Vol. 128 No. 6
I move amendment No. 1:
1. To add to the section the following sub-section:—
(3) An Order appointing a day for the purposes of this Act shall be laid before each House of the Oireachtas as soon as may be after it is made, and if a resolution annulling the Order is passed by either such House within the next 12 days on which that House has sat after the Order is laid before it, the Order shall be annulled accordingly, but without prejudice to the validity of anything previously done thereunder.
Perhaps amendments Nos. 1 and 3 might be taken together.
I want to point out that the first part of Deputy Mulcahy's amendment is already in the Bill and the second part merely arises for discussion now. I am, however, asking for a shorter period than is mentioned in the Deputy's amendment as necessary for a resolution of annulment, because there would be a number of bodies waiting for the decision.
The shorter period makes the matter more businesslike, I think. My main purpose in putting down the amendment giving a power of annulment arose out of the fact that this Bill proposes to do a thing that will create a considerable number of difficulties that have not yet all been explored or assessed. I pointed out on Second Reading what some of these difficulties are. We are now imposing on young people who have received their university qualifications as doctors the obligation of spending another year at a mixture of work and study in a hospital and we are preventing them practising in the ordinary way until they have gone through that year. Sufficient facilities for carrying on that work and doing that study do not exist in the voluntary hospitals and in the hospitals that have been recognised as teaching hospitals up to the present, and the question arises where accommodation is going to be found for giving these particular classes the required instruction or experience.
The Minister indicated on Second Reading that, I think, the Irish Medical Registration Board had gone into some examination of that situation and had reviewed the facts. I asked the Minister whether he would be able, in dealing with the Committee Stage, to give us any information arising out of that examination. If it is clear that the teaching hospitals or hospitals that have been regarded as teaching hospitals up to the present cannot take in, in the form in which they are asked to take in, these interns, it would be necessary to extend the list of the approved institutions for the purposes of this Bill and to take in a number of other voluntary hospitals and hospitals run by local authorities. I ask the Minister, can he give us any information as to what is likely to happen in that respect?
Again, if provisionally qualified doctors are to be required to spend a year without earning any normal income, I ask what arrangements are to be made to maintain these provisionally recognised doctors in the institutions in which they are to serve and what kind of payment is going to be made to them to enable them to maintain themselves, apart altogether from having a roof over them, and having food and other necessaries provided in these institutions. It is quite clear that somebody will have to provide the cost, both of their maintenance and the cost of whatever payment is to be made for the services they will render.
The Minister, I am sure, is quite clear as to what is involved in that way. As far as the local authorities are concerned, the obligation would no doubt fall on them to provide that. As far as the voluntary hospitals are concerned, it is well known that there are substantial deficits attached to the carrying on of those hospitals. I wanted to know how these deficits will be made up. I felt it was necessary to put in an amendment such as the Minister has now put in for the purpose of giving the House an opportunity of raising these questions again if, by the time the appointed day comes round, matters have not been settled in as satisfactory a way as I think the Dáil requires.
On a purely procedural point, is there any precedent for the 12 days in the amendment? The 21 days is a well-recognised precedent for the purpose of retaining the ultimate authority of the Dáil to annul an Order. I view with some alarm the introduction of 12 days if this is the first place where the period for annulment has been reduced.
I am afraid there is no precedent for it.
Will the Minister concede the maintenance of the 21 days? I do not suppose an Order is annulled once in ten years.
The trouble I had was that the other House does not meet as frequently as we do and 21 days might take us over a long period. I feel that, as a rule, if a person is going to object to something he will probably do it fairly quickly, that he will do it within the 12 sitting days, which, of course, is what this is.
The period of 21 days is enshrined in 100 or more Acts and it is the ultimate sanction of this House to control a Minister's Order.
The Deputy knows that under all these Acts anything done in the meantime is valid. It would be awkward to make anything done in this case valid.
I ask the Minister to consider my point and to meet it, if it is possible.
We did consider it very carefully. We thought we could reach a compromise by taking half the 21 days in this case.
