Tuesday, 13 June 2017
Health Services Staff Training
I also welcome the Minister of State, particularly on a day when his attention is, presumably, directed elsewhere, as is the case for many others. I am grateful to him for coming to take this urgent Commencement matter, one that has been raised quite a number of times for the attention of successive Ministers for Health. I raise it again in order to keep the pressure on as it is hugely urgent and impacts severely on the experience of patients within the health care system.
To put it briefly, I ask the Minister for Health to inform the House when he intends to bring forward the legislation promised to change the criteria for medical training to alter the eligibility requirements for doctors in Ireland from non-EU countries to enter specialist training programmes here. There are doctors working here in psychiatry and a number of other specialist divisions who were trained in other countries. They are permitted to work here as non-trainee doctors, but they are not allowed to enter the trainee specialist divisions because they have not completed a recognised internship. I am told that there some doctors from non-EU countries such as Australia, New Zealand and South Africa who have been recognised from 2006 onwards. There is, however, a significant number of doctors from other countries work who should be on specialist registers but are unable be included because the necessary legislation has not been brought forward. Certainly in the field of psychiatry there are doctors from India, the Philippines and Nigeria who should be allowed onto the trainee register but are not. This means that they do not receive the supervision they should if still in training. It also means that it is very hard to recruit or retain doctors where we need them because they do not receive the training opportunities and recognition they would receive if the legislation was to be brought foward.
There is a bizarre anomaly in the health system. I have spoken to colleagues who work in the sphere of psychiatry and elsewhere who have told me that it is bizarre and recognised as such. It has an impact on patient safety because there is no supervision to the required level. It also has an impact on waiting lists because the necessary specialist doctors cannot be recruited or retained. The effect on patients is very clear and has been recognised by successive Ministers for Health. I know because I spoke to our colleague, Senator James Reilly, when he was Minister for Health. At the time he promised to bring forward the necessary legislative change. A simple amendment is required and would be supported by the Medical Council and every other stakeholder. There is no political disagreement on the issue. It seems to be due to a bureaucratic delay. In late 2016 the Minister for Health, Deputy Simon Harris, promised that the necessary legislation would be brought forward in the first quarter of this year. Previously, the Minister for Social Protection, Deputy Leo Varadkar, when Minister for Health, said he would bring forward the legislation. I am told that the most recent ministerial comment is that it will be brought forward in the final quarter of this year, but that is simply not good enough. The deadline for doctors in training is July 2018. Therefore, the legislation must be concluded by the start of January 2018. Bringing it forward in November or December will be too late to enable us to see the benefit in having a sufficient number of doctors on the specialist register next year. The matter is urgent and the legislation must be brought forward.There is a political commitment to doing it and I am simply seeking to apply pressure in that regard. My colleague in the Dáil, Deputy Alan Kelly, our spokesperson on health, will also apply pressure about this. I am anxious to hear from the Minister why the legislation has not been forthcoming.
I thank Senator Bacik for raising this important issue. I also take this opportunity to wish the Taoiseach, Deputy Enda Kenny, well. As I speak, tributes are being paid to him in the Dáil. From my perspective, having worked with him as a Minister of State over the past 12 months, he has always been very positive and inclusive. He did not have issues with people having different views. He was very supportive of me and my portfolio as Minister of State with responsibility for disability issues. I wish him, his wife, Fionnuala, and all his family well for the future.
This is an opportunity to update the House on the position relating to amendments to the Medical Practitioners Act 2007 regarding specialist medical training in Ireland and entry to the trainee specialist division of the Medical Council register by doctors from non-European Economic Area, EEA, countries. The Medical Practitioners Act 2007 provides that nationals of non-EEA countries are registered in the trainee specialist division of the Medical Council’s register if they have passed the council’s pre-registration examination system, PRES, or are exempt from the PRES in line with legislation, have an approved training post and have been granted in a third country a document which, in the opinion of the council, is at least the equivalent of a certificate of experience.
