Wednesday, 18 April 2018
I welcome the Minister of State, Deputy Jim Daly. In light of the issue regarding recruitment and retention of doctors, I wish to ask the Minister for Health to consider amending section 49 of the Medical Practitioners Act 2007, which currently limits access of trainee specialists to those who have graduated within the EU or completed a period of internship within a restricted list of countries. There are many young doctors working in this country who, despite having plenty of experience, are being blocked from accessing further training as they do not fit this restrictive criteria. These are skilled and experienced doctors that the Irish health care system badly needs to retain.
The Medical Practitioners Act 2007 states that a medical practitioner must have completed a period of internship to the satisfaction of the Medical Council to gain access to the trainee specialist division, which is fair enough. However, the Medical Council states that doctors who gained their qualification outside the EU cannot gain access to training schemes unless they have completed their internship in a restricted list of countries, namely, Malaysia, New Zealand, Pakistan, South Africa and the Sudan. If these doctors completed their internship in a country outside that list, they are deemed ineligible for the trainee specialist division, which is currently a requirement to apply for any of the medical training schemes. There are currently no means to remediate this. Many of these doctors have accumulated considerable experience and are working alongside and helping to train junior colleagues who are on training schemes, so there is an irony there. Any career progression for these doctors is pretty much blocked and, as a result, we are losing these doctors, who are leaving to go to jurisdictions where they can access training and upskill to progress their careers, which is obviously basic for anyone in the profession.
It was a young doctor, Dr. Sarah Barry, who brought this to my attention. She was a trainee in the midlands GP training scheme and also worked in smaller peripheral hospitals, such as the Midland Regional Hospital in Mullingar, Portlaoise and Tullamore, and St. Loman's psychiatric hospital in Mullingar. She has seen how reliant these smaller provincial hospitals are on doctors who have completed their medical degrees outside the EU and completed their intern foundation years outside the designated six countries.
This issue has been flagged repeatedly with the national doctors training and planning association as part of the MacCraith reviews and it has been flagged to the HSE and the Medical Council but, as yet, I am unaware of any concrete plan to rectify the situation. It appears that simply adding the words "or its equivalent" to section 49 of the Act could address the intern year issue blocking access to trainee specialist division and the intern year. Priority could be granted first to EU residents as a similar system prioritises Australian citizens for their trainee schemes. I have made my point and I am interested to hear the Minister of State's reply.
I thank Senator Noone for raising these issues and for giving me the opportunity to update the House on the position in regard to them. I am pleased to say that, at the end of February 2018, there were 2,977 consultant whole-time equivalents employed in the public health services, which is 98 more than at the end of February 2017 and an increase of 750 in the past decade. The number of non-consultant hospital doctors also increased by 288 from February 2017 to the end of November 2018, with 6,327 non-consultant hospital doctors employed, an increase of 1,438 in the past decade.
I acknowledge the current difficulties attracting and recruiting consultants, particularly to certain specialties, including psychiatry and paediatrics. The HSE has been focused on addressing these issues and is now giving effect to the report, "Towards Successful Consultant Recruitment, Appointment and Retention", completed in December 2016, as well as to the implementation of the MacCraith group recommendations to support the recruitment and retention of consultants and non-consultant hospital doctors.
I acknowledge the valuable contribution made by doctors who are from outside the European Union to the Irish public health system. I am very aware that they play an important role in Irish healthcare. I am also aware that specialist medical training may be an important career pathway for these doctors but that some are unable to access this training.The Medical Practitioners Act currently provides that doctors whose qualifications are from non-EEA countries require the equivalent of a certificate of experience, that is, an internship, to access specialist training in Ireland. The Medical Council currently recognises internships from Australia, New Zealand, Pakistan, South Africa, Sudan and Malaysia as being equivalent to Irish internships. A doctor whose qualification is from a country other than those cannot access specialist training. The Minister, Deputy Simon Harris, has therefore decided to amend the Medical Practitioners Act 2007. The amendment will be introduced by a regulated health professions (amendment) Bill, which will amend the five health profession regulatory Acts in respect of a number of areas. This Bill will amend the Medical Practitioners Act to remove the requirement to hold the equivalent of the certificate of experience to access specialist training. It is a large and complex Bill and is currently at an advanced stage of drafting by the Office of Parliamentary Counsel in liaison with Department officials. It is expected to be published in this Dáil session, subject to no major issues arising.
It is important to mention that Ireland is committed to a national policy of health worker self-sufficiency and has signed up to implementing the World Health Organization 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 members states "strive [...] to create a sustainable health workforce and work towards establishing effective health workforce planning, education and training, and retention strategies that will reduce their need to recruit migrant health personnel".
I do not think I have ever had such a satisfactory answer to a question I have asked as a Commencement matter. The fact that the Minister, Deputy Harris, has decided to amend the Medical Practitioners Act and the fact that the amendment is in train is great. I will be very happy to communicate that. I was at the Irish Medical Organisation conference the weekend before last and it was one of the concerns that was raised. It is great to see that the Minister, Deputy Harris, and the Minister of State, Deputy Daly, are on top of it. I thank the Minister of State.
The next item is in the name of Senator Máire Devine. There is no sign of her. Perhaps we will move on to the matter being raised by Senator Kevin Humphreys as it is being answered by the same Minister of State. We will take his Commencement matter now.