Seanad debates

Wednesday, 20 February 2013

Medical Practitioners (Amendment) Bill 2012: Second Stage

 

1:30 pm

Photo of Michael MullinsMichael Mullins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister of Health, Deputy James Reilly.

Photo of Colm BurkeColm Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I move: "That the Bill be now read a Second Time."

I, too, welcome the Minister. I am pleased to introduce this Bill in the House and acknowledge the contribution of the Minister who when in opposition in October 2009 introduced the Medical Practitioners (Professional Indemnity)(Amendment) Bill. The then Minister, Mary Harney, acknowledged the need for change in this area and legislation to be put in place to make it compulsory for medical practitioners to have insurance. Three and a half years on, we are back with a new draft on which I have worked with several parties. I acknowledge their contribution in bringing forward the Bill. They include Dr. Brian Hunt, parliamentary draftsperson; Ms Clare Mungovan, a solicitor in my office, and Mr. Tony O'Connor, senior counsel. I met Ms Caroline Spillane and members of the Medical Council, Mr. Ciarán Breen of the State Claims Agency, representatives of the Irish Medical Organisation, IMO, the Irish Hospital Consultants Association, IHCA, and Medical Protection Society, MPS, Ireland insurers and Department of Health officials. I thank all those who assisted my office and me in preparing the draft Bill.

As a car owner, the Acting Chairman cannot drive a car without insurance. As a solicitor, I cannot practise without insurance. However, there is no legal obligation on a general practitioner to have insurance. That is not to say, however, general practitioners do not have insurance. I imagine 99.9% of all medical practitioners in the country do have insurance. However, concern has been expressed for some time as to whether we can ensure that if a person is offering a medical service and it goes radically wrong, there are adequate safeguards in place to compensate someone who may suffer a loss. This issue came to the fore in 2008 and 2009 in the case of cosmetic surgery and breast implants, although in the end I do not believe it was an issue.

One new issue arising relates to where persons offering services have insurance and the question is whether they have adequate insurance. I refer, in particular, to the growing tendency to offer scanning services. There is a question as to whether the insurance people have is adequate to cover the service. As legislators, we have a duty to ensure the public is protected. The idea behind the Bill is to ensure it would be compulsory for all medical practitioners to have insurance. The HSE provides cover for all of its employees engaged in medical services. However, there are people working in a private capacity as medical practitioners and we need to ensure adequate safeguards are in place.

The Bill is self-explanatory in the sense that it would amend the Medical Practitioners Act 2007. Reports have been produced in the United Kingdom where there is a similar problem. The Finlay Scott report of 2010 involved an examination of the issue of professional indemnity insurance in the United Kingdom. One recommendation in that report read:

In my judgement, making insurance or indemnity a statutory condition of registration is the most cost effective and proportionate means of achieving the policy objective. The main reasons are:
a. A statutory condition of registration would apply equally and unequivocally to all registered healthcare professionals; would be seen by patients and the public to do so; and would enhance patient and public confidence.
b. A statutory condition of registration has the unique advantage that, when supported by appropriate powers, enforcement action can be taken through low cost administrative procedures rather than high cost fitness to practise procedures.
c. As a result, a statutory condition of registration would reduce enforcement costs compared with alternatives, without increasing compliance costs or the costs of compliance testing.
d. A statutory condition of registration would require the registrant to be able to prove a positive, namely the presence of cover, rather than the regulator to prove a negative, namely the absence of cover.
We took into account various recommendations made in that report in drafting the legislation.

I realise the Bill is imperfect and that it is likely the Department will bring forward some amendments. I would support this because I realise we are all working in the public interest.

The Bill is divided into five parts and contains nine sections. I will outline the various sections and what they seek to do.

Section 1 sets out the Short Title of the Bill and provides for the collective citation. Section 2 provides a definition of the principal Act, that is, the Medical Practitioners Act 2007. Section 3 seeks to amends section 2 of the 2007 Act and proposes to insert four new definitions, including a definition of an indemnity provider. It is important that there be a distinction between an insurer and an indemnity provider. For example, MPS Ireland provides cover, but it is not an insurance company; rather, it is a medical protection society.

It is not an insurance company but it is a medical protection society which offers cover to the vast majority of medical practitioners in this country. Section 3 defines the terms "clinical indemnity scheme", "professional indemnity committee" and "professional indemnity cover". Section 4 operates a clinical indemnity scheme.

Section 4 amends section 10 of the 2007 Act by substituting a revised text of subsection (1), the purpose of which is to expand the immunity of the Medical Council so as to ensure that it will not be held liable for the wrongdoings of medical practitioners in respect of their obligation to hold professional indemnity cover.

Section 5 amends section 11 of the 2007 Act by inserting seven new subsections which empower the Medical Council to make rules specifying each category of medical practitioner who will be required to hold professional indemnity cover. As there are different categories of medical practitioners, from GPs to medical consultants in the private health care sector, various types of cover are needed. Subsection (2C) requires the Medical Council to make rules specifying the indemnity providers which have been recognised. The Act covers both the insurer and the indemnifier. The State Claims Agency is also included because it now has responsibility for dealing with claims against the HSE and can therefore offer considerable expertise that would not otherwise be available. It is important that its role is recognised and its advice taken on board in the guidelines that are being issued. Subsection (2D) states that the Medical Council must not issue a certificate of registration to a medical practitioner unless he or she has provided evidence of the required level of cover being in place. Subsection (2E) permits the Medical Council to specify in its rules the minimum level of cover to be held by practitioners. Subsection (2F) empowers the Medical Council to exempt practitioners from the requirement to hold professional indemnity cover. This would apply in particular to people who are employed by the HSE because they would already have cover.

