James Reilly (Dublin North, Fine Gael) | Oireachtas source

I am happy to have an opportunity to participate in the Second Stage debate on Senator Colm Burke's Bill which proposes the introduction of mandatory professional indemnity cover for medical practitioners engaged in medical practice. It proposes to do this by amending the Medical Practitioners Act 2007. I thank the Senator for proposing the legislation and acknowledging that I tried to make progress with a similar Bill when I was in opposition. Equally, I acknowledge the great work he has done to bring the Bill to the House today.

I must advise Senator Paschal Mooney that he should ask a representative of the previous Government why it did not publish the heads of a Bill. I am not privy to that information. I assure him, however, that I pursued the matter every time I had an opportunity to do so. Since that time, major events have shaken the country to its foundations. We have had to rely on money borrowed from the troika to run the country. A great deal of legislation across all Departments has been introduced as a consequence of these arrangements.

It makes it very difficult to get a Bill such as this into the queue. I am very grateful for Senator Colm Burke's attention to this Bill, for his bringing it to the floor of the House and, by so doing, progressing it.

Many Members of the House may be aware the matter of mandatory indemnity is a very necessary one. I would like to explain that the initial thought process behind this was that we would not be playing catch-up, as Senator Crown said, but rather be pre-emptive. One will not be able to register unless one is insured whereas, at present, people register and proof of insurance may follow later, after the event.

Another very important area we need to address is that of appropriate insurance, to which Senator Gilroy alluded. We have had situations where people have practised cosmetic surgery in Ireland and, while they were insured, they were insured for GP work, not for cosmetic surgery. In answer to the Senator's question, I am aware of situations in the past where people were not insured and took a chance. I am also aware of the fact people have suffered as a consequence and, although malpractice was proven, as the individual was not insured, there was no recourse for the patient.

Professor Crown made some assertions around the number of doctors, including NCHDs. While I would certainly like to deal with that issue, it is perhaps for another day because today is about this Bill. However, I will say this. There would be a contention that Ireland needs double the current number of GPs yet if we had advanced nurse practitioners working in practice, managing chronic illness care and screening patients to see if they need a GP or not, I wonder just how many more GPs we would need. Similarly, NCHDs are doing a lot of work that could be done by others, such as being called out of bed at night to put up an intravenous line, which an advanced nurse practitioner could do, or perform a catheterisation, when a nurse could be trained to do that. A lot of the work that is currently being done by some professionals could easily be done by other professionals, freeing doctors up to do the work they and they alone can do. That is the underlying principle when I talk about treating the patient at the lowest level of complexity that is as safe, timely, efficient and near to home as possible, or, to put it another way, the right patient being treated by the right person at the right time in the right place.

Because there are many similarities in both Bills, I have discussed this Bill and the Department's Bill with the Attorney General and understand the Department's Bill will take account of Senator Burke's Bill. The Government's Bill will be prioritised and my aim is that it will be published before the summer recess. I hope Senator Burke will agree to this proposal, whereby the Government's Bill will, where appropriate, adopt the provisions contained in his Bill. In this way, we will get maximum benefit from the input of our respective legislative experts on this important matter.

I strongly believe there should be a legislative basis for the introduction of mandatory medical indemnity for medical practitioners engaged in medical practice, as Senator Noone and others have pointed out. My officials have engaged in an extensive consultation with the relevant stakeholders and I am conscious that Senator Burke has also consulted widely on this legislation. Of course, consultation with all parties will continue as the Bill progresses.

My officials have also taken into consideration the Finlay Scott report, an independent review of the requirements to have insurance or indemnity as a condition of registration as a health care professional. As has been said, this work was commissioned by the UK Department of Health in 2010. The report set out a number of key principles in support of its recommendations. They include the need to place a statutory duty upon registrants to have insurance or indemnity in respect of liabilities which may be incurred in carrying out work as a registered health care professional. Specifically, the report indicated that a statutory condition of registration should require the registrant to prove a positive, namely, the presence of cover, rather than the regulator to prove a negative, namely, the absence of cover. The outcomes of these considerations and the report's recommendations are being reflected in the Bill.

I agree with the overall objective of Senator Burke's Bill, and we are in agreement that mandatory professional indemnity cover for certain medical practitioners should be introduced. However, there are a number of important areas where we have reservations on the approach being taken in it, and I will give the House a few examples as to why we have these reservations.

