Wednesday, 9 October 2002
Adjournment Matters. - Recognition of Medical Qualifications.
I welcome the Minister of State. It is appropriate that we are debating this matter this evening because, as he will be aware, the European Commission has given a warm welcome to the ten candidate countries, indicated that they have fulfilled a sufficient number of the Chapters they were required to fulfil and stated that all that is needed is a "Yes" vote by the Irish in the referendum on the Nice treaty. I am an enthusiastic supporter of the treaty.
The matter I wish to raise involves the internal market which, we hope, will be enlarged after the Nice referendum and consequently will have even greater importance. We complain frequently about bureaucrats in Brussels making all the decisions. Unless we take part in the decision-making process, however, it will be quite impossible for us to influence any of the decisions that are made. That is why I want the Minister for Health and Children to address this issue immediately.
The Commission, in its proposed Directive COM (2002) 119 final, intends to change a reliable, well understood system for the recognition of the medical qualifications of member states in other EU states to a system which will become cumbersome and discriminatory. As it stands, any doctor qualified and registered in a member state has the automatic right to practise in another member state. This right will be severely curtailed by COM (2002) 119 final.
The Doctors Directive 93/16/EC, last modified by Directive 2001/19/EC, guarantees automatic mutual recognition of qualifications between the states. A total of 52 medical specialties are recognised by this directive, some of which are common to all states – 17 in all – but others are recognised by two or more states. The new directive will restrict automatic recognition to the 17 specialties common to all states. All the others will be placed within a new general directive system which will be governed by member states. This will create a new two-tier system of doctors' qualifications. Why, when the EU is striving for an even closer union, is the Commission seeking to divide European medicine?
As already stated 17 specialties – anaesthesia, diagnostic radiology, general medicine, general surgery, morbid anatomy and histopathology, neurological surgery, neurology, obstetrics and gynaecology, ophthalmology, orthopaedic surgery, otolaryngology, paediatrics, plastic surgery, psychiatry, radiotherapy, respiratory medicine and urology – are recognised in all states. At present, however, if a specialty is recognised in two states or more it is still recognised as a specialty. For example, cardiology is recognised in 11 states including Ireland; child and adolescent psychiatry is also recognised in 11 states including Ireland; microbiology-bacteriology is recognised in 12 states including Ireland; occupational medicine is recognised in 14 states including Ireland; and thoracic surgery is also recognised in 14 states including Ireland. However, accident and emergency medicine is recognised in only two states – Ireland and the United Kingdom. There is nothing to say that other countries will not proceed to recognise this area of medicine as a specialty. That is what one would expect and it is what everyone in the medical profession in the European Union has been working towards in the past 30 years. It is, therefore, extraordinarily difficult to understand the course of action taken by the Commission.
Ireland recognises 24 of the 35 specialties at present and the new document COM (2002) 119 final will place a twofold burden on doctors whose specialty is not one of the 17 recognised by all member states. First, it will oblige them to seek verification from any member state in which they propose to practise. The EU currently guarantees them the right to practise provided that they are registered in any one member state. This is an extremely important part of the internal market. Second, the drive to innovate and improve the quality of medicine will be hampered. Any doctor wishing to practise a specialty not currently offered in another member state will have to seek the right to practise, whereas, as things stand, the law allows him to practise as of right.
From the doctors' point of view, the new directive will restrict civil rights – which the current directive upholds. No adequate reason is given for the loss of these rights. From the member states' point of view, it will add additional burdens to national regulatory authorities – in Ireland, the Medical Council, the Hospital Services Employment Authority, health boards and the Department of Health and Children.
Having multiplied the burdens of administrators and doctors, the Commission proposes to reduce the resources available to bear these loads. Until now, the highly successful system of mutual recognition has functioned because of the Commission's co-operation with the medical profession through the Advisory Committee on Medical Training and the committee of senior officials of public health. This has evolved and operated for over 30 years. The ACMT and the CSOPH have enabled the Commission to tap into the medical profession's continually evolving training and educational expertise. The Commission plans to abolish both committees, in effect cutting itself off from the institutional structure which has underpinned the success of the current directive.
