Is the Minister aware that the present Medical Registration Council are planning elections which will be at considerable cost? Since the Bill will be enacted within a couple of months would the Minister consider this to be warranted and has he made known his intentions to the Council in this regard? My question relates to both sections 3 and 4.
Medical Practitioners Bill, 1977: Committee Stage.
Sections 1 to 3, inclusive, agreed to.
SECTION 4.
Question proposed: "That section 4 stand part of the Bill."
I am aware that there are a number of views from the existing registration council and I will be referring to these from time to time as we go through the Bill. When I have received these views I shall deal with the points the Deputy raises.
Question put and agreed to.
Section 5 agreed to.
SECTION 6.
Question proposed: "That section 6 stand part of the Bill."
Is this not merely a repetition of section 3 of the 1927 Act?
It provides simply for the establishment of the council.
Question put and agreed to.
Sections 7 and 8 agreed to.
SECTION 9.
Amendments Nos. 1 and 2 are related and may be discussed together.
I move amendment No. 1:
In page 7, subsection (1), line 32, to delete "at least".
I agree that there should be 25 members but I consider the distribution of membership as between academics, consultants and general practictioners not to be proper having regard to the fact that there are 1,600 general practitioners in the country and some 800 consultants. Consequently, in fairness and considering that general practitioners are the main body of family doctors concerned with patients and who come under closer scrutiny than consultants or academics, it would be more appropriate to provide as I have suggested in the amendment. My amendment is reasonable and the profession in general would agree with it. I agree with the proposal to include on the council five academics representing UCC, UCD, UCG, the University of Dublin and the Royal College of Surgeons in Ireland and to include two persons appointed by the latter institution having regard to the fact that that college is a post-graduate education body and would represent anaesthetics and radiology, but one of these would represent surgical specialties. Again, we have two consultants here. The Royal College of Physicians will appoint two members representing the medical specialties. There is provision also for the appointment of one person appointed by the Minister after consultation with such body or bodies as, in his opinion, represent psychiatry. Again that allows for another consultant.
There is provision then for the appointment of a person representing general medical practice and for ten fully-registered medical practitioners of whom at least two shall be consultants, one being a consultant psychiatrist and the other engaged in community medicine. That is a consultancy post. There is provision also for a person who shall be engaged in hospital practice other than as a consultant. That would be a junior doctor. Only two of those appointed shall be general practitioners.
Therefore, there shall be nine consultants, only three general practitioners and one junior hospital doctor. I am sure that the vast body of the profession would agree that this is totally out of proportion to the number of family doctors in the country vis-à-vis consultants. I have up-to-date figures on the numbers of family doctors and consultants. These are 1,600 and 875 respectively. I should think that the proportion would be the other way around. If anything one might say that there should be nine family doctors, three consultants and one junior hospital doctor.
In this amendment it would not be unreasonable to make it five instead of two elected general practitioners. This would mean removing the words "at least" and substituting "five" for "two" in line 32. It puzzles me when the Minister says, "ten fully registered medical practitioners, of whom at least...". When you add it up it does not come to ten, it comes to only seven. Where did the others come from?
The last point which Deputy O'Connell has mentioned is the key to the whole situation. I assure him that I have a considerable amount of sympathy with his thinking with regard to the council. I would like to go back for a moment to consider what this council is all about. It is primarily concerned with codes of behaviour, with ethical standards, with regulating the profession and with the training of the profession. Therefore, it is perfectly legitimate and proper that the training institutions, be they academic institutions or the hospitals, should be very fully and adequately represented, and within the confines of the overall number of 25 it would be difficult to give them representation except in the way we have done.
This council will certainly have a function in regard to the professional behaviour of general practitioners but only in that limited way, and hopefully the number of times that they will have to impinge on the activities of the general practitioners will be very few. Fortunately we have very high standards of general behaviour in most general practitioners. To that extent it is necessary that this council would give very full weight and representation to the teaching and training side of the profession.
To come to the point made by Deputy O'Connell, the idea of paragraph (f) is that ten members of the profession will be elected. It is stipulated that two shall be consultant psychiatrists in general hospitals, one shall be a consultant psychiatrist, one shall be engaged in community medicine, one shall be engaged in hospital practice and two shall be general practitioners. As Deputy O'Connell points out, that is seven altogether. The idea of putting it in this way is that the other three will be left at large and that the profession will have discretion to pick the other three and so they will not be confined in their election. Of the ten members they will have to elect seven of them from particular categories, but they will have complete freedom of choice in regard to the remaining two. That is desirable and it goes a long way to meet Deputy O'Connell's point.
In so far as the general practitioners are in an overwhelming majority it is almost certain that the additional three will be general practitioners because general practitioners have the voting strength. From the point of view of the profession it would be somewhat rigid and unfair to them if we laid down strictly the type of people they would have to elect without giving them some flexibility. The general body of practitioners, who will be in the majority, will very likely elect two of their own under the heading (v) and three more from the general body; on the other hand they might not. The general body of practitioners might wish to elect some very eminent person in the medical world who is not a general practitioner and who is not covered under any of the other heads. That is all that is involved and there is no attempt to deprive general practitioners of a full and adequate voice in the council. It is simply to give them flexibility of choice. From that point of view the make-up of the council as specified in section 9 is all right.
I want to make this point to Deputy O'Connell. It is not necessarily a conclusive argument but, as he can imagine, the composition of this council has been fully discussed and debated with all the various interests concerned and the constitution of it has been hammered out in pretty close-knit argument with the different bodies legitimately seeking representation. I would be very reluctant at this stage to upset the balance which is provided for in the section unless it could be overwhelmingly proved by anybody in the House that it is necessary to do so. If we want to keep the council to a limited size—25—and we want to give proper representation to all training and educational institutions, then the structure as set out in section 2 is the right one, particularly when the general practitioners have the overwhelming voting strength. It is almost certain that if they so want, the final three places, as it were, in the electoral system will be at their disposal.
There are a few points I would like to bring to the Minister's attention with regard to this. I accept and agree that this is concerned with a code of behaviour for doctors. It is also concerned with the training of doctors and with education. What we forget is that general practice is a specialty in its own right. At one time any dogsbody could go into it. Now family medicine is a real specialty and no person has a greater right on this body than the general practitioner. It is now realised that he is the first line of communication with patients. In America he is called the primary physician.
60 per cent of the population never go beyond the general practitioner.
That is right. He is concerned with training. What has been wrong with our medical education for too long is that general practitioners were not involved in the training of students. As medical students we went to hospitals and saw there rather rare medical conditions which we never saw after we left hospital. We would not see such conditions in a lifetime of general practice. The consultants in the hospitals were allocating beds to interesting cases rather than necessary cases because an interesting case was always a good case to show to students. Therefore when we went into general practice after hospital training we did not go in equipped to cope with general practice and we had to gain experience over the years. This should be borne in mind. In the last number of years it came to be recognised that the primary physician, the general practitioner or the family doctor was the most important person, the line of first contact with patients. General practice is a specially now and the general practitioner must also be concerned with the training of the doctor. Training was wrong; training now has been altered because students now must have attachment schemes to general practitioners. They work in a general practitioner's rooms. There is vocational training in general practice for newly qualified doctors. No man has a greater right on the new medical council than the general practitioner to be involved in training.
The next thing to concern us is what place he should have on this council. Those who are most vocal on the bodies representing the medical profession in general are the consultants because they have most time available. We all agree that the general practitioner is a very busy man and he has very little time to spare. He is so busy after his day's work trying to keep up with post-graduate work, refresher courses and reading the medical journals that he has not time to take part in medical politics, the work of the IMA or the Medical Union. We might find, because of this that those who might call for greater representation will be consultants. Although the general practitioner is numerically much stronger he may have a very small representation on those bodies. The consultations which took place with the various bodies may have taken place with the consultants rather than with the general practitioners. The Minister might consider this.
It is in the interests of the public that the general practitioners be fully represented on the council. I am here to represent the public not the medical profession. When I say that consumer interests must be represented it is because I represent the public. I do not believe that any council like this should be composed of doctors alone. The public must have representation. I want to see them involved in this new council and I want to see the council answerable to the public. That is why I put down the other amendment that there be representatives of consumer interests on the council. I know that the Minister is in agreement with this general idea.
I find myself in agreement with a good deal of what the Deputy said. There are a few points I want to make. First of all, it should be clearly recognised that in the general set-up as set out in the different paragraphs there is still recognition of the importance of the general practitioner sector. Under paragraph (e) they are given their own special representative. I must consult with them and I must appoint somebody who, in my opinion, represents the general practice. They are there in their own right. If the Deputy thinks of it calmly he will find that under subsection (1) (a) University College, Dublin, which represents the largest body of medical students will have one representative. They can put forward only one representative. We then have the general practitioners as a body putting forward one representative. This is the institutional sector of the profession getting their own specific representation.
We then come to the election part of the section. First of all, we stipulate specifically that there must be two general practitioners. It is almost certain that the three which are at large will be general practitioners. That makes five general practitioners taken at its worst. When we add their own special representative under paragraph (e) they have a total of six representatives. Deputy O'Connell should not presume that none of the others will be general practitioners. For instance, the Dean of the Faculty of Medicine in TCD who might well be nominated by Trinity College was a general practitioner. I do not believe there is any practical danger that the general practitioners will not be very fully represented.
In regard to the specific point in Deputy O'Connell's amendment to make paragraph (f) mandatory and remove total flexibility out of it, I believe the Deputy is wrong here. He would deprive the general practitioners of a certain amount of freedom that I want to give them in the election system I propose, that there must be at least two of them general practitioners and they can decide about the other three. They can decide, because of their overwhelming voting power, if they want the other three to be general practitioners or if they would like to pick some particular person outside of the area of general practice.
I believe that Deputy O'Connell on consideration might agree that the structure which I propose is about the best mix we can get particularly if we want to keep it to a limit of 25, which is a great achievement. It is very important that this council will not go beyond 25. We can give everybody plenty of representation if we keep on expanding the size of the council. In order to have a compact council and at the same time try to give representation to everybody who should have it I believe the structure set out here is about the best we can devise.
Is the Minister aware that in paragraph (b) there are consultants? In paragraph (c) the Minister is also specifying consultants. In paragraph (d) a consultant is also specified. If there was any ambiguity about this I would agree with the Minister. I take his point about the Dean of the Faculty of Medicine in TCD being a general practitioner. It was an historic event in academic medical practice in Ireland that we should have a general practitioner in that post.
Would Deputy O'Connell accept that six out of 25 is a reasonably solid representation for the general practitioners?
I would agree.
That is what will happen. One person will be specifically appointed by me.
Two will be elected.
Yes, and almost certainly the other three.
I would agree if that were the case but general practitioners, being so busy, are unable to make their voices heard and when it comes to elections they do not necessarily get their rightful place. There are over 1,600 general practitioners and 875 consultants. In the representation here they are getting three out of 25. It should be the other way round.
Plus another three if they want to appoint them.
It is not necessarily if they want to appoint them because the general practitioner has not the time to involve himself in some of those bodies. I will not press the point. I believe the general practitioner has not got his rightful place. If we are to have more emphasis on community medicine and general practice we must see that the general practitioners are fully represented on this council. The Minister emphasised at a meeting of the Federation of Voluntary Hospitals in Dublin the rightful place of community medicine and that we must get away from hospital medicine. We must give general practitioners sufficient representation on this council so that the medical students' education will be directed towards the general practice of medicine.
I am fully in agreement with the Minister's thinking in regard to community medicine. I want to see the education of medical students changed towards that end. There is enough money going into the health services but it is going into the wrong places. If the Minister could succeed in persuading his colleagues in Government to give him another £2 million he might not necessarily improve the health services. I doubt that the Minister would, given the present structure. I know the Minister is a dynamo. What he is doing at the moment is tremendous. I have great admiration for him. We have to change the whole concept of the health services. This could be a step in that direction. I am not saying it necessarily will be. We want to change the thinking of students about medical practice. That would be a great step forward.
Perhaps the Deputy is going at this in the wrong way. Under other provisions, I can give this new council directions. Perhaps that is how I could achieve what Deputy O'Connell wants to achieve.
I would be happy with that.
I support Deputy O'Connell's point. It may be interesting to point out to the Minister and to the House that, in the original 1927 Act, out of a council of 11 it was specified that two should be GPs. Now the specification is two in one section and one in another, making a total of three GPs out of 25. The proportion specifically allocated to GPs has been reduced substantially.
However, I must admit I am much more impressed with the points made by the Minister than the points put forward in favour of the amendment. The section represents a fair mix of the medical profession with the specialties. I am sure Deputy O'Connell knows his politics as well as he knows his medicine and, on his own figures, it is quite obvious to me that the GPs, if they so want, could have six members, five elected by themselves and one appointed by the Minister on the Medical Council. It is a little beyond the bounds of credibility to suggest GPs are so busy that they will not get around to voting. I know how busy GPs are, but they are also very interested in their profession. They would be interested in seeing that they would have the best possible share of representation. The section as it stands provides for a fair mix of general practice with the specialties. I would be more inclined to support the Minister's point of view than the point of view put forward in the amendment.
In view of what the Minister has said I withdraw the amendment.
Amendment, by leave, withdrawn.
Amendment No. 2 forms a composite proposal with amendment No. 1.
Amendment No. 2 not moved.
Amendment No. 5 is an alternative amendment to amendment No. 3 and amendment No. 4 is related, so we might discuss them together.
I move amendment No. 3:
In page 7, line 43, after "persons" to insert ", at least three of whom shall not be registered medical practitioners,".
