Mary Hanafin (Dún Laoghaire, Fianna Fail)

I thank the Senators for raising this issue, which is of importance not only for education but for society in general. There has been a number of developments recently in regard to medical education. As Senators have outlined, a control has operated since 1978 on the annual intake of Irish and EU students to medical schools. It has become clear in recent years that there is a need to review that quota, not only from the perspective of students' needs but also to ensure we have a sufficient output of graduates to meet our medical requirements and the demand that exists within the health services for doctors. As Senator Henry observed, we must also ensure the demand for student clinical placements can be met.

In tandem with the intake of Irish and EU students, which is set by quota at Government level, the medical schools have independently over the years offered additional places on a commercial basis to non-EU students. This has created an important source of income for the colleges, allowing for investment in the overall quality of medical education, as well as enabling them to develop valuable international links. We spoke before about the importance of marketing Ireland as a place for quality education. Earlier this year, departmental colleagues and I went to China to attract students and we will go to India in January to do the same. Some of those Indian students are medical students. In the academic year 2003-04, where the overall intake of medical students was 782, 305 were from the EU, as per the quota, and 477 were non-EU in origin.

It is important to emphasise that the stream of international activity has not compromised the number of places on offer to Irish students because the quota is set in this regard. It is also important to state that selection of non-EU students for entry to medicine is subject to rigorous standards of assessment. The entrance requirements for potential non-EU students are determined by each medical school. That is why, for example, we have seen the change in regard to A-levels. As Senators correctly observed, some colleges used to work on the basis of three A levels but have now determined to use four. There is even some concern that this might in some way, in some of the colleges, discriminate against Northern Ireland students who traditionally came in significant numbers to Trinity College, for example.

There are other issues to consider in this regard. The colleges are committed to ensuring that a high academic standard is maintained. This is essential because it is in the interests of the medical schools to ensure there is a high standard in terms of their intake of international students. The international reputation of the schools hinges on the academic standard of their programmes and the associated standards of entry required of international applicants.

For students who wish to study medicine in Ireland, there are very limited routes of entry. It is mostly done through undergraduate entry on the basis of the leaving certificate examination. This year, it was particularly difficult for leaving certificate students because of the huge demand for undergraduate places and the high performance of so many students. I too have met students who attained 570 or 575 points, almost perfect leaving certificates, and were heartbroken not to attain places in medicine. It is almost the case that students require 590 or 600 points to secure a place. Such high points are now the norm. For a number of students who reached the cut-off point, rather than entering a random selection process, some were offered places this year. If this was not possible, they were offered a place for next year on the basis of entrance at the same level as those who started this year. For a candidate subject to a random selection process, however, there is no guarantee of success, which is why an individual may lose out.

As Minister for Education and Science and a former teacher, I am anxious about the high points issue and the pressure this puts on young people. From a medical and societal perspective, there is a need to ensure more doctors can qualify. It was with these objectives that my predecessor, Deputy Noel Dempsey, set up the working group on undergraduate medical education and training, under the chairmanship of Professor Patrick Fottrell. This was established to review the organisation and delivery of medical education and training. As well as looking at the number of places and the entry routes, the working group also examined the quality of education. The report it produced is a valuable work with good recommendations as to how we should proceed. This is a joint effort between the Tánaiste, as Minister for Health and Children, and I. We considered the report at Cabinet sub-committee level and will bring forward recommendations to Government shortly.

It will examine the number of places and the routes of entry involved. It would be wrong at this stage to set out exactly what the proposals are. However, it is our intention to increase the number of medical places available to students in line with what will be required in the health service. We will try to achieve a better balance between EU and non-EU places. Unfortunately, it will take a significant number of extra places to bring down the number of points required because of the number of students who have applied. In the short term, there may not be a significant difference, but at least by having extra places available, it will open more doors for more students.

While I would like to be in a position to provide more details about what the Government is doing, the Adjournment debate has probably come a few weeks too early. We will bring forward proposals based on the Fottrell report, bearing in mind what the Senators have said, because it is such a significant issue.