There may be another complication which would perhaps make this acceptable. If the 21 days were pressed, that might raise another question. The powers of the Seanad are rather curtailed from what they were when the draftsmen in the early days drafted this regulation about the 21 days. In the amendment, you are giving power definitely to the Seanad to annul an Order bringing the Statute into operation. The Seanad at present has no power which would enable it to annul a Statute. It has only a delaying power. There might be too many questions to be solved in regard to the 21 days in respect of the Seanad. Power is being given to the Seanad under the Minister's amendment definitely to annul an Order so as to prevent the Act coming into operation.
As to the other point raised by Deputy Mulcahy, unfortunately I have not got a clear-cut statement to make with regard to the interns and their salaries, treatment, etc. The Medical Registration Council have estimated that there will not be more than 300 qualified in one year. They do that on their experience over many years. Taking the number of students and the qualifications over three or four years, according to their calculation, the number will not exceed 300.
Some of them may go to England for internship, but the council have based their calculation on the assumption that they will not go. Even on that assumption, they think they can fit them all in. Their present intention is to place about 220 in the voluntary hospitals and about 80 in the local authority hospitals. They think that there should be more of these interns in the voluntary hospitals on the per bed basis than in the local authority hospitals.
When it comes to the question of remuneration and cost of maintenance, they have to take into account what the hospitals are paying at the moment. The local authority hospitals are paying their house surgeons and house physicians £150 a year, I think—I am not sure about that—and are also maintaining them. It would not be unfair to the hospitals to say that they must pay £120. There must be some allowance made for what they are paying already. The same would apply to the voluntary hospitals. There are a number of rather difficult and complicated calculations to be made, but I am quite sure the Medical Registration Council will have got over these at a very early date, and will then be in a position to tell the hospitals what they expect from them. Before we mention the appointed day, I think that should be done.
Can I get from the Minister on behalf of the Government a declaration that if, in the special circumstances which he finds himself, the House consents to the 12 days' period for the first time, this is not a precedent to which the Government will hereafter appeal to justify any similar deviations in any other proposed legislation?
I have no intention of making this a precedent at any rate.
Then the 21 days will stand as these are to be regarded as exceptional circumstances in which the Minister makes application for the 12 days?
Yes.
I move amendment No. 2:—
In paragraph (b), page 2, line 34, to insert "he was before the appointed day possessed of the qualifying diploma, or of one at least of the qualifying diplomas, by virtue of which he claims registration or" before "it".
This was an omission which obviously should be covered. Suppose we make the appointed day the 1st January, 1953, and a man who qualified in the previous December neglects to register, as the Bill stands he will have to do his internship before being properly registered. We want to exempt such a case where a man qualifies before the appointed day and neglects to register so that he will be registered without doing his internship.
On the section, it would be worth while harping back to the point raised by Deputy Dillon as regards the 12 days as against 21 days. The reason for asking for amendment No. 1 which the Minister has put in is that we may have power to intervene in the matter and have a chance of getting information. Under Section 3, power is provided for setting up approved hospitals and institutions in which the internship will be worked out. Does the Minister contemplate that such certificates as are to be issued will be ready for issue immediately after he makes the Order with regard to the appointed day so that the information with regard to the type of hospitals approved will be available to us to enable us to make up our minds whether a motion is necessary to consent to the appointed day Order or not?
I expect all these preliminaries will be fixed up before the appointed day is announced.
Does this refer only to foreigners?
Yes. If a foreigner applies for registration he must either have had satisfactory experience in a resident medical capacity in an approved institution here or similar experience elsewhere.
Is there any method prescribed for proving that, or who is to be satisfied?
The Medical Registration Council.
I move amendment No. 4:—
To delete sub-section (6), page 5, and substitute the following subsections:—
(6) The council may, if it thinks fit, in lieu of or in addition to, including the separate part of the register referred to in sub-section (5) of this section in the annual publication of the Medical Register of Ireland, cause a list of persons provisionally registered to be prepared at least twice in each year.
(7) A list under sub-section (6) of this section shall be prepared in the prescribed form and shall be compiled by reference to a date directed by the council and specified in the list and the council shall cause copies of the list to be available for purchase by any person on payment of the prescribed fee.
(8) A copy purporting to be a copy referred to in sub-section (7) of this section which is for the time being the latest such copy shall be evidence in any court until the contrary is proved that every person whose name is entered therein is provisionally registered in accordance with this Act and that any person whose name is not entered therein is not so registered.