We are all on the same lines here. My amendment arises out of the views expressed in the Second Stage debate. I gave some thought—and I can see both Deputy Boland and Deputy O'Connell did also—to the question of the legitimate interest of the general public in the affairs of the council. I had always intended that the four persons I would nominate would be non-medical people and would represent the general public. It was my intention to give a ministerial assurance to the House to that effect. I was going to ask the House not to put it in as a statutory obligation on me, and I would give that assurance binding on myself and on my successors, in so far as you can bind your successors in these matters. I thought that was the right way to do it because that would give me a certain amount of flexibility.
To give the House my thoughts on it. I thought at first that I should stipulate that four persons should be non-medical persons. Then it was pointed out to me that there just might be the odd circumstances in which some very distinguished and important medical person would not come within any of the other categories and I might wish to appoint him to the council or, alternatively, I might wish to appoint somebody from the medical or one of the para-medical sides of my Department.
I hope I am not giving the House too tortuously my thinking on this and my approach on it. Finally, I came to the conclusion that the right way to do it was to stipulate that at least three of these four persons shall be non-medical persons and probably the four. My normal approach would be to have four civilian members, but I thought I should at least compel myself statutorily to have three non-medical persons and just give myself that slight flexibility as regards the fourth if I thought it necessary in some circumstances to appoint a medical person. These are my thoughts on the matter and I will be interested to hear what both Deputies have to say.
The Bill does not guarantee such representation. I recognise that the Minister is very anxious to have consumer representation but his successor might not be. That is why I should like to have this built into the section. We do not know who will come after the Minister. It may be somebody who does not want consumer representation on the council. If we build this into the Bill we will ensure that his successors will protect the public interest by having consumer representation on the council. That is what I was aiming to do. I was giving the Minister greater latitude by saying in my amendment "after consultation with such body or bodies as, in his opinion, represent consumer interests". The consumer interests would be trade unions and consumer bodies. I do not know how active the Patients' Right Association are. There are many different national and local organisations the Minister would want to consult and then make up his own mind.
I honestly believe this provision should be built into the Bill, not for this Minister because I know what his thinking is, but for his successors. In doing this we might serve a very useful purpose. None of us in this Dáil will be dealing with this Bill again. The last Act which took effect was the 1927 Act and there are not many people here today who were here then. We should bear that point in mind. The whole purpose of the Bill, besides protecting the doctor, must be to protect the consumer because he is the person who avails of the health services and he also foots the bill. He must be protected at all costs. As public representatives we will be representing consumers. We will come across cases over and over again where people got unfair treatment in hospital, maybe, or perhaps there was neglect of patients by doctors. We will then look at the Act and say: "What happened when it was going through the Dáil? Did we not see to this?"
There is no consumer representation on the Incorporated Law Society. Many public representatives come across cases of the public not getting the right kind of attention, shall we say, or the attention they deserve from solicitors. If you report a case, the Incorporated Law Society say their powers do not protect the consumer.
I am afraid I must confess I set that one up too.
The Minister had the best of intentions then. Unfortunately his intentions were not carried out. I have no doubt that, when the Minister set that one up, it was his intention to protect the public. I have gone into this in great detail. The powers of the Incorporated Law Society certainly do not protect the public as they should. That is what I am afraid of in this Bill. This is a great idea and I should like to see consumer representation statutorily enforced in this Bill. This is very important.
In my amendment I proposed that the Minister should appoint these persons after consultation with such body or bodies as, in his opinion, represent consumer interests. That would not be restrictive on the Minister. He will make up his own mind who will represent consumer interests. I do not think my amendment is unreasonable. After consultation with these bodies the Minister would make up his own mind. To say "at least three of whom shall not be registered medical practitioners" is very restrictive and does not give recognition to consumer interests. The other way gives statutory recognition to consumer interests.
The Minister said his own amendment is more binding on him and his successors than either Deputy O'Connell's or mine. He says the effect of Deputy O'Connell's amendment is to oblige the Minister to have consultations with consumer interests with a view to having some of his appointees represent those interests. My amendment was designed to ensure that two of the four persons would not be doctors and would be appointed by the Minister because, in his opinion, they represented the interests of the general public. The Minister has gone a step further and obliged himself and his successors to appoint three of those four people as non-medical people. I welcome the thought behind his amendment and it is obvious that we are all at one on this. I would merely like to invite the Minister to consider the wording of Deputy O'Connell's amendment and the wording of mine, which is very similar to the Minister's except that if goes a little further and specifies that the reason why some non-medical people are to be amongst the Minister's appointees is that they are to be, in the Minister's opinion, representatives of the general public. It might be as well if that were enshrined in the Bill.
Everybody here agrees that the present holder of the office of Minister for Health means to do the right thing but, as Deputy O'Connell says, we are legislating for perhaps six, seven or eight Ministers for Health who might not have the same idea about consumer interests. I have the highest opinion of consultants and medical practitioners, but, as in every other profession, there is the odd one who will not consider the consumer interest and who will damage the prestige of the profession. It is vitally important that consumer interests be represented on this board. This board is intended to look after the general conduct of the medical profession as well as the training of the profession. I congratulate the Minister on the fact that he has tied himself even more than would be the case under Deputy Boland's amendment in saying that there must be three instead of two non-medical representatives.
I want to remind the House, particularly Deputy O'Connell, that one of my later amendments will ensure that one of these persons will have to be on the Fitness To Practise Committee, which will go a considerable way to meet what Deputy O'Connell was talking about, complaints about doctors in hospitals and so on.
I am somewhat reluctant to compel myself to undergo this process of consultation with consumer interests because in this context "consumer interests" is a very vague term. There is a consumer interest concept emerging now which is strictly related to the purchase and sale of goods in the shops and so on. To use the term loosely like that might have an unnecessarily restrictive influence on me. Also, to compel me statutorily to consult consumer interests in this might be too vague a thing to be capable of fulfilment by me; and then my appointment might be challenged on the basis that I had not complied with the obligation to consult consumer interests. I would prefer if I could avoid that.
Any Minister for Health, if he is to be compelled to appoint three non-medical people, will certainly see to it that the general public are represented. When it comes to medicine we are all consumers. Some of us, perhaps myself, are more voracious consumers of medicine than others, but we are all consumers. Therefore if you say I must statutorily consult the consumer interests where medicine is concerned, then I have to consult the whole population. It is too vague a term. I would go part of the way to meet Deputies by adopting something of Deputy Boland's proposal, that is, that I would agree to putting in some words on Report Stage about representing the interests of the general public. If my amendment is accepted at this stage, I could give an undertaking to elaborate a little further by indicating that the three non-medical persons I would appoint would, in my view, represent the interests of the general public, which, I think, is a better phrase than "consumer interests".
I would hope the Minister's thinking would be advanced enough to know that when we are talking about consumer interests it does not relate just to looking in shop windows or to the Consumer Association of Ireland. That is nonsense. We are now living in an age in which the consumers are the recipients of health care. If it is deemed to be a new term in the Dáil, then we had better remember that consumer interests are the public. In Britain and America, "consumer interests" is accepted as the term for the public who are recipients of health care.
I completely accept that.
That is the term for it, whether we like it or not. Therefore "consumer interests" is not a narrow term for people who just purchase goods. The Department of Health and Social Security in Britain recognise this term; they have it in their documents, and I would ask the Minister's civil servants to look this up. That is the term they use for the public who are availing of the health services. Our job is to protect the consumer interests.
What I am saying is that, if not the Minister, his successor could appoint hospital administrators or hospital secretaries. I think the Minister will agree that it would not be in the best interests of the public if hospital administrators or those closely identified with hospital administration were on the board. Lay members of the hospital board could be on this. They would not necessarily be, in fact I might even say they would be far from, representing the public interest or consumer interests, as we had better accept the new term.
"Consumer interests" is the new term and I maintain there should be consultation with these interests because they represent the public generally. We have trade unions and other organisations. One does not necessarily have to select from the different organisations but it is a good idea to give recognition to these bodies because they represent the consumers. If that is not accepted the way will be open—not for the Minister necessarily but for his successors—to appoint hospital administrators and people like that and the degree of impartiality may not be so obvious. That is the reason I want to put this in.
But why would a politician do that?
Successors of the Minister may want to do that.
Is it not more natural to assume that a Minister would do the other?
Why would it be more natural? Why not tie his hands now and make sure he will do that? All I am asking is that consumer interests be consulted. I will not say these representatives must be taken from a particular body or anything like that.
I do not necessarily accept modern jargon. This means one would have to describe anybody as a consumer of medicine.
I do not know what else one would call such a person.
This is another piece of verbalising and jargon just because the British and the Americans use the term. I prefer Deputy Boland's simple phrase "represents the interests of the general public". In the ultimate the person who should really represent "consumer interests" is the hypochondriac. Is it the intention that a society of hypochondriacs should be formed to represent "consumer interests"? They are, after all, the most extensive and intensive consumers of medicines. That is not what we are concerned with here. We are concerned with the interests of the general public, the ordinary man in the street who may never go into a hospital but who is vitally interested in ensuring that he is served by a reputable, well-behaved medical profession. I refuse to accept modern jargon.
The Minister is misconstruing.
Perhaps I am but I am legislating for an Irish public and not for people in America and Britain.
But the Minister will get bodies representing consumers.
The Irish public generally are not aware of these modern jargonistic clichés. If I were to insert "consumer interests" here I should have to define it and, since it is a vague term, I would have to leave it to the courts to interpret subsequently. By defining the term I should be getting into all sorts of areas into which I do not want to enter. If the onus of consulting with "consumer interests" is placed on the Minister he might not always be able to discharge that onus. He might not be aware of all the bodies which would regard themselves as representing "consumer interests" and he might not therefore discharge his statutory obligations correctly. The ordinary man in the street. when he hears about "consumer interests", thinks in terms of goods sold in supermarkets. I may be wrong but that is my interpretation of the situation. I infinitely prefer the straightforward language of Deputy Boland's amendment—represents the interests of the general public—and, as everybody has an interest in a good medical health service, I believe that is the phrase we should use. I propose that the House accepts my amendment making it obligatory on me to appoint three non-medical people and later I will come along with a suitable amendment ensuring that these three will represent the interests of the general public.
The Minister has made the case for my amendment so excellently that I am reluctant to enter into the discussion at all. The Minister suggests three of the people should not be registered medical practitioners. Deputy O'Connell suggests the Minister should appoint people representing "consumer interests". I suggest that at least two of the four should not be registered medical practitioners and should represent the interests of the general public. Would it not be simpler to accept my amendment and on Report Stage change the "two" in my amendment to "three" to come into line with the Minister's proportions? That would meet the point made that non-medical people should represent the interests of the general public or "consumer interests".
I would prefer to let the draftsman have a look at it.
I am happy with that.
I am looking ahead to a patients' rights association. There is one in America.
How representative is it?
I am looking forward to the time when we will have a representative patients' rights association and an ombudsman. I am not just thinking of now. This Bill is not for me or for any of us. It is for later on and that is where I see the difficulty. In the future you will have consumers of health care who will be represented by a body and that body should be consulted by the Minister. I can see this coming. It is certainly on the way.
Is that not a different area? Is that not coming into the area of discipline, training and regulation of the profession? I accept that is coming.
This is in the Bill and the people I am talking about will want a say in the training of doctors, the ethics and the code of practice. These are the people who will find standards are not right. These are the consumers of health care who will want to ensure that doctors face up to their obligations and provide proper cover. We want to ensure there will be no negligence and we want to see that they pursue a proper investigation of patients. These people will be consumers of health care. "Consumer interests" is not a modern term at all. You can have consumers of legal care and we will have these also.
The Deputy talks of "consumer interests". He does not say "consumers of health care".
Representatives of consumers of health care.
Surely the consumers are the general public.
Yes, but I can see bodies being established and I can see a body representing consumers of health care.
One could have bodies of self-appointed chronics.
I agree but I would hope to see a proper body representing patients.
Whatever about the future, if the Deputy places on me now the obligation to consult with "consúmer interests" that might prove an impossible obligation to discharge at this stage, whatever about the future.
It could be but I hope the Minister appreciates the sentiments in this amendment. It is designed to ensure that he or his successors will appoint without political patronage.
That is what will happen. Let us face realities.
I do not think it need necessarily happen. I want to ensure that people are not appointed by political patronage. I am not talking about the present Minister. I am talking about his successor.
I am beginning to get a very bad impression of the successors.
We know it can happen: it happened before. I want to ensure that the people on this body will be there for the purpose of representing the consumers of health care, not necessarily an administrator of a hospital or somebody who is there by virtue of the fact that he is a member of a branch or something like that. I should like to see that the proper people are appointed by the Minister and that is what I was trying to embody in this amendment. That was its purpose and I think the Minister recognises the sentiment behind it, that there would be properly qualified people representing the public.
Is the Minister now suggesting that his own amendment No. 3 needs to be modified in the light of points made in relation to amendments 4 and 5? Would it not be simpler to withdraw amendments 3, 4 and 5 with an undertaking to introduce them as additional amendments on Report?
I should like it to go now and, while I am not promising, I shall see if I can devise something to meet Deputy Boland's wording on Report.
The Minister is not giving an undertaking?
Not at this stage.
Amendment put and agreed to.
Amendments Nos. 4 and 5 not moved.
Question proposed: "That section 9, as amended, stand part of the Bill."
The wording is not clear in the original Act and I just wanted to ask whether the appointees from the teaching colleges would be from the governing bodies of the colleges concerned or from the medical faculty. My other point is that whereas in the remainder of the Bill there is the normal provision for regulations to be laid before the House after they have been made, in this section—and I think it is important due to the important nature of the section—the provision is that a draft of the regulations will be laid before the House. That is a very welcome provision.
