David Norris (Independent)
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I wish to share time with Senator Henry. I welcome the Minister for Education and Science to the House. She will want to address the situation I am going to outline. She is aware of it because one of my constituents has been in touch with her about it — the disadvantage faced by Irish applicants to Irish medical schools who must compete for entry with people from outside the European Union.

A working group on undergraduate medical education was established in 2003 under Professor Patrick Fottrell. He drew some remarkable conclusions and I was unaware until I was approached about this of how disastrous is the situation. More than half the places go to people from outside the EU. A minority of medical students in this country are Irish, even though there is a yawning gap for doctors throughout the community. The group made recommendations on extra funding and I am sure the Minister has some plans for that.

We invest in medical education but not to the extent of other countries. Comparisons have been drawn with Canada, which spends two or three times more than us, and Britain. Our medical schools only remain open because they are selling medical educations to people from outside the country. This is wrong. In 2003, 516 of the 831 first year places in the Republic's medical schools were allocated to non-EU students, meaning that 83% of fee income came from overseas. The Exchequer that year provided a miserly €2.36 million in first year fees. Most people do not know this is the case. We can contrast this with the support given to veterinary medicine. Animals are subsidised to the tune of €26,604 per annum, while the subvention to medical students is only €9,000, roughly a third. This is astonishing.

This situation also acts to the disadvantage of developing countries because we are taking their students, educating them and often we must then employ them to make up our own short-fall. Almost 500 Irish students who should qualify every year are denied places they should have when their academic attainment is taken into account. The chairman of the Irish College of General Practitioners, Dr. Éamon Shanahan, says that a third of GPs will retire in the near future and they will not be replaced because the system is not flexible enough. For over 25 years we have capped the Irish and EU student entry at 305 places per year. That must stop.

I will move now from the general to the particular. I have been in correspondence with a person whose family is well know to me. Her father was a doctor, as is her sister, and her son now wishes to enter the profession. The latter attained 570 points in his leaving certificate, an achievement which should qualify him to study medicine, but he did not gain a place. Students from outside the EU with 450 points can gain admittance to medical courses. A large number of students from outside the State come in on substantially less points than are required by Irish students, who are thereby squeezed out of the system. I cannot but believe this is wrong.

There is yet another form of discrimination in respect of those candidates who take the A-level examination. These students only take four subjects. Although they are sometimes older than most leaving certificate students, they are awarded 150 points per A grade. However, no distinction is made at A-level between an A1 and an A2. Thus, an A-level student could attain 600 points for four 85% grades whereas an Irish student would receive only 360 points for four A2s. In a roughly comparable situation, we discriminate against our own students in terms of how their academic attainment is evaluated.

Prospective Irish medical students are, therefore, disadvantaged in a number of ways. These relate to the problem with regard to the way in which scores are evaluated; the cap in numbers; and the fact that Irish students are in a minority within our medical institutions. Moreover, society is disadvantaged because we do not have sufficient doctors to cope with the requirements of the community.

I see a worried expression on the Minister's face. We know she is an excellent Minister; we have witnessed this in performance. We have seen the way she handles matters and believe she is the very person, with the type of vigorous approach she has shown in tackling other equally different problems, to set about dealing with this issue. It is a source of great regret to me that the young person to whom I referred did not attain the place he desired. He is a person from a medical background, which can be useful because such persons know the situation. He would have a good manner if he is anything like the other family members with whom I am acquainted. Having attained all that should be required in terms of points, he was nevertheless not accepted because our third level institutions are forced, in order to keep their doors open, to sell student spaces to people from outside the European Union. This is a problem the Minister inherited. It would redound to her credit if she could do something to solve it.

Mary Henry (Independent)
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I thank Senator Norris for sharing time with me. A motion I put down earlier this year, supported by all the Independent Senators, stated that we should double the number of places in the medical schools for EU students. Irish students cannot be given preference in this regard. I am glad 70 extra places were provided this year but there is a problem regarding the clinical years, as we have discussed with the Minister. It is three years before students go into clinical training so I would have thought the hospitals would be in a position to sort this out.

Senator Norris is right to point out the advantage enjoyed by students who take the A-level examination. It is only recently, in the last three or four years, that the universities offering high-demand courses have increased their requirements from three A-levels to four. For many years, therefore, students taking A-levels had a huge advantage over their counterparts studying the leaving certificate. We must take seriously the issue regarding the number of students from abroad being educated here and retained in the system to the disadvantage of their home countries and, worse still, the number of qualified doctors we take from developing countries to fulfil our needs. We have an enormous moral responsibility in this regard. I am interested to see that some African countries are now qualifying health workers after four years because they are determined not to be robbed by the West. This is an issue we must examine carefully.

In regard to the individual case raised by Senator Norris, it makes it particularly hard that the young person's points were upgraded to 570. At this points level, a system of random selection was in operation. However, he was not included in the random selection because of his initially lower point score and so did not even get the chance to secure a place. I understood from other cases in which I have been involved that in such situations, the person was given a place. Unfortunately, that did not happen in this instance. As fair as the points system may seem, it turns out to be very inadequate for some.

