Róisín Shortall (Dublin North West, Labour)

The provisions of the Bill before the House will enable the Medical Council to register doctors in a newly created supervised register. The doctors registered will be assigned for a defined period of time not exceeding two years to identifiable, supervised posts to which specific criteria will be attached. Given the seriousness of the shortage of non-consultant hospital doctors, NCHDs, in our hospitals, the legislation is being debated within certain time constraints, in regard to which I appreciate the co-operation of the House. I make it clear that the problem of the shortage of NCHDs in Ireland is not related to funding, any recruitment embargo or moratorium, or any reorganisation of hospitals. It is due to an inability to attract enough doctors to work in our hospitals, in regard to which we are not unique, as many countries in Europe, including the United Kingdom, are encountering the same problems.

A total of 450 posts, including approximately 180 NCHD vacancies - mostly in service rather than training posts - are due to be filled from 11 July, when the next rotation takes place. The number of vacancies is decreasing on an ongoing basis as doctors are appointed via the HSE centralised recruitment process. Following an intensive recruitment drive by the HSE, just over 200 doctors from India and Pakistan have applied to fill these vacancies, but it is unlikely they will all be in a position to meet the new registration requirements of the Medical Council provided for in the Bill by 11 July, which means the take-up of duty will be phased over a period of weeks. The Minister for Health has stated in the Dáil that he will not oversee any process that results in the employment of NCHDs who are not capable of providing safely the services required. Certain specialties such as emergency medicine will be most affected by the NCHD vacancies. Together with my Department and the HSE, the Minister is working to devise arrangements that can be implemented in hospitals if required to ensure any resulting impact on services is minimised and that patient safety is maintained.

The current legislative provisions in the Medical Practitioners Act 2007 do not facilitate the registration by the Medical Council of doctors from Pakistan and India who have applied to work in Ireland. The reason for this is the requirement to sit the pre-registration examination system known as the PRES which is best suited to those who have recently qualified, rather than those who have been qualified for some years and have worked in specialty specific posts for the greater part of their careers. In recent weeks the Minister has been dedicated to determining how these doctors can be enabled to work in Ireland in a manner that will give complete assurance regarding the safety of patients and compliance with the regulatory standards required. The Medical Practitioners Act 2007 which provides the current statutory framework for the regulation of the profession is robust in terms of the protection of the public and great care has been taken in the preparation of the Bill to ensure it is not undermined in any way.

The Minister has been working intensively with the HSE, the Department, the Medical Council and the Forum of Irish Postgraduate Medical Training Bodies to introduce regulatory arrangements that will facilitate recruitment of suitably qualified doctors, particularly those from India and Pakistan, without delay. All involved have shown a great ability and willingness to work towards a resolution to this matter. It is expected that all involved will embrace and support the changes proposed in the Bill.

The Medical Practitioners Act 2007 provides for the registration and regulation of medical practitioners in four divisions of the register: the general division, the specialist division, the trainee specialist division and the visiting EEA practitioner division. The Bill provides a legislative basis for the establishment of a fifth division which will be known as the supervised division. This new division will allow the Medical Council to assess applicants under a range of headings and link a doctor's registration with an identifiable, supervised post in a specific specialty and for a contract specific period not exceeding two years in aggregate. This will enable the council to fulfil its core statutory responsibility as the regulatory body accountable for the protection of the public. It will also support the HSE in putting in place arrangements to facilitate recruitment on a basis that meets the objectives of service delivery and the provision of safe, high quality care. To further strengthen the role of both agencies in safeguarding the public, the council is finalising statutory rules to underpin the operation of the new supervised division.

I am acutely aware of the need to ensure any doctor from India or Pakistan seeking registration by the Medical Council should be proficient in the English language. The HSE has given written assurance that in respect of those selected for recruitment, the entirety of their medical education has been conducted in English and many have also acquired postgraduate qualifications in the English language. The people concerned were interviewed through English using the standard HSE interview, marking and scoring process but in this case, the pass mark was raised from 40% to 60% in each domain, including language and communication skills. In addition, language and communication skills will also be assessed in the course of the new knowledge and clinical skills assessment process particular to the new supervised division. When in post, the ongoing supervision criteria attaching to each post will also facilitate ongoing monitoring of language and communication skills.

Part of the solution in addressing the underlying problem of sourcing and retaining doctors in the health service is being addressed by the HSE which in recent years has created a significant number of additional consultant posts and will continue to build on this in parallel with reducing the number of non-consultant hospital doctor, NCHD, posts in the system, especially non-training posts. The HSE has also taken steps to improve the quality of all NCHD posts and continues to do so. As of 11 July, 80% of the 4,660 NCHD posts will be part of structured training schemes run by the postgraduate training bodies and funded by the HSE. This contrasts with the situation in 2007 when only 53% were in structured training, 31% in stand-alone training and 16% receiving no training at all.

The Bill is only part of the solution and the Minister for Health is committed to addressing the wider issues which have contributed to the situation confronting us. These issues include a requirement for a better skills mix, new and more flexible rostering arrangements and the reorganisation of health services, all of which form part of the ongoing reform of how we access and deliver health services.