In reply to the Deputy, the nominations will be made by the governing bodies.
Question put and agreed to.
Section 10 agreed to.
SECTION 11.
I move amendment No. 6:
In page 8, subsection (3), line 17, to delete "may" and substitute "shall".
There are two reasons for introducing this amendment. The simple one is that I think the CEOs of health boards are the obvious people to act as returning officers. More important, and my reason for putting down the amendment, is this. The Minister will notice that there is a later and more substantial amendment the effect of which would be to place an onus on CEOs to keep a roll of all doctors practising in their areas. In that context if that roll were being kept it would be more than obvious that the CEO should act as returning officer for all elections because at all times he would have an up-to-date list of all registered medical practitioners in his area. Might I suggest that it might be better if amendment No. 6 were taken in conjunction with amendment No. 18?
I think we can discuss this now because I want to say something about section 17 separately.
We are taking amendment No. 6 on its own at this stage.
If the later amendment were accepted and CEOs were maintaining a roll of all medical practitioners in their areas they would be the obvious people to act as returning officers. Quite apart from the effect of that later amendment if accepted I think that the CEOs of the health boards are the obvious people to act as returning officers. They are disinterested parties and they should have some knowledge of the doctors operating in their areas. It seems a little unnecessary to write into the Bill that the regulations may provide that the CEOs act as returning officers. It would seem simpler either to omit that subsection altogether or make it mandatory that CEOs act as returning officers.
I think I would adopt the other suggestion that the Deputy is now making and omit it altogether because I have been having second thoughts about this as I believe some medical people have also. It seems that the practicality of the situation would indicate this. There is an electorate of only about 3,000 doctors. On the whole it would be desirable to have the election run from one centre. I shall be looking at the whole of section 11 again in that context.
I think there is need to omit this subsection also because the CEO of a health board is not in a position to do this nor does he have the power to do so. He has responsibility only for those who are operating under the general medical service; the others are private contractors and as such he has no control over them. If I, as a general practitioner decide to see one patient a year, do I have a right to vote? Does the CEO know of my existence? I cannot see where he comes into this. Secondly, how would a CEO of a health board have any control over the consultant who might just decide to see a patient? He may not necessarily be in a CEO's health board hospital. The CEO is irrelevant here. That is why I could not favour the new amendment Deputy Boland has put down to this section because I do not see that the CEO would be the right person unless we decide to have a free health service. This is where Deputy Boland and his party would have to decide; if they want the CEO to have the power they had better start talking in terms of whether we should have a free health service. If there is a completely free health service then Deputy Boland's amendment would have relevance but not here. I agree with the Minister.
I agree with the Minister's suggestion that the section might be deleted because it could lead to all sorts of problems such as in the case of doctors working in a number of health board areas and doctors who are perhaps on the borders of two health board areas. Perhaps the registrar of the new general Medical Council might be the appropriate person to be the returning officer for the election. The other question is: who would be entitled to vote? Under the section as it stands there might be difficulty in deciding who is in active practice in an area. It might be appropriate that any doctor living in the country and who is on the register should be entitled to vote.
The more you think about it, that seems the right way to do it. It is a small electorate, only 3,000 in total. I think the right way to do it is to have the elections run under the council centrally instead of having a number of separate elections. If Deputy Boland would withdraw his amendment we could come back to that section on Report Stage and discuss it along the lines I am suggesting.
Amendment No. 6, by leave, withdrawn.
Section agreed to.
Section 12 agreed to.
SECTION 13.
I move amendment No. 7:
In page 8, subsection (2) (b), line 41, after "committee" to insert ", to be known as the Fitness to Practise Committee."
This is merely in the nature of a drafting amendment. The section refers to a committee to be set up and later in section 38 or section 39 there is reference to the Fitness to Practise Committee which is not referred to at any earlier stage in the Bill. I felt it would be better if the actual establishment of the Fitness to Practise Committee by name was enshrined in the legislation.
I discussed this matter again with the draftsman and he is quite satisfied that it is all right as it is. The Fitness to Practise Committee is defined in the definition section. It states clearly there that the
"Fitness to Practise Committee" means the committee to be established by the Council under section 13 (2) (b) of this Act;
It is named in the definition section and the mechanics for setting it up are set out in section 13. If we were to insert the words suggested by the Deputies, we would be tautological.
Amendment, by leave, withdrawn.
Amendments Nos. 8, 9 and 10 are related.
I move amendment ment No. 8:
In page 8, lines 49 to 52, to delete subsection (5) and to substitute the following subsection:
"(5) Every member of the committee referred to in subsection (2) (b) of this section shall be a member of the Council and—
(a) a majority of the members of such committee shall be persons who have been appointed by election to the Council, and
(b) at least one member of such committee shall be a person other than a registered medical practitioner who has been appointed to the Council by the Minister pursuant to section 9 (1) (g) of this Act.".
Deputies will agree that my amendment is very specific. It is proposed to delete subsection 5 and to substitute this new subsection. I already mentioned to Deputy O'Connell that the effect of paragraph (b) of the new section proposed to be inserted by the amendment will be that one of the civilian members whom I will appoint will be a member of the Fitness to Practise Committee. The House will agree generally with that. It also stipulates that a majority of the members of such committee shall be members who have been appointed by election to the council. I trust that will recommend itself to the House.
If the Minister can embody what I was saying in the other amendment, it is grand.
Amendment agreed to.
Amendments Nos. 9 and 10 not moved.
Section, as amended, agreed to.
Section 14 agreed to.
SECTION 15.
Question proposed: "That section 15 stand part of the Bill."
On looking through this Bill again last night, I noticed that there is nothing in the Bill which states that the media and the public must be informed as to when the council holds its meetings. This may have been omitted accidentally. At present the Medical Registration Council are statutorily obliged to inform the public and the media as to when they hold their meetings. Could the Minister enlighten me at this point as I have seen no reference to it?
I would not have thought it appropriate in normal circumstances that a body of this sort should have to inform the press of its meetings.
They are obliged to.
Could the Deputy give me the reference?
I do not know it but I checked with the Medical Registration Council and I was told that they are obliged to inform the public and the media.
Is it the 1927 Act?
Yes.
That is not my information.
The Minister can take it form me that that is definite.
I do not think it is in the 1927 Act.
It may be in the amending Act of 1952 but certainly they are obliged to inform the public and the media. Perhaps the Minister's advisers would check that. There is a statutory obligation. They have to put a notice in the papers that they are holding a meeting.
Is that a meeting of the full council or the Fitness to Practise Committee?
No, the Medical Registration Council. Reporters from the Press go to their meetings. They are statutorily obliged to inform them.
I can understand them notifying the media but I am not aware that they are statutorily obliged to, but I will have a look at it.
Will the Minister incorporate this in the section?
I will certainly favourably consider it.
Question put and agreed to.
SECTION 16.
Question proposed: "That section 16 stand part of the Bill."
In subsection 2 there is no specific method laid down for the selection and appointment of the registrar. Is there nothing in the Bill as to the method of selection of the registrar for the council?
The only constraints on the council in this regard would be those set out in section 4 where the Minister has a sort of reserve power. Otherwise it would be left to the good sense of the council to appoint the registrar in the appropriate way. It would not be appropriate for the statute to direct the council to appoint a registrar in any particular way.
Would the Minister explain subsection 3 of this section?
There shall be paid by the Council to the Registrar out of funds at its disposal such remuneration and allowances as the Council, with the consent of the Minister, from time to time determines.
This seems to be a contradiction. The funds of the council must be provided by the medical profession. Neither the State nor the Minister has any say in the matter nor does the Minister give any money to it. Why should the Minister have to give his consent in relation to remuneration and allowances? I cannot see why the Minister should have that power. I agree that the State should have a greater say but if the Exchequer is not to provide money for the council why would the consent of the Minister be needed for the payment of remuneration and allowances to the registrar of the council?
It is just in keeping with modern thinking in these areas since Devlin has an attempt to try and keep some sort of coherence and sensible relativity between all these different types of bodies. It seems reasonable that the Minister should have this reserve power. The Minister will not be determining the level of remuneration and allowances; he will just have the reserve power of consenting to whatever is decided upon.
The Minister should not have it at all. If the St. Vincent de Paul Society decided to apply for registration as a body in the same way as this, would the chief officer of the St. Vincent de Paul Society pay its information officer or registrar with the consent of the Minister? I think this should be omitted.
This is a statutory body.
It is but no money is coming from the Exchequer.
That is not necessarily so.
It says in the Bill that the Council from its members shall provide the funds. No money comes from the Exchequer.
This provision is not put in arising out of the relationship to the sources of the funds. It is put in in an attempt to have some relativity between all these bodies operating in the public sector. It is a Government decision that, in so far as possible, some relationship be kept between the salaries of the top executivés of all these bodies. The Deputy will agree that that is sensible. Unless there is some sort of guideline, co-ordination or liaison of this sort there can be extraordinary distortions with some one particular body setting a whole pattern of relativities. The fact that the Minister has this power to give his consent does not derive from the source from which the funds are coming. It derives simply from ministerial responsibility to try to keep some common sense throughout the whole of the public pay sector.
Did I understand the Minister to say that the requirement about the Minister's consent has been entered into this section as a representation of modern thinking?
Modern practice.
I am sure the Minister and the House will be interested to know that the same stipulation was in the similar section of the 1927 Act, 50 years ago. In that Act the stipulation was that the council would pay its officers with the consent of the Minister and of the Minister for Finance. That was 50 years ago. Therefore, I do not think that the explanation that it is in line with modern thinking is justified.
All I can say is that its inclusion in this Bill is out of an endeavour to observe some relativities in the public sector.
This section is a rewrite of part of section 14 of that Act. I do not understand the purpose of subsection (4) of this section which is really the only new part of the replacement of section 14 of the 1927 Act. Indeed, I do not understand what it is all about or why it is there.
Could the Minister quote a precedent for a statutory body who receive no money whatsoever from the Exchequer having a condition like this imposed on them?
Trading, profit-making State bodies.
No, this is not a profit-making body.
No, but they do not receive any money from the Exchequer; they have this control.
But they do get grants.
It does not matter. If they never received a penny from the Exchequer, if they were absolutely on their own conducting commercial operations, profit-making organisations, they still have this control. As I have tried to explain, it is not related to the source of the funds from which the salaries are paid. It has nothing to do with the disbursement of moneys from the Exchequer that is involved here. It is an attempt to keep some relativity between the different salary levels.
I could understand that if they got any money from the Exchequer, when, properly, the Minister would and should empower.
Whether or not the money comes from the Exchequer has nothing to do with trying to keep a level of some relativity between the top echelons of the public sector. If the Deputy accepts that there is some sense in trying to keep some relativity between these top salaries in all these different organisations then he must accept this provision even though any particular body does not receive a subvention from the Exchequer. That has really nothing to do with it. It is the level of salaries that counts. This provision is put into all of these bodies to try to stop any one of them going mad and distorting the whole pattern.
Then the parliamentary draftsman did not think about this at all.
Oh, yes, he did.
I have more respect for the Minister's intelligence than to listen to him saying that. I am talking about a person whose name will be on this register. If we come across a situation in which the registrar of this body must keep in line with the directors or chairmen of semi-State bodies it will mean that the fee for inclusion of one's name on the register will have to be increased substantially. If the body—the Medical Registration Council, the new Medical Council or whatever—was receiving any money from the State I could understand it. But it really has no relevance; it is a moot point. I am merely saying that the parliamentary draftsman never thought, he just looked back. As Deputy Boland said, he put in what was in the 1927 Act, and nobody spotted it at that time either. That is exactly what happened.
Deputy Boland will see that the Minister for Finance is removed from the 1927 Act. Therefore, it is not a dead "cog" from the 1927 Act. Subsection (4) of this section is not in the 1927 Act at all. The Deputy must accept that this is my Bill: this is not the parliamentary draftsman's.
Honestly, I am surprised.
The principles in this Bill are my principles. They are put into words by the parliamentary draftsman. He does not decide these issues. I decide them, and this House decides them.
Another fellow put quite a lot of work into it before the Minister came into this Department.
It has been the practice of the Government ever since the Devlin Report that any Bill coming before this House—and if you go back over the records you will see what I am talking about—setting up a statutory body has this provision in it. The reason for it is that in the Devlin Report we tried to establish some retionality in salaries throughout the public sector. That is why these provisions are now in every Bill.
That is right.
Deputy O'Connell is not being fair. He is being erroneous when he suggests that this is being slipped in here inadvertently by the parliamentary draftsman. I must reject that totally. If Deputy O'Connell goes back over any Bill—and I brought in a number of them myself—setting up bodies since Devlin he will see that the Department of Finance, by Government direction, now insist that a provision of this nature goes into the provisions governing the salary of every top executive. That is the only point I am trying to make.
I want to make this point, that it has nothing to do with Exchequer funds or otherwise. It is of universal application to every body now being established. Since Devlin, if we had a Bill amending, say, the ACC, the ESB, the Industrial Credit Company or any other, if we had legislation amending the legislation governing any of those bodies that opportunity has been availed of to put in something of this nature. It has nothing to do with Exchequer financing. It arises out of an attempt to have rationality in salaries in the public sector at the top level.
Is section 16 agreed?
If the Deputy cannot accept that I cannot argue any further.
I think the Minister, in his heart and soul, knows that it is totally irrelevant here. The parliamentary draftsman made a bad mistake. Of course the Government must put this in for other bodies. They can be a burden on the Exchequer. Every one of the other bodies can be a burden, not necessarily will be but can be. In every one of those Acts bringing in semi-State or statutory bodies there is provision; they can all become a liability on the State. As such, the State has an obligation to its Minister to have that point included. What section are we on?