(9) A certificate purporting to be signed by the registrar and to certify that on a specified day or days or during the whole of a specified period a particular person was duly provisionally registered or that on a specified day or days or during the whole of a specified period a particular person was not provisionally registered or that on a specified day the name of a particular person was erased from the separate part of the register referred to in sub-section (5) of this section shall, without proof of the signature of the person purporting to sign the certificate or that he was the registrar and notwithstanding any discrepancy between the certificate and any list under sub-section (6) of this section or copy thereof, be conclusive evidence of the matters certified by the certificate.
The Medical Registration Council came to me and told me that on consideration they thought that the printing of a special part of the register would be a very onerous job because examinations are held in the various colleges twice a year and it would mean printing the list many times in the year. They thought it would be sufficient to have what is provided in this amendment; that is, that a list of persons would be provisionally registered.
In that way a typed list would be sufficient for the purpose. It would, of course, be open to inspection and it would be supplied to anybody who had a right to see it, such as universities, hospitals or anybody else who might have reason for examining the list. Extracts would also be sent from the list in the same way as from the register on payment of the usual small fee. I must say I agree it would be a very onerous job to have the list printed several times in the year. I think this is quite sufficient.
What is the position of a person who finishes his academic career to the point of being eligible for provisional registration? He goes and registers himself. Is it intended that there will be provisional registration opened up immediately after the examination?
Immediately after. This will make it possible to do it immediately.
Does the Minister agree that it is not in keeping with the dignity of the profession that anybody could be provisionally qualified?
I am not an authority on the dignity of the profession and I do not understand the Deputy's question.
It does not sound right to me.
On the section, there will then be no delay between a person being granted his sixth year academic qualifications and his being eligible to take up work of internship?
There will be no delay at all.
Will there be any delay in a person completing his academic course and finding an institution to which to go?
That raises some difficulty because obviously internships will have to be arranged for a certain date, say, 1st January and 1st July each year. As Deputies are aware, the final examinations are usually held in June and December. I think, therefore, internships would start in the following month. That is a matter, however, for the council. I have nothing to do with it.
Would the Minister state what position an internee will be in if he falls ill during the course of his internship?
I do not think a short illness would matter very much. In the case of a long illness I take it he would have to complete his internship. There is provision here where a man is physically incapacitated-say, through injury to a hand-and incapable of doing surgery; in that case he can substitute midwifery or medicine during his year.
Would the Minister consider seeing that the many difficulties in the way of qualifying would be lessened and that the craze on the part of university professors of failing students be curbed?
This is in fact really a seventh year added to the medical course.
It is.
I do not suppose it is open to any layman to argue the necessity for this continued extension of the academic course to which a student is committed. It is worth remembering, however, that the doctors who attended us when we were children graduated in three years and they were extremely good physicians. I am not suggesting that because that was so it is necessarily enough to qualify a doctor now; but I do suggest that some advertence should be had to a tendency, which is I think growing amongst technically qualified persons, to build up a greater and greater complexity of preliminary study before a man can embark on the practice of a profession.
That is exactly what is happening.
The three years' course was extended to four. Then it was extended to five. Then it was extended to six-no, there was a pre-medical year.
That would be the sixth year.
There was a pre-medical year stipulated for. Now there is a post-medical year stipulated for. That makes it seven. I do not think I am wrong in saying that many reputable physicians and surgeons would be prepared to maintain that, if the existing curriculum were carefully scanned, while many of the additions would certainly be approved, good grounds could be brought forward for eliminating certain of the somewhat archaic requirements which have been left in the curriculum while necessary additions were being made. Ordinary people in a society like ours ought to have as ready access as possible to any professional vocation that they feel called upon to assume.
Would it be improper for Oireachtas Eireann, in enacting this measure at the instance of the medical profession, to suggest to the profession that, while the Oireachtas is prepared to accept their professional view as to the necessity of this intern work, they think that, in the light of the addition of the pre-medical year, the profession should instruct whatever body is charged with the consideration of such matters to discuss with the medical faculty of the universities the curriculum with a view to seeing whether, by the elimination of certain branches of study which might have become a supererogation over the last 50 years, they could not avoid increasing the student's period of apprenticeship from seven years as now contemplated to six years as a maximum, including the pre-medical year and the intern year envisaged? Would the Minister consider that?