Section 6 empowers the Medical Council to establish a professional indemnity committee to carry out its functions relating to professional indemnity cover. Section 7 states that it is an offence for a person to practise medicine whilst not being in compliance with the Medical Council?s rules, not having in place professional indemnity cover or falsely representing that he or she has the correct level of cover in place. Section 7 also makes it an offence for a person to contravene new sections 110, 111 and 112 which are proposed to be inserted into the 2007 Act by section 9 of this Bill.

Section 8 inserts a new section 44A into the 2007 Act so as to place a duty on insurers to notify the Medical Council if they become aware that a medical practitioner?s professional indemnity cover has lapsed or been cancelled. Many people pay insurance by instalments but once the insurer becomes aware that payment has lapsed, clearly it would cease to provide cover at a certain point. The section obliges the insurer to notify the council and the individual concerned in such instances so that the situation does not arise whereby somebody who paid the first few instalments subsequently discovers that his or her insurance has been cancelled because the remainder of the premium was not paid.

Section 9 inserts new sections 110, 111 and 112 into the 2007 Act. The proposed new section 110 imposes a general obligation of full disclosure on medical practitioners who are seeking professional indemnity cover. Section 111 provides that where a person or a business, other than a patient, proposes to engage a medical practitioner, he or she is obliged to seek proof of the existence of the required level of professional indemnity cover in respect of that practitioner. This is to cover situations where a locum is hired for a medical practice. Section 112 obliges a medical practitioner to display evidence of professional indemnity cover at his or principal place of practise.

I may not be ticking all the boxes with this draft legislation and I understand that the Department will come forward with amendments. I am happy to work with departmental officials in progressing the Bill. I thank the Minister and his officials for their assistance in drafting it.

1:40 pm

Photo of Catherine NooneCatherine Noone (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I second the motion. I welcome the Bill, which we have been calling for since 2009. I am glad we have been consistent in this regard and that we are acting on the matter now that we are in government. This is an eminently sensible Bill which will reduce liability and offer peace of mind by obliging medical practitioners to hold professional indemnity insurance. This should have been the case for many years. It is incredible that Ireland does not have a regulatory authority which can force doctors to take out insurance, with the result that they are not legally obliged to be insured. Many medical practitioners have insurance cover but those who do not have insurance are not necessarily disadvantaged, which leads honest doctors to question their own wisdom. Such a lax attitude would not be tolerated in the legal world, as I know from my own experience. We cannot practise without indemnity insurance and, in many cases, clients insist that the appropriate level of cover is in place before they will employ a solicitor. This is particularly common in the area in which I specialise, namely, insurance defence. It is incredible that the same standards do not apply in the medical world, where mistakes cannot be undone. It seems appropriate that patients should be able to ask their GPs or medical consultants about their insurance cover before they take on their services.

This Bill will require written evidence of medical and professional indemnity insurance to be submitted to the Medical Council before it will issue a certificate of competency to practise. I was concerned about the implication for current doctors who do not have professional indemnity insurance but have already been granted a certificate by the Medical Council. It appears this is covered appropriately by sections 7 and 8, however. Section 7 states that it is an offence for a person to practise medicine without having in place professional indemnity cover. Similarly, section 8 sets out a duty on medical insurers to notify the Medical Council if they become aware that a medical practitioner's professional indemnity cover has lapsed or been cancelled.

If the Medical Council, the State Claims Agency and the Financial Regulator work together to determine the appropriate level of insurance to be held by practitioners, it would be straightforward to migrate to this system without causing serious problems for medical practitioners while providing an assurance to patients that they are in safe hands at all times.

Photo of Paschal MooneyPaschal Mooney (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I compliment the Minister on showing his continued respect for the House by taking this important Bill. I am sure he has a sense of déjà vu listening to the robust proposals put forward by Senator Colm Burke. I will not repeat the arguments made by the Senator, particularly given that the Minister spent many waking hours putting together the original version of this Bill in 2009. I presume the Minister went down the same route as the Senator.

Paragraph 51 of the Medical Council's guide to professional conduct and ethics for registered medical practitioners states that medical practitioners must ensure they have adequate professional indemnity cover for all health care services. Clearly this cannot be equated with a statutory obligation to have in place such cover and, consequently, it could be submitted that patient protection measures are not what they ought to be.

Fianna Fáil would support the objectives of that Bill. In the 2009 debate, the then Minister, Mary Harney, was very sympathetic towards the Bill when it was brought forward by Deputy Reilly, now the Minister. Deputy Reilly raised a number of issues at that time. He said the majority of doctors were responsible and carried appropriate medical negligence insurance. One would assume that would be the case. As a medical practitioner, Deputy Reilly himself would be aware of the need for such insurance because of the highly litigious nature of the business in which GPs operate. We have not quite gone as far as the United States in that regard, but it has been said many times in recent years that we seem to be going down that route. Doctors tend to take a more cautious overview now than heretofore in terms of how they deal with patients and I am sure Professor Crown would have something to say in that regard.

What the then Minister, Mary Harney, said at the time is still relevant. She continually referred to the trust between patient and doctor. I would trust Professor Crown completely if I was under his care and, perhaps, would not be thinking about whether he was covered adequately if I was availing of his expertise. At the same time, in the real world in which we live, I am sure he and his colleagues would be of the view that it is better for them to have the defence of having adequate insurance in place, in the event of something going wrong, which is essentially what we are talking about here. Interestingly, it was stated at the time that the Department of Health and Children and the Medical Council did not know how many practitioners had insurance, what level of cover they held, the type of insurance or who provided it. I wonder whether that remains the case. However, this legislation will address the situation and because insurance will be obligatory the information will be available.

