Deputy O'Connell was in possession.
Medical Practitioners Bill, 1977: Committee Stage (Resumed).
Debate resumed on amendment No. 33:
In page 17, between lines 32 and 33, to insert the following subsection:
"(6) A patient's medical record shall be made available to the committee only with the consent of the patient, or of his parents, or of his next of kin, or of his legal guardian".
—(Deputy O'Connell.)
The Minister said I was putting up a very good case against my amendment but unless the Minister is prepared to include in the Bill a section stating that all meetings of the Fitness to Practise Committee are privileged it will be necessary to have such an amendment because a doctor would leave himself wide open to being involved in litigation with a patient. When I mentioned a specific case by way of illustration, I mentioned it as part of a clinical record and not necessarily the entire clinical record. There was an instance in Britain where a doctor, without the consent of the patient, a young girl, confided to her parents the condition from which she was suffering. He found himself brought before the General Medical Council on the matter. The Minister himself and the Department might consider providing that all meetings of the Fitness to Practise Committee would be privileged and that any information disclosed to such a committee would be privileged. That would be a better answer and would relieve the doctor of the risk of serious litigation. If the Minister would consider that it would be a great help. I think the Minister knows exactly what I mean. I am not trying to make it difficult for the Minister or the Department but they may produce an answer along the lines I suggest.
I can go some way to meet the Deputy. First, all these proceedings would be absolutely privileged. Section 46 states:
Proceedings under section 39 of this Act, reports made by the Fitness to Practise Committee to the Council under this part of this Act and any other communications between the Committee and the Council made in the exercise or performance of the powers, duties or functions of the Committee or the Council, as the case may be, shall in any action for defamation, be absolutely privileged.
I would be prepared to go further and suggest that if the Deputy would withdraw his amendment I would introduce an amendment on Report Stage but it will have to be very carefully drafted. The idea would be that a patient's medical record would not be made available to any inquiry by the Fitness to Practise Committee without his consent unless the production of the record is demanded by the committee under section 39 (5) (b). The Deputy will see what I am getting at. This would ensure that a doctor could not voluntarily produce the records. He could only produce them if they were demanded by the Fitness to Practise Committee: of course, he can produce them at any time with the consent of the patient but if that is not forthcoming he could only produce them if compelled to do so by the committee under section 39 (5) (b) and in that case they would be absolutely privileged.
That certainly meets my intention. It would be the complete answer and so I withdraw my amendment.
Amendment, by leave, withdrawn.
I move amendment No. 34:
In page 17, after line 52, to add a new subsection as follows:
"(8) The Medical Council shall publish a set of guidelines outlining in detail the offences for which a medical practitioner can be brought before the Fitness to Practise Committee and the procedures through which the public can bring a complaint to this committee".
I believe there is need for the Medical Council to publish a set of guidelines and in doing so to be more explicit about the various offences for which a medical practitioner can be arraigned before the Fitness to Practise Committee. One might say that a doctor is an educated person, fully experienced in life, and should know what constitutes good professional behaviour but some of the guidelines that were published previously by the Medical Registration Council were not very explicit as to what constituted professional behaviour. It would be a good idea if guidelines were published not only for the edification of the doctors but also for the public. Guidelines are all the more necessary because from now on a doctor may not only have his name erased; he can be disciplined, warned and advised about his professional behaviour, so he will need a set of guidelines so as to know what constitutes unprofessional behaviour in relation to neglect of patients and so on. Previously, doctors received a set of guidelines perhaps when they qualified and they were unlikely to read them more than once. This set of guidelines should be sent to doctors at regular intervals and it should also be made available to the public. Members of the public do not realise the various offences for which a doctor can be brought before the Committee. In this case there will be need for such a set of guidelines to be published in the public interest and in the interests of practising doctors.
There is a great deal of substance in the amendment proposed by Deputy O'Connell and it is a matter of some importance. It raises some fundamental questions. In relation to the last aspect of this question mentioned by Deputy O'Connell, in section 62 (2) it is stated that:
It shall be a function of the Council to give guidelines to the medical profession generally on all matters relating to ethical conduct and behaviour.
