Róisín Shortall (Dublin North West, Labour)
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I wish to clarify for Members that this Bill does not provide for a return to the temporary registration as was the case in the 1970 Act. It is a new supervised registration which is post and specialty specific and limited to two years. It will be subject to ongoing supervision and will be obtained through a two-part assessment, which is again specific to the specialty.

Senator Leyden asked why we were restricted to Pakistan and India in recruiting. Part of the reason is that the Medical Council and medical colleges have strong links with India and Pakistan which makes access and processing of documentation much easier to do in this time of emergency. I accept there are very highly trained doctors in Cuba but complex visa issues are involved, which is why the concentration is on Pakistan and India.

Senator O'Donnell asked about the two-year time limit. This division will remain for the foreseeable future and it is the individual doctor who is restricted for two years and not the division on the register.

Senator Mooney asked about proficiency in the English language. As I said on Second Stage, clear assurances were given that all doctors coming into the country would be proficient in the English language and that their entire medical education would have been conducted in the English language. That is subject to ongoing review across the two-stage assessment process and I provided those details in my speech.

Senator Kelly asked about the standard to which HIQA works. The standard is based on the international best practice and it is an independent quality agency. It is very much linked into the issue of critical mass, which is a factor we cannot ignore given the small size of the country. I was asked about the up-to-date position in respect of Roscommon. I have a detailed note on the matter and if any local Members or anybody else wish to speak to me after the debate, I would be happy to share that information with them.

In providing an assurance to the House that considerable work is under way in addressing the long-term and underlying problems which have given rise to this crisis, we are considering a new grade within hospital doctors, a kind of general specialist grade. This issue is being addressed at management level and ministerial level in the Department. A working group has been established and work on medical manpower planning is under way. I assure Members of the House that in government we intend to live up to the challenge to address the immediate and urgent as well as the fundamental long-term requirements of changing the health system. We do not suggest that this measure is adequate to deal with this; fundamentally it is not. It is an immediate response to an immediate problem. The underlying issues that give rise to this problem arising now and on a regular basis are being addressed in a very serious way within the Department.

Colm Burke (Fine Gael)
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I have a question on section 50A(1)(b), as inserted by section 8 of this Bill, which refers to "the relevant criteria specified in rules made under section 11 relating to the registration of medical practitioners in the Supervised Division". I presume that is section 11 of the 2007 Act. I presume the Medical Council sets the rules but is it answerable to the Minister? In 2009, Dr. Mick Molloy raised concerns about the new procedures. A suggestion has been made that the new procedures and the rules subsequently implemented by the Medical Council caused some of the problems with regard to what happened in 2009. I referred to an e-mail I received from a doctor who, after having worked for five years, found he no longer fitted into the jigsaw here and that he had no post. Do we need to examine the discretion given to the Medical Council? I am not looking for an amendment to the section but perhaps this is something we should consider in the long term.

Under section 50A(3) as inserted by this section of the Bill, a medical practitioner may not be registered in a supervised division for a period in excess of two years in aggregate. Earlier, the Minister of State referred to how someone who has been in a job for 12 months is treated by his or her seniors. If there is a clash of personalities involving a junior doctor, he or she may find he or she must leave the job after 12 months and cannot remain for two years. Taking both section 50A(3) as inserted by section 8 and section 9, it appears a person cannot return to the system. Perhaps I am reading this incorrectly but I am concerned about it. If a person finishes a job on 1 July having worked for 12 months but his or her next job is not available until the end of August there will be a gap and, according to section 9, it appears the person will not be able to return. Will the Minister of State clarify this?

Under section 50A(6) as inserted by section 8 of this Bill, a medical practitioner whose name is entered in a supervised division may not practice medicine in the State other than in the post, referred to in subsection (4) to which the practitioner is registered. If a smaller hospital has to deal with a major accident or emergency, such as a multiple car accident, whereby everyone is called to the accident and emergency department to assist, will this section prevent a junior doctor from assisting in such a case? Will the Minister of State clarify these issues?

Sean Barrett (Independent)
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I thank the Minister of State for returning to the House after lunch. I echo Senator Burke's concern about the two-year period. The five-year period for introducing competition in health insurance should come prior to this in order that hospitals will be competing and freeing up resources that are necessary. If these posts end after two years, the health insurance market has not been opened up and we do not have more GPs in the 24-hour service which the Minister of State mentioned before lunch, we could face the same problem again. It is contingent on a much faster pace of reform than was envisaged when we spoke about this before lunch.

Róisín Shortall (Dublin North West, Labour)
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With regard to the rules being set by the Medical Council under section 8 to which Senator Burke referred, it is correct that the Medical Council sets the rules but they are then referred to the Minister and it is open to the Minister to amend them, following which they are set down by way of statutory order. With regard to the two-year aggregate, it is possible that a person who may have to leave post after two or three months can return. It is an aggregate limit. I draw the Senator's attention to the fact that the posts are specialty specific. The person would have to return to a post in the same specialty, and this would need to be addressed in any arrangement. With regard to section 6 and dealing with an emergency, the description of a post will be set by the employer in this regard.

With regard to reforms, the fact there is a five or six year lead-in to full universal health insurance, UHI, does not preclude action being taken to achieve better value for money from the hospitals. In the 1990s when Deputy Howlin was Minister for Health, he introduced a tendering system for hip operations. He went to the market to see what was the best price he could get for batches of hip operations. There is much to be said for taking this type of approach. We are not precluded from doing this in the long-term planning for UHI. It does not mean that all other initiatives need to stop.

Colm Burke (Fine Gael)
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With regard to section 9, I am concerned that it appears-----

Paddy Burke (Fine Gael)
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We have not come to section 9 yet.

Colm Burke (Fine Gael)
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It ties in with the section 8.

Paddy Burke (Fine Gael)
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Continue.

Colm Burke (Fine Gael)
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If someone drops out of a designated post, my understanding is that section 9 will prevent him or her from returning. Sections 52(4) and 52(5) of the Act specifically provide for allowing a person to return. Perhaps I am interpreting this incorrectly but I seek clarification.

Róisín Shortall (Dublin North West, Labour)
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It is important to clarify that these doctors will not be doing a general exam; they will sit a specialty specific exam. Doing such an exam would not qualify them to work in general medicine. It relates to a particular specialty.

Colm Burke (Fine Gael)
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I am satisfied with the Minister of State's answer to the question I asked previously. I wanted to know whether a person could stay in a specialist area but transfer to a different hospital if he or she was no longer able to continue working in the first hospital. I am still concerned about the impact of section 9 on the ability of a person who has sat an exam for a particular specialist post to work in a similar specialist post in a different hospital. Perhaps the Minister of State will clarify this.

Róisín Shortall (Dublin North West, Labour)
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The registration refers to a particular specialty and a particular post. One could apply for registration for a different post in the same specialty.