Colm Burke (Cork North Central, Fine Gael) | Oireachtas source

I welcome the Bill and thank the Minister of State and her Department for the work done in progressing it. It is important that regulation and legislation be kept up-to-date at all times. This is the third or fourth Bill we have dealt with regarding registration. The CORU figures for 2017 to 2021, which include social workers, medical scientists and physiotherapists, are interesting. The number registered has increased from 12,574 in 2017 to more than 22,866 in 2021. There has been a significant change in the number of physiotherapists registered. The figure for 2017 was 1,782 and it is now 5,323. It is welcome news that this rate of registration is taking place. It is about making sure that there are checks and balances in every area of the healthcare sector, whether that is social care workers, people working in the community, GPs, general doctors in hospitals or nursing staff. It is important that there are checks, balances and regulation in place.

One major change that has occurred over the past 25 years in Ireland is the reliance on overseas medical personnel across the board, including nursing staff, doctors and care assistants. We are running into problems in some areas such as nursing homes, which are finding it difficult to get nurses and care assistants. It is fine bringing people in, but it also need to be ensured they have the correct training and qualifications and expertise required.

The number of doctors registered in Ireland has increased from 18,000 in 2013 to in excess of 24,000 today, an increase of 33% in less than ten years. That is welcome, but it is important that we use them to best effect. We need to ask whether work is being done by general doctors that other professionals could do instead. That is one of the structures we need to examine in our hospitals. I worry in particular about whether doctors who are qualified for less than three years are doing jobs that could easily be done by experienced and trained nurses. We have a significant advantage in this country in that we have expertise in the nursing profession and we do not appear to have given nurses a greater role in the management of patients. Doctors could then do other work and this would make the system more efficient.

When people come in from overseas, it is important that we make it as easy as possible for them to register while, at the same time, making sure that they have reached a certain standard. I heard of a case where a junior doctor was taken on and had given the impression that they had worked in a hospital in the UK. After a week or two, people became concerned and found the doctor had only worked as an observer in a hospital in the UK. That can easily happen, but the issue did not arise in the interview process. That is why we need personnel to be monitored carefully. They are managing people's care and the wrong decision can make a huge difference to how that care is provided and managed.

Another important issue has occurred with training. While we are very much tied into the UK system in respect of medical training and a number of countries are very much involved in medical training together, there is a different type of training throughout Europe, even in EU member states, and it is different again outside Europe. Doctors in many jurisdictions are not required to do basic stuff that doctors here are required to do and even though they are registered, these doctors may have difficulties in dealing with the challenges when they work in a hospital here. It is important that we make sure the regulation and registration is properly put in place and that there is supervision thereafter to make sure that, at all times, the best possible care is being given to our people in our hospitals.

I know the Minister of State is making a plan on the issue of Irish people who qualify here but we are losing quite a number of Irish people who are qualifying in various areas of nursing or as care assistants or doctors and we need to do much more to keep them here, rather than relying on getting people from abroad. When we bring people from abroad, especially from countries outside the EU, we are taking from their medical services. We need to do much more about keeping our trained staff here.

I have raised on a number of occasions at meetings of the Joint Committee on Health the need to do exit surveys. We are not doing enough exit surveys of our staff. Why are they leaving? What is the reason? Is it that the training they are getting is not what they want? Do they feel there is no opportunity for further promotion? How do we deal with that?

I was recently talking to a nurse who had left a hospital in Ireland to work in London. She started off at level 5 within the nursing profession in London and she can climb to level 7. There is a clear pathway for her to do so. The other issue she raised with me was the ratio of senior nurses to nurses qualified less than four years. No matter what day of the week one is working in the hospital, there is a set ratio of people who are qualified for quite a long time and those who are recently qualified. She found that did not happen in Ireland. It varied from day to day. One might have one senior person to 15 or 16 juniors one day and five senior people to ten newly-qualified people the next.

That applies to doctors and consultants as well. Consultants have difficulty giving the time that trainees require in certain hospitals. I heard of one junior doctor who had a very good consultant working with her who made sure she had an opportunity to come to theatre and be involved in the whole process from the ward right through to theatre. The next hospital the junior doctor went on to, she found that she was told to go for this and that but got very little training. It is important that there should be a structure for training that is implemented and there are checks and balances.

However, I very much welcome this Bill. It is very important that the proper regulation should be in place but we also have to deal with the delay in registration because that is a complaint I get. Sometimes people get very frustrated with the time period to get the registration through from start to finish. We need to do something. It may be the case that the various bodies require additional staff. I heard of general doctors going to New Zealand and within two weeks, they were registered with the medical council there, whereas when they came back home they found it took 12 weeks. That is going back a few years ago. I am not sure what the up-to-date position is. We need to follow up on these issues and make sure there are no glitches in the system. I thank the Minister of State for bringing forward the legislation and I look forward to working with her on it.

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