Maurice Cummins (Fine Gael)

I welcome the Fottrell report, an analysis of medical education in Ireland. This is the first time an inclusive review of this nature has been undertaken and it has been a worthwhile exercise. It provides a platform from which we can take stock and from which we can provide for differently structured access to a professional education that equips young professionals and disposes them towards continuous professional development when they enter employment.

Given the needs of society and ever-changing patterns evident in other professions, it is clear that a fresh approach to medical education is needed. Similar change is required in medical research and an extending knowledge base will call for ongoing reform in syllabi and curricula. It will call for other things too. It will call for a more diverse range of skills and understanding and it will call for a different sense of mission.

Health issues are complex. The health service is struggling; costs are spiralling. However, we should not lose sight of the care of individual patients — something that should be at the centre of our thinking on health services. Good medical education and quality health care are inextricably linked and perhaps we have not always recognised this in the past. We must change the structure of medical education. The concurrent model for undergraduates has served a purpose and may do so in the future, though in a more limited way. A consecutive graduate/postgraduate model must be introduced immediately to multiply access routes to the profession. Multiple access routes will widen the perspectives and approach of medical practitioners. Different perspectives shared will deepen professional conviction and foster diversity.

Alternative access to the medical profession is, ironically, a health issue because it is not healthy for 16 year olds to be deciding on careers in medicine while pressure to score maximum CAO points to secure a place in medicine is deeply unhealthy for even the most well adjusted school leavers. In addition, the single route for entry to medicine is not a healthy prospect for the patients who the emerging doctors will ultimately treat.

Difficulty of access to and, indeed, exit from the medical profession does not make for a healthy professional community. It is time to set aside all orthodoxies and think more creatively about medical education. Medical education should not be the preserve of universities or the establishment. The professionalisation of nursing is a case in point. Nurse education departments have been established at both universities and institutes of technology around the country. In my constituency of Waterford, the nurse education programme at Waterford Institute of Technology attracts students of outstanding quality and commitment from across Ireland and overseas. The facilities provided in the learning environment there are particularly advanced and impressive.

On the wider issue of funding in higher education, there are two strands, namely, how much we spend as a country and how we spend it. Recent attempts to play catch-up in terms of the amounts we spend are welcome but what is often forgotten is that investment in higher education is investment in the future and a vote of confidence in our young people. Inadequate funding is a problem but so too are inadequate distribution mechanisms. State funding for organisations should not be a given. It must be competed for by higher education institutions, especially those seeking financial support beyond minimum and core requirements.

Greater coherence with regard to objectives and measuring outcomes and purpose is also needed. We must differentiate the scales of funding for various initiatives so they better match strategic goals at regional and national level. I would like to see an extension of the specialised funding programmes already in place. Advancing national objectives and goals and building a better society should be key bases on which we judge funding bids from the institutions. We must ensure that medical education and, more widely, the entire higher education community is steering a true course in specific directions while not neglecting other imperatives.

Reference was made by Senator Ormonde during the debate to the question of a university for the south east. I lend my support to that quest. There are fewer graduates in the south east than in any other region of the country. A comprehensive submission has been made by Waterford Institute of Technology for its upgrading to university status. I fully support that submission, as do all politicians and the electorate in the south east, which is the only region without a university.