Section 16.
We are dealing with section 16.
This council gets no money from the Exchequer; it provides its own funds. There is not even provision that if it should run short of funds the Exchequer would move in. In that situation it pays its own registrar out of its own funds, with the consent of the Minister as required. It is ludicrous when the State has no control over the finance at all.
It has control over the finance.
In what way?
If the council wants to borrow it must have the consent of the Minister for Finance.
Does that give the Minister power to do that?
Will the Deputy try to get one simple point clear? Either he accepts that the Government have some responsibility to try to have a rational pay policy in the higher levels of the public sector——
It is not the public sector.
Of course it is. It is a statutory body. It is not the private sector and in that case it must be the public secor. Will the Deputy accept my assurance—and Ministers in the former Coalition Government will confirm what I am saying—that since Devlin there has been a positive Government policy by both Governments that so far as statutory bodies are concerned these provisions must go into legislation governing every statutory body so that some relativity is preserved in the salaries of top executives in these bodies.
Even if it is irrelevant?
When the Deputy says "irrelevant", does he mean even if the body concerned does not get State subvention?
Yes.
It has nothing to do with the Exchequer funds. This is not a device to protect Exchequer expenditure. This is a device to control salaries. It is a device which emanates from an attempt by the Government to have some rationality in this area. Devlin was the first step. Devlin was set up to try to relate all the salaries in the public sector to each other, the public service, the State bodies and so on. Devlin applies to bodies that do not get subventions from the State.
What will be the situation if a body does not have enough money to put payment to its registrar on a par with that of other semi-State bodies? Will the Minister answer that question? If all the doctors decided they would not pay more than a specific once-and-for-all fee for inclusion of their names on the register and if we reached a stage where the cost of living meant that the register had to be paid a phenomenal salary each year, if the body concerned were not able to pay the salary—they might decide to pay a salary of £1,000 per year for a part-time register—what would happen? I realise this is a hypothetical case but it is relevant.
It is so hypothetical it is ludicrous.
It looks as if the Minister and I will have a few more confrontations if he adopts that attitude.
It is ludicrous.
The Minister has thrown down the gauntlet today.
I have not thrown down the gauntlet. The Deputy has put forward a hypothetical case.
The Minister's predecessor got a hard time. The truce is over.
The Minister is in possession.
I have listened with great attention to all the Deputy's arguments. I have tried to answer them——
I do not want any pseudo flattery.
I have been trying to answer the Deputy's arguments with reason and logic——
Logic was absent.
The hypothesis the Deputy has put forward is not sustainable. The circumstances which he visualises would not occur.
The argument is irrelevant now. Let us end it like that.
I want to say to the Deputy——
The Minister can explain it to someone else. He can go into the details for the next hour. I only raised the matter as a point that could have been slipped in by accident. If the Minister decides my argument is ludicrous——
No. I did not.
I am afraid the Minister did so decide.
The Deputy must not get too touchy. I did not say the Deputy's argument was ludicrous. I said his hypothesis was ludicrous and it is. None of us would visualise——
The Minister has taken on some challenge and I am sorry about that.
The Deputy should allow me to talk. He has put forward a suggestion that this got in here inadvertently. I have assured the Deputy so far as I can positively do so that it is not in inadvertently. This is now a standard insertion in all legislation of this kind. By government decision it is standard practice in this type of legislation, that the Government wish so far as possible to have a rational approach to these salaries.
Was it in the 1927 Act?
Yes.
That is all I wanted to know. Now it is standard thinking.
I can only assure the Deputy that since Devlin this is standard practice in all legislation of this kind.
The Minister has told us it was in the 1927 Act, that is enough.
The great Ministers in those years anticipated Devlin by 40 years.
The provision is inserted in this section in pursuance of government policy to try to maintain relativity in all statutory bodies.
I do not wish to delay the House any longer on this section but I did ask the Minister what was the purpose of subsection (4).
It is simply to give me a reserve power in relation to the conditions the council can lay down, to give me control over the terms and conditions of appointment.
On the same basis as the standardisation of the public service?
Question put and agreed to.
SECTION 17.
I move amendment No. 11:
In page 9, after line 46, to insert a new subsection as follows:
"(2) The Council shall in addition appoint an Information Officer whose duty it shall be to keep the public informed on the work of the Council, the nature of complaints procedures, and other matters of interest to the public".
I believe too little information emanates from the Medical Registration Council. The public and the Press have not been able to obtain information from them. The question of any information sought is referred to the general body of the council which meets twice or three times each year. If a member of the Press were to put a question to the council he would not get an answer for months. That is a most undesirable situation.
There is need for an information officer to be appointed to the council who would have authority to act on their behalf and answer any queries from the public or the media. It is vital that we include the amendment here. It is in the public interest that it be accepted. People may have reason to complain about some matter; they may feel aggrieved at the attitude of doctors, at the lack of care——
As I am at the moment.
I will not interrupt the Minister if he does not interrupt me.
I am trying to introduce a note of humour.
The Minister may do so in his own contribution. There is need for the public to know to whom they should direct complaints. They go to the evening papers, to the health boards, to the Irish Medical Association and the Medical Union but these are not the appropriate bodies to whom complaints should be directed. People approach these sources because there is an appalling public ignorance about where they should direct their complaints. It is due to the fact that information is not available about the Medical Registration Council. Without fear of contradiction I say that 90 per cent of the membership of this House was not aware that there was such a body in existence prior to the initiation of this Bill. We do not want complaints flooding into the office every day. If we appointed an information officer he could advise the public and the Press. At present the public direct their queries to the media. If any member of the Press tried to get information on behalf of the public, he would be disappointed to know that their queries might not be answered for a long time.
For years I have been pressing for the introduction of such a Bill. I am appalled that there is no person available to give authoritative information about the work of the council or the nature of complaints procedures. There is a vital need for this amendment to be included in the Bill.
I do not agree with the amendment for a number of reasons. Such an appointment would add to the expenses of the general medical council. It is also possible that many trivial complaints might be referred to the council and this would be a pity because the disciplinary committee of the general medical council is supposed to deal with the more serious complaints against the profession. There is adequate machinery within the health boards for dealing with complaints. The CEO of the health board has the authority to suspend a medical officer if he wishes to do so. Perhaps the council could decide the information they want to give and the registrar could assume this function for them.
I am not averse to the spirit behind the amendment. Indeed, I have been considering the general question of the new council providing more information for the public. I shall be adverting to the matter later when we are discussing the registrar and the making of the registrar available to members of the public. At that stage we may make some changes and, perhaps, make some provisions about the obligations of the council to provide information for the public. I would not like to accept the amendment in its present form because I do not want to tie the hands of the council. The Deputy has already pointed out that I am taking power to tie their hands in regard to the remuneration and allowances of the registrar. It is implicit in his remarks that such a course would not be desirable. The more flexibility and freedom that we can give to the council the better it will be for them. They will be a high-level responsible council with stringent statutory obligations and we are entitled to give them the maximum amount of discretion. We should also give the council as much freedom as possible to run their affairs in their own way.
I would not like to tie the council to appointing an information officer as the council might allocate that function to one of its other officers. As Deputy O'Hanlon said, it might be onerous to appoint a specific information officer. I would prefer to leave this matter to the discretion of the council. I would prefer to consider the obligations of the council in regard to informing the Press and the public and then leave it to themselves to decide the best way to discharge that obligation. I am not averse to the idea behind the amendment but I would not like to accept it in its present form because it would be too mandatory on the council.
Deputy O'Hanlon is ill-informed when he says you can refer the matter to the chief executive officer of the health board. That is ridiculous because the chief executive officer can do nothing about a private practitioner who is not employed by the general medical service. Many private practitioners and consultants are not employed by the general medical service. You might as well write to An t-Uachtarán as complain to the chief executive officer against a private practitioner who is not working for the health board.
If there are trivial complaints it is the business of the Fitness to Practise Committee to deal with them. It would be in the interests of the public to channel all complaints to such a body rather than have scare headlines in the newspapers. What is a trivial complaint? What may be a serious complaint to one person may be a trivial complaint to another. If a doctor does not make a return call to a child and the child dies, is it trivial that the doctor did not make a second call? It may be trivial to the doctor but it is not trivial to the mother of the child.
I am asking that information be made available to the public and to the media. The council should be able to appoint an information officer with authority to give information on request.
I direct the Deputy's attention to section 50 of the Bill which reads:
The Council may make and carry out arrangements with any person or body to assist the Council in the proper discharge of any of its functions.
Under that section the council could appoint the sort of person the Deputy has in mind.
The Minister mentioned, first, the effort to control and, secondly, the desire to give the council absolute discretion. The two are not compatible. We talk of giving the council discretion but what happens if they decide not to appoint an information officer, if they decide that information will not be available to the public?
As the Bill stands we have to accept their judgement and their decision on that matter but if the Deputy would bear with me for a moment I would remind him that in so far as sections 17, 18 and 19 are concerned, what are involved mainly are questions of salaries, allowances, limits, superannuation, staff and the recruitment of staff and conditions of service. The only one officer that we stipulate must be appointed must be the registrar. It is easy to understand the reason for this. A register has to be kept. Therefore, it is important that there be a statutory registrar. But subject to that one provision we are leaving it to the good sense and to the discretion of the body concerned to carry out their functions and discharge their obligations as they think best. This is the case generally in this sort of legislation.
I would not necessarily visualise the council deciding not to appoint an information officer. They might be well advised to do so but I would not like to place on them a statutory obligation to appoint a specific officer as an information officer. They might well decide that another officer would assume also the duties of an information officer. I suggest to the Deputy that if, later, we decide to place some obligation on the council in regard to the provision of information, that that would be a right way to act and to leave it to them to define how they should discharge that obligation, regardless of whether they might decide to appoint a full-time information officer. There is provision in section 50 for the council to make arrangements with any person or body to assist the council in the discharge of their functions. The terms of that provision are wide enough. They enable the council to employ an information officer, either on a part-time or on a full-time basis, or to employ a public relations firm.
All I can say to that is that it is 50 years since the other Act went on the Statute Book and that in the intervening time no attempt has been made at any stage to provide an information service. Can the Minister envisage the provision of such a service in the next 50 years? I am having regard merely to what has been the position since 1927.
Amendment, by leave, withdrawn.
Section agreed to.
SECTION 18.
Question proposed: "That section 18 stand part of the Bill."
Subsection (2) reads:
The Minister may, by order, amend or revoke an order made under this section, including this subsection.
I am wondering whether the last three words of the subsection are necessary.
They are necessary. I am being empowered to make an order amending the section, including the subsection under which the order is made.
Do the words "this subsection" refer to subsection (1)?
They refer to subsection (2). What is being provided is that I can make an order under subsection (2) and then make another order under subsection (2) amending the first order.
Question put and agreed to.
SECTION 19.
Question proposed: "That section 19 stand part of the Bill."
Perhaps Deputy O'Connell will note here that the Minister for the Environment is now involved.
The words "as if it were a local authority" are used here. This is not a semi-State body but yet these words are included. The logic of this escapes me.
May I make one final attempt to put the logic? We are dealing here with superannuation. As the Deputy points out correctly, this body will not be receiving funds from the Exchequer for superannuation purposes. Nevertheless, there is provision in the section for the introduction of the Minister for the Environment because he has overall jurisdiction in respect of local government superannuation matters.
Question put and agreed to.
SECTION 20.
Question proposed: "That section 20 stand part of the Bill."
This is a fairly standard section in that similar provision has been enshrined in a number of pieces of legislation during the past seven or eight years.
I am wondering though, whether paragraph (c) of subsection (1) is rather harsh. My understanding was that other people in the public service such as doctors or people employed by State bodies could, if elected to either House of the Oireachtas, obtain leave of absence but continue to contribute to their superannuation fund thereby ensuring that they were not at a loss from a superannuation point of view for the time they spent in either House. I do not recall seeing similar provision in any previous legislation. Of course, such an eventuality is not likely in the context of the Bill before us unless, for instance, Deputy Dr. O'Connell becomes the registrar.
I was pleased with this provision because I considered it an improvement. Normally, sections of this sort provide that when a person is nominated for election he must relinquish his post. At least here we are providing that it is only after a person has been elected that he must give up his post.
That is only right.
Yes, because he might be nominated but not elected but I shall consider the point the Deputy makes. I expect that the reason for this provision is that when a person is a member of either House he qualifies for a different sort of pension.
I am sure that when teachers come in here they continue to pay superannuation contributions.
Question put and agreed to.
Sections 21 to 24, inclusive, agreed to.
SECTION 25.
I move amendment No. 12:
In page 11, paragraph (a), line 30, to delete "first or any subsequent".
This is a drafting amendment because there is now no instance where there can be subsequent legislation.
Amendment agreed to.
I move amendment No. 13:
In page 11, paragraph (c), line 35, to insert "erased or" before "removed".
The new section 33 which will be brought in by my official amendment No. 17 speaks of removal of a person's name on request. All other references are to "erasure" which is thought to have penal connotations.
Is this the removal of a person's name on request?
Yes, it is not being erased, it is being removed.
Could I ask the Minister what prompted the inclusion of this amendment, what representations were made to him in this regard, and why did he consider it relevant to this Bill to bring in this amendment at this time?
It is very simple and there is nothing sinister about it. If an Irish doctor wishes to go abroad he cannot be registered in some countries if he is still registered in Ireland. In order to practise medicine in another country he would have to have his name removed from the Irish register.
As the Minister is aware, thousands of doctors have gone abroad, more than in any other profession, and this section was not relevant.
There is a country now. I can explain it when we come to the amendment, but there is an instance where it would be necessary.