That aspect is taken care of. It will be a function of the council to lay down guidelines as to professional conduct and behaviour. I agree with Deputy O'Connell that this is very important and is perhaps becoming increasingly important because there are so many developments now in modern medicine that it is vital that practising doctors have the best possible advice available to them on the various issues that arise, moral as well as medical issues.
We will have to be judicious in the matter of the lodging of complaints with the council or with the Fitness to Practise Committee. We have to decide whether we will trust this council to do its work fairly and impartially and to serve the public interest as well as protecting the legitimate interests of the profession. That is the dilemma that will present itself to the council—to protect the public and at the same time protect the profession and professional standards. No matter what guidelines are laid down in the end it will all come back to whether or not this council will be the sort of council we want it to be and whether it will perform its functions impartially, objectively and judiciously. For the council to try to outline the sort of offences that a doctor might commit and for which he might be brought before the Fitness to Practise Committee would not be a wise procedure. The very publication of such a document would give rise to all sorts of disputes as to whether or not a matter complained of came within the terms of the guidelines. What Deputy Dr. O'Connell would be doing, if we accepted his amendment, would be restricting the freedom of the general public, although his intention is to try to help the general public. The very fact of a set of guidelines being published would almost certainly inevitably mean that on some occasions something would be left out or some matter would arise which would not come within the terms of the guidelines. It is much better to leave it open and to leave the general public free to raise with the council and with the committee anything that it feels should be brought to their notice without any restriction and then leave it to the judicial function of the council or the committee to decide whether or not a genuine legitimate cause of complaint exists. That would be my approach in this regard.
I am inclined to say the same thing about the suggestion about the manner in which complaints brought to the notice of the council or the committee should be defined. This would restrict the rights of the general public and the individual who had a complaint. The less formality in this area the better. The simpler it will be for an individual to bring a complaint before the council and the committee the better. One would visualise that a simple letter written to the registrar would normally be enough to activate the process.
I am not entirely adamant in regard to the second portion of the Deputy's amendment: the procedure whereby complaints can be brought. There might be something to be said for the council indicating how this could be done. I will consider that, but at this stage of debate it is best to leave it open, not to stipulate any formal procedure but to leave it as free and as flexible as possible so that any member of the public who feels that he has a complaint can just simply draw that cause of complaint to the attention of the council by whatever means is most convenient and appropriate in the circumstances.
I decided to put down this amendment not because this Bill was coming before the House but because the set of guidelines which the Medical Registration Council published are not available on a regular basis to doctors. I received a set when I qualified, and it was only then I began to look into the whole problem of the function of the Medical Registration Council that I sought another. I was astonished, as no doubt most doctors would be, at the guidelines that are laid down. They are very good. Doctors will need these guidelines more now because on committing an offence their names will not simply be erased from the register, but they can be admonished and warned in relation to certain practices.
This set of guidelines should be incorporated in the Bill. I doubt if any ordinary member of the public knows anything about the Medical Registration Council. The Minister and his Department might just contact the two medical organisations and they will inform them that most people just write to the two medical organisations who are unions or representative bodies protecting the interests of the medical profession. They never heard of the Medical Registration Council and I doubt if anybody here even knows the address of the council. The Medical Registration Council should make its whereabout known to the public. Members of the public write to the health boards and to their TDs in relation to unsatisfactory service from their doctors because they do not know of the existence of the Medical Registration Council. A set of guidelines will be necessary whether or not we leave it to the discretion of the council. Perhaps the Minister would consider some kind of amendment to ensure that it be made available to doctors on a regular basis to keep them alert. It is not restricting doctors' rights; it is improving the image of the profession and ensuring that doctors maintain a very high standard. Most doctors want that. Therefore it would be helping the doctor to improve his profession and the standard of practice of members. It is all in the interests of the medical profession and, just as in any other profession, we should aim to ensure that their high standards are good. A booklet sent at frequent intervals— perhaps once a year, every two years or even every five years—might be good. I got one when I was qualifying but, in those balmy days, one never bothered to look at it. I requested a booklet recently and that is the only reason that I got it. I went through it and was a little alarmed to find that I had been practising without knowing the number of restrictions. Perhaps it was my fault for not having checked but I never knew about it. To tell the truth, I do not remember receiving it when I qualified. I would assume that I did but it is very important.
