Liam Twomey (Wexford, Fine Gael)
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Question 54: To ask the Tánaiste and Minister for Health and Children when she intends to amend the Medical Practitioners Act 1978; and if she will make a statement on the matter. [15503/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Work on the new medical practitioners Bill is well advanced and it is envisaged the heads of the Bill will be circulated for comment to interested parties, including the Deputy, before the summer. This will assist in drafting the Bill. I intend to publish the Bill later this year.

Liam Twomey (Wexford, Fine Gael)
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That is good to hear because there is a fear that somehow this legislation will not be implemented before the next general election and considering the recommendations that were made in the Lourdes hospital report, this is very serious legislation. However, I also wish to ask the Tánaiste what is being done in regard to clinical governance, clinical audit and competence assurance because these are not just catch phrases we can throw out all the time. In some respects the Tánaiste is trying to slip away from the importance of these issues by saying she will ensure a lay majority on the Medical Council.

As a State organisation, whether the Medical Council has a lay majority or is self-regulated with a majority of doctors is of no benefit to patients unless the issues around clinical governance, clinical audit and competence assurance are dealt with. As we saw from the Lourdes hospital report the Medical Council acted appropriately once it was informed. In fact, the Medical Council had to report Dr. Neary to itself in order to investigate the matter. Many facts have been lost in the very emotive issues that surrounded this crisis in the north east. What does the Tánaiste intend to do before the summer in regard to issues such as clinical audit and competence assurance?

The Tánaiste has quoted Professor John Higgins in CUH about clinical directorates and doctors having to do more themselves. It is our responsibility to protect patients. It is not up to the goodwill of a few consultants, doctors or voluntary organisations, it is our responsibility. I would like to hear more, not just about the legislation, because even if we do bring the Bill to the House in September it will not be enacted before the next general election, and we need to know what will happen in regard to those other big issues.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I certainly hope it will be enacted because otherwise it will fall. A huge effort is being made in the Department of Health and Children to try to make sure we have modern and robust legislation enacted with great speed.

Clearly, there are deficiencies in the 1978 legislation. We need more modern and robust legislation but, notwithstanding the deficiencies, that is no excuse for what happened in the maternity unit of Our Lady of Lourdes Hospital for 25 years. To be quite frank, if it were not for that brave midwife and the response of both Ambrose McLoughlin at the time and Mr. Lennon we might never have got to the stage of finding out what happened there. Notwithstanding the legislation or the deficiencies in it, many things could have been reported that were not reported and we need to learn from that. Everybody has responsibilities in regard to this issue.

Specifically on competence assurance, in medicine in particular, but more and more in other professions, continuing professional development is an important prerequisite for maintaining one's skill base. That will become mandatory in the new legislation. We need to ensure that those who are on the register, the specialists in our health care system, are involved in a process where the patients can be reassured that they are competent to do the job they originally qualified to do. I know most progressive doctors feel very strongly about this as well.

The Lourdes hospital report also raised issues for the college of obstetrics, the Royal College of Surgeons and others, as well as for hospital management. That is why we want to have clinical directors in the context of a new consultants' contract. Currently in the health care system consultants are independent contractors. They are not required to work as part of a team. Each person is his or her own boss, as it were. I know some doctors are critical of this but the best health care systems in the world are ones where people work as a team and there is a clinical director with specific responsibilities. Generally, the chairperson of the medical board of a hospital does this on a pro bono basis and maybe in some places they might get a session or something in lieu of the work they put in. We have to take this issue more seriously and see this role as a job in itself where people are hopefully appointed to the position based on their expertise and competence. They would then be responsible for the team with which they work. That is when we would get the best results.

Clearly, there has to be a national audit. As Members are aware, we have given resources to Cork University Hospital to establish an audit in regard to maternity issues. Professor John Higgins from Cork is the person who put the idea to me. It is borne out of something he had seen elsewhere. I am happy to say we have provided the funding to get that up and running so that details in regard to all births nationwide will be fed into a central unit at Cork University Hospital. I hope it will be possible to detect something like what was happening in the maternity unit in Our Lady of Lourdes Hospital much earlier because it should be evident if the pattern in one hospital is very different from the pattern in some of the other hospitals in the country.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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While I acknowledge that the Tánaiste clearly envisages that the legislation will address the important issue of ensuring that all medical practitioners are properly qualified and trained, would she not also accept that we can have no dependence on whistleblowing alone in terms of drawing public and wider attention to malpractice or irregularities in terms of service delivery in any of the disciplines? The legislation must contain a guarantee of regular monitoring and ongoing assessment.

Will the Tánaiste give an indication of what is intended in the medical practitioners Bill in that regard because, ultimately, it is the only real safety net and the one that can instil the greatest confidence in the widest number of people. The confidence of many people has been greatly diminished and in some cases shattered by the experiences of the Neary case and others in recent years. What can the Tánaiste tell us about that and can she give us an indication of when exactly the medical practitioners Bill will come before us? If she is in a position to do so, will the Tánaiste release the heads of the Bill which would be of assistance to Opposition Members in assessing exactly what she intends?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I intend to release the heads of the Bill. This will be helpful given that it will be major legislation that will be of great interest not only in this House. A better debate on the Bill will ensue if there is feedback and input at an earlier stage. There will be an ongoing process of competence assurance because we have noted this happens elsewhere. Most of our best doctors constantly attend seminars or international events and keep their skills up to speed by writing in journals and undertaking research. We must ensure this becomes the norm for all specialists in the health care system. The president of the medical council, Dr. Hillery, has done some very innovative work in this area and we are working closely with him on those aspects of the legislation, whatever about the issue of lay participation.

The medical council currently has 25 members. Any member involved in a fitness to practise inquiry could be involved for up to three days a week and this would also entail considerable advance preparation, yet the lay members do not receive any remuneration nor is the fact that they have other lives and other careers taken into account. These are some of the issues that need to be examined. If we want to have lay participation — which most people would welcome — we must facilitate this happening. We must consider the significant time involvement by the current members, particularly those on the fitness to practise committee which is an onerous committee for many of them. It is certain that we would not be able to continue with the current regime on an ongoing basis if there were to be many fitness to practise inquiries in any one year. These inquiries can go on for a considerable length of time.

Jerry Cowley (Mayo, Independent)
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The medical practitioners Bill will not cover alternative practitioners. The Tánaiste was given a report in December and I believe she will launch it on 12 May. Is it true that this will not include any regulation to cover alternative practitioners and will be just a voluntary code? Having seen two people in my area die at the hands of Mineke Kamper, a common killer, who operates in my area without any regulation whatsoever, has the Tánaiste any news on this?

Séamus Pattison (Carlow-Kilkenny, Labour)
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This is not in order.

Mary Harney (Dublin Mid West, Progressive Democrats)
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This is a medical practitioners Bill, so clearly it does not deal with anyone other than medical practitioners. The Deputy is well informed about the date of 12 May because I did not know the specific date. It is a good report which makes some very practical suggestions.