Is it just one country?
That is all we know about.
Amendment agreed to.
Section, as amended, agreed to.
SECTION 26.
I move amendment No. 14:
In page 12, between lines 4 and 5, to insert the following subsections:
"(3) Each person whose name is entered in the register shall be sent, by the Council, notice by pre-paid and registered post stating details of his entry in the register.
(4) Amendments to the register carried out in accordance with sections 32 and 33 of this Act shall be notified by the Council by prepaid and registered post to the person affected by such amendments or, in the case of deceased persons, to their next of kin.".
The purpose of this amendment would be to insert two new subsections into section 26 which would place an obligation upon the council following the registration of a medical practitioner to send to him a notice giving him formal notification of his entry on the register and details of the entry made about him in the register. I did not see anywhere, either in this Bill or the earlier Act, any requirement that this should be done. I understand that it happens, but the council should be obliged to send a document which is referred to in the Act which would state categorically the details, specifications and qualifications of a registered medical practitioner. The House will realise that if a doctor wanting to practise in any part of the country was obliged to produce a certificate of his qualifications that would have a bearing on that later amendment which I referred to earlier. The council should be obliged to send to that doctor details of the conditions which they have entered about him in the register.
The reason for the second subsection is that any details of subsequent amendments concerning his entry in the register or the inclusion of any post-graduate or special qualifications he might achieve afterwards would be sent to the individual concerned by pre-paid registered post. That obligation should be placed upon the council and there should be a formal document which would be the doctor's certificate of entry in the register.
There is sense in what Deputy Boland says because it can happen through typographical errors that a doctor's name could conceivably be omitted in the printing of the register and the doctor would not know of this. The Department of Posts and Telegraphs is the villain in the case of a number of doctors whose names have been left out of the telephone directory and who have suffered considerable inconvenience because of this and they had no way of knowing about it. This is more vital than the telephone because a doctor's right to practise could be questioned if his name was not included and he did not know in time.
Deputy Boland has another amendment in later that the chief executive officer of a health board would have certain control over doctors in his area. I cannot agree with that. If Deputy Boland brings his party into line with a comprehensive free medical health service we might see the logic of it. There is a certain validity in his argument in that he is trying to prevent charlatans and others from masquerading as registered medical practitioners. He might consider putting down another amendment on Report Stage that the Medical Registration Council issue to every doctor a certificate of his registration and that this be on display in the doctor's consulting room for the benefit of the patients. This is what is done in the USA which might not be an ideal country but they have a lot of rigid enforcements of such rules. Perhaps embodied in Deputy Boland's amendment might be some certificate which would incorporate the spirit of what was meant by his other amendment preventing these unauthorised, un-registered doctors from practising.
A few years ago I brought to the attention of the Medical Registration Council a man who had sought and received provisional medical registration in this country to act as a doctor. He applied to the Medical Registration Council and received this on the basis of bogus certificates from a far-off country. The Medical Registration Council issued this provisional registration and he was in practice here until I brought the matter to the attention of the Medical Registration Council and highlighted the fact. Only then did the Medical Registration Council find that he had bogus medical qualification. This kind of thing can happen despite all precautions. Whether the council were lax or not we do not know. The man was a foreigner from Taiwan or China and it was found that there was a bogus medical school in that area. A few people masquerading as doctors could set up practice in this country and the public would not know whether they were registered medical practitioners or not. Indeed any Member of this House living in a city would not know. In small towns in Ireland bogus doctors have come in and practised. In the west one was practising for nearly a year before he was found out. Other practitioners in the area were wary of him. Of course this is not confined to the medical profession. We had a bogus bishop in Cork. The point is that there is no way of knowing. There was the classic case of a man who was appointed head surgeon to a hospital in the USA. He had never been to a medical school. He was operating for five years as a surgeon and no one knew that he was not qualified. He was sentenced to 14 months' imprisonment and there was a recommendation from the judge that someone finance his medical education because he was so good. This is the right way to ensure that we do not have bogus doctors.
I accept Deputy Boland's amendment in principle, perhaps not in the exact wording here. If the Deputy will withdraw it I will bring forward something on Report Stage. I am impressed by the arguments put forward. The original thinking behind the Bill was that the register would be sufficient evidence of a doctor's registration. As the House knows, the Bill provides that the register will be published once every five years and that there will be yearly supplements. Presumably, the theory was that the doctor would buy the register, note that his name was included on it, and then get the yearly supplement. One can see that it would be desirable that a medical practioner would be informed of his registration. The only argument against it is that it involves counselling and some administrative work. We might have to accept that. The idea of notification is an admirable one.
I am also impressed with Deputy O'Connell's suggestion that there should be a certificate which would be on display. I would like to think a bit more about that between now and Report Stage. It would go a long way towards meeting the point Deputy Boland has in his later amendment about the role of the practitioner if there was a provision that the certificate of registration was on display in each doctor's room. It would certainly have some advantage but I would like to think what the complications might be in that. I am accepting in principle the idea of each member on the register being notified of his entry on the register. I will bring forward something on Report Stage to meet that.
I would like to thank the Minister for the manner in which he has met the principle behind this amendment. I am quite happy to withdraw it and see a similar amendment framed by the parliamentary draftsman on Report Stage. As the Minister said, there is merit in Deputy O'Connell's suggestion and it would go a long way towards meeting the purpose of my later amendment. The examples we have been given cover the case of people setting up as GPs or specialists in private practice but do not necessarily cover the case of somebody who applies to a hospital or health board for employment in one of their institutions. This person might not necessarily have an office of his own and might be working in the institution. One of the main reasons behind my later amendment was to find a way in which that institution could be satisfied that the person applying actually had the qualifications. It might be better to talk about that later. I am a little perturbed that some of the public bodies do not appear to check the qualifications of some people prior to their employment. That is one of the reasons I put down the later amendment.
I wanted to ensure in the amendment we are discussing at the moment that every registered medical practitioner should have a certificate issued by the council and sent to him so that he could display it. This would be substantive proof of his entry in the register even if time elapsed between publication of a supplement to the register and the publication of the five-year register. If the Minister meets the amendment it will certainly improve the procedure. I would like to thank him for his approach to this matter.
The Minister will probably be told by his advisers that a doctor can put on display his diploma or his degree certificate and that this would be adequate. It would be far from adequate because he is given that certificate when he qualifies but mean-while he could be erased from the register. The Minister might tell his advisers that the diploma certificate would not be adequate. He would need to produce a certificate of inclusion on the register. I do not know if my name is on the register because I have not seen a copy of the medical register. I hope the Minister realises the importance of something being displayed, not necessarily the certificate of graduation from the medical school.
The numbers that graduated from the medical colleges in the last three years were 435, 449 and 481 so there would not be a great amount of administration involved.
There is a great deal of merit in what is proposed now. If there is any administrative problem a fee could be charged for the certificate and this would cover the administrative cost. I will look very carefully into the question of a certificate which will be on display. I hope, despite the earlier passage of arms, Deputy O'Connell will not object to my including him among the advisers I will consult in this area.
I am glad I appear to be having a soothing influence on the Minister and other people in the House.
Amendment, by leave, withdrawn.
Section agreed to.
SECTION 27.
I move amendment No. 15:
In page 12, subsection (5), line 50, to delete "28 days" and substitute "two months".
I believe this amendment is necessary because a doctor might be abroad at the time he is notified and would not have sufficient time to present his case. I do not think it is unreasonable to ask that two months be allowed instead of 28 days. I know it can happen that the person involved could be abroad. It happened in Britain where they had the same kind of arrangement and he was too late to present his case. We could be more reasonable towards the person involved and give him two months.
I am accepting the amendment.
Amendment agreed to.
Question proposed: "That section 27, as amended, stand part of the Bill."
The expression "pre-paid post" is used in this and other sections. I am not sure what is meant by it. Surely documents as important as those referred to in this and subsequent sections notifying a person either of his or her formal entry, disqualification or prohibition from entry on the register should be sent to the person involved by registered post? The section refers to pre-paid post. I am not sure if that infers it is registered post.
Would the Deputy like to see it "registered post"?
Surely documents as important as those contained in this and subsequent sections should be sent by registered post. If the Bill goes to the trouble of specifying that it should be pre-paid post I presume that means there should be a stamp on it. Should it not say the document should be registered, especially in the context of section 27 where they are notifying a person that they are not putting his name on the register because they think he is unfit?
Admittedly, these are important things. It is just standard practice to be notified by post. The Attorney General's view has been obtained on this and he appears to be satisfied with pre-paid post.
The Attorney General was satisfied that pre-paid post was what?
That pre-paid post was sufficient.
With all due respect to him——
I am only saying that from the legal point of view he was satisfied.
What does it mean?
Through the normal paid post.
Could it conceivably be that we could leave that out? Would it mean letters would go unfranked or unstamped if that were left out? Is that what that means?
They could be delivered by hand.
There is a lot of wisdom in what Deputy Boland said. We know that very often letters can go astray. In a serious matter like this, the Minister might consider putting in "by registered pre-paid post". Registered post would ensure that you could leave out the two months.
I have accepted the Deputy's two months.
Registered post might be in the person's interest when there is so much at stake.
Perhaps the Minister would have a look at it before Report Stage.
I will. May I just mention on the question of registered post versus pre-paid post, that apparently there is a point? It will occur on another section, so I might as well deal with it now. Apparently registered post has some slight disadvantage in that it must be delivered to you personally and, if you wanted to take evasive action, you could avoid receiving it.
The doctor could argue that somebody else in the house-hold received it and he did not. It could go on ad infinitum. He could refuse to accept it. That could happen.
Question put and agreed to.
Section 28 agreed to.
SECTION 29.
Question proposed: "That section 29 stand part of the Bill."
In section 29 (1) (b) there is a reference to the requisite knowledge and skill for the efficient practice of medicine. The 1955 Act refers to the person having the requisite knowledge and skill for the efficient practice of medicine, surgery and midwifery. I wondered what the purpose was in omitting the other qualifications, or whether it is now felt, as apparently it was not felt in 1955, that the word "medicine" covers the entire broad area.
I also notice that in subsection (2) there is now a requirement that the aggregate periods for temporary registration shall not exceed five years. That is a new provision in this re-writing of section 3 of the 1955 Act. It is good that a person cannot go on ad infinitum being registered in a temporary capacity and asking for a renewal. I suppose this subsection dealing with linguistic ability is a reflection on the increased mobility of persons around the different parts of the world. I presume it refers to non-nationals.
Yes. They had quite a to-do about that in Britain. The practice of medicine is defined in the definition section.
I see.
The practice of medicine is defined in the definition section to include the practice of surgery, midwifery and other disciplines of medicine and "medical practitioner" shall be construed accordingly.
Section 29 (3) provides:
For the purposes of this section, the Council may require any person taking temporary registration to undergo such tests as may be necessary to determine that he has the necessary linguistic ability for the practice of medicine in the State.
Could the Minister explain why this was incorporated in the Bill?
It really arises out of the EEC provisions. Nationals of the EEC will be entitled to full registration here and this just enables the council to impose linguistic tests on foreign doctors wanting to come here to practise. I am sorry. It will not apply to EEC doctors. The Deputy may have noticed that they had apparently quite a number of problems in Great Britain with this matter of doctors who could not converse or communicate with their patients because of language difficulty. It is simply to get over that difficulty. In case I misled the Deputy, EEC nationals will not have to comply with that.
This is a very dangerous thing to include. If we are to discriminate against coloured people, that is a very serious matter. That is obviously the reason for the inclusion of this provision. I fail to see why a person from India, or Pakistan, or any of these places, should be obliged to have linguistic ability to practise medicine in the State. Why should we discriminate against him and not discriminate against a German, or a Frenchman, or an Italian? How will the patient in Dublin or Dún Laoghaire feel about an EEC national? Maybe I am on the wrong track.
Maybe I misled the Deputy.
A few Irish doctors could undergo the test as well.
The situation with regard to EEC nationals is a little bit complicated, perhaps, and maybe I should read out the exact position. Nationals of EEC countries are entitled to full registration and do not come under the provision for temporary registration, the section 29 provision. Under the EEC directives, doctors coming here are not required to have a knowledge of the language for the purposes of registration, but we are obliged to ensure, in the interests of their patients and in their own interests, that they acquire the necessary linguistic skill. We cannot refuse to register EEC doctors for linguistic reasons, but we can ensure that they acquire the linguistic skill after they come here.
How can we ensure that?
It would be the council's function to ensure that.
That is not incorporated here. That is the point. This clarifies exactly what I have been saying. We will now discriminate against those who come here from abroad and who are not members of the EEC.
Not necessarily coloured people.
We are just saying that. We exclude the EEC countries and we exclude the developed countries. Next we talk about under-developed countries and, when we talk about the underdeveloped countries, in the vast majority of cases we are talking about coloured people. There is the problem. We have decided now that we will not discriminate against EEC nationals. They can come here and they need not know a word of English. They can be fully registered and, once they are fully registered, we may discourage them, but we will not stop them from setting up in practice. We can stop a person from Pakistan, or India, or one of those places, from coming here. We will require him to undergo a special oral test in English. We do not require this of EEC nationals. To me that is grossly unfair and it is discrimination in the broadest sense of the word.
I would not accept that. Obviously, the EEC is in a different position from any other country or group of countries. We have mutuality among the member states of the EEC. They are now affording us privileges and we are affording them privileges. We all afford each other the right of establishment, not just in medicine but right across the board, all the professions——
This would apply to Swedes or Norwegians or Spaniards, or Yugoslavs.