With such a set of guidelines the Medical Registration Council should engage in quoting cases of doctors— not necessarily stating specific cases —who have got themselves into trouble due, let us say, to accidental neglect. In that way we would be ensuring that litigation against doctors would be on the decrease. It would be in the interest of the profession that it be done on a regular basis. The Minister might give some thought to inserting an amendment on Report Stage providing that it be sent to doctors on a regular basis.
The other important aspect is that the new Medical Council would make themselves or their presence known to the public. Nobody is trying to badger the medical profession. There is no intention whatsoever of doing that. But the public should know and the Medical Council should say: "We want to ensure that the public get what is right for them, that they get a fair deal. We want to ensure also that doctors are not maligned unnecessarily, so we will process claims, we will know of any complaints."
The present position is far from satisfactory with regard to that Medical Registration Council. I wrote to them about a doctor from Clonmel, a German doctor living here, who feels called upon by his friends—he is a registered medical practitioner in Germany—to prescribe for them. Occasionally friends come down to him and he likes to keep his hand in practice, as does many a doctor. I wrote to the council about him some months ago and, other than receiving a single line acknowledgment, nothing else has happened. I find this council most unsatisfactory and unco-operative. I can only tell the Minister of my experience in eliciting information from them, when I have found them most unsatisfactory. I even went down to them to see if I could bring about a satisfactory situation by explaining it to them. Therefore, I am afraid of leaving too much to them at their discreation. I should like to see the new Medical Council being an active one, upholding the good name of doctors, ensuring that high standards are maintained, keeping the public informed and ensuring also that their members are not maligned unnecessarily.
Perhaps the Minister could come up with some amendment providing that the public and doctors are protected and that both are kept fully informed. It is vital that doctors be constantly informed in the areas of ethical conduct where members might go wrong. Keeping any profession on the alert in that way is in the interests of the profession and the public alike.
I accept that it is important that the new council should be as helpful as possible to the medical profession in guiding them in their professional behaviour. There are so many new issues arising now this assumes increasing importance. That will be done under section 62. It will be a function of the council to give guidance to the medical profession generally on all matters relating to ethical conduct and behaviour. I will look at section 62 (2) again to see if it can be expanded. We are talking there purely in terms of guidance to the profession by the council. I have already accepted from the House the suggestion that something more should be done by this council to inform the public of their existence, to let the general public know more about how they can have access to it. I have accepted that in principle and I shall see what we can do between now and Report Stage along those lines.
I accept also that we should do something more in the Bill about informing the public about the way in which they can contact, have access to, the council. The appropriate place to do that is in section 62. Therefore, if the Deputy would leave the matter for the moment I will come along on Report Stage and see what amendments I can put down to that section to try to meet the wishes of the House in these areas. There is, first of all, the expansion or development of the function of the council in guiding the profession. Secondly, there is the question of letting the public know as much as possible about the guidelines the council have issued to the public and, finally, how the council should or could inform the general public more about their affairs without creating unnecessary nuisances for themselves.
I thank the Minister for his co-operation. On that basis I will most certainly withdraw my amendment.
Amendment, by leave, withdrawn.
Question proposed: "That section 39, as amended, stand part of the Bill."
Subsection (4) on page 17 says:
When it is proposed to hold an inquiry under subsection (3) of this section the person who is the subject of the inquiry shall be informed by the Registrar of the nature of the evidence proposed to be considered at the inquiry....
Could the word "in writing" be inserted after the word "Registrar", so that the person who is to be the subject of the inquiry would get the evidence in writing?
Yes, I think that is reasonable. If the Deputy will leave it I will consider putting it in on Report Stage. It seems a reasonable precaution to take.
Question put and agreed to.
SECTION 40.
I move amendment No. 35:
In page 18, line 5, to delete "practise" and to substitute "engage in the practise of medicine".
We have already dealt with this amendment.
Amendment agreed to.
Amendment No. 36 in the name of the Minister.
Amendments Nos. 3, 37 and 38 are all drafting amendments dealing with the same point. I move amendment No. 36:
In page 19, line 15, to delete "A person whose name" and to substitute "The name of any person which".
Amendment agreed to.
I move amendment No. 37:
In page 19, line 17, to delete "a person whose" and to substitute "a person's".
Amendment agreed to.
