Camillus Glynn (Fianna Fail)

I welcome the Minister of State to the House and I welcome this legislation. It is true the medical profession plays a pivotal role in a very important area of life, namely, public health. It is important people in this profession have the optimum training and the best expertise that can be acquired, and this Bill is designed to facilitate just that. It may need to be tweaked, but in the main, it emphasises those areas needing attention. Given that it is the first major legislation of this nature for almost 30 years, it is important we debate the matter on Second Stage in the House.

There have been some amendments to the 1978 Act, but they have been piecemeal. This is the first legislation relating to medical practitioners since that 1978 Act. In general, the Medical Practitioners Bill 2007 provides for an enhanced and modern system of regulation of the medical profession in Ireland. It correctly puts public interest first and modernises regulation of the medical profession. The main objective of the new legislation is to provide for a modern, efficient, transparent and accountable system for the regulation of the medical profession, which will satisfy the public and the profession that all medical practitioners are appropriately qualified and competent to practise in a safe manner on an ongoing basis.

Regrettably we have had recent examples — I do not need to refer to them because they are in the public arena — where certain medical practices left much to be desired. This Bill is a significant step in our drive towards assuring standards of patient safety and has been approved as a major reform to support and increase public confidence in medical practice in a structured and sustained manner for the decades ahead. As I have stated, the Medical Practitioners Act dates back 30 years. It is clear that in the interest of patients and doctors alike, a modern, accountable and efficient system of regulation is required.

There have been some amendments to the 1978 Act, but this is the first time in 30 years we have engaged in a total review and modernisation of the statutory regulation of medical practitioners. At this stage, piecemeal change to the 1978 Act is not enough and this new Bill is required. The need for doctors to keep abreast of new developments, the rights of patients to be informed and the expectations of the public have greatly increased since the passage of the 1978 Act. I do not have to remind Members that 20 years ago, if somebody was going to hospital, half the parish would be around moaning, wailing, crying and wringing their hands. An ordinary person may now elect to go for certain medical procedures, including surgery, with nothing thought of it. We have come a long way in that time. The balance between self-regulation and public accountability needs to adjusted to reflect these requirements. It is explicit in this Bill that the purpose of the Medical Council is to safeguard the public interest. In the main, given the terms of reference to date, it has done just that.

The Bill contains many practical new measures towards this goal. For example, both patients and doctors will benefit from a modernised system of continuous competence assurance. Since the Medical Council will have the public interest as its primary goal and objective, its membership of 25 is designed to support just that. Only people with expertise will be elected to serve on the board and no one group will be in the position to exert any dominant interest. As is provided in the Bill, medical practitioners will not be in a majority. There is some disquiet about this point and there is no reason in stating otherwise. I have been contacted by a number of medical practitioners who feel this to be incorrect. It is a matter for debate, and as this process continues, I am sure there will be many comments on it.

These people will work with other people of standing and expertise to advance the interests of patients and the public at large. The fitness to practise committee will also have lay members as a majority, while the new health committee and education and training committee will have a majority of medical practitioners. The latter provision is sensible and practical. To meet today's standards of openness, fitness to practise hearings will normally be held in public unless the committee decides the public interest is best served otherwise. That provision is important and we may have further comments on this on Committee and Report Stages.

The Bill is the latest step in the reform of regulation of health professionals as outlined in the health strategy. It is consistent with the objectives set out in the strategy. We have already debated legislation governing pharmacists. Alongside the Health Bill 2006 and reinforcing standards and enforcement, this Bill demonstrates this Government's commitment to ensuring patient safety in legislation and regulation as well as to the enforcement area.

The Medical Council will continue to consist of 25 members but the balance between medical and non-medical representation has been altered significantly to include a majority of people who are not nominated by the medical profession. As I have stated, questions are being asked about this provision, although many members of the public would support such a position. We will see how the issue evolves in the fullness of time.

Modern governance and accountability arrangements applicable to other statutory bodies, particularly in the health and social care area, will now apply to the council. The Bill includes a statutory requirement for doctors to maintain professional competence on an ongoing basis and the Medical Council, the Health Service Executive and other employers will be required to facilitate this. These and other provisions were central recommendations contained in the Lourdes hospital inquiry report, and I do not have to remind the Acting Chairman or Members what that report was about.

The registration system for medical practitioners will be reformed so patients can be clear on the level of competence of their doctor. I hope steps will be taken so that some of the examples we have had over recent years will not be repeated. A medical specialist with appropriate qualifications and experience from outside the EU will now be able to gain direct entry to specialist registration. This is what I would term professional enrichment of the medical profession, which is a very important measure in the Bill. I am pleased it is included.

Fitness to practise provisions will be streamlined to include a preliminary screening process for complainants which can, if appropriate, be referred to other procedures such as the HSE complaints procedures or to the competence assurance system if required. Provision for mediation in appropriate circumstances is also included, which again is a very important provision.

A majority of people on the fitness to practise committee would not be medical practitioners and fitness to practise inquiries will normally be held in public, unless it is considered not in the public interest to do so. The fitness to practise committee may decide, on application by the medical practitioner or a witness, including the complainant, to hold some or all of the inquiry in private, depending on the circumstances.

Clear responsibility on medical education and training are outlined for the Medical Council and the Health Service Executive, which takes over many of the responsibilities of the Postgraduate Medical and Dental Board, which is also being dissolved by this legislation. I hope this Bill will permanently consign to pasture certain people who have been struck off the register and who have evolved to another area of professional life called alternative medicine. Many examples have been given in this Chamber of such a practice, and I hope the Minister will rule with a heavy hand on the matter. An example near Mullingar of a dear and departed loved one's treatment at the hands of the people in question made for sorry listening.

The Health and Social Care Professionals Act 2005 will be complemented by forthcoming legislation regulating nurses, midwives and dentists. Let us be clear in both Chambers that only those who are appropriately qualified and registered will be able to practise in any profession. If chancers have lost their positions through malpractice or gross professional misconduct and are deemed to be unfit to practise by the medical council, their peers or so on, they should not practise under any guise. I hope the Minister of State will ensure this tenet is pursued to the letter of the law.

The legislative instruments will have a common thread of ensuring robust governance, clarity of procedures and formal systems of accountability. They are aimed at the protection of the patient while recognising the need for due process in respect of the handling of allegations and complaints against health care professionals. I welcome the Bill, which is long overdue. Working at the edges of existing legislation was not the way to go. Hence the advent of this Bill, which I commend to the House.