That is the point I was coming to. Deputy O'Connell seems to think it would apply only to certain nationalities. These tests will apply to any country outside the EEC and many of these countries have a different language from us.
They are all developed countries.
There are French Canadians coming here.
That is what I mean. They are all developed countries where there is a tremendous demand for doctors. This is the point.
Let me put it the other way to the Deputy. The only reason why this linguistic test is not stipulated here for EEC doctors is that it cannot be stipulated. We have now entered into certain arrangements with them. They afford us certain privileges and we afford them certain privileges, and we cannot apply this to them. It is not put in here in opposition to doctors of particular countries. It is simply put in here for the protection of our patients and the doctors themselves. It would be of universal application except that we have different arrangements for EEC doctors.
Do the Department use their influence in Brussels to have such a condition attached to registration of foreign doctors in this country? Would it not have seemed equally logical to have our Irish representatives in Brussels press for the inclusion of such a condition for the free movement of doctors in individual countries, that they have this linguistic ability? My point is that it does not matter whether we get a directive from Brussels or not; it is discriminating against one section. It has been proved in Britain that this test was to prevent these people coming to practise in Britain and their high failure rate had nothing to do with their linguistic ability. We are supporting the British in this, and this type of Powellism is wrong and we should not be encouraging it. Obviously, if the person has not got the linguistic ability the patient will not see him anyway.
I know there is an agreement, but could I ask the Minister why, for instance, a German doctor would be exempted if he could not speak English and he had the same linguistic difficulties with patients. I agree with Deputy O'Connell that there is clear discrimination here, and the effect of it is to discriminate mainly against Indian doctors in this country. I would be worried about it.
Not at all. None of us would tolerate discrimination against an Indian doctor, in particular, because we have long associations with India in the medical field. In fact, I would hope very soon now to be getting on with proposals for developing increasing medical contacts with the Arab countries.
Contacts with the Arab countries are long developed by now.
There have been many individual contacts but I am hoping to put it on a more formal basis. However, under the EEC treaties we have to afford the right of registration to EEC doctors here just the same as they have to afford the right of registration to our doctors in their countries. The question of the linguistic capacity of a German, a French or a Belgian doctor here has still to be worked out. It is still under discussion in the EEC as to what qualifications should be necessary in that regard.
In so far as it is of practical importance to us in appointments to particular posts, we can stipulate language qualifications; in other words, if it is a post where the appointee would of necessity have to deal with English-speaking or Irish-speaking patients, then we can stipulate that he must have a fluent knowledge of the language concerned. Similarly, in Belgium, for instance, they would be entitled to stipulate for a particular appointment that an Irish doctor would have to have whatever language was necessary to enable him to fulfill that appointment. As I say, discussions have still to take place in the EEC as to what stipulations different countries will be able to make in regard to doctors from other member states coming to them. That has not been finalised yet.
At the risk of contradiction, may I say that a doctor from any of the EEC countries can come here as from 1st January last and get permanent registration in this country.
That is correct.
There is no question of linguistic ability. We should omit this provision here. Other foreigners cannot get permanent registration. I emphasise this because, while Deputy Boland talked about Sweden and other countries, Swedes do not come here to practise, because of the high standard of living they can attain in their own country and, indeed, doctors from other developed countries would not be induced here by the attractiveness of the remuneration here. Therefore, we must eliminate those because they are red herrings.
What I am saying is that if we incorporate this provision in the Bill we are making it very difficult for doctors from the underdeveloped countries to come here even for provisional registration. They may come here for post-graduate work. We should leave it to the employing bodies concerned to decide if a doctor has the requisite knowledge of English to be given the post. This smacks of racialism and it should be eliminated. This is not good, and the Minister, if he despises, as I have no doubt he does, this racialism should have it, eliminated. We will not do any harm by eliminating it. We are giving the powers to the employing bodies, who are usually a board of doctors anyway. If a doctor from an underdeveloped country comes for appointment in a hospital and if he is not able to talk at an interview in plain ordinary English, it is obvious that he will not get the job, but to make it a pre-condition for provisional registration would seem very unjust.
People who have qualifications from any of the EEC member states are entitled to full entry on the register under the terms of section 27, although they might not necessarily be able to speak English, whereas under the terms of section 29 a person, to obtain temporary registration, may have to undergo a linguistic test. One would have thought that what was sauce for the non-EEC goose would be sauce for the EEC gander as well. I am not sure, therefore, that it would be a good thing to have a limit and it might be better to have a look again at section 27 and talk to our EEC partners about the possibility of having a linguistic test.
These talks will take place.
If there is a linguistic test for our nationals within the Community then Irish doctors are likely to do less well than those from other EEC countries because the teaching of languages here is neither as advanced nor as widespread as it is on the mainland of Europe. We should have been looking at this under section 27 and saying that there should be a requirement that every EEC qualified practitioner should be competent to speak in the everyday language of the country to which he is moving. I am concerned that the House might give the erroneous impression that we are in some way setting out deliberately to discriminate against people coming from a particular country. Certain countries were mentioned and I do not think they should have been mentioned because mentioning them might create the impression that there is a bias against doctors or students coming from these countries. Now we have a long tradition in the education of students and doctors both at graduate and post-graduate levels from the countries that were mentioned and, indeed, other countries too. In 1973-74, 481 doctors qualified in colleges in Ireland of whom 140 were non-nationals. In the following year we had 100 non-nationals and in the third year there was a further 100 non-nationals who received primary degrees here. I would be concerned if any impression were given that there was an intention to discriminate against people coming from undeveloped countries or countries outside the EEC. We have a limited number of medical training schools and an admirable record in training non-nationals at all levels. I do not believe it is our intention to discriminate in any way.
Deputy Boland refers to the 100 non-nationals. Now we are not talking about students coming here with their GEC. Deputy Boland says we should not create an erroneous impression. The only people who come here seeking provisional registration are people from undeveloped Third World countries. The Swedes, the Canadians and so on do not come here. Neither do they seek employment here.
They might marry Irish girls.
If the Minister wants to play about with zero ad infinitum then we can talk about that. This is aimed primarily against those coming from outside EEC countries. We will require them to have a special test in English. There is neither reason nor purpose in this test because, as every-one knows, we have more than enough family doctors in practice here. The competition is very keen. Those coming from outside come here for post-graduate education and positions in hospitals. I say leave it to the hospital authorities to decide on the basis of personal interview. No one is appointed without an interview and there are doctors on the interview board. They are the most competent people to decide whether an applicant is fit to be employed. We should not incorporate this provision here because we will be depriving them of a chance to study. They will not get provisional registration unless they pass an English test. That is the point. In Britain they had to take certain steps because of problems created by the inflow of coloured doctors who were really there to serve their own coloured communities. But there was a fear that the country would be swamped with coloured doctors and so they incorporated a provision in legislation to prevent this happening. The same thing was done in America for purely selfish reasons. One had to be a citizen of the United States before one could practise outside of a hospital. I think that is wrong. It is an overt form of racialism. We have always prided ourselves on our heritage of post-graduate education. Since we do not make our proper contribution to the Third World this is one way in which we can redress the balance. That should be made clear. We have an obligation to take these people. It is a good contribution to make to the Third World. We must recognise that. Here we are closing the door by incorporating this provision in our legislation, a provision which could be very damaging to our good name. We have no reason to fear an influx of doctors threatening to jeopardise the position of our own doctors. We are not associated with racialism in any form and we have no wish to be. But, if we do what is proposed here, then we shall leave ourselves open to an accusation of racialism. French, Belgians, Italians, Germans, Luxembourgers can come here without knowing a word of English and we cannot do anything about that. If we cannot. why incorporate this provision?
I suggest in section 27 we should be doing this against the EEC as well.
No.
We cannot change the right of nationals of member states to full registration. We cannot change that but we can and are——
Did I hear correctly —we cannot?
We cannot. We cannot change the right of a national of a member state of the Community to full registration here. Deputy O'Connell is not fully correct in thinking that no doctor from any part of the world outside the EEC can get full registration here—he could. Paragraph (d) section 27 (2) makes provision, admittedly in exceptional cases, for registration where a doctor "satisfies the council that he has undergone such courses of training and passed such examinations as are specified for the purpose of this section in rules made by the Council..." It gives them an opportunity to permit a doctor from outside the EEC or Ireland in exceptional circumstances to get full registration, not to mind temporary. We cannot change the rules which say that a doctor national of a member state is entitled to full registration here but we can and must have protection for our own nationals——
My hearing is not as good as I would wish and if the Minister could use the word "cannot" instead of "can't" I would understand a little better.
I shall endeavour to use "cannot". I was brought up to use "can't". It is not possible for us to prevent a doctor national of a member state of the Community from procuring full registration in this country but we can make stipulations, and we shall have to make them, about the linguistic capacity of such doctors to practise medicine here and to protect the patients here. At present we have certain safeguards inbuilt into the situation and Deputy O'Connell mentioned them, that a person cannot procure an appointment in a hospital unless he has the language capacity to fulfil the task. That will apply whether or not he is an EEC national or comes from outside. No EEC agency can compel us to appoint a doctor to an institution or to an appointment for which he has not the necessary lingustic ability. Discussions are, and will be taking place on this whole problem so far as EEC doctors are concerned but at present this provision is inserted in section 29 as a simple safeguard for our own patients to ensure that if they are attended by a doctor he will at least be able to understand their language and communicate with them. I do not think this has any imperialistic or colonial overtones and it is certainly not meant to have. It is here as an elementary safeguard and while this provision is here to deal with non-EEC doctors we are also pursuing through the normal EEC channels the same sort of safeguards in respect of EEC doctors.
Question put and agreed to.
SECTION 30.
Question proposed: "That section 30 stand part of the Bill."
I have no very strong views about it but I think it worth while for the House to discuss whether this section allows the council the power, with the Minister's consent, to set up apart from the register of medical practitioners, a separate register of medical specialists. It does not oblige the council to set up that register on the coming into operation of the Act. The suggestion is that the register of medical specialists should not be drawn up for some time although a similar register operates, I should say, in most other EEC countries and in a number of non-EEC countries. There is no such register in Britain at present and apparently the suggestion is that because there is not a specialist register there we should not set up one until we disengage from the separate agreement we have with Britain. A number of public bodies employing doctors would welcome the concept of a separate specialist register and I should like the Minister to give us some idea of how long he envisages it might be before the register of medical specialists is established. Would he agree—obviously he must, when he has included section 30 in the Bill but in a permissive rather than a mandatory way—that it might have been better if an obligation were placed on the council to create within a certain period a separate register of medical specialists?
I had to take an urgent phone call. Could I ask the Minister what was his decision about that section?
We have left that section and we have been dealing for some time with section 30.
If the Deputy would like to put down an amendment to section 29 for Report Stage I shall consider it.
As I see it, the creation of a specialist register is contingent on agreement being reached between the various EEC countries as to what constitutes a medical specialist. I think that is the reason for the Department's decision not to set a deadline for the creation of such a register. There is a wide variation between the EEC countries as to what constitutes a specialist. Differing numbers of years of training are required in, say, anaesthetics in different European countries, in Belgium as compared with France or Ireland or Britain. The same applies in regard to other specialities. Consultations are taking place and these are ongoing. I presume that was one of the reasons, if not the main reason, for the inclusion of this section giving latitude to the council to prepare the register in time, but setting no specific deadline or making it mandatory.
The establishment of these specialist registers is an integral part of the Bill and we regard it as very important and I would be very anxious that it be proceeded with as rapidly as possible. Deputies, however, may recall that I said on Second Stage that in this area we want to try to co-ordinate our activities with the United Kingdom particularly. There are also EEC connotations but it is particularly the UK that we are concerned about because we are trying to have co-ordination of specialist training arrangements. Medical people are anxious that in the post-graduate specialist area there should be reciprocal arrangements and for that reason we would like to wait until the British establish their specialist register before we do so. The delay is not on our side; we are ready to do it but apparently they are not. They have internal problems in proceeding with the establishment of their specialist register. The matter is left open because we want to co-ordinate the two registers when the time comes. Certainly, it is a situation that will have to be kept under review. If it looks like dragging on indefinitely something will have to be done, because we regard the specialist register provisions as an integral part of this legislation.
I do not accept what the Department have said about that. It is due to the fact that there is disagreement within Europe as to what constitutes a specialist. The main reason is that we are trying to harmonise specialist degrees. Deputy Boland is unduly alarmed about what constitutes a specialist.
I did not ask that question.
The Deputy asked the question just now. The Deputy asked when would the specialist register be set up.
I did not ask what constitutes a specialist.
But the Deputy is concerned about it. I heard the Deputy referring to people who are not specialists purporting to be specialists in applications to health boards for employment.
No.
I am sorry if I misunderstood the Deputy.
We need not place undue emphasis on what constitutes a specialist. A person could have all the degrees in the world but that does not mean he is the most competent person. Some people make a habit of collecting degrees just as some people collect stamps. We should not be unduly alarmed about the setting up of this. It is not of great practical importance other than to protect our specialists vis-à-vis their EEC counterparts.
I am now more confused than ever. The Minister has given one reason as to why the register of medical specialists is not to be set up and Deputy O'Connell has given a different reason. Both of them very definitely state that their's is the reason why the register is not being set up. If we are to believe the Minister the reason it is not being set up is because there is no register of medical specialists in Britain and as we share to some extent in the training and the awarding of post-graduate degrees, until there is some harmonisation in that situation the register should not be set up here. That is not a good reason. Deputy O'Connell says that the reason for not setting it up, is that there is disagreement within Europe as to what does or does not constitute a specialist. That is when the discussion about what constitutes a specialist started. I had referred to a house officer, not a specialist, who had falsely represented himself when applying for that position.