Another aim of the Bill is to close a loophole that could allow an unscrupulous doctor to apply for medical registration and practise without insurance. There are only a small number of such cases. Senator Burke referred to 99.9% of practising doctors having adequate insurance. In the event of mistakes or medical negligence, the State must offer patients the best protection it can. Compulsory indemnity would instil confidence in the system and guarantee patients redress if something went wrong. This is what Deputy Reilly said at the time and we would all agree with that. He also pointed out - I am curious as to whether these figures changed - that it was expected the State would pay out some ¤60 million in medical legal costs in 2009, ¤20 million of which would go to lawyers. Far be it from me to suggest Senator Burke would have a vested interest in that regard, but I better not go down that road.

In her response, the former Minister, Mary Harney, gave the background and context for the debate. The Medical Practitioners Act 2007 was a comprehensive modernisation of legislation dating back 30 years governing the medical profession. She said it was clear from contributions to the 2007 debate that trust was at the heart of the doctor-patient relationship and that oneself or one's family member was a patient, one wanted to have the utmost confidence and trust in one's doctor, not from blind faith or deference but for good reason. However, she said she did not believe people wanted a bevy of lawyers, legislators or insurers metaphorically sitting in on the confidential discussions with their doctors. We would all agree with that. Perhaps, that is what guided her view at the time she deferred the Bill, although she said she fully agreed with the objectives behind it at the time.

She went on to say that given the complexities and sensitivities of medical indemnity insurance, the method deserves detailed reflection from the legal, administrative and practical points of view. She did not elaborate on that, but perhaps the Minister will. Has anything changed since with regard to what she referred to as "complexities and sensitivities of medical indemnity insurance"? Financial intermediaries, solicitors and a range of other professionals are compelled to hold professional indemnity cover and I do not see why it should be any more complex for the medical profession. Was that just the Government's way of saying that it was a fine Bill, but it would not give the Opposition the credit for introducing it so would kick it down the road for a few months and then come back to it? However, the then Minister did not come back to it.

The last reference I can find to what happened to that excellent Bill dates to January 2011. The then Tánaiste and acting Minister for Health and Children, Mary Coughlan, said the heads of a medical practitioners (amendment) Bill to make it mandatory for registration purposes for doctors to have clinical indemnity insurance had yet to be approved by Government. This was approximately 18 months since then Deputy Reilly had introduced his Bill. Was there something going on in the Department of Health and Children we need to know about?

1:50 pm

Photo of John GilroyJohn Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

There was nothing going on in the Department of Health and Children under Fianna Fáil.

Photo of Marie Louise O'DonnellMarie Louise O'Donnell (Independent)
Link to this: Individually | In context | Oireachtas source

This is the longest six minutes of my life.

Photo of Michael MullinsMichael Mullins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

The Senator's time is up.

Photo of Paschal MooneyPaschal Mooney (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

In fairness, I did not go down the road of bringing in the vast body of legislation introduced by former Minister, Mary Harney, during her time in office, which brought in the infrastructure on which current practice within and outside the Department and medical practice is built. I did not want to do that because I thought I would be accused of political point scoring. I was introducing politics into this at all. I am just asking whether there is a particular reason why, having agreed with then Deputy Reilly this was a good Bill and should be introduced, the then Minister went on to talk about legal complexities. These were not elaborated on, there was further delay and the last word of the previous Government was that the heads had yet to come before the Government. That is the core of what I am asking. Is there some obstacle to the passing of this Bill?

Photo of Michael MullinsMichael Mullins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am sure the Minister will respond on that in his contribution.

Photo of John GilroyJohn Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister to the House. I wish to comment first on the amount of work Senator Burke has put into bringing this Bill to this point and on the list of stakeholders to whom he referred. I had a conversation on this with the Senator in the past few days; he has put a remarkable and exemplary amount of work into this. It is probably one of the more elaborate and well-thought out Bills I have seen originating in this House and being introduced in Private Members' time. I commend Senator Burke on that. I note this Bill is a progression of an idea the Minister had himself when in opposition. Senator Burke has taken that idea and developed it to this point.

It is mind-boggling that there is no legal requirement for medical professions to have insurance. This is something I had not considered until last week when Senator Burke brought it to my attention. I suspect that not many of the general public would even think it was necessary to ask their medical practitioner whether he or she had insurance to indemnify patients against any risk inherent in a procedure being carried out. I suspect that is the last thing a patient would think of, yet there is no legal obligation on a practitioner to have indemnity or to say he or she has.

Senator Burke referred to the fact that 99.9% of medical practitioners have some sort of indemnity insurance. Are his figures based on anything more than an intuitive belief? If his figures are correct, this means that for every 1,000 practitioners in the country, one has no medical insurance at all. Could the Minister provide more information on this? Senator Mooney suggested the IMO is unaware of the number of doctors without insurance or of the type of insurance provided.

There is a concern that medical insurance is becoming even more important as it becomes more common for procedures which used to be carried out in hospitals where all medical practitioners are insured to be carried out in community or private sector settings. I do not know whether the types of medical indemnity product are standardised. Can one go to a company and say, "I am looking for general medical cover"? Are there particular varieties of such products? Is there a gold standard of such cover? If the Minister understands the point I am trying to make, perhaps he might clarify whether there is the equivalent of third party fire and theft cover or comprehensive cover in this sector. In the absence of a legal framework in which medical practitioners face certain requirements in this regard, is there a concern that the providers of indemnity or insurance products might be a little behind the curve in developing medical indemnity or insurance products? As medical practices evolve, the line between those procedures which used to be considered invasive and non-invasive is becoming blurred. As medicine evolves in the community and private practices, these distinctions are becoming more and more blurred. Do the providers of medical indemnity and insurance products keep themselves fully up to speed in the development of their products? Are they as informed as we would like them to be? I would like information in that regard.