The certificate of experience is the certificate received on completion of an Irish internship. The Medical Council recognises internships in a number of countries as equivalent to Irish internships. These include Australia, New Zealand, Pakistan, South Africa, Sudan and Malaysia. However, internships from non-EEA countries outside of those countries are not currently recognised by the council, and I am aware that this creates difficulties for doctors from those countries who wish to access specialist training programmes in Ireland. Given these difficulties, the Minister for Health, Deputy Simon Harris, has decided to remove the certificate of experience as a requirement for registration in the trainee specialist division. This will mean, in effect, that entry to the trainee specialist division for doctors who obtained their qualification in a non-EEA country will be by way of the pre-registration examination system - unless, as previously mentioned, the applicant is exempted from sitting the PRES in line with legislation - and the offer of a specialist training post by the HSE in a recognised training programme. The requirement to hold a document considered by the Medical Council to be at least the equivalent of a certificate of experience will no longer be a prerequisite.
The amendment will be introduced by a Health (Miscellaneous Provisions) Bill, a complex legislative measure which is currently being drafted by the Office of the Parliamentary Counsel in liaison with my officials. The drafting of the Bill was delayed due to the transposition of the modernised professional qualifications directive, which was transposed on 17 January 2017. The current timeframe is to publish the Bill by the end of 2017, but this is subject to no major issues arising. It is important to mention, however, that Ireland is committed to a national policy of health worker self-sufficiency and has signed up to implementing the World Health Organization, WHO, global code of practice on international recruitment of health personnel. The code establishes and promotes voluntary practices for the ethical international recruitment of health personnel and the strengthening of health systems. Article 3.6 of the code recommends that member states "strive to create a sustainable health workforce and work towards establishing effective planning, education and training, and retention strategies that will reduce their need to recruit migrant health personnel".
I thank the Minister of State for his response. I join him in wishing the Taoiseach well on his retirement. I offer best wishes to him, his wife, Fionnuala, and his family. However, I am disappointed with the substance of the Minister's reply, which does not bring matters forward in any way. Indeed, it simply re-states a decision that had previously been made by the former Minister, Senator James Reilly, some years ago and which was re-stated in August 2015 by the then Minister, Deputy Varadkar. It appears that nothing has changed. In 2015, the then Minister, Deputy Varadkar, told The Medical Independentthat legislation was being drafted at that time. It is a simple amendment to the 2007 Act.It is not a huge Bill, as I understand it.
The Minister of State also raised an important ethical issue, which is that currently we are poaching doctors from developing countries without offering them any opportunity to increase their specialisation or to train in a recognised training structure here. That is why we are losing people and that is why we cannot retain or recruit sufficient numbers of qualified doctors to bring down our horrendous waiting lists in the health system. I know that the Minister of State is a passionate advocate for reform in the health system. This is a very simple reform and I do not see how the Minister for Health can say that the timeframe is to publish the Bill by the end of 2017, subject to no major issues arising. This is an urgent matter. One of the organisations that has consistently highlighted this is Overseas Medics of Ireland. Its former general secretary, Dr. Shakya Bhattacharjee, emigrated to the UK from Ireland out of frustration and to access a training post in neurology there. We cannot keep the doctors that we need here and that has a knock on effect on our own people, as well as on the developing countries from where we are poaching doctors. I will continue to raise this and I will also rely on Deputy Alan Kelly to raise it in the Dáil. I ask the Minister of State to bring the message back to the Minister for Health that this must be dealt with more urgently than is currently the case.
I take the Senator's point that she has raised this matter with successive Ministers for Health in recent years. I also take her point about the deadlines being too late and I will bring that back to the Minister for Health. I acknowledge the Senator's disappointment and accept that if it is a question of drafting a relatively simple amendment, we should go ahead and do that. I will give Senator Bacik a commitment that I will highlight this particular issue with the Minister and my Government colleagues. I agree with the Senator that the question of poaching doctors is an ethical one that must be resolved but at the same time we need people to work in our health services who are well trained and qualified. I will bring all of the Senator's concerns to the attention of the Minister for Health.