If there is disagreement in Europe as to what does or does not constitute a specialist that should not be a reason why this country should not maintain a register until such time as Europe can agree amongst themselves. The personnel and employing sections of some of the large public bodies engaged in the health service have expressed the view that the existence of a register of medical specialists would be very helpful when they are required to fill posts, especially posts for which there may be a shortage of qualified people. There ought to be some stipulation that the register would be set up within some period of time. The section might be better if instead of saying that the council may with the Minister's consent establish a register of medical specialists, it said that the Minister shall by order direct the council to establish a register of medical specialists, or words to that effect, which would have left the Minister with the power to decide when it was appropriate to set up the register. I appreciate that Deputy O'Connell had left the House for a few minutes but it was merely something on those lines which I suggested. The Minister might before Report Stage have a look at that situation to ensure that within some reasonable length of time the register will be brought into existence.
What sort of bodies is the Deputy referring to?
The main ones are the health boards.
I want to make it clear that the EEC are not involved in this matter. There is no uniformity in the EEC about specialists and all the directive does is stipulate for all the specialities a minimum training period. We hope, in our specialist register to go way above those minima. The delay here is only concerned with the British situation. We are keeping the 1927 agreement in existence for this purpose. If Deputies turn to section 61 of the Bill they will see that we are continuing this agreement in force for the time being but that the Minister will have the power to bring it to an end by order. That is because we want to preserve this link with the British medical board in so far as specialist training and education are concerned. Everybody is agreed that it is desirable to maintain that co-ordination in post-graduate and specialist training and education. For that reason it is worth-while to delay the establishment of our register pro tem until such time as the British are in a position to establish their register. When we establish ours we can bring the 1927 agreement to an end and we can both go on from there with this co-operation continuing between the two countries so far as post-graduate and specialist training is concerned. It is not an EEC situation which is holding us up in this regard. Deputy Boland has a point in asking that this situation be not allowed to drag on indefinitely. I assure the Deputy that it will not be allowed to drag on indefinitely and if it transpires that no solution is forthcoming in the immediate future we shall have to review the situation and see what can be done.
If what I have said is wrong and the Minister's advice is infallible then what is the purpose in setting up a specialist register if an EEC doctor with only three years training can come in here as a specialist entitled to permanent registration as a specialist, whereas a doctor here must undergo about seven years specialist training before he is admitted to the specialist register? Does the Minister not see a certain logic in the reason for the delay in reaching harmonisation in relation to what constitutes a period of training for a specialist degree?
Is section 30 agreed?
Has the Minister no comment on that?
I do not understand the Deputy's point.
In certain countries in the EEC one may become a specialist after three years' training whereas for the same degree here approximately six years' training is required. The specialist from Italy with three years' training would be included in the register here as a specialist along with the specialist who had to undergo six or seven years' training. That is an anomalous situation. This is one of the reasons that there are consultations with the UEMO, which is the body representing doctors in Europe. There are consulations going on about achieving a degree of harmonisation regarding post-graduate training for degrees. That should be abundantly clear.
Would that in any way be covered by section 31 (1) (c) which says that the specialist qualification must be recognised by the Irish council? Could a situation arise in which the Irish council would not recognise a specialist qualification from, say, Italy or some other country?
That is what they are working on at present, to try to achieve a degree of harmonisation.
It need not stop us establishing the register in the mean-time.
Question put and agreed to.
SECTION 31.
I move amendment No. 16:
In page 14, lines 5 to 14, to delete paragraphs (a) and (b) and to substitute the following paragraphs:
"(a) every registered medical practitioner who, prior to the establishment of that register, has, in the opinion of the Council, completed his specialist training in a specialty recognised by the Council pursuant to section 38 (1) of this Act,
(b) every registered medical practitioner who following the establishment of that register, is granted evidence of satisfactory completion of specialist training by a body recognised by the Council pursuant to section 38 (3) of this Act,".
The purpose of paragraph (a) of this amendment is to enable doctors who are otherwise qualified but who are not engaged in the practice of a medical specialty to be registered in the register of medical specialists. Persons concerned, in the main, would be persons holding whole time teaching or other non-clinical appointments in universities or medical schools. The purpose of paragraph (b) is to provide for cases such as, say, psychiatry where more than one body may be recognised for granting evidence of satisfactory completion of specialist training.
Amendment agreed to.
Question proposed: "That section 31, as amended, stand part of the Bill."
Would the Minister like to comment on the question I raised in relation to paragraph (c)? I wondered if the wording of that paragraph went any way towards meeting the difficulty Deputy O'Connell was outlining, in that a national of an EEC member state, to be registered on the proposed Irish specialist register, would have to have obtained a qualification recognised by the Irish Council. Was it envisaged that the Irish council might decide only to recognise qualifications higher than the basic standard in the EEC directive?
This would be very much a question for the council to decide.
But the council would have the power to decide that they would not recognise, say, the example Deputy O'Connell gave of a three-year specialist course in Italy.
Yes, when the register comes to be established.
But if the register of specialists is not established can these people come over here? Suppose it is not established for two years if, as the Minister and his advisers say, we are totally dependent on Britain about this to try and achieve synchronisation of the register of medical specialists. According to the Minister the British were somewhat confused about this. Long ago they settled which doctors are and are not specialists in Britain. The big problem arises with Europe and there is no use in our fooling ourselves otherwise. The Department have to recognise it. I do not see any great relevance in establishing the register. The more I see of EEC doctors coming over here the more I realise that so-called specialists might not be specialists. Therefore, the Community are trying to achieve this degree of harmonisation as to what constitutes a period of post-graduate training. Assuming the register was not established they could come over here and practise as specialists when they might not have the requisite amount of training. That is what Deputy Boland is talking about.
Then the only safeguard you have is the body making the appointment.
That is right.
The body making the appointment—I take it the Minister is referring to an Irish body—will normally refer to the Irish Medical Registration Council for details of non-nationals' qualifications. If the Irish Medical Council have not got a specialist register set up there may be delay in obtaining the information.
When a doctor is being appointed to a hospital he does not merely hand in his degrees and certificates. There is an interview and his experience has to be gone into. They get replies from hospitals where he may have served before. One does not just find a lay administrator of a hospital appointing a consultant or a doctor. He does not do that. He leaves that to the medical staff who will interview him to ascertain whether he is competent and who know his work. That is why I said the amendment of the other section was irrelevant. It is all based on interviews and the interviewers are medical men, not merely lay administrators. One could not have that. If that were the case one would not know who would be let loose in hospitals.
Earlier Deputy O'Connell gave us an example of a bogus doctor who he said he brought to the attention of the registration council. Later I will give the House an example of a bogus doctor who was interviewed by professional doctors, was appointed and served for a long time. That is what we are talking about.
I am speaking about the man who receives provisional registration on the basis of phoney degrees. That is different from an interview by doctors in a hospital.
I am speaking about a bogus doctor who was interviewed and employed.
The man about whom I was speaking was granted provisional registration on the basis of bogus degrees. That is a different matter. The Medical Registration Council gave a certificate of provisional registration. That is a completely different matter from a man being interviewed by doctors in a hospital. If it was an isolated case, I would say they must have been day-dreaming.
Question put and agreed to.
Section 32 agreed to.
NEW SECTION.
I move amendment No. 17:
In page 15, line 6, before section 33, to insert the following section:
"33. (1) Any registered medical practitioner may apply to the Council to have his name removed from any register maintained by the Council in which his name is registered and, on receipt of such application and on payment of the appropriate fee, the Council may remove the name of the registered medical practitioner from any such register.
(2) Any registered medical practitioner, whose name has been removed pursuant to subsection (1) of this section from any register maintained by the Council, may, at any time, apply to the Council to have his name restored to such register, and, subject to the provisions of this Act and on payment of the appropriate fee, the Council may restore the name of the registered medical practitioner to any register from which it has been so removed.
(3) Nothing in this section shall operate to prevent the Council from refusing to restore the name of any person, who is otherwise, entitled to be registered, on the grounds of the unfitness of that person to engage in the practice of medicine.
(4) On making a decision under subsection (3) of this section, the Council shall forthwith send by pre-paid post to the person to whom the decision relates a notice in writing stating the decision, the date thereof and the reasons therefor.
(5) A person to whom a decision under subsection (3) of this section relates may, within the period of 28 days, beginning on the date of the decision, apply to the High Court for cancellation of the decision and if he so applies, the High Court, on the hearing of the application may either—
(a) declare that it was proper for the Council to make the decision, or
(b) cancel the decision and direct the Council to restore the name of the person making the application.".
This is a new section. Its purpose is to enable a doctor to apply to have his name removed from the register. The Bill does not provide for this and normally the need for it would not arise. However, it has come to our notice—as was mentioned earlier— that, in some countries, the registration authorities will refuse to register any doctor even if he is a Community national who is registered in any other country. Therefore, it is desirable to provide that a doctor registered here and wishing to go to practise in one of those countries will be able to ask voluntarily to have his name removed from the register.
Could the Minister specify the countries concerned?
France is one such country.
This is inserted as an EEC directive, is it?
It is a useful provision to have.
May I suggest that I could use it, as a doctor, if I were guilty of professional misconduct? Before a case went before the courts I could apply immediately to have my name removed from the register. Then my name is removed from the register of my own volition.
This is merely conferring the right on the council to remove the Deputy's name, but they might not accede to his request.
But suppose they did not know of a particular event. I am merely saying that I could use this provision if I wanted to.
Well then justice has been achieved; the Deputy is removed from the register.
I could not be erased from the register, which is a different matter. I sought removal of my own volition. I could re-apply two years later to have my name restored in the normal way and I would not have been found guilty of an act because I was not on the register at the time the matter came to court.
I do not see the difficulty the Deputy sees. I think the Deputy will agree that it is a reasonable provision to have. Doctors quite legitimately might want to have their names removed from the register. As the Bill stands, there is no such provision. Therefore, we want now to give the council power to remove, as distinct from erasing, a name. One instance I cited was the case of France. For instance, there could be a French doctor who came here, had registration here, and that registration here would debar him from practising in France. Therefore, he would want his name removed from our register. Alternatively, an Irish doctor, who might marry a French girl, might want to go and practise in France and, in order to do so, would have to have his name removed here.
Is it only because of France? Is that the only reason?
That is the only specific reason. However, I could visualise other reasons.
I was wondering what they might be.
Suppose I want to retire from medicine altogether, I do not want my name on the register. I do not want to be paying my fee and so on.
But a doctor pays a once-only fee. That is the point. That is why I wondered.
I do not want my name on the register; I do not want to be a doctor any more; I want to go and do something else.
There has never been a case yet in the history of medicine.
We are living in a changing world.
If it is for France and it is an EEC directive——
It is not an EEC directive; it is a French thing.
Well, it is an EEC member nation that wants it done.
It is an individual country which has this provision. It is not an EEC directive; it is not a Community matter.
It seems strange that the Minister should go to all that trouble just for one little country. Every member country will have to include the same provision.
I should not like any of my French friends to hear the Deputy dismiss France as a little country.
Perhaps I like to deflate them.
The Deputy envisages some problems arising and I want to tease them out. If there are problems we should examine them. Do I understand the Deputy correctly as stating that if a doctor finds himself in trouble and suspects he may be hauled before the council that he would apply to have his name removed? Presumably he would have to give some reason to the council for having his name removed?
Does he have to give a reason?
Perhaps not, but one would imagine that a wise council would ask him for the reason. Even if they do not ask, what is lost if he has his name removed and is no longer a registered practitioner? I do not see the difficulty.
This is a hypothetical case but I wonder why the Minister is bringing in such a weighty measure to serve just one member state. It seems to me that the other member states will have to do the same to satisfy one country. Would it not be easier to ask France to change her laws rather than asking the other eight countries to do so? As a doctor I am putting forward a hypothetical case. If a doctor finds himself in trouble and if he realises his name may be erased from the register, the first thing he might do would be to apply to have his name removed. The section does not say he has to give a reason. He could let two years go by and then apply to have his name restored on payment of a fee. Is that the situation?
Paragraph (3) of the amendment states:
Nothing in this section shall operate to prevent the Council from refusing to restore the name of any person, who is otherwise entitled to be registered, on the grounds of the unfitness of that person to engage in the practice of medicine.
In the case of an errant doctor who has his name removed, then presumably the person who has a complaint against him would still pursue his complaint. The council would know of this and would refuse to restore his name to the register.
If a doctor finds himself in trouble that could justify the removal of his name from the register he could first apply to have his name removed. He could leave the matter in abeyance for three years and on re-applying to have his name restored the council would look back on their records and see that the doctor had requested that his name be removed. There could be new members on the council—nobody is immortal.
If the person who made the complaint against the doctor——
To whom would he complain? To the members of the Medical Council? The members are not immortal.
The Deputy is visualising a certain situation that could occur. If we are dealing with doctors who are guilty of professional misconduct, they would be capable of anything. They would resort to any device. The situation the Deputy envisages is where a member of the public has a complaint against a doctor for professional misconduct. He is about to institute proceedings but the doctor cleverly has his name removed. However, that does not prevent a member of the public pursuing the complaint.
Surely the council are not obliged to remove the name if the doctor applies for removal? They may remove the name if they agree.
I have said that almost certatinly the council would ask the doctor to stipulate the reason. Deputy O'Connell points out that is not in the section and presumably the council erroneously accept the wish of the doctor to have the name removed but that will not remove the cause of the complaint. The person making the complaint presumably will apprise the council of the misconduct and that will be on their records. If the doctor applies for restoration of his name the council will check their records and presumably under the provisions of the section they will refuse.