In supporting Senator Colm Burke's proposal to ensure medical insurance would be obligatory, I suggest there be a relentless focus on the need for indemnity to keep pace with the ever-evolving and complex procedures that take place in the medical sector. I will conclude on that point as I am afraid my voice is about to go. I support the legislation proposed by Senator Colm Burke. On the basis of his professional experience, does the Minister know of any case that was taken against a practitioner who did not have insurance? If there was such a case, what was the outcome?

2:00 pm

Photo of John CrownJohn Crown (Independent)
Link to this: Individually | In context | Oireachtas source

Cuirim fáilte roimh an Aire. I am very supportive of this legislation which has a sort of resonance with some of the issues that have arisen in the context of the abortion debate. We believe the contingency for which we are legislating is extremely rare, thankfully, but that does not mean the necessity for this legislation is invalid. We have an obligation to ensure the bases are covered, just as we are obliged to ensure appropriate guidelines are in place for the rare cases in which the life of a pregnant woman may be compromised. In this case, we must make provision for the extremely rare circumstance where people practise medicine without the appropriate insurance. I compliment Senator Colm Burke on the initiative he has shown in bringing forward this Bill. He is a thoughtful and extremely well informed commentator on health care issues. In the past two years he has brought a great degree of wisdom to various health debates in this House.

The Minister might be familiar with the tombstone imperative, a phrase used in air safety circles. It refers to the manner in which attempts are made to ensure air safety by examining previous disasters, learning from the mistakes made and trying to prevent similar bad things from happening in the future. It is based on things like black box technology and flight recorders. We are familiar with the dramatic scenes when teams of investigators descend on these locations. Having been involved in studying aspects of the health service for the past ten years or so, it seems that a version of the tombstone imperative has been in operation in that period. I accept that this has not been a characteristic of the tenure of the Minister for Health, Deputy James Reilly. It can be argued that the politics of the last health care atrocity, to borrow a phrase, is used in many circumstances to advance the health care reform agenda. Issues to do with breast cancer care in certain areas led to the reform of the health service. Problems with diagnostics in other areas led to further improvements.

We have to understand something. My colleagues have alluded to the fact that Ireland appears to be adopting the US attitude to medical litigation. If I am not mistaken, Ireland has the second highest rate of medical litigation in the world, after the United States. We had the third highest rate, after the United States and New Zealand, which had a quirkily high place in the pecking order, for many years. We are now higher on the league table than New Zealand. Certain similarities between our system and that in place in New Zealand are relevant in this regard. I give a regularly recurring lecture on legal aspects of cancer care as part of a course on the legal aspects of medicine, or the medical aspects of medico-legal care. There is no doubt that it is incredibly important. In the United States breast cancer is the one disease which leads to doctors being sued. The cases refer to misdiagnosis, a failure to refer for mammograms appropriately, inappropriate treatment and a failure to provide proper multidisciplinary care, etc.

There is no doubt that there is a major problem in this country in dealing with cancer and other diseases. For this reason, I have studied the famous book the Medical Protection Society publishes every year. It is an annual reminder of the horrors that can befall us. It goes through various cases that have appeared on the society's case books in the previous year and the various mistakes made. I recommend it to anybody who wants to get a sense of how things can go wrong in medicine. The problem that most frequently recurs in Ireland is the making of inappropriate decisions by non-consultant doctors and trainees. The core reason we have so much medical litigation is we have an abnormally small number of career level legally responsible doctors at general practice level and in hospital specialties. Overall, we have a relatively average number of doctors. However, we have a bizarre demographic. Many of our doctors are involved in various training jobs in which they are asked to make responsible decisions.

I support this legislation and it is likely that I will make some comments on amendments on Committee Stage. I suggest we consider the issue of tailback insurance for people who have passed retirement age. We need to ensure the relevant section of the Bill is worded in a way that would not impose an extra burden on those who may not have much income at the time of retirement. We should remember that in some specialties the annual premium is higher than the public salary.

Photo of John CrownJohn Crown (Independent)
Link to this: Individually | In context | Oireachtas source

We have to be careful to ensure we do not leave a ticking timebomb for retired individuals who might think the burden has been lifted. There has to be a means of ensuring the insurance provision they responsibly made during their careers gives them adequate coverage after retirement. They should not be asked to pay premiums which are simply not sustainable for people at pension level.

This good Bill would plug a gap. It needs to be borne in mind that the phenomenon of doctors not having insurance is as rare as it is because almost every job for which they apply requires them to have made insurance provision. There are very few circumstances in which a medical practitioner can seek employment without having insurance. It is theoretically possible, however. It is certainly possible in the cases of people who practice on the fringes of medicine. I refer to those who may have medical degrees and set themselves up to practise non-conventional medicine. It is critically important that the Bill plug all of those gaps. I commend Senator Colm Burke and look forward to further debate on the legislation later in the session.

Photo of Michael MullinsMichael Mullins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

As the Minister needs to keep a commitment later today, I propose to call him next if that is okay with other speakers.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context | 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.