Amendment No. 38 is proper to section 43 so section 40 has to be dealt with first.
Question proposed: "That section 40, as amended, stand part of the Bill".
I wonder if the provisions of section 40 (1) (b) are not rather harsh. I realise it would be very unusual if the council were to write to a doctor and not receive a reply from him, or have a retention fee submitted by him, within two months of writing. It appears that the provisions of that paragraph are a little harsh and I invite the Minister to consider the matter.
I think he is entitled to a reminder at least.
The other matter is in relation to very important notices. This question runs through several subsections of this section and earlier sections and I referred to it last week. If it is self-evident that we should specify that the notice should be sent by pre-paid post, should we not specify that it be sent by registered post so that proof of delivery might be obtained? We are talking about the situation here where a doctor's name can be erased from the register which would prevent him from practising. Every safeguard should be taken to ensure that the notice has been properly delivered to the person who will be affected by the far-reaching provisions of this section.
There is a suggestion in this section that the medical practitioner may have to pay a fee on a regular basis to have his name maintained on the register. This is a very serious matter. A person qualifies as a doctor after many years of study and he has his name included on the register of medical practitioners. It appears to me that it is the intention of the Medical Council to charge an annual fee. If a doctor does not pay this annual fee, he will find he is no longer a doctor. This matter can be challenged in the courts. It will have to be changed in some way on Report Stage. By refusing to pay an annual fee of £20 a doctor may find his name erased from the register and thus he is deprived of his right to practise. This is a very serious matter because the person concerned has undergone intensive training for six years and a compulsory internship. He may also have carried out post-graduate work but because he will not pay the annual fee his name is erased from the register thus depriving him of the right to work.
The Minister may say there is no such intention but, unfortunately, there is a precedent for this in the General Medical Council in Britain where there were massive stirkes by doctors. They decided they would all withdraw and a very serious situation arose in Britain. I can see the same thing happening here. We must insert some provision to the effect that it will happen only with the consent of the overwhelming majority of the profession. It would not be right to leave it just to a council alone. There is a serious constitutional issue at stake here, the right of a doctor to practise. I do not think anyone has the right to deprive him of his failure to pay an annual fee to keep his name on a register. There is a principle involved here. To my mind it is unjust and possibly unconstitutional that one has to pay an annual fee to keep one's name on a register. By removing a doctor's name from the register, automatically he is deprived of the right to practise. I would be glad to hear the Minister's views on this matter because he can be more objective about it.
First, I wish to deal with the points raised by Deputy Boland. This is a matter of normal administration. The Deputy will note that under section 40 the professional person concerned must get two months notice and if he does not pay the fee as requested the council may decide that his name be erased from the register. He is given further notice of that decision under subsection (2). The person concerned gets two notices about the matter before he is finally struck off or removed from the register. I do not know if this is a matter on which we should go into too much detail in the legislation. Perhaps it is a matter that would best be left to the common sense of the council. I could not imagine them capriciously or irresponsibly removing a name from the register because of the mere inadvertence of the practitioner to pay his fee. However, I will look at the matter.
With regard to the question of the registered letter. I do not think we can accept that. Of course, there is expense involved but apart from that a person does not have to accept a registered letter. I understand that refusing to accept a registered letter is a device resorted to from time to time by certain people when they do not want to receive the communication in question for reasons best known to themselves. It has been found from normal routine of administrative practice that the way it is laid out in the section is the best way of dealing with the matter. However, I will consider whether it might not be desirable to put into section 40 some intermediate step between the first notification and the decision to remove the name.
I am at a loss to understand Deputy O'Connell's anxiety about the retention fee. We have already accepted the idea of the retention fee in section 25 of the Bill. That section stipulates that retention fees can be charged by the council. I might mention here that the level of the fee will be subject to my consent. The Deputy and I had a passage of arms about the provision regarding the consent of the Minister in other sections but, perhaps, he will agree that in that section it is desirable that I should have this authority to consent to the level of the retention fee and make sure it is not excessive. Subject to that, I cannot see any objection in principle to a retenion fee. No matter what organisation one belongs to——
This is not an organisation.
It is a registration body.
That is quite different.