Mary Hanafin (Dún Laoghaire, Fianna Fail)
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I thank the Senators for raising this issue, which is of importance not only for education but for society in general. There has been a number of developments recently in regard to medical education. As Senators have outlined, a control has operated since 1978 on the annual intake of Irish and EU students to medical schools. It has become clear in recent years that there is a need to review that quota, not only from the perspective of students' needs but also to ensure we have a sufficient output of graduates to meet our medical requirements and the demand that exists within the health services for doctors. As Senator Henry observed, we must also ensure the demand for student clinical placements can be met.

In tandem with the intake of Irish and EU students, which is set by quota at Government level, the medical schools have independently over the years offered additional places on a commercial basis to non-EU students. This has created an important source of income for the colleges, allowing for investment in the overall quality of medical education, as well as enabling them to develop valuable international links. We spoke before about the importance of marketing Ireland as a place for quality education. Earlier this year, departmental colleagues and I went to China to attract students and we will go to India in January to do the same. Some of those Indian students are medical students. In the academic year 2003-04, where the overall intake of medical students was 782, 305 were from the EU, as per the quota, and 477 were non-EU in origin.

It is important to emphasise that the stream of international activity has not compromised the number of places on offer to Irish students because the quota is set in this regard. It is also important to state that selection of non-EU students for entry to medicine is subject to rigorous standards of assessment. The entrance requirements for potential non-EU students are determined by each medical school. That is why, for example, we have seen the change in regard to A-levels. As Senators correctly observed, some colleges used to work on the basis of three A levels but have now determined to use four. There is even some concern that this might in some way, in some of the colleges, discriminate against Northern Ireland students who traditionally came in significant numbers to Trinity College, for example.

There are other issues to consider in this regard. The colleges are committed to ensuring that a high academic standard is maintained. This is essential because it is in the interests of the medical schools to ensure there is a high standard in terms of their intake of international students. The international reputation of the schools hinges on the academic standard of their programmes and the associated standards of entry required of international applicants.

For students who wish to study medicine in Ireland, there are very limited routes of entry. It is mostly done through undergraduate entry on the basis of the leaving certificate examination. This year, it was particularly difficult for leaving certificate students because of the huge demand for undergraduate places and the high performance of so many students. I too have met students who attained 570 or 575 points, almost perfect leaving certificates, and were heartbroken not to attain places in medicine. It is almost the case that students require 590 or 600 points to secure a place. Such high points are now the norm. For a number of students who reached the cut-off point, rather than entering a random selection process, some were offered places this year. If this was not possible, they were offered a place for next year on the basis of entrance at the same level as those who started this year. For a candidate subject to a random selection process, however, there is no guarantee of success, which is why an individual may lose out.

As Minister for Education and Science and a former teacher, I am anxious about the high points issue and the pressure this puts on young people. From a medical and societal perspective, there is a need to ensure more doctors can qualify. It was with these objectives that my predecessor, Deputy Noel Dempsey, set up the working group on undergraduate medical education and training, under the chairmanship of Professor Patrick Fottrell. This was established to review the organisation and delivery of medical education and training. As well as looking at the number of places and the entry routes, the working group also examined the quality of education. The report it produced is a valuable work with good recommendations as to how we should proceed. This is a joint effort between the Tánaiste, as Minister for Health and Children, and I. We considered the report at Cabinet sub-committee level and will bring forward recommendations to Government shortly.

It will examine the number of places and the routes of entry involved. It would be wrong at this stage to set out exactly what the proposals are. However, it is our intention to increase the number of medical places available to students in line with what will be required in the health service. We will try to achieve a better balance between EU and non-EU places. Unfortunately, it will take a significant number of extra places to bring down the number of points required because of the number of students who have applied. In the short term, there may not be a significant difference, but at least by having extra places available, it will open more doors for more students.

While I would like to be in a position to provide more details about what the Government is doing, the Adjournment debate has probably come a few weeks too early. We will bring forward proposals based on the Fottrell report, bearing in mind what the Senators have said, because it is such a significant issue.

David Norris (Independent)
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I thank the Minister for her clear reply and for the indication that proposals will go to Government in this session.

Mary Hanafin (Dún Laoghaire, Fianna Fail)
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The end of the session is next week.

David Norris (Independent)
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I mean this session of the Parliament, before the next election.

Mary Hanafin (Dún Laoghaire, Fianna Fail)
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Absolutely.

David Norris (Independent)
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While I welcome what the Minister said, I regret that it probably will not be possible to do anything for this particular individual. It appears that he is going to Nottingham. It is a loss to Ireland that a good, decent and caring young man must go abroad for his education. I hope he will be able to come back and make up for some of the deficiencies in the health service here. I wish he had been able to go to Trinity College.