2:20 pm

Photo of Marie MoloneyMarie Moloney (Labour)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister to the Chamber and I thank Senator Colm Burke for introducing this Bill. From speaking to the Senator, I know he has put an amount of work into this Bill. Given the number of malpractice cases, I find it incredible in today's climate that not all medical practitioners have adequate insurance cover. Any medical practitioner operating without adequate insurance is playing Russian roulette with his or her career. We must also bear in mind the safety and well-being of the patient, who must be protected and safe in the knowledge that if anything goes wrong there will be a financial back-up through insurance to meet his or her medical needs. The Minister spoke about putting the professional indemnity insurance certificate up on the wall or in a public space where the practitioner operates, but one still does not know what coverage the practitioner has and whether it is adequate to cover the procedures he or she is carrying out. I am sure every medical practitioner will have a certificate but the general public would not know whether it is adequate or not. I do not know whether simply putting the certificate up on the wall will work.

The Minister also said the HSE was moving to speed things up and carry out procedures. It seems to be going the opposite way in Kerry General Hospital because it has withdrawn ultrasound services from GPs so they can no longer access these services in the hospital. This means they must now refer patients to the clinic, which means longer waiting times and lists. This is a step backwards. It was time enough to send people to the consultants once they received the ultrasound readings.

I again thank Senator Colm Burke for introducing the Bill which we will, of course, be supporting. In fairness, the Senator is watching out for the interests of the general public. When we discussed the Bill, he informed me that certain practitioners were carrying out scans, etc., and that they did not have adequate insurance cover. I wonder how we will police this and how we will ensure medical practitioners have such cover. I thank the Minister for coming before us.

2:30 pm

Photo of Terry BrennanTerry Brennan (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Ba mhaith liom fáilte a chur roimh an Aire ar ais go dtí an Seanad.

The purpose of the Bill is to ensure doctors have appropriate insurance in order that they might practise medicine. The vast majority of doctors are extremely responsible and have appropriate professional indemnity insurance. As is the case with all professions, however, some may not have an appropriate level of cover, either inadvertently or by choice. The Bill would make professional indemnity insurance cover compulsory for all practising doctors and bestow on the Medical Council the power to set the appropriate levels of insurance to be held by different classes of practitioner. The council currently has no such power and merely recommends that doctors have such insurance. The Bill also suggests that before it issues a certificate to practise to a practitioner, written evidence to the effect that the appropriate level of insurance is in place be produced to the council.

The Bill provides for circumstances in which insurance may lapse and would make it an offence to practise without insurance where such insurance is required. An irresponsible individual could practise in Ireland without having the appropriate professional indemnity insurance. In the event of negligence or unsatisfactory treatment, an aggrieved or injured patient may have no access to any form of compensation. The Bill is intended to apply to doctors who are not domiciled in Ireland but who often practise in private clinics here, as well as to practitioners normally resident in the country.

I acknowledge the many hours of hard work done by and the commitment of Senator Colm Burke in bringing the Bill before the House.

Photo of Sean BarrettSean Barrett (Independent)
Link to this: Individually | In context | Oireachtas source

I also wish to welcome Senator Colm Burke's Bill. The Senator obviously did a great deal of work on the legislation and the explanatory memorandum to it, both of which read well. Of course, he brings a wealth of experience to this matter and it is an honour to contribute to the debate on his Bill.

The annual report of the State Claims Agency for 2010 indicates that at the end of that year it had clinical claims under management with an estimated liability of ¤786 million. This is an extremely important area. In the context of our commendable and successful efforts to reduce the level of risk and the number of accidents on the roads - the number of deaths fell from a high of 650 in the past to a low of 160 last year - one sometimes wonders whether similar efforts are required in the health service, in which the level of claims is quite high.

It would be interesting to discover how much the indemnity insurance to which the Bill refers would cost and whether it would be a barrier to entry. Would people have difficulty in obtaining insurance if they had no track record? There is a need to do further work in this matter, particularly in the context of the difficulties with the public finances. We have tended to transfer the cost of catastrophes to the taxpayer. As there is insurance, we should move risk away from the taxpayer, given that the Exchequer is hard pressed.

One of the suggestions Mr. Justice Quirke and his committee made in meeting claims is that we consider using periodic payment orders rather than awarding lump sums. That may have attractions similar to those relating to the promissory notes, whereby payment would be made over the period of total liability, rather than in the form of an up-front lump sum. Mr. Justice Quirke's committee recommended the introduction of legislation; perhaps this might also be considered.

The Minister has said he foresees difficulties with the new subsections (2A) to (2G) to be inserted into section 11 of the 2007 Act. These subsections appear to contain perfectly normal functions in respect of insurance and I do not understand why the Minister perceives that they will give rise to difficulties, particularly as he stated, "The Medical Council is doing a very good job in providing an efficient and accountable system for the regulation of the medical profession." Seeing to it that people are insured does not appear to raise the obstacles to which the Minister referred. I am sure, however, that matter will be resolved during the discussions between Senator Colm Burke and the Minister as the Bill progresses.

The Minister has also indicated that he has certain concerns with regard to competition and how certificates should be displayed. On the latter, his concern seems to relate to whether a practitioner's certificate should be displayed at his or her principal office or at his or her second office, if he or she owns one. The original could be displayed at the principal office and a photocopy could be put on display at the second location. Sometimes the responses to certain Bills seem to be designed to make it appear that minor obstacles are actually major difficulties, which is not the case.

I commend Senator Colm Burke for introducing the Bill. I also commend the Minister for his response to it. I look forward to progress being made on this matter because it is very important that medical practitioners be properly insured. I hope the Bill will be allowed to proceed.

