Feargal Quinn (Independent)

Drawing on my background, I considered the customer in each Bill. In this case, as Senator Norris has identified, the customer is the patient. I wish to see if this Bill is in the best interests of the patient. I was chairman of a hospital and tried to get the hospital staff to call patients "customers". The medical profession found this difficult to do.

Listening to this debate and reading the debates on the Bill in the other House, I am struck by the similarity that exists between the medical and teaching professions. Both are vocations rather than professions and both are lucky enough to have members who are driven to pursue excellence through idealism rather than profit. Both have a tiny minority of people whose talents are not suited to their chosen profession and who are bad doctors or bad teachers. Perhaps it is a tiny minority but it exists.

The two professions also share a rather undesirable attribute in the way they treat their non-performing members. They have traditionally rallied around their delinquent members and attempted to shield them from outside criticism instead of adopting the commonsense approach and ensuring unsuitable members are not allowed to continue practising or, better still, are weeded out before they qualify. From the point of view of a profession that wants to preserve and encourage the highest standards, this behaviour is not only dysfunctional but suicidal. The days when they could get away with behaving like this are long passed. All learned professions have a tendency to live in the past, which is why we need legislation such as this Bill.

Although I believe in self-regulation, and have argued for it in many cases, it has failed in medicine. In an ideal world self-regulation is the best kind of regulation. However, one cannot continue to argue for self-regulation when that kind of regulation has spectacularly failed. Failures such as the Neary case deal a credibility blow to the medical profession from which it will be very difficult to recover. We must face up to this and deal with the consequences.

At the same time, we must not replace self-regulation with something worse. I am in favour of public accountability but I am less of a fan of political accountability. Those who write our legislation seem to think the only way to ensure public accountability is through political accountability. It is not the only way, nor is it the right way. Methods of public accountability that would not necessarily extend ministerial powers should be considered at official level. If such methods could be devised there would be enough common sense at the political level to see the merit in them.

I wish to highlight once again the shortcomings in how we remunerate the medical profession. We pay our doctors for the work they do, not for the results they achieve. In China the tradition was to pay doctors according to the number of patients they kept alive, rather than the numbers they treated. If one became ill the doctor did not get paid. Our method is the opposite because the doctor does not get paid when one stays healthy. As soon as one is ill the doctor is paid. I am in favour of the Chinese system. I am not sure how we could apply it but I raise it for consideration.

Whether that system still applies in China, we must change the reward systems in medicine to provide practitioners with a strong incentive to invest time in preventative rather than curative medicine. We have a series of medical fire brigades but we need a force of propagandists to prevent fires in the first place. From the point of view of public policy, there is a clear benefit to be gained in purely monetary terms. Money spent on preventative medicine, euro for euro, provides a much greater return than money spent on purely curative activities. The State should take a long-term view of this matter, especially since the State picks up most of the bills.

There is another way we should consider in regard to changing the remuneration of our medical practitioners. To remain effective in a fast-changing world, practitioners need to spend more time keeping themselves informed of the latest developments. However, it seems that, increasingly, other pressures on time conspire against this happening to the extent that it should. One doctor confessed to me that the only reason he keeps up with the latest developments is that, thanks to the Internet, his patients were far more informed than him. In the past patients would simply accept a diagnosis from their doctors, but the first thing they do now is rush to their computers and become experts on the ailments from which they are suffering. It should not be patients who pressurise doctors to keep up with the latest developments in treatment. A strong incentive to devote a sizeable proportion of their working time to professional development should be built into the methods of rewarding medical practitioners

I mentioned my worry about legislation that has been rushed through the Houses and I am, therefore, concerned that the lack of concentration on preventative medicine and the lack of reward for professional development are not addressed in this Bill. The Bill will be passed and I understand the necessity for it but I urge the Minister to give serious consideration to a change in direction in the years ahead.