Liam Fitzgerald (Fianna Fail)

I welcome the Minister to the House. Her approach to the funding of third level education was set out in detail in her speech. It is important to remind the House of the Minister's stated objective on third level education and her intention to invest in the enhancement of third level to support national strategic goals. That theme has recurred every time the Minister has discussed her vision of and priorities for third level education.

The OECD report published in 2004 stated that if we want to lead in the information age, we must have a world class third level education system. It is clear that it has been the Minister's intention from the outset to build on the Government's success in achieving that goal. The Minister has outlined the packages that have been provided prior to and since the budget in terms of capital and current spending and the innovation fund.

There are two partners in this scenario — the Government and those who deliver the services. Sometimes it is forgotten when criticising the Government's commitment to putting third level education at the centre of our national strategy that the other partner to the deal was not front-loading either. The Minister's predecessors challenged the bona fides of those agencies, both the universities and the institutes, to be more specific about delivery of objectives.

A submission was made to Government last year on reform of the culture in the institutes and relationships between them. In this regard it is significant to note that the Minister's achievement in securing increased funding for third level education in the budget has silenced some of the Government's loudest critics. I was also heartened to read in recent weeks that some of her most vocal critics have become some of her most vocal champions. This is a matter of public record. For example, one former critic stated the Minister has achieved a seismic shift in Government policy on third level funding, which has become anchored at the heart of our national economic and social strategy. This is a heartening development. While I do not propose to address issues in detail at this point, I will do so in my concluding remarks if the opportunity arises.

I warmly welcome the contemporaneous publication of the Report of the Working Group on Undergraduate Medical Education and Training, known as the Fottrell report, and the joint announcement by the Minister and her colleague, the Tánaiste and Minister for Health and Children, Deputy Harney, of a €200 million package of reforms of medical education, a major initiative which will be of critical importance. I read recently — I am not good at tracing my sources — that the problems facing the health service can be simplified by breaking them into two parts, namely, funding and service delivery. This applies equally to first, second and third level education. The scribe in question pointed out that while health service funding was characterised by serious shortcomings in the past, these have been compensated for in large measure in recent years and it is now up to the other parties, the professionals in the field, to address the issue.

The working group on undergraduate medical education, which was established in 2003, has now reported to the Minister and her colleague, the Minister for Health and Children. The publication of the Fottrell report is timely. Its conclusions and recommendations represent a broad consensus of views and analysis from top professionals and administrators drawn from the full range of stakeholders involved in the delivery of medical education and training and the health service in general. This is important as it ensures the Ministers are given an holistic, rounded picture.

I join the Minister in paying tribute to Professor Patrick Fottrell and his working group. Like her, I believe the report before us is a landmark document which charts our future course in medical education. I also acknowledge the publication of a report on postgraduate specialist training by Dr. Jane Buttimer. Before commenting on several of the many issues addressed in the Fottrell report, including weaknesses in the system and how, based on international best practice and excellence, we should meet the challenges which constantly arise in the health service, I pay tribute to the standards of excellence achieved by our doctors and consultants at national and international level. While I have been an occasional critic of certain aspects of the medical professions' behaviour and have not changed my views in this regard, nevertheless, I commend their excellence over the decades.

When the working group on undergraduate medical education under Professor Fottrell started work on its terms of reference it noted major lacunae in terms of how we will meet future needs and recommended radical changes across the spectrum, particularly in the area of medical education and training, for which it envisaged a critical role in enhancing the quality of health care delivery. In responding to the report, the Minister's initiative facilitates greater access to the medical profession, a point on which all sides agree. It also has the potential to address at least two issues of major significance, namely, the easing of entry to medical training and the provision of greater numbers of doctors to service our medical care needs.

As we are all aware, entry to the medical profession has become extraordinarily competitive in recent years. The leaving certificate requirement for entry to medical training is, I understand, 570 points and the CAO system is the virtually the only entry route to the system. I understand a small number enter the professions via the medical schools but I am not familiar with the procedure or numbers involved. While the CAO system is a fair assessment and yardstick of competitive academic achievement, it has serious shortcomings in its application to training for medical professionals. I am pleased, therefore, that the working group examined this issue and made some far-reaching proposals for reform.