The pace of change in medical knowledge is just as fast as in other parts of modern life. The Commission seems to be turning away from the profession just at a time when it needs it most. The new directive contains no undertaking from the Commission to ensure the same level and quality of professional input and participation within the parameters of the new directive. As the Minister of State is aware, there are Department officials on the committee as well as people from the Medical Council and people representing the profession.
It is vital for the maintenance of the currently successful system that the representative body of the European medical profession has a right of participation within the new system. I ask the Minister of State to make urgent representation to the Commission to find out why these proposals are coming forward and to have them reversed from the point of view of practicality.
I welcome the opportunity of making my first visit to the House as Minister of State. I compliment Senator Henry on the statement which she has so knowledgeably and eloquently presented. I also thank her for her positive leadership in supporting a "Yes" vote in the forthcoming Nice referendum. Senator Henry and I have worked well together on a number of issues and we usually find ourselves on common ground as in the present instance.
Perhaps some explanation is required on the background to the issues which Senator Henry has raised. At the request of the Council of Ministers, the European Commission has produced a proposal for a directive, which is aimed at simplifying and consolidating several sectoral and general systems directives governing the recognition by EU member states of the qualifications of professionals. This proposal was launched by DG4 of the European Commission on 7 March 2002.
The Minister for Health and Children notes the concerns that have been highlighted by Senator Henry in her address to the House. The Department of Health and Children also has a number of concerns regarding the proposed directive, as have the health service regulatory bodies – Medical Council, An Bord Altranais, the Dental Council and the Irish Pharmaceutical Society. The Secretary General of the Department met with the four bodies earlier this year to discuss their concerns and to agree a modus operandi for co-ordinating responses to the proposed directive. In this regard, the Department of Education and Science is the lead Department for the negotiations at Council level and is co-ordinating the Government's response to the proposed directive. The Department of Education and Science has set up an interdepartmental group to collate the views and observations of the various Government Departments. These contributions are then presented for discussion at the Council working group.
My Department, both directly at the Committee of Senior Officials on Public Health and through the Department of Education and Science, has been making Ireland's concerns known to the European Commission. Our main concerns and those of the regulatory bodies regarding the proposed directive include article 5, which makes provision for a professional registered in one member state to work in another member state for a period of up to 16 weeks per year without having to register with the regulatory authority in the host member state. The Department also has concerns regarding the proposal to abolish the advisory committees under Article 45. These committees examine the training programmes in member states and provide advice to the European Commission and member states with regard to the standards and suitability of training programmes undertaken by members of the various professions.
As highlighted by Senator Henry, there are also concerns regarding the automatic recognition of certain medical specialties. At present, certain specialties are recognised by all member states and others are recognised in two or more member states. This second group is covered by the sectoral directive which provides for automatic recognition in the relevant states. If adopted, the proposed directive would do away with this system in favour of a general system under Article 24. This could adversely affect the right to automatic recognition for certain medical specialists who wish to work in other member states.
There are, clearly, a number of important issues to be resolved. Both the Department of Education and Science and the Department of Health and Children have made Ireland's position quite clear on these issues. In addition, contact has been made with other EU delegations to brief them on our views and to explore their positions. These liaison arrangements are ongoing on a number of fronts in the area of health policy. On Tuesday of this week, I had a meeting in Luxembourg with Ireland's EU Commissioner, David Byrne, on health issues. There is great co-operation among the member states and I hope the liaison arrangements to which I have referred will have a positive outcome.
As part of the co-decision process, the European Parliament held an oral hearing into the proposed Directive on 1 October 2002. Representatives of both the Department of Health and Children and the Department of Education and Science attended this hearing as observers. The Irish regulatory bodies were also represented at this hearing. It is clear that other member states and regulatory authorities share our concerns and that redrafting of the proposed directive will be required before it meets with general approval. Officials of the Department of Health and Children will continue to monitor the progress of the proposed directive, to consult with the relevant bodies, both nationally and at EU level, and to raise relevant concerns regarding the proposed directive with the European Commission.