Section 5 of Senator Burke's Bill proposes to introduce a new subsection (2C) into the 2007 Act. This proposed subsection requires the Medical Council to make rules, specifying the indemnity providers which are recognised by it, for the purpose of providing professional indemnity cover to medical practitioners. Such a task would be beyond the council's current range of knowledge or competencies and may raise competition issues.

Section 6 of the Senator's Bill requires the Medical Council to establish a committee, to be known as the professional indemnity committee, to perform certain functions set out in the proposed subsections (2A) to (2G) of section 11. I believe the establishment and operation of such a committee may cause serious practical difficulties for the Medical Council and may have a disruptive effect on the registration process as established under Part 6 of the Principal Act.

Section 8 of the Senator's Bill proposes to insert a new section 44A into the 2007 Act. This new section requires the insurer or indemnity provider to notify in writing both the medical practitioner and the council when it becomes aware that cover has lapsed or has been cancelled. This provision will have significant practical difficulties for indemnifiers. There may also be confidentiality issues concerning insurers providing the required information to the Medical Council. However, I want to assure the Senator I agree in principle with this and we will try to overcome these difficulties. We need as many cross-references and safeguards as possible to protect patients.

My Department's Bill is being drafted by the Attorney General's office in consultation with the relevant stakeholders, including the Medical Council, the State Claims Agency and representatives of indemnity providers, and it will have regard to the issues raised by all parties. Under the Bill, if the practitioner does not have indemnity, the Medical Council will have the power to refuse registration. The council will also have the power to remove a practitioner from the register where indemnity is not maintained. The continued maintenance of indemnity cover will be confirmed by the practitioner, by declaration, at the time of his or her annual retention of registration. It will be the responsibility of each medical practitioner to establish that they have the required professional indemnity. In this legislation, the role of the council will be supported by powers, not duties, to require the relevant information from registrants for the purpose of registration and re-registration.

The Medical Council does not have the required expertise in the insurance or brokerage market to determine the appropriate level of cover for a medical practitioner, having regard to the type of work or specialty in which he or she is engaged. Accordingly, the legislation will provide for the State Claims Agency to assist the council in making available guidelines, setting out indicative or minimum levels of cover, having regard to specialty and procedures. This is an important aspect that has to be covered.

Overall, my Department is approaching the draft legislation at a high or enabling level. The Medical Council can subsequently specify the necessary detail, by the provision of guidance and-or rules, in accordance with the statutory powers given to the council in its establishing legislation. I wish to assure the Senator that most of the sections in his Bill will be reflected to some extent in the final text of my published Bill. In addition to the introduction of mandatory medical indemnity cover, I believe that systems must also be in place to minimise the need for patients to initiate civil litigation. At this point, one might also consider talking to the Medical Council with regard to insisting that the current medical indemnity certificate is displayed in a public place where the practitioner operates. Obviously, this would cause difficulty for people who operate out of several premises but, where there is a single premises, it certainly should be the case.

The Medical Practitioners Act 2007 introduced a more proactive system of robust registration and regulation of the medical profession. This Act, which we will be amending, has already strengthened areas such as governance, mandatory registration, fitness to practise procedures, education and training, and maintenance of professional competence.

The enactment of the Bill should help instil further patient confidence in our health system and help underpin other initiatives which are already delivering good outcomes for patients. For example, the HSE national clinical care programmes provide a national, strategic and co-ordinated approach to a wide range of clinical services. They have three main objectives - to improve the quality of care, to improve access and to improve cost effectiveness. The primary aim of the clinical programmes is to modernise the way hospital services are provided across a wide range of clinical areas. This is being done through standardising access to and delivery of high quality, safe and efficient hospital services, and maximising linkages to primary care and other services.

There are approximately 30 clinical care programmes and programme initiatives in different stages of development or implementation. Many of the programmes have produced models of care and guidelines and are developing both integrated and primary care solutions.