It is the professional body of the medical profession. The doctor is asked to pay an annual subscription to ensure his retention on the register. The Deputy said he would be denied the right to practise but of course he will not be denied that right. All that will happen is that his name will be removed from the register and we already have had that distinction earlier in the debate, namely, the difference between the right to practise medicine and the right to be a registered medical practitioner and hold oneself to be a registered medical practitioner. If the doctor in question refuses or omits to pay his retention fee, he is prevented, with all the inhibitions that places on him, from holding himself to be a registered medical practitioner, but he is not prevented from practising medicine. I cannot share Deputy O'Connell's anxiety in this matter.
It is reasonable that a practitioner should pay some annual fee towards the upkeep of the council and that is best done by providing that he should pay a retention fee. I would have thought that this would be in line with the Deputy's thinking in regard to the council and their functions. As I understand it, Deputy O'Connell is anxious that there should be increasing contact between the practitioner and the council. In other words, that the situation he describes in regard to himself would not arise, that is, that a medical practitioner has contact with the council when he qualifies and never hears of them again. We would all like to think that there would be increasing communication between the council and the practitioner and to that extent the idea of a retention fee would be in keeping with that concept. Provided the retention fee is cast at a reasonable level I cannot see any objection to asking doctors to pay an annual contribution towards the upkeep of a body that is regulating their profession.
The Minister mentioned the altercation we had and I apologise for that. I accept that the council should undertake more work for the profession and the public. For that reason, public money should be given to the council. If a doctor's name is removed from the register because he refuses to pay a registration fee, has he the right to prescribe? There is no indication that the fee will be a nominal sum because the setting of it is left to the discretion of this body. If a doctor decided not to continue on the register, he would be an unregistered medical practitioner. Deputy Boland said that unregistered practitioners should not have the right to practise. Deputy Boland would want fines or imprisonment against them, but would they have the right to prescribe if they did not pay their annual fee? After completing six years in medical school and a one-year internship with, perhaps, another four years' post-graduate work, a practitioner may be irked by having to pay an annual fee of, say, £5. If he does not pay he will not be a registered practitioner or specialist. If he is a consultant, has he the right to work in a hospital? If he is a general practitioner, has he the right to engage in general practice? Will a pharmacist refuse to accept his prescriptions? All these questions need to be answered.
In Britain it caused a serious upheaval among the profession. They finally arrived at a compromise which was acceptable to the profession. The Minister's advisers should consider this problem. However, the Minister will dictate the policy of the Department and I only want his advisers to do the drudgery for him. I have not said that about any Minister for Health with the exception of the late Donogh O'Malley, who was a great decision-maker.
Would a doctor immediately regain the right to practise on payment of the fee? Many people have gone to prison over matters of principle. I heard of a lady in Britain who had paid her car tax but, due to a clerical error, she was told that she had not paid it and she went to prison. This is the kind of situation that could arise in regard to this matter.
First of all, the simple answer in regard to the question of prescribing is no. The matter is dealt with in section 53, which provides that any certificate which is required by any Act of Parliament should be signed by a registered practitioner and that it will not be valid or acceptable unless it is signed by a registered person. There might be prescriptions which it would be possible for a doctor to issue which would not come within the terms of section 53. Therefore, the effective answer is that unless a doctor is a registered medical practitioner he will not be entitled to prescribe. What we are getting at here is the validity of the registration itself. The Deputy mentioned the situation in the UK. My advice is that the situation in the UK arose because the doctors were not prepared to pay for inadequate representation on the council. Hopefully that situation will not apply here because we are giving reasonable representation to general medical practitioners.
There are precedents for the idea of a retention fee. It is provided for in the Dentists Act and in the Opticians Act. Deputies O'Connell and Boland agreed with the idea which evolved in the course of our discussion that doctors should have certificates which they should display in their consulting rooms, and we all regard that as desirable. Surely, a retention fee would keep a connecting link between the doctors and the council throughout their medical careers. On the one hand we will issue certificates and provide useful information from time to time on new issues, moral or medical, that may arise and in return, a medical practitioner makes a contribution to the finances of the council by way of a retention fee.
Deputy O'Connell has asked me to consider the matter again and I have agreed to do that. At this stage I am not persuaded that it is a draconian provision to ask a medical practitioner to pay an annual fee to have his name retained on the register. It is more or less an administrative matter that he makes this annual contribution to the cost and upkeep of his own governing body.
