Margaret Cox (Fianna Fail)

I am not an expert in this area and have no medical background. I did, however, meet some people who made some points and perhaps the Minister of State would be kind enough to address them.

This Bill is necessary and is supported by the medical profession and the Medical Council as an attempt to reform current procedures. It is important to ensure that existing competence structures are put on a statutory basis so the weight of law is given to the requirements of these assurance structures. It is surprising, however, that the incoming council will be responsible for drafting some of the structures that will be in place within six months of its inception.

The main functions of the Medical Council are to oversee the quality of medical education, to register and license practitioners, to assure itself of European and international qualification standards, to ensure that the Irish standards meet current international standards and vice versa, to discipline and recommend actions to help practitioners whose behaviour or practice falls below an acceptable standard and to set ethical guidelines for the profession. Those are important and give no cause for disquiet.

My query relates to the proposed composition of the council. A total of 25 members will be appointed by the Minister. Of these, 12 will be proposed by the professions — seven elected and two of the remaining five representing colleges for basic medical education and three representing colleges of specialist education — while of the 13 others one will be proposed by the Royal Irish Academy, one by the HSE, one by an Bord Altranais, one by the Health and Social Care Professional Council and seven will be non-medical practitioners, which may include representative of advocacy groups and service users, while two will be proposed by the Minister.

It is possible that this method of appointing people to the council may result in a lay majority and this is the area of concern. Those who spoke to me pointed out that according to the recent World Health Organisation review, there is no need for a lay majority. A recent document on the regulation and licensing of physicians in the European Union reviewed the status of 39 countries' processes for basic licensing and specialist registration, and in 18 countries where a council is responsible for those processes, none has a lay majority. The highest lay representation is in Britain, where 40% of council members are non-medical. It is important to have lay members on the council because the public must have confidence in the processes that govern medical self-regulation. However, if the members of an autonomous profession are defined by specialist knowledge and experience resulting from training and education whose goals and purposes are governed by the principle of ethics and service, why is a lay majority necessary?

The council was established over 100 years ago to protect the public from quacks and charlatans by setting the standards for education for medical students to be doctors and for doctors to be specialists, and acting as judges of their behaviour. As respected representatives of the position, the public and profession had confidence in the council. There is a genuine concern now that a lay majority will not increase confidence in the profession but reduce the respect of the profession for the decisions of the council. That could be a problem in future because the council's role is to protect the public to ensure quality standards are met, so it must be seen as completely independent and responsible in terms of the quality standards it is setting and have an understanding.

It is also important it is not seen to be a body that is at the whim of the Minister. There must be separation between the two. Perhaps the opportunity exists to ensure this will not happen and I look forward to hearing the Minister of State's remarks on that.

The briefing I received from the Department of Health and Children and the legislation did not make it clear how the council will be funded. Who will pay for it? It is currently paid for through the subscription of the medical membership. Will that change? Will the council be paid for by the Government? How will those appointed to the board be recompensed for their expenses or will they work on a voluntary basis?