How does the person know that he should apply to the Medical Council if there is no information officer to give information to the public? The complainant takes the doctor to court—the usual procedure —and on the basis of the court decision the Medical Registration Council takes action about the erasure of the doctor's name. That is the usual procedure following a court conviction. If an errant doctor is in trouble and knows that court proceedings may follow he could have his name removed and if the matter goes to court he is no longer on the medical register. You cannot erase someone's name who is not on the register. If after two years the doctor applies for restoration of his name on the register the council will check their records and see that he voluntarily requested that his name be removed. Members of a board may change. All they do is check to see if the doctor's name was removed by the council because of improper conduct. If it was not erased from the register because of improper conduct, there is no reason why it should not be restored to the register.
They would have a note of the court case.
How would they? If a person is reported who is not on the register what can be done?
In the case the Deputy instanced the matter was brought to court with all the attendant publicity. Presumably the council would be aware of those circumstances.
I just wondered why the Minister introduced such a weighty measure to suit one country?
I admit that the reason for bringing forward the amendment is the French situation but even if that were not so I think this is a desirable provision. In fact, I could imagine Deputies on reading the Committee Stage discussion telling me there was no provision for a voluntary removal of one's name from the register. Apart from the French situation, this is a desirable enabling power.
Was this provision included in the Act dealing with the Incorporated Law Society?
I do not remember.
It seems to me that it is a case of everyone being out of step except France.
I do not think there is a register of solicitors. They are officers of the court but I do not know if there is a statutory register of this sort. It may be that the French situation is the immediate cause of introducing this amendment. On reflection, the Deputy will agree that there could be other cases. For instance, a doctor might wish to retire and he should be entitled to do so.
The register is never accessible to the public. The public only see the name on the plate and in the directory. It has never arisen before that a doctor has sought to have his name removed from the register.
It is the university that gives him his title, not the register.
You are not a doctor until you are registered.
Amendment agreed to.
SECTION 33.
Question proposed: "That section 33 stand part of the Bill."
Section 33 replaces section 22 (1) of the 1927 Act. Section 22 (2) of the 1927 Act reads:
For the purpose aforesaid the Council may at any time send by prepaid post to any person registered in the register a letter addressed to him at his address as stated in the register inquiring from him whether he has ceased to practise or has changed his address, and if no answer to such letter shall be received by the Council within six months after the posting of such letter the Council shall at the expiration of such six months remove the name of such person from the register.
That provision is missing from the new section. There is a defect in the Bill in that the system of checking is absent from it. The Minister agreed in principle to accept my earlier amendment which provides for the issuing of certificates by the council. The 1927 Act obliged the council to write to registered members inquiring if they were still in practise. If a reply was not received within a reasonable period their names were erased from the register.
Section 23 of the 1927 Act placed an onus on the Registrar of Deaths to notify the council of the death of a registered person. Section 33 includes the phrase "correct all verbal or clerical errors". I do not understand how there can be a verbal error in a register. Perhaps the Minister can tell us why the provisions in section 33 appear to be less than those in the 1927 Act.
Section 33 provides for the removal from the register of the names of all persons whose deaths have been notified to or have come to the knowledge of the council. We are relying on the detention fee mechanism to ensure that there is a live register.
Is it right that the onus has been taken from the Registrar of Deaths to notify the council of the death of a doctor?
It had fallen into disuse.
What does the reference to verbal errors mean?
The Council could be informed verbally by an applicant of some information which subsequently turned out to be incorrect.
I am not sure that that is a verbal error.
Question put and agreed to.
NEW SECTION.
I move amendment No. 18:
In Part III, page 15, to insert the following new section before section 34:
"34.—(1) As soon as may be after the establishment of the Council it shall be the duty of the chief executive officer of each health board to prepare and establish a roll of all those persons who are engaged in the practice of medicine within the functional area of such health board and to verify with the Council that those persons are properly registered in accordance with the provisions of Part III of this Act.
(2) After the establishment of the roll referred to in subsection (1) of this section no other person shall be entitled to practise medicine within the functional area of any health board unless he has firstly furnished to the chief executive officer of such health board—
(a) a copy of the notice of registration referred to in section 26 (3),
(b) verification to the satisfaction of the chief executive officer of such health board, that he is the person in respect of whom the notice referred to in paragraph (a) of this subsection applies,
and received notice from the chief executive officer that his name has been entered in the roll referred to in subsection (1) of this section.
(3) It shall be the duty of the chief executive officer of each health board to verify the authenticity, and currency, of notices submitted to him in accordance with the provisions of subsection (2) (a) of this section.
(4) Where the chief executive officer of the health board is satisfied, in accordance with the provisions of subsection (2) (b) and (3) of this section, that an applicant is entitled to be entered in the roll referred to in subsection (1) of this section he shall so enter his name and inform him by pre-paid and registered post accordingly.
(5) Where the chief executive officer of the health board is not satisfied that an applicant for entry on to the roll referred to in subsection (1) of this section is entitled to entry he shall notify the Council of this fact forthwith.
(6) Where the chief executive officer of any health board is aware that a person is engaged in the practice of medicine within the functional area of such health board and has not complied with the provisions of this section he shall notify the Council of this fact forthwith.
(7) Where a person who is registered, or entitled to be registered. under the provisions of Part III of this Act, fails to comply with the provisions of subsection (2) of this section, the Council shall refer the matter to the Fitness to Practise Committee."
This amendment is the kernel of the defective area in the Bill, that is, the system of checking to ensure that a person who purports to be a medical practitioner is, in fact, registered.
Approximately a year ago a person applied for the position of house doctor to one of our health boards. He was interviewed for the position by medical personnel and was appointed a junior house doctor. In a statement made afterwards to the members of the health board, the deputy CEO said the reason for his appointment was that he appeared to have the necessary medical qualifications. According to this statement, he was subsequently asked by the health board to apply for the form of registration required of a doctor who qualified outside the State. In other words, he was asked to apply for provisional registration. We now know that this man was successful in convincing medical people that he was a doctor. It was only after he took up duty that he was asked to apply for provisional registration. It seems that the health board erred in employing the man before he was registered. Apparently his provisional registration was subsequently confirmed to the health board. The only conclusion that can be drawn from this case is that the registration council were misled by this man and issued provisional registration to which he was not entitled. The man continued practising in the hospital for eight months before some of the staff became suspicious of him. The matter was brought to the notice of the health board and they asked the man for further details in connection with his claim to have qualified in Britain. When he was asked for this proof, he applied for leave and has not been seen since. One would have thought that the health board or the council would have checked on his absence and misrepresentation.
Although the financial penalties contained in the 1927 Act are very small in present day terms, there is still provision of a gaol sentence for fraudulent misrepresentation by a person claiming to be a doctor. The situation is that a person was employed by a health board, interviewed by doctors, employed as a doctor in a hospital for six or eight months and apparently provisionally registered by the Medical Registration Council on foot of presumably false information which he supplied. In other words he was given the job as a doctor without being on the register. After he started the job he was asked to enter his name on the register and it was provisionally entered, although he was not a doctor. There is some dispute in the health board area in question as to whether he was a medical orderly, a psychiatric nurse or a theatre porter. I am told that when this man was working as a junior house officer some people became convinced that he had performed their operations although he had not even been in the operating theatre at the time.
I appreciate that this sort of thing does not happen very often. Deputy O'Connell reminded the House of a bogus doctor who had been operating as a GP for some time before he brought him to the attention of the Medical Registration Council. I have heard of other instances which happened some time ago but are not worth going into now. If it was thought that this could happen very easily, it would cause a great deal of public disquiet.
It could happen that in a remote part of Ireland a man might put up a shingle outside his front door. There does not seem to be any provision in this Bill or in any legislation where a person can ask to see a doctor's qualification and if the doctor refused, the person could tell him not to practise there.
Last week a doctor told me that some years ago, not long after he had qualified, he was employed for some weeks as a locum in rural Ireland. Nobody asked him for proof that he was a doctor or that he was registered with the Medical Registration Council. That is an undesirable practice and should not be allowed to continue.
The Minister will agree that the 1927 Act has stood the test of time very well, particularly as so many sections in this Bill are, word for word taken from that Act. This Bill is updating the 1927 and amending Acts. In it we are introducing new sections, new obligations, expanding the size and role of the Medical Council and giving them the responsibility for post graduate training and education. We should also be taking the opportunity to ensure that no person can represent himself as being a doctor and no person or authority should be allowed employ somebody as a doctor without first seeing his certificate of registration issued by the Medical Council and being satisfied that he is who he claims to be. That was the reason behind this long and complicated amendment which has seven subsections.
The purpose of subsection (1) is to place on the chief executive officer of each health board an obligation to establish a roll of all persons engaged in the practice of medicine within the functional area of such health board and to verify with the Medical Council that those people are registered. I admit that that subsection would require the most work and would place a burden on the eight CEOs of the health boards on the setting up of the new Medical Council. They would have to prepare a list of all doctors working in any capacity in their functional areas, ask the Medical Council: "Are these 875 people qualified and entered on your register?" This would ensure that everybody working as a doctor is a registered doctor.
Under subsection (2), after the eight rolls were set up, if anybody wanted to practise as a doctor in a health board area, either in the public health service or as a GP, he would have to show the CEO a copy of his certificate of qualification, which we all agreed should and will be now issued by the Medical Council. He would also have to satisfy the CEO that he was the person he claimed to be and about whom the certificate related. I do not think that is any great burden to place on any doctor. Until he fulfils those conditions he should not be allowed to practise.
As well as placing an onus on the person involved, it would also place an onus on the health board and the employing authority, because they would not be allowed employ anybody until they were satisfied he was a registered medical practitioner. This would ensure that the example I gave earlier would not happen again. The purpose of subsection (2) of my amendment would be to prevent any employer or authority from employing a person as a doctor until he was registered and that the CEO of the health board was satisfied he was registered. Subsection (3) places upon the CEO the onus to verify the authenticity and up-to-date nature of the certificate of registration with the Medical Council. Where he is satisfied that the person to whom the certificate related was the person who applied for the position and that the certificate was up-to-date he would be obliged to enter the doctor's name on the roll in accordance with subsection (4) and to notify him that his name had been placed on the role.
The effect of the entire section would be that until that notification from the CEO arrived he would not be entitled to practise in the area of that health board. In my view that is a very reasonable and simple method of ensuring that all doctors in health board areas are doctors and are registered. The reason for subsection (5) is where a CEO is not happy that a doctor is registered or that the applicant is the person he claims to be there is no further onus on him to do anything more except to draw the attention of the Medical Council to the fact that there is an applicant in his health board area about whom he is not satisfied. The onus would then be on the Medical Council to take steps to investigate the authenticity or validity of that person's claim. It is fair that at that stage the CEO should not be involved any further.
The effect of subsections (6) and (7) would be that where a person has not applied to the CEO but sets up in practice as a doctor he could be dealt with. It is designed to deal with the situation where a person sets up as a GP. It is more likely that a CEO would hear of a person purporting to be a doctor if he applies for a position in the public service. Subsection (6) would deal with the person who puts a sign outside his door announcing that he is a doctor. If the CEO became aware of such a person and if that person had not shown him his certificate of registration as a doctor then the CEO could notify the Medical Council and get them to deal with the situation. Subsection (7) is concerned with persons who are qualified to be on the register, or were already on the register, and move to another area but do not bother to notify the CEO in the new area. The sort of situation I envisaged was where a person had been practising in the Eastern Health Board area and decided to move to Cork without giving any notification to the CEO of the Southern Health Board. In the event of a doctor acting as irresponsibly as that and not assisting the CEO in keeping the local roll of doctors up-to-date the attention of the Fitness to Practise Committee should be drawn to him.
The effect of the amendment would be to ensure that no person could set up as a doctor or be employed as a doctor and that no other person would be allowed to employ a person as a doctor unless the person involved proved to the satisfaction of the CEO in the health board area concerned that he had a certificate of registration from the Medical Council and that he was the person to whom that certificate applied. That would eliminate the sort of occurrence which took place in a health board area last year where a person was employed for a considerable time as a doctor but was not a doctor. It would also eliminate the problem referred to by Deputy O'Connell of a bogus doctor operating for a time until the attention of the registration council was drawn to his presence. It would also serve the useful function that the CEO of each health board area would know the qualifications of the doctors in his area. There was some discussion concerning the problem I raised earlier at a health board meeting.
It is beginning to emerge which health board it was.
Would the Minister like to tell me?
We know the Deputy is operating in the North Eastern Health Board area.
The Deputy will have to examine the geography on that matter. I have gone out of my way not to mention the health board area as opposed to others who brought us on a tour of the Third World a short while ago. I do not think we should be specific about things of that nature. At a meeting of the health board involved a medical member of the board tabled a motion calling on the board to initiate and maintain a register of new full-time general medical practitioners setting up in the area. In the course of a report an official of the board stated that they already had a full register of doctors in the GMS, a register of doctors in the maternity and infant care service, a register of doctors employed by themselves and some knowledge of other doctors. For that board to get their local register up-to-date all they had to do was to get full knowledge of those not in some way involved with the board. It would also be necessary to check that the people concerned were registered and had the necessary qualifications. After that the onus would be placed on any doctor moving into the area to present his certificate to the CEO. If the CEO was satisfied with the certificate he would issue a statement to the doctor to the effect that he had been entered on the local roll and could practise medicine in the area.
The amendment is an important one. The Minister has already agreed to my suggestion that a certificate should be issued in respect of each doctor registered with the Medical Council and this amendment is a progression of that. It represents a system of checks and balances. It is a check against employers taking on people who are not registered and ensures that they check thoroughly that they are qualified medical practitioners.
Progress reported: Committee to sit again.