I must say that I agree very much with the Deputy, but I do not see what I can do about it.
Beyond discussing the matter with the profession I would not ask the Minister to press the matter.
It is very hard on parents to keep their children at school for seven years. I think the thing could have been fitted in better if they were agreeable to work more than six and a half months of the year.
I think there is a great deal of foundation for the irritation which has been expressed by Deputy Maguire and Deputy Dillon and for what the Minister says. Is it not a fact, however, that the whole of this situation is involved in this, that we are maintaining reciprocity with the medical organisation in Great Britain, and that the reason why we have so strongly to maintain that is that 70 per cent. of our finished products as doctors go to Great Britain or go abroad? Therefore, there is very little chance of protecting them except in this particular kind of way. That is what is involved, and not the Ministry here discussing matters with the medical fraternity here, but rather the medical fraternity and the Ministry trying to get a different kind of approach, if a different type of approach is wanted by the medical authorities in Great Britain.
The medical faculty in Britain stipulate for certain things to get reciprocity, but not for seven years. If we get the programme done in six years and satisfy them that it was done in six, that would not interfere with reciprocity.
If that is so, I think the Minister would find a fairly considerable volume of authoritative medical opinion here in favour of the idea that the course here could very definitely be shortened, and that the year which is being added on in this particular way could be subtracted in other ways.
The matter is worth investigating.
I think there is plenty of authoritative medical opinion here in favour of the idea that the course could be shortened.
Would there be any possibility of the Minister taking the point of view of reverting to the five-year course?
I would like to investigate it.
I move amendment No. 5:—
In sub-section (1), page 5, line 51, to delete "with the approval of the Minister".
This amendment is being moved because I thought, after examining the Bill when it passed through the Second Stage, that there was no necessity for the council to have the approval of the Minister for the persons appointed as visitors to hospitals and so on.
Is the Minister divesting himself of the power to give approval?
Yes.
I am quite prepared to say that the Oireachtas would expect a Minister, having the duty of approval, automatically to give it unless in very exceptional circumstances. But you know these exceptional circumstances sometimes arise. You may get a most admirable person appointed a visitor. He is a normal, genial and rational person until he assumes the role of visitor, whereupon he becomes an extremely difficult person. I have had long and bitter experience of most respectable gentlemen functioning as visitors under an ancient statute in the case of various bodies. They were as decent a body of men as you could meet in a day's march, but once the mantle of visitor was thrown around them and they marched into institutions, pandemonium broke out, and then it became a very great difficulty to know how you could avoid quite unnecessary upsets of that kind.
I, certainly, am not in favour of extending bureaucratic control, but sometimes I think it is a good thing to be able to say, without in the least casting any reflection on any particular person, that you would prefer if the name of some other person were submitted for the role of visitor. You can get a terrible lot of trouble if some well-intentioned man comes in as visitor. He may appear to be in every sense admirably suited for the position of visitor, but it turns out that he is not just suited for that purpose, and so he may cause a lot of unnecessary irritation.
Is the British Medical Association going to appoint visitors here, and we are going to appoint visitors for England?
Yes.
Who will pay them?
As far as I know, there will be a joint arrangement.
I am surprised at Deputy Dillon, in view of the fact that he sat in this House when we were dealing with the Health Bill of 1945 and, later, with the Health Bill of 1947. I think the Minister should be commended for taking his finger out of a responsibility that can very well be left to the Irish Medical Registration Council. The visiting of institutions approved by the Medical Registration Council as institutions in which the intern work can be properly carried out can, I think, be very well left to the council whose whole responsibility this scheme is. I think that approval by the Minister would be just inviting ministerial interference in an arena where such interference has created an awful lot of upsets in the past.
Is it necessary at all to appoint visitors? Surely it should be left to the residential medical officer to see that those qualified men will do whatever work is required of them in order to ensure that their qualifications will be such as to permit them to take up general practice. I am dead against it.
I am not pressing the point.