As with most professions, aptitude and suitability are key requirements for qualification as a medical professional. We have all known academically brilliant people who achieved fantastic leaving certificate results and flew through medical school with many accolades but proved unfit for the job. If unfitness for a job is damaging and potentially dangerous in any profession, it is in medicine where lives and the health of individuals are at risk. The approach to aptitude and suitability recommended in the report is critically important. The reforms proposed by the Minister for Education and Science and the Tánaiste and Minister for Health and Children include the introduction of a new graduate entry programme for medicine, the development of new aptitude tests for selection for graduate entry and a new selection mechanism to involve a combination of CAO points and suitability test performance.

The Minister consistently emphasises that all new criteria must be objective, transparent and fair and must be seen to be so. The competitive selection measures must adhere to these fundamental principles. The reforms will have considerable benefits in opening up access routes to those who aspire to a medical vocation but could not realise their aspiration as a result of failing to obtain the required points in the leaving certificate examination. As a result of the variety of routes to be introduced under the proposed reform programme, many adults who still cling to their childhood dream of working in medicine — we all know some of them — will have an opportunity to realise their dreams because they will be given a second chance. It is wonderful to introduce a second chance for all professions based on fundamental criteria.

I am pleased the Minister has selected a basic points threshold of 450. This is a wise, fair and reasonable decision as the figure reflects an appropriate level of ability for those who aspire to practise medicine, a discipline which requires them to constantly increase their scientific and technical knowledge.

As regards the aptitude test, I will address some of the issues raised by Senator Ulick Burke. I am an advocate of the aptitude test. The Minister is determined about fairness, objectivity and transparency. Who will devise the aptitude tests? What is the appropriate aptitude test for a person going into medicine? What constitutes, as near as we can achieve, the ideal test for such a person? The same question applies to teaching and other professions but medicine is more critical. What input will doctors have into designing the test? What score will be given to familiarity with the medical profession? Will it be seen to favour a candidate who socialises in a medical household? It must not.

The Minister will be anxious to ensure the new system does not facilitate a privileged entry corridor for the sons and daughters of doctors. It is vital that from the outset the integrity of the system be seen to exist and be safeguarded. I suggest the oversight committee, to which the Minister referred, be employed to monitor the formulation, introduction and implementation of the aptitude test system. This may be inappropriate but it is a suggestion. If it is not appropriate, another body should be considered for the role.

I welcome the doubling of places for Irish and EU students. Like Senator Ulick Burke, most of us were never happy with the fact that previously up to 60% of the student intake has been of non-EU students. It is inappropriate for a progressive country such as ours. It is unacceptable that we should then have to recruit doctors from abroad, often from countries where they are needed, instead of training more of our own. The Minister has grasped that nettle and is implementing reforms on a phased basis. We must be realistic about it.

We would all love to aspire to Senator Ulick Burke's suggestions but this can be done only on a phased basis. There are significant implications for costs, curriculum change, group sizes and interaction between professionals. Developments are also required which medical students will need to see in place, which they have never had before and which the Fottrell report found to be serious lacunae without which we could not aspire to compete with international best practice. I accept that the Minister for Education and Science, the Tánaiste and Minister for Health and Children and the Government can approach this only on a phased basis but it is heartening that they are starting now and I welcome it.

I welcome the path on which the Minister has started. Although there are commendable elements to it, there is no such thing as a perfect system and there will always be slight questions. I have one or two, one on the repeat leaving certificate. Although we are all idealists, pragmatism must play a role. If I had more time I would explore it further but I will not dwell on that now.

This programme of reforms of medical education and training is not a quick fix. Such a solution does not exist. It is a vital element of the programme of reform of the health services and of medical education and training. It is critical we do it now. The programme outlined by the Minister has unquestionable merit as a solution. It is not a fond hope but a well-founded, prudent plan to address the inadequacies of our deficient medical service and I commend it.