There are many specific examples of tangible outcomes of the programmes for patients. A programme worth mentioning is the new stroke programme which, since its initiation, has resulted in one life saved per week and an avoidance of the necessity for long-term care for three more of our citizens every week. We also have an excellent heart failure programme. Both programmes were mentioned by Don Berwick, one of President Obama's health spokespersons, in a keynote address in Oregon as examples of what can be achieved in an economy as challenged as ours using a reduced budget. More than 120,000 bed days were saved by the implementation of the acute medicine programme, which aims to save half a million bed days over three years. Yesterday, I launched the first national clinical guideline - the national early warning score for Ireland. The launch was the accumulation of the good work of a number of patient safety initiatives, including the national clinical effectiveness framework and the clinical care programmes of the HSE. The national early warning score clearly sets out how to recognise and respond to patients whose conditions are deteriorating. Recognising a patient whose condition is deteriorating and responding to his or her needs in an appropriate and timely way are essential components of safe and high-quality care. This guideline is based on international evidence of what is known to work best and Ireland is the first known country to agree a national early warning score. Whether one is a nurse in Tralee or Letterkenny or a doctor in Tallaght, one will be aware of the same standards that will allow one to assess whether a patient is deteriorating and what action needs to be taken. It has since come to my notice that we have been nominated for a European award for this, so I congratulate all involved. I have no doubt it will save many lives in the future. Furthermore, one of the leaders told me yesterday that since it was introduced in Beaumont Hospital, the incidence of myocardial infarction, or heart attack, has dropped by 29%. These are very welcome developments that enable us to maximise the benefits for patients from the resources in our health care system but, crucially, they also underpin the continuing focus on quality of care, which is my primary concern.

While I am here and have the opportunity, I will talk about the significant improvements that have been achieved in the waiting times for unscheduled emergency care against a background of reduced funding and staffing levels. It is a very challenging socioeconomic climate and a growing number of older persons with an overall increase in life expectancy are now attending our hospitals. The fact that our citizens are living longer lives is a welcome development and we want those lives to be healthier. I will provide a few statistics. There was a reduction of 23.6% in the number of patients waiting on trolleys in 2012, compared to 2011. This equates to 20,352 fewer patients waiting on trolleys. With regard to the nine-month access target for adults, excluding endoscopy, the number of patients having to wait more than nine months for inpatient and day case surgery was down to 86 at the end of 2012 from 3,706 in December 2011, which represents a 98% decrease. The target for 2013 is a guaranteed maximum waiting time of eight months. In respect of children, the number waiting over 20 weeks for procedures excluding endoscopy was down to 89 at the end of December 2012 from 1,759 in December 2011, which is a 95% decrease. The number of patients waiting over 13 weeks for a routine GI endoscopy procedure was down from 4,590 in December 2011 to 36 at the end of December 2012, representing a 99% decrease. We are trying very hard to ensure that by 30 November 2013, no patient will be waiting more than 52 weeks for a first-time consultant-led outpatient appointment. At this early stage of 2013, the figures generally remain approximately 10% below those for the same period in 2012. Despite the challenges we face both financially and in terms of staffing levels, the health service has responded and shown that it can change by empowering those on the front line to do things the way they want them done and not having the system strangle them as it did in the past. To those who work in our health service, I offer a heartfelt "Thank you" on my behalf and that of the Government and this House.

My mission is to improve the health and well-being of the people in Ireland in a manner that promotes better health for everyone, fair access, responsive and appropriate care delivery and high performance. The main purpose of the Medical Practitioners Act 2007 was to shift to a proactive system of robust registration and regulation of the medical profession in order to minimise the risk of adverse clinical events. The Medical Council is doing a very good job in providing an efficient and accountable system for regulation of the medical profession. The public can be satisfied that registered medical practitioners are both appropriately qualified and competent to practice in a safe manner. My predecessor, Mary Harney, did change the structure of the council, as was mentioned earlier, so that the majority of members are not medical practitioners, which helps instill confidence in the public that medical practitioners do not have majority control in the governance of their regulatory body.

When this Bill is enacted, the additional requirement of having adequate indemnity on registration and again on retention of registration will further assure patients and their families that the system in which medical practice is undertaken is operating in a person-centred, effective and fair fashion and a manner focused on protecting them from the inevitable times when things go wrong. It is not a perfect science or a perfect world but we can ensure that if something does go wrong, the harm and hurt to the patient is minimised through having adequate compensation and measures in place to support him or her to lead the fullest of lives possible afterwards.

I am pleased to have had the opportunity to address the House today. I once again acknowledge the work Senator Colm Burke and his team have put into drafting this Bill. I would like to support Senator Burke's Bill and I will now arrange for the content of his Bill to be used in finalising the text of Government's Bill. I look forward to working closely with Senator Colm Burke as the Bill progresses through the Oireachtas, to the benefit of all our citizens.