Photo of David NorrisDavid Norris (Independent)
Link to this: Individually | In context | Oireachtas source

I have just come from a meeting of the Joint Committee on Foreign Affairs and Trade. I apologise, therefore, for not being present to hear the contributions of the Minister and many of my colleagues. I am sure they were extremely significant. We are very lucky to have someone such as Senator John Crown, a professor, among us. I look forward to reading the transcript of his speech.

It is interesting that the Minister for Health is in the House. He is a senior member of the Cabinet, which shows a degree of respect for Senator Colm Burke whom I commend for introducing this timely and important Bill. It is appropriate that the Minister is present because he addressed this matter in 2009 when he presented the Medical Practitioners (Professional Indemnity)(Amendment) Bill, the principal object of which was to make it a criminal offence for a medical practitioner not to have medical insurance. I understand it is neither a criminal nor any other kind of offence not to have medical insurance. Not having such insurance is extremely unwise. I apologise if previous speakers referred to this fact and have no wish to be repetitive, but I would be surprised if more than a very small number of doctors did not have medical insurance. Although the Bill includes penalties for those not registered with insurance companies, it does take a somewhat benign approach to the matter. I have no doubt, therefore, that those involved in the medical profession would find its provisions reasonable.

The difficulty that arises revolves around the enormous cost of insurance, particularly for the medical profession.

I refer to the considerable cost of all kinds of insurance but particularly of medical insurance and the avariciousness the human animal displays sometimes when dealing with doctors. I have had serious infection as a result of a rather badly done treatment but I did not sue the doctor. I do not like suing doctors because I think they do their best. I am reminded particularly of the woman in America whose life was saved by a doctor on board a cruise ship. He removed an ulcerated appendix which was about to burst - and from which the patient probably would have died - with a penknife, on the deck, at the behest of the captain. Having recovered she subsequently sued the doctor for the cosmetic appearance of the scar which rose above the bikini line. She received $1 million. That would put anyone off. If I were a doctor and I saw someone dying I would say, "Go on, just die." It is a terrible story. We have to recognise this kind of culture which leads to a significant increase in costs.

I refer to a settlement of ¤45 million in January between the Medical Defence Union and the Government which was part of the indemnification involved. The Medical Defence Union is a British body and a mutual association. It is not a commercial insurance company. In fact, the costs to the Government were considerably greater than this. Tragically, there are situations and circumstances involving injury to a child, perhaps during childbirth and the child is brain-damaged or there is other damage. Negligence is asserted by the family on behalf of the child and then enormously expensive treatment is made available so that this child can continue to live. No one would decry the life support systems that are necessary but which are very expensive. That is the realistic fact in terms of medical insurance.

I ask the Minister of State, Deputy McGinley to convey to the Minister for Health the issue of the price of medicine in this country. The Joint Committee on Foreign Affairs and Trade was dealing with trade issues between Britain and Ireland. I asked about the impact of our financial situation down here in terms of the rather realistic approach of many people in Northern Ireland and which may have affected the recent poll. The first reaction was to do with the medical services here. In the North there is a system of free at delivery to the patient. Apparently the services are considerably better and perhaps cheaper - I know this is the case with dentistry. I refer to an article in The Irish Timeswhich asks if there is a reasonably priced doctor in the house. I am aware that I am standing next to a seated doctor so at least I am in a position to run away if I antagonise him very much. I know there are very good doctors who charge very reasonable fees and are charitable in that they sometimes will not charge a poor person. The article described a couple of cases such as a woman in very average circumstances who had very little money. She was charged ¤50 for a repeat prescription. She did not even see the doctor. She wanted to collect a repeat prescription from the receptionist who refused to give her the prescription until she coughed up ¤50. In another case, it cost ¤60 for a repeat prescription. I ask the Minister of State to convey this information to the Minister. That practice should not be tolerated.

Senator Burke has done the House and the Oireachtas a service. I note the quality of the debate and the attendance of the senior Minister. This is a good day for Seanad Éireann. I note that the Minister has said he has great sympathy and that Senator Burke has done considerable work and has consulted very widely. I do not know if he consulted with his party colleague, the Minister, Deputy Reilly, but the Minister has taken the usual position of saying that the Bill is excellent work but that it has some deficiencies and that it will be put through. I would have thought it would be much better, having studied this legislation, having attempted to introduce legislation of this nature unsuccessfully in the other House, it would have been preferable if the Minister had taken the time and the trouble, with this officials, to amend the Bill. The degree of variation between the Minister's position and that of Senator Burke, is not sufficiently large to sink the Bill, in my opinion. We have had Bills in this House with more than 200 Government amendments presented at the same time as legislation. It would not have killed the Government to lose its dog in the manger attitude and to put Senator Burke's excellent Bill through with whatever amendments the Government chose. It could show a little bit of deference and respect to this august Chamber of Seanad Éireann.

2:40 pm

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Senator Cullinane missed his speaking slot but I will allow him now.

Photo of John GilroyJohn Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

After the last day, that is only right.

Photo of David CullinaneDavid Cullinane (Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank Senator Burke for tabling this Bill and for his research work in this area. I join with other Senators who have acknowledged the considerable contribution of Senator Burke, not just on this Bill but on many issues relating to health care. I regard him as one of the outstanding Senators and I have said so publicly and privately on a number of occasions. It is incumbent on us when we see people putting in effort and taking the time to deal with these important matters to recognise that effort.

