Colm Burke (Fine Gael)
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I apologise for dragging the Minister back again so soon.

James Reilly (Dublin North, Fine Gael)
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I am delighted to be here.

Colm Burke (Fine Gael)
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He has been in the Chamber three or four times this week. A number of people from the medical profession have been in contact with me. Some of them are members of organisations within the medical profession and others are individual medical consultants. The problem lies with the Medical Protection Society, MPS, which is a non-profit organisation that provides insurance for those in private practice. My understanding is that because the number of claims has increased, insurance premia are to rise substantially.

I received a telephone call this morning from someone in the MPS in the UK. I also received an e-mail. It appears that the claims environment for private hospital consultants has deteriorated significantly in the past two years with actuarial estimates of the cost of indemnity per member increasing by more than 90%. That is a result of large increases in both the rate at which hospital consultants are being sued and the average size of the claims. Regrettably, that means the cost of subscriptions must rise to reflect the increasing risk.

The MPS is a non-profit mutual organisation owned by and accountable to members. As I understand it, the capping at the moment for obstetrics, spinal surgery and neurosurgery is €565,000 and for most other areas it is around €1.13 million. Those who approached me said it would be helpful if it is possible to reduce the capping in order to bring some kind of order to what is going on. I understand that from 1 July, insurance for some people in the private sector will be as high as €97,000 and in some cases might rise to more than €100,000. One might argue that medical consultants charge large fees but there are other costs in addition to insurance. One person said recently that it cost them approximately €250,000 per annum before any income is earned.

It is costing on average approximately €250,000 per annum before they have any income, which is a problem.

The other issue that has been highlighted to me is that 41% of elective surgery is carried out by those in private practice. Any reduction in the level of private practice available has the knock-on effect of that having to be dealt with by public hospitals which puts increased pressure on them. I am raising the issue in that context. I know the MPS has had discussions with the State Claims Agency and the Department of Health. However, I tabled this on the Adjournment because the matter is being revised on 1 July.

James Reilly (Dublin North, Fine Gael)
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The indemnity caps for medical consultants in private practice were introduced, with Government approval, in February 2004, following the migration into the State's clinical indemnity scheme, CIS, of hospital consultants engaged in public practice. With the establishment of the CIS, the medical defence organisations, such as the Medical Protection Society and the Medical Defence Union, had a significantly diminished income stream to meet the cost of future claims. Without the caps, indemnity subscription rates of consultants in whole-time private practice would have been greatly increased.

Under the cap scheme the State's clinical indemnity scheme covers claims over a certain cap or amount against private consultants arising from adverse clinical events occurring after 1 February 2004 in private hospitals. In July 2013, the Government agreed to continue to provide the cap scheme for another five-year period. It was also agreed that the caps would continue to be adjusted annually from 1 July 2014 in line with the consumer price index. The present cap rates are as follows: for obstetricians, neurosurgeons and orthopaedic surgeons undertaking spinal surgery €565,000 per claim, including damages and legal costs, subject to annual aggregate limit of €1.695 million per consultant; and for all other specialties, the limit is €1.13 million per claim, including damages and legal costs, with no aggregate limit.

The Medical Protection Society provides indemnity cover to the majority of medical consultants in Ireland. The MPS has notified the Department that it faces major challenges in maintaining a solvent indemnity fund for its Irish consultants and without an increase in premiums this year its income from premiums will not match its liabilities. It notified its members earlier this month that the membership fee for indemnity would increase by an average of around 42% for all members. The Department has been informed that approximately 1,000 consultants are affected - 350 in full time private practice and the rest have B consultant contracts which allows them part-time off-site private practice.

The cost of Irish clinical negligence claims is much higher than the cost in the UK. A major problem is the long period that it takes before Irish cases come to trial. This results in significant increases in awards and in legal costs. Legislation is being drafted by the Department of Justice and Equality to address various pre-trial aspects of litigation but the impact of a change in legislation on awards will not be seen for a number of years.

The Irish Hospital Consultants Association is seeking a reduction in the caps for low-risk specialties and for high-risk specialties in order to reduce the level of the increase in premiums for its members. It argues that if this is not done, consultants may be forced out of business, while others may pass on the increase to patients.

Changes cannot be made in the short term without an in-depth actuarial analysis of the impact of any change on the financial risk to the State of such change. The State Claims Agency, which manages the clinical indemnity scheme, has commissioned this analysis. Discussions are under way between Department officials and the State Claims Agency in this regard. Officials from my Department have also met representatives of the Irish Hospital Consultants Association and the Medical Protection Society about the issue.

It took months of consideration and assessment before the Government agreed in 2013 to the continuation of the caps and the Government decision stressed that a value-for-money review should be undertaken before any change was made to the scheme. At a time of huge financial pressure on the public system any change to the caps system for the consultants in private practice must be carefully considered and a Government decision would be needed to effect such change.

Colm Burke (Fine Gael)
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When I was contacted, I was advised that the MPS might withdraw from providing cover in Ireland - that occurred in Australia. A representative of that organisation telephoned me this morning to clarify that it did not intend to withdraw from providing insurance cover in Ireland. However, that also happened with the Medical Defence Union when it withdrew from Ireland, which left its own problems. We need to be careful on this matter. There is concern that any reduction in the level of services being provided in the private sector will result in the public sector having to pick up the pieces. We need to bear in mind that 41% of all elective surgery is done by medical consultants working in a private capacity. This needs to be given serious consideration given the pressures within the sector at the moment and given the number of consultant vacancies in the HSE.

James Reilly (Dublin North, Fine Gael)
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On the last matter, we have more consultants working here than ever before. There are a couple of hundred more than there were in 2008.

On the substantive issue, it would require a Government decision to enact any changes in this. We are awaiting the outcome of the actuarial study that is being undertaken. I thank the Senator for raising the matter.