Fergal Browne (Fine Gael)

I welcome the Minister of State, Deputy Power, to the House. I also welcome the Bill which is ultimately about ensuring adherence to proper medical practices. Unfortunately, as long as human beings are involved in the health system the potential for another case similar to that of Dr. Neary will exist. What shocked me about the Dr. Neary case was not that one person made a mistake and patients were the victims of his malpractice but that he was cleared by his peers afterwards.

As Senator Feeney stated, it takes a great deal of courage and bravery for a patient to query not to mind make a complaint against a medical person and people are slow to do so. They must have been shattered when Dr. Neary's three colleagues gave him the all-clear. Thankfully, it was corrected afterwards and perhaps it resulted in this Bill.

It is a difficult area and I am conscious that one of my late constituents led the campaign to highlight the illegal retention of children's organs. Recently, we had a tragic case where a person died in Ireland and was sent for burial in England where another post-mortem was conducted in which an organ not belonging to the person was discovered in the body. Things can go wrong beyond what any of us can imagine.

Recently, the son of a friend of mine was quite ill and brought to a medical centre where he was wrongly diagnosed. Thanks to my friend's maternal instincts she sought a second opinion and saved her son from being gravely ill afterwards. I do not envy the job of a doctor in having to decide whether a person with chest pains has indigestion or is on the verge of a heart attack. I am sure none of us in the House would like that job.

I welcome the lay majority, a matter which has received much airing. I speak as a former primary school teacher who worked in a school with a board of management made up of the parish priest, teachers and parents. People on the board may also have been parents of former pupils or from the parish. It works well in the Minister of State's constituency in Kildare, Sligo, Carlow, and the constituency of the Acting Chairman, Senator Ulick Burke, in Galway. I do not see a problem with it. If the right people are on the board it can make a great difference.

I will not be a hypocrite. Every day in the Oireachtas I complain about the rate of MRSA in hospitals. I am delighted to be involved with the group MRSA and Families. I attended its first public meeting which was held in Kilkenny and have been with it ever since. I travelled abroad with it and this group of lay people has done major work in raising awareness about the issue of MRSA in our hospitals. If it were up to the medical profession, the issue would not receive the airing it does. At times it is no harm for any of us to look outside the box.

Senator Feeney referred to lobbying. That is the nature of politics now. Aristotle stated that it is through the clash and collision of ideas that matters get sorted and that is how it should be. Having stated that, I do not agree with many of the representations made to me by certain people, particularly with regard to the lay majority. To be fair to the Minister for Health and Children, she addressed the matter in her speech here and in other fora.

In terms of fitness to practise, we must strike a balance between protecting the good name of a medical practitioner and acknowledging a wrong done to a patient while under his or her care. It is a difficult area. Recently, the Minister mentioned 10% of deaths could be due to negligence in hospitals such as wrongly prescribing or administering drugs or other procedures. I am not a great fan of the television programme "ER". I watch it every so often. Genuinely I do not understand how anyone could work in the conditions many people in the Irish health services do. They are under huge pressure and must make vital decisions in life and death situations.

A great deal of lobbying was done on this Bill and I kept all of the correspondence I received. Some of it was sent at the beginning of the year and I know a great deal of consultation took place on the Bill. I will discuss some of the concerns raised, and I assume many of them were addressed either before the Bill was published or when it went through the Dáil.

This morning, I received a letter from the College of Anaesthetists expressing concern about the mechanism for the arbitrary removal from office of individual council members and the replacement of the entire council. With regard to council membership, it is concerned that representation from all 13 training bodies is a minimum requirement for the council to perform its duties adequately. With regard to funding, the point was made that the Bill imposes significant additional duties and responsibilities on the Medical Council and the College of Anaesthetists feels it is imperative to provide the financial resources necessary for the Medical Council to perform its duties to the optimum level.

I was also contacted by numerous GPs including some in my constituency. They are concerned about the ministerial power to control the medical council in terms of policy and membership. They point out correctly the council's original responsibility was as an independent watchdog to safeguard the interests of patients. They feel the Bill will remove its ability to be independent of the Minister and the Department of Health and Children. Will the Minister of State address these concerns?

The Irish Medical Organisation which represents doctors would like a slight majority of medical practitioners on the Medical Council. It wrote to us in February stating that the World Medical Association stated no evidence exists that governments or lay bodies do the work any better than self-regulatory bodies. It claimed ample evidence of the opposite existed. I do not necessarily agree with this view but it is worth raising the issue for clarification by the Minister of State.

The Irish Medical Organisation is also concerned about the democratic deficit in representation of medical specialists and urges that the nominated representatives of psychiatrists come from the Irish College of Psychiatrists and not from the Irish Psychiatric Training Committee. Perhaps this matter was dealt with in the Dáil.

The issue of hearings in public is raised time and time again when we debate health Bills. A fine balance must be struck and I am encouraged by the reference to this matter in the Minister's speech. The option to hold it in private is still reserved both from the patient's point of view and that of the medical practitioner who is in the dock.

I was also lobbied by the Postgraduate Medical and Dental Board which is concerned about the lack of an explicit requirement for the HSE to put in place robust national medical educational structures with ring-fenced funding independent of service pressures. It expressed concern that much of the voluntary good will involvement in self-regulation and training may be lost in the process.

Another person who lobbied me was concerned that if a hospital's training accreditation is withdrawn it can no longer employ non-consultant hospital doctors which could immediately impact on service delivery. The point was also made that although the council's primary and independent role is to protect the public it could now be an extension of the Department of Health and Children, the Minister and the HSE. In such a case a conflict of interest could arise. The introduction of the HSE to the council and the need to meet service demands by the HSE raises a very obvious conflict of interest. These concerns were raised by a general practitioner. We clearly need to separate the role of the Irish Medical Council from the HSE and the Department of Health and Children, and we should ensure patient safety is paramount at all times.

I welcome the Bill and I have taken the opportunity to raise some of the concerns from many people who have lobbied Members on this Bill. I would appreciate it if the Minister of State, in concluding, could indicate whether those concerns were addressed in the Dáil debate, and if they were not, the measures taken in the Bill which make such concerns unfounded.