Court to confirm any sanction handed down, even in circumstances where the sanction is not being appealed, thus adding an additional financial penalty to the professional sanctions laid down in the Pharmacy Act. They are querying who should bear these costs, and I would appreciate if that could be clarified.

In the section pertaining to dentists there is also much welcome movement. Regarding section 17 where it proposes that the Minister is no longer notified of sanctions and that the HSE and other appropriate persons, including an employer, will now be notified, what are the reasons for this change, particularly given that a large number of dentists are not employed by the HSE and do not hold contracts with it to provide dental care? Are there difficulties arising with the existing reporting arrangements or is this to centralise these matters across the board? Clarification on that would be welcome.

Finally, on this Part, in section 18 it suggests that the Dental Council would, if it is in the public interest, publish part of all of the fitness to practice proceedings. This differs considerably from the existing provisions whereby only proven charges are published. I would also like to hear the reasons for that change. Has there been an issue with current arrangements or is this again an effort to centralise and streamline all reporting in the interest of the health service?

Regarding the section which pertains to interns, I have a question on it as this section is of particular interest. The Bill seeks to amend the Medical Practitioners Act to remove the requirement for interns to hold the equivalence of the certificate of experience for entry to the trainee specialist division of the register. I would be grateful if the Minister of State could reassure the House that checks and balances are not being removed. Will there be a similar measurement of experience, so we can be sure that our high standards in the medical field are upheld? I understand the requirement of internship equivalence is preventing some non-EU doctors from accessing training posts, even where they may hold memberships of Irish postgraduate medical colleges. However, this is a complex issue and there needs to be the appropriate evaluation of medical proficiency to ensure that the doctor in question has the requisite skill set.

The current recruitment and retention crisis has meant that the health service has not been able to attract and retain enough highly educated and trained doctors and sometimes to fill these gaps, under-qualified doctors have been appointed to roles in the health service, which is wholly inappropriate. We saw that last November during High Court proceedings where Mr. Justice Peter Kelly stated that defective procedures for recruiting doctors represented a danger to patients and laid bare the implications of the Government’s failure to address the doctor recruitment and retention crisis and the failures of the HSE in that regard.

To refresh people’s memories, this was where a non-consultant hospital doctor in a hospital maternity unit was suspended from practising by the High Court after other doctors had raised serious concerns within days of his starting employment on the basis that he lacked basic medical competency and was a danger to patients. The doctor had graduated from a medical school outside Ireland and his basic medical training was found to be seriously flawed and not comparable to that of the doctors who had trained here. I know that the Medical Council and the Irish Medical Organisation welcome this move and I bow to their knowledge and expertise. However, I would like the Minister of State to explain to me how any new system will operate for interns in order that we can ensure we will have the best medical professionals working in hospitals.

As with all parts of the Bill, there are a number of amendments to the fitness to practise provisions of the Medical Practitioners Act which should result in a speeding up of the fitness to practise process, which is to be welcomed. The Bill encompasses all professions - nurses, midwives, dentists and doctors - and it is welcome that declarations of convictions and criminal sanctions will be necessary before being registered to practise here. Also welcome is the allowance of disciplinary inquiries in other jurisdictions to be used as admissible evidence in Irish fitness to practise proceedings under the new proposals. It is welcome that there are extra protections for medical and healthcare professionals in that fitness to practise committees will be given the power to order that some or all of the information given at a hearing not be published. The allowance of a right of appeal to the High Court against sanctions of advice, admonishment or a censure is also an interesting inclusion, given that currently there is no right of appeal against these sanctions.

I welcome the provisions which will allow the chief executive of the Medical Council to investigate complaints made to the council in order to ensure frivolous or vexatious complaints will not proceed to the preliminary proceedings committee.

With regard to section 103 as it relates to fitness to practise hearings, I have spoken to doctors and their representative bodies. They hope, given that fitness to practise hearings can be extremely stressful for individual doctors and have severe consequences for their health, reputation and livelihood, that the idea of proceedings being held in camerawill be looked at and that no information, including on the identity of the doctor, will be made public until poor professional performance has been proved.

As we seek to implement these European directives, it is important to look at areas where our medical professionals may have scope to learn from their European colleagues. There are many opportunities to impart wisdom to their European colleagues and vice versa. In particular, there is scope for our medical professionals to learn more about social prescribing, different physical activity regimes as part of a broader chronic disease management policy and the use of medicinal cannabis, to name but a few. Such improvements would benefit medical and healthcare professionals, as well as patients.

While we will be supporting this legislation, we hope to work further with the Minister of State and others to amend it on Committee Stage.

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