Senator Norris also referred to the fact that the Minister in a previous incarnation as the Opposition spokesperson on health, tabled a very similar Bill. It would have been better if the Minister had worked more closely with Senator Burke to ensure that the Bill was progressed through this House and the other House more speedily. However, I hope the Minister will at least allow the Bill to go through to Committee Stage and that any issues which need to be teased out can be dealt with. While the Bill may contain some flaws its logic is quite straightforward. The reason many people - including the Minister - have raised all sorts of other issues outside the parameters of the Bill, is because the Bill is very straightforward. The Bill proposes that all medical professionals be statutorily compelled to hold professional indemnity cover, in the same way as solicitors and many other professionals. This is the simple logic or intent of the Bill. I hope the Minister will allow the Bill to progress. I would be the first to concede that we cannot be experts on every issue and I admit I was not aware that doctors and medical professionals did not have to have insurance cover. I was quite surprised as would be many members of the public.

I was not in the Chamber to hear Senator Burke's opening remarks but the vast majority of medical professionals in this State have insurance cover. We are dealing in this case with very small numbers of people who are taking a chance. In an area as important as the provision of health care the people who provide the care should have the appropriate insurance. The Minister referred to some professionals with some level of insurance for some medical care but who were practising something different. He gave the example of cosmetic surgery. Medical professionals should have insurance and also the appropriate insurance for the medical care or treatment they are providing.

All the arguments have been made by other speakers. I commend Senator Burke on tabling the Bill. I appeal to the Minister to ensure that it progresses through the House and the Lower House as quickly as possible. As Senator Norris said, this is a good day for the Seanad when such a Bill is brought forward as opposed to motions which can often be the case. This is an important piece of legislation being tabled in this House which is the prerogative of the House. The Minister made the point that there are many important issues which must be dealt with by the Government. This explains the significant legislative list. However, the issues raised in this Bill are also important. The Government can use this House to bring forward Bills to help in the overall delivery of important legislation.

For that reason also, I commend Senator Colm Burke. My party will be fully supporting the Bill.

2:50 pm

Photo of Caít KeaneCaít Keane (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I support the Bill. It is difficult speaking now that I know the Minister for Health, Deputy James Reilly, has said he will not be accepting it. I apologise for not having been able to make it for his speech. I was absolutely surprised to hear the Bill was not being accepted. In 2009, when in opposition, the Minister published his own Bill in this area, the Medical Practitioners (Professional Indemnity) (Amendment) Bill. I am quite confident that Senator Colm Burke examined it with a fine tooth comb to determine how well he could marry it with his Bill, the purpose of which is to introduce a requirement for professional indemnity cover for medical practitioners. The aim is the same. Is the Senator's Bill being rejected because it is being introduced in the Seanad? As Senator David Norris stated, there was a Bill in the Seanad to which 200 amendments were accepted. There could not be very many amendments associated with a three or four page Bill.

Is it too late to examine the 2009 Bill to determine where it is similar to and different from the Bill before us? Is there any comeback on it? If the intention of the 2009 Bill was the same as that of the Bill before us, we have an ideal opportunity to use the Chamber to address this matter, bearing in mind that the other legislative House is so busy. The Bill is important. While most doctors have cover, only one doctor must have no or insufficient cover to pose a problem. Is there a minimum level of cover? All these questions must be answered. I support the Bill, but I am disappointed we cannot advance it further. Is there any comeback on it? I do not know.

Photo of Rónán MullenRónán Mullen (Independent)
Link to this: Individually | In context | Oireachtas source

Rinne mé dearmad fáilte a chur roimh an Aire níos luaithe. Tá áthas orm an deis a fháil arís fáilte a chur roimhe.

I am very much in agreement with the tributes paid to Senator Colm Burke who is extremely thoughtful and has paid great attention to detail. I add my voice to those complimenting him on the work he has done in bringing forward the Bill which is typical of his approach. He is a very fine parliamentarian.

If there are two types of narrowmindedness that beset politics here, one is party political whereby Members immediately resort to defending their side and castigating the other, as we have seen this very day, while the second is the narrowmindedness of the Government towards the Legislature. There is real resistance to the notion that the Legislature might beat the Government to the punch in bringing forward sensible legislation. It would be as easy for the Minister to join in and seek to improve Senator Colm Burke's Bill as to propose to take it into account for the future.

I was struck by what Senator David Norris had to say in his very interesting speech. It reminds me of a recent story about a friend of mine who needed to undergo some liver tests or a cholesterol test. He advised the doctor and made his appointment for the next day. He turned up and was informed, after having various other matters looked after, that he could not have his bloods done because he had not been fasting. Therefore, he had to return on another day and was charged twice. When he returned to have his results explained to him, he was charged for a third time. The word that came to his mind at the time was "ching". This has nothing at all to do with the issue of indemnity, but it is one of good practice. It is definitely one of those areas in which we have a long way to go in "crowning the customer", to borrow the words of my distinguished colleague Senator Feargal Quinn.

This is a sensible, clear Bill, the aim of which is to improve the lives of citizens. It would close what is a very apparent loophole. Having insurance would be in the interests of doctors and the customer, the patient. It is interesting to note that in Austria, Germany, Latvia, France and Slovakia it is mandatory for doctors to have insurance. The Czech Republic, Finland, Hungary, Poland and Spain require health care institutions and individual doctors to be insured. In Lithuania and Portugal there is a requirement for institutions to be insured and it is also advised that doctors be insured. In Italy and Estonia having insurance is voluntary. In Denmark and the Netherlands there is a state indemnity scheme. Sweden also has a state indemnity scheme, but there is an additional requirement that doctors practising in the private sector be insured, either personally or through the service companies in which they work.

Discretionary indemnity is allowed in the United Kingdom, Ireland and Malta. Therefore, in our system we do not have a guarantee of cover. I am not saying anything any Member present does not know at this point. Can we do more to inform the customer, the patient, of ways of obtaining redress if he or she believes he or she has been harmed or mistreated? How do we give patients this knowledge, given that so many are travelling abroad for medical procedures? Patients need to be informed of the various systems in EU member states and the extent of the insurance provided. It would be worthwhile determining whether we could raise this matter at EU level during our Presidency. The subject of cross-border health care is very important.

