Thursday, 10 February 2005
Question 2: To ask the Tánaiste and Minister for Health and Children the measures she is taking to protect patient care, in view of the decision by hospital consultants to ballot for industrial action; the outcome of the promised meeting of legal teams; if she has satisfied herself that proper tendering procedures were used in the procurement of the State indemnity scheme; and if she will make a statement on the matter. [4408/05]
It is regrettable that the Irish Hospital Consultants' Association and the Irish Medical Organisation are contemplating industrial action in pursuit of a resolution of the dispute over medical indemnity cover for consultants. The only people who suffer as a consequence of this or any industrial action in the health service are patients. It is particularly unfortunate that consultants should chose to embark on this course of action when they and the Government should be uniting to pursue the common goal of ensuring the Medical Defence Union lives up to its obligations to its Irish members.
Over the years, Irish hospital consultants paid significant amounts in subscriptions to the MDU. Between 80% and 90% of these costs were ultimately borne by the Irish taxpayer. Taxpayers and consultants have a common interest in ensuring the MDU does not escape from its responsibility for meeting the cost of claims from these years. I therefore appeal once again to both organisations to withdraw their threats and to work with the Government in pursuit of our joint interest. It is clear, however, that even if we kept industrial action to a minimum, it would cause delays in the treatment of patients and prolong their suffering.
Within a month of my becoming Minister for Health and Children, I gave an assurance about cover at a conference of the Irish Hospital Consultants' Association and put it in writing. It stated that "no Irish person who has suffered from a medical mishap would be left without compensation and no consultant would be left without cover in all reasonable circumstances and in accordance with the law." Last November, I put in place arrangements for the legal defence of one consultant at St. James's Hospital who was taken off cover by the MDU and against whom a claim had been notified. I met quickly this consultant, representatives of the medical board of St. James's Hospital, the Irish Hospital Consultants' Association and the IMO to agree these arrangements. I am still engaged in intensive efforts to avoid this eventuality through discussions with both organisations. I am exploring whatever avenues may be open to the State in its own right, without compromising its legal position and in association with the consultants affected by a withdrawal of cover by the MDU, to pursue the MDU by legal means. Arrangements are being put in place for representatives of the Chief State Solicitor's Office, the Office of the Attorney General and outside counsel to meet legal representatives of both organisations to discuss these issues. It would not be appropriate for me to make any comment on these discussions.
As the Government decided that the clinical insurance scheme should be operated by a State body, namely, the National Treasury Management Agency acting as the State's claims agency, no procurement procedure was required. All aspects of the operation of the scheme required to be supplied are operated by external contractors where the full public service tendering procedures apply.
I thank the Minister for her reply. It is regrettable that the hospital consultants are threatening this action. Does the Minister not accept, however, that doctors are extremely anxious and concerned at the situation in which they find themselves? They understood at first that they had cover from the MDU that turned out in practice to be discretionary, which let them down badly. They fear that, despite her promise, the Minister will let them down again and are intent on ensuring that does not happen. They want a legally binding commitment that they and their patients will not be left without cover, not just words and promises at a conference.
Surely the Minister is aware that when a similar process took place in Britain to set up a state indemnity scheme, the state took on the historic liabilities. In this instance, however, a secret deal was done with a competitor of the MDU which is a matter of some concern. Does the MPS have any historic liabilities? Does the deal with the Department protect it from any claims coming through? It seems extraordinary that the historic liabilities were not dealt with comprehensively, leading to the mess in which people find themselves.
There is a misunderstanding. The arrangements with the MPS were also offered to the MDU. When the MDU complained to the European Commission, it held that the procedures were fair.
The British Government took over the historic liabilities of obstetricians whereas we are concerned with all consultant activity in the public sector. I gave an assurance in good faith but I cannot compromise the State's legal position. It may be that, as a result of the communication from the MDU last Friday, this matter will be resolved through litigation rather than negotiation. We would prefer negotiation but if that is not possible, we will have to pursue the matter legally although I cannot compromise the position of the State and the taxpayers.
The MDU should meet its responsibilities. That was the view expressed in Mr. Justice Johnston's judgment in the High Court last Tuesday. The consultants, the Government and the patients are all at one on this issue. From a legal perspective we must ensure that we do nothing that could compromise our position and the State finances.
Will the Minister assure us that a legally binding guarantee will be given to patients as well as doctors to resolve the immediate problems of potential industrial action? The Minister has not answered my question about the MPS and the historic liabilities. Will she publish the secret deal made with the MPS? Does she not accept that the problem is the large claims in obstetrics? While it may include other consultants, the MDU raised this issue with the Department in the early 1990s.
It is regrettable that the Minister's words before the Oireachtas Joint Committee on Health and Children have set us further from negotiation on this issue. Will she publish the secret deal and ensure that a legally binding guarantee is provided for the doctors? We understand the legal complexities but there is a central need to protect patient care.
My comments were similar to those of Mr. Justice Johnston. The MDU should meet its responsibilities. This has gone on for far too long. Obstetricians are not the only ones affected. Mr. Young from St. James's Hospital is a cardiac surgeon and he was taken off cover. I have a brief on the history of the MPS and the MDU. The MPS took over the obstetric cases and ring-fenced the subscriptions paid. A complaint was made to the EU that unfair practices followed and the Commission held that the procedures were correct. I can make the briefing note available to the Deputy.
Two issues arise. From the perspective of State aids, if an unfavourable deal was done with one group, namely, the MDU that would have implications for the MPS which at all stages made it clear that it is prepared to make a sum of money available if we were to take over the past liabilities.
We have tried to have a due diligence exercise carried out because there are major differences between both sides. The MDU puts the value of the historic and known cases at approximately €160 million. The State team puts it at €400 million. There is a large gap between the two. The due diligence exercise is to establish the true position with a view to reaching agreement on the sums of money concerned. We do not have those issues with the MPS and if we were to take over the MPS cases, we would expect an appropriate monetary contribution.