Mary Seery Kearney (Fine Gael)
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I welcome the Minister of State, Deputy Niall Collins.

Alice-Mary Higgins (Independent)
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I welcome the Minister of State to the House.

I will begin by commending the more than 200 graduate entry medical students who wrote to the Minister in October to highlight the extremely urgent issues and problems with the current fee model for graduate medical studies in this State. In their letter they highlighted that: "GEM students are not eligible for SUSI (or any other similar student financial support schemes), and since 2022 have had no access to any private medicine-specic loan services." This is following the end of the Bank of Ireland loan which previously filled that role. The yearly cost of tuition for these students can range "between €14,580 and €17,760 (with no option of payment deferral)" in terms of tuition fees. These costs do not include transport, equipment costs and, fundamentally, do not include the exorbitant cost of accommodation. These students have highlighted that entire sections of society are therefore precluded or effectively blocked "from obtaining a medical education – regardless of their drive, passion or academic achievements," or any desire they have to contribute in that area.

The issue of "pricing people out" from education is one of fundamental importance. It is education of a fundamental public good. Fees that diminish equal access to that are, indeed, a public bad and something we need to address. Crucially, in terms of medical education only being provided, we know that general education medical students may use the 1916 bursary, which the Minister of State may speak to in his response, but the maximum amount of bursary payable is €5,000 per year, which does not even cover 50% of the fees.

The Minister has previously referenced the availing of the student assistance fund. Again, that fund is not a systemic answer to ensuring access to a whole strand of medical education. The fund is something that was meant to be there on a needs basis and decided case by case. The level of funding available to students is not sufficient to live on. Also, the level of work required for a GEM course means that students do not really have the time or capacity to engage in sufficient paid employment to earn a living thus meaning they can pay for their tuition.

Exorbitant fees and "pricing out" taken together is completely unacceptable and, indeed, foolish at a time when the Department of Health's national task force has identified the need for an additional 2,000 hospital consultants and 1,000 junior doctor posts by the end of the decade, and that the working experience of junior doctors needs to be improved. We need to ensure that we retain doctors and have a pipeline that means medical education is accessible. It is also important to have a medical profession that reflects wider society because not only is education a public good but health is a public good.Having doctors who reflect wider society is part of ensuring that we have health systems that genuinely work for all communities. We saw how important that was during the pandemic.

It is important and interesting to note that one of the most impactful persons ever to enter the medical profession in Ireland, Dr. Noël Browne himself, was only able to do so because he received a scholarship for his medical education. His lived experience in respect of the destructive effect of tuberculous on Irish families and poor communities across Ireland was hugely important in inspiring him to take the actions to become the person who eradicated it. This is just an example of why we need diversity in our education system and in medicine.

I would like to know what steps are being taken to ensure equitable access in medicine.

Mary Seery Kearney (Fine Gael)
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This is an extremely pertinent issue. Well done, Senator.

Niall Collins (Limerick County, Fianna Fail)
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I thank Senator Higgins for raising this matter. Graduate entry medicine is open to students who have already completed an honours undergraduate degree in any academic discipline and achieved a minimum 2.1 award in this degree. Students pursuing graduate entry medicine programmes do so as a second degree course and, consequently, are not eligible for free fees, funding or student grants.

It is important to state that this is also the case for all other degree courses. The State currently has no role in providing fee or grant assistance to a student who pursues a second degree. The fees payable by these students are determined by the institution and, as such, it is not open to me to intervene in the tuition fee policy of institutions.

However, our Department has been working to address the number of undergraduate medicine places. On 12 July 2022, the Ministers, Deputies Harris and Donnelly, announced an agreement with the Irish medical schools to increase the number of places available for EU students by 200 over the next five years. The agreement reached with the medical schools began with an additional 60 EU students in September 2022, climbing to 120 in September of last year and up to 200 by the year 2026. The agreement included additional graduate entry medicine places. To date, an additional ten graduate entry places – five in 2022 and another five in 2023 – have been created, with further additional places planned up to 2026.

This marked a significant expansion in the number of places available to students applying through the CAO system. It increases the opportunities for students to progress to study medicine in Ireland and to help us build up our talent pipeline.

We have been making improvements though. The State currently provides a subsidy to HEIs towards the cost of provision for graduate entry medicine places, and that is gradually increasing. The subsidy has already increased from a rate of €11,950 in the 2021-22 academic year to €12,100 per student in the 2022-23 academic year, and will progressively increase over the coming years to the new rate of €14,500. The State contribution towards graduate entry places will be increased in phases so that by 2026, all graduate entry places will be funded by the State at €14,500, with additional fees as determined by the university payable by the student. The adjusted subsidy rate is an important component of reaching agreement with the medical schools to increase medicine places for EU students.

In addition, our Department provides bursaries to students who have been identified by their higher education institution as being the most socioeconomically disadvantaged students under the national access plan. Students who avail of certain bursaries will now be allowed to retain them if they choose to enter the graduate entry medicine programmes. This is a welcome development that will also help diversify the profession.

Students on graduate entry medicine programmes will also be eligible to apply to the student assistance fund for financial support. This is an area we need policy clarity on. We have engaged with the Department of Health on it and continue to do so. We must ensure that whatever decision applied is fair and proportionate.

Alice-Mary Higgins (Independent)
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The measures the Minister of State outlined are about engagement with the institutions but not providing support to the individuals.The concern is that we are in a situation whereby the discussion is as if this education was a commodity rather than a pipeline for an essential public service. I have sat in committees where we talked about the lack of doctors and yet there does not seem to be a concern in relation to this. I would say that the bursary measure is the only measure that is targeted towards students and it is a woefully inadequate measure. Is there a recognition that this is a problem for the State in terms of not having sufficient numbers, which we have talked about briefly, but also not having sufficient diversity in those coming through our medical systems? I suggest that this is one area that is particularly different. The Minister of State, Deputy Collins, said that we do not give fees or grant assistance for a second degree. This, however, is an area where the State requires a second degree. This is a public need and is not solely around the individuals. There is a public need for more doctors and more diversity within the medical profession.

Niall Collins (Limerick County, Fianna Fail)
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I thank the Senator and I will make her views absolutely known to the Department. The matter of health workforce planning and ensuring an appropriate pipeline of qualified healthcare workers within Ireland is a major priority for our Department. I want to assure the Senator that it is our key objective to try to continue to make improvements for all students including general entry medicine students. It does require both Departments to be at the table and we are working on it. It does raise complex issues that need to be considered and we will continue to engage with this House and with the Senator on these matters.