Members have been provided with an explanatory memorandum which sets out in detail the contents of the Bill. However, I will briefly outline the Bill's provisions. In summary, it provides for a new division of the medical practitioners register which will be called the supervised division. Registration in this division will be limited to two years and is linked with employment in a post and the medical practitioners will be supervised by their employer. Medical practitioners who apply to be registered in this division will undergo an assessment and examination which differs from that for registration in the other divisions on the register. The assessment will be specific to their medical specialty and the fact that the post is supervised.

Section 1 sets out the definitions used in the Bill. Section 2 amends definitions in the Medical Practitioners Act 2007. Section 3 amends the functions of the Medical Council to allow it to approve posts for the purposes of the supervised division.

Section 4 amends the Medical Council's powers to make rules to provide that it can set criteria for assessing applications for registration in the new supervised division and to allow it to specify the examinations and assessments for registration in the division. It is envisaged that this will comprise a two-stage process. The first stage will involve providing documentary evidence in respect of medical education etc., while the second will involve a specialty specific knowledge and clinical assessment. Section 5 amends the Medical Practitioners Act to provide that the council can charge a fee for registration and retention in the new division.

Section 6 provides that the register will now have five divisions rather than four. The new division will be called the supervised division and registration will include the identifiable post to which each registration applies. Section 7 amends references in the Medical Practitioners Act to include a reference to the new division.

Section 8 is a key section. It details how medical practitioners register in the new supervised division. It provides that the medical practitioner must meet the requirements specified in the legislation and the criteria outlined in rules. It also provides that a person cannot be registered in this division if he or she can be registered in another division of the register. A medical practitioner can only be registered in this division for a maximum of two years. The registration is linked with identifiable posts approved by the Medical Council and posts must be certified as publicly funded. The HSE will not certify that a post is publicly funded unless the post is funded substantially by it. The council will only approve posts where it is satisfied that adequate arrangements are in place for the supervision of the medical practitioner and will take into account his or her experience, the seniority of the post and the duties to be performed. The medical practitioner ceases to be registered when he or she leaves the post and the employer must notify the council within five days of the person leaving. These provisions have been included to ensure the safety of the public by ensuring medical practitioners are supervised and can only work in specific posts.

Section 9 provides that a medical practitioner who removes himself or herself from the register cannot seek to have the registration restored under the provisions of section 2 of the Medical Practitioners Act 2007. Section 10 relates to fitness to practise. As the medical practitioners in the supervised division are only registered for two years or until they leave a post, the Bill provides that, unlike other divisions of the register, the Medical Council can investigate complaints made against these medical practitioners, even if they are no longer registered. This is to provide for due process for both the medical practitioner and the person who makes the complaint. This means that fitness to practise procedures will apply to the medical practitioners in the supervised division when they are registered in the division and they are no longer registered on the register.

Section 11 is another measure for the protection of the public. It provides that the Medical Council can apply to the court for an order to prohibit a medical practitioner who was registered in the supervised division but is no longer registered from applying for registration in any division of the register. This is only done where it is considered necessary to protect the public. The court can make any order it considers appropriate.

Section 12 provides that section 70 of the Medical Practitioners Act which provides for the steps to be taken by the Medical Council following a fitness to practise report, will include a reference to a new section to inserted by section 14. Section 13 inserts a new section into the Medical Practitioners Act to provide that the sanctions provided for in sections 71 and 72 of the Bill do not apply where the medical practitioner is no longer registered in the supervised division or in another division. This is because section 14 provides for the sanctions in these cases.

Section 14 inserts a new section into the Medical Practitioners Act to provide for sanctions in cases where the medical practitioner is no longer registered in the supervised division. These sanctions include advice, admonishment, censure, a fine not exceeding €5,000 or the attachment of conditions which would apply if the medical practitioner applied for registration, or a prohibition on the medical practitioner from applying for registration in a division or divisions for a specified period.

Section 15 inserts another new section into the Medical Practitioners Act. It is linked to the previous section in that it provides for the council to decide on the amount of the fine, the nature of conditions and the period a practitioner is prohibited from applying for registration.

Sections 16 to 19, inclusive, provide for amendments to sections 73 to 76, inclusive, of the Medical Practitioners Act 2007 which relate to sanctions and the right of appeal. The amendments provide that these sections now include a reference to the new section 71A inserted by section 14 of this Bill and relates to sanctions for those who were registered on the supervised division but are no longer registered.

Section 20, the final section of this Bill, provides for the Short Title of the Act and its commencement. Some sections of the Act will commence on enactment while more will require a commencement order. The sections which require a commencement order cannot be commenced immediately as they rely on rules or criteria to be set by the Medical Council prior to commencement.

In conclusion, this Bill will form a major part of the arrangement being put in place to attract doctors to Ireland, not just now but in the coming years as we continue with the ongoing reform of the health system and the arrangements governing medical manpower planning and medical education and training. I am seeking the co-operation of the House in the speedy passing and enactment of this Bill. I commend the Bill to the House.