The deterrent effect of the legislation would be great, but I would be concerned if the cost of cover were to be passed on to consumers through doctors' fees and charges. How do we protect against this, or can we? I would be interested in obtaining some information on this from the Minister and perhaps Senator Colm Burke in due course.

I commiserate with Senator Colm Burke as his very fine Bill is not being accepted. If he chooses to put the matter to a vote today, he will have my support. I hope the Government will, at the very least, not delay in bringing forward the necessary legislation.

Photo of Maurice CumminsMaurice Cummins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I join my colleagues in complimenting Senator Colm Burke on introducing this Bill to the House. I know full well the amount of time and effort he has put into it. The Minister and the Department have been talking about introducing such a Bill for a number of years, yet when a Member of the House introduces one, irrespective of whether the Department believes it is flawed, it is not accepted. It could be amended on Committee Stage. I am disappointed that the Bill has not been accepted and question why the Department is dragging its heels on it. That is what is happening. People have been talking about indemnity for medical practitioners for the past three to five years. I am disappointed, therefore, that the Department has been dragging its heels in dealing with this matter.

The Minister has stated he will take on board quite a number of sections in Senator Colm Burke's Bill when the Government introduces its own legislation. When are we likely to see that Bill? If it has been postponed, as it has been for a number of years, we will not see it before the Government's term is up. For that reason, I compliment Senator Colm Burke. I acknowledge the consultations he has had with many people in drafting the Bill and I am disappointed that it is not being accepted, as I believe it could be amended on Committee Stage. It is welcome that many parts of the Bill will be included in the Government's Bill, but I question when the latter will be brought before this House or the other.

Photo of Colm BurkeColm Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank all my colleagues who made a contribution to this debate. Let me cover one or two matters that were referred to. To put it bluntly, I am stunned by what has occurred. I was told an hour ago that the Department was to accept the Bill and intended tabling amendments to it. It is not that I did not give the documentation to the Department; I gave it to it over eight weeks ago. I did not receive a response and I am totally astonished that this is the approach of the Department at this stage.

Photo of Sean BarrettSean Barrett (Independent)
Link to this: Individually | In context | Oireachtas source

Shame on the Department.

Photo of Colm BurkeColm Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

It certainly came as a huge surprise to me.

Let me touch on one or two issues that were referred to. The Minister referred to Medical Council expertise. It is referred to in the Bill. At my meeting with representatives of the council Mr. Ciarán Breen of the State Claims Agency was present.

A concern was expressed to me that the Medical Council did not have the expertise to decide the level of insurance doctors should have. As a result, we have incorporated this into section 5(2B) of the Bill which states the council "shall, having consulted with the State Claims Agency, publish on its website guidelines as to the form and scope of professional indemnity cover to be held by medical practitioners". That deals with the criticism made by the Minister that the council does not have the expertise. I fully acknowledge this and we took that criticism on board.

The second issue raised by Senator John Crown is very important because if affects doctors who want to retire and are retiring, namely, follow-on cover. This issue must be dealt, but I am not at all sure how we should do so. I have provided for it in section 5(2A)(b)(i) in that there would be an obligation to have follow-on cover after retirement. I accept it is a problem at which we must look in the long term. The Medical Council must be involved in this issue. There are more than 18,000 medical practitioners in the country and I fully accept that they have a huge administrative workload and that this would be a further task. There would be no point setting up a new regulatory authority or giving this tasl to another Department. The Medical Council is the most appropriate body to deal with the issue.

Senator John Gilroy asked if there was any evidence of people not having insurance. Recently I spoke to a legal practitioner in Cork who said he was involved in litigation against a medical practitioner who did not have professional indemnity insurance. It is happening and important that we close this loophole as soon as possible.

Senator Sean D. Barrett referred to the periodic payments scheme. The Quirke report on the scheme was very comprehensive and is something at which we need to look in the context of the award of compensation. Going back to what Senator John Crown said, we need to look at the issue of litigation, which is costing the State and medical practitioners a considerable amount of money, to see if we can do something to deal with it, while ensuring there is adequate compensation for anyone who suffers as a result of inappropriate treatment. However, there must be limits also.

I looked at the initial Bill published in 2009 and had consultations during August and September, when there was less pressure on people, which were extremely helpful. The Bill may not tick all of the boxes, but it covers 90% of the issues which need to be dealt with. I am a little surprised that the Department believes it needs to draft a totally new Bill because this one can be amended and we can take on board amendments it may propose.

The Medical Protection Society has written to me again to say it needs one or two things to be tidied up and I have no difficulty in taking on board its views, as well as those of the Medical Council. As I said, one cannot drive a car or I cannot practice as a solicitor without insurance, but one's local general practitioner is not required by law to have insurance. I do not want to alarm people as the vast majority of medical practitioners have insurance, but we need to tidy up this area because under EU regulations, we cannot stop a person from coming to this country and setting up a practice. We must insist on the public being protected by ensuring there is adequate insurance cover. That is the reason I brought forward the Bill and why we should proceed with it.

Question put and agreed to.

3:00 pm

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

When is it proposed to take Committee Stage?

Photo of Colm BurkeColm Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

On Tuesday.

Committee Stage ordered for Tuesday, 26 February 2013.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

When is it proposed to sit again?

Photo of Maurice CumminsMaurice Cummins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Ar 10.30 maidin amárach.