I agree that it is not a draconian provision to ask a medical practitioner to pay a reasonable fee. There is nothing in this Bill to suggest that the fee be reasonable. In section 25 I noticed that provision was made for a retention fee. That was fair enough but I did not see anything about the fee being on an annual basis. The first I heard about annual fees was when Deputy O'Connell mentioned it this morning. What upset me was that in his reply the Minister twice referred to the fact that it was intended that this would be an annual fee. It was not referred to in section 25 which was the section enabling a fee to be charged nor was it referred to in this section. If it was intended that there should be an annual fee, it should be written into the Bill. As the Minister now tells us that the fee should be on an annual basis, we shall have to look again at section 25 and at the provisions of paragraph (b) of this section.
I am not sure that I would be opposed to this fee being on an annual basis if I was satisfied it was of a reasonable nature but there is no provision to specify that beyond the fact which says that the fee which the council set must be with the consent of the Minister. Last week the House spent hours bemoaning the dreadful acts the Minister's successors were likely to carry out. We all know we do not allow the Minister's successors the sort of latitude we might allow the holder of the office at present. If a practitioner decided a fee was exorbitant—we must be realistic, I do not think many practitioners would decide that——
On principle.
A newly qualified doctor might find the fees more punitive than a doctor some years in practice and he might be a little remiss in submitting his retention fee if it were to be on an annual basis. That was why I said this is a completely new ball game and I suggested that we have another look at it.
I suggested that the provisions of paragraph (b) were rather harsh because if the council write to a doctor asking for a retention fee and do not hear from him for two months they may then remove his name from the register. They will write to him again to tell him they have done that——
They will tell him they have decided to do that.
He then has the right to go to the High Court.
He could send in the fee presumably.
At this stage we are talking about a doctor possibly becoming involved in a very expensive court action to have his name restored to the register because through inadvertence or lack of funds or any other reason his name was removed from the register.
When talking about the issuing of notices that may to a large extent affect the livelihood of a practitioner, it is important that there should be proof of delivery of the notice to the practitioner. The Minister said that there are ways around avoiding acceptance of registered letters. My recollection is that in previous legislation provisions are enshrined for the delivery of a notice which can have far-reaching effects on a person. The sections usually specify that there would be proof of delivery by registered letter or, in the event of nondelivery, the notice would be served upon the person or at the address at which he was last known to reside. There are provisions which cover this kind of situation.
Not only in section 40 but right through Part V of this Bill, we are talking about the livelihood of a doctor, his possible removal from the register and possibly discrediting him in the eyes of the public. Notice should clearly be seen to have been served on the doctor to give him every opportunity of complying with the necessary conditions. It is not enough to say that if he is upset by having a second notice served on him telling him he will be removed from the register he may then apply to the courts. After the second notice is served, it is not clear whether from that time until the 21 further days have elapsed he is removed from the register after the provisions of subsection (2) apply or if he is not removed from the register until his appeal period of 21 days have elapsed.
The point Deputy O'Connell raised brings us back to the long discussion we had last week as to whether a person who is not a registered practitioner should have the right to practise medicine. The Deputy went a little further than I intended when he said I suggested that a person who was not a registered medical practitioner should not practise medicine. What I was saying in a layman's way was that I did not think he should have the right to prescribe drugs. I am not sure that I accept the Minister's point that if he is not a registered practitioner, under the provisions of section 53 he cannot prescribe drugs. I think he cannot prescribe drugs specified in their recent Dangerous Drugs Act. I imagine that is the legislation the Minister is referring to. I am sure not every drug is covered by legislation. If the Minister checks this, he will find that it is only those drugs specified at that time as being dangerous that he could not prescribe.
That is what I said.
As Deputy O'Connell knows, there are new drugs coming on the market every day. Many drugs that may be dangerous may not be specified under the recent Dangerous Drugs Act.
In my opinion that doctor is not prevented in any way from prescribing those or any drugs. I cannot see how he is prevented from practising as a surgeon simply because he is not a registered medical practitioner. This is a very important area which the Minister's advisers will have to look at before Report Stage. They will have to make it clear what people who hold themselves to be medical practitioners should be allowed to do if they are not registered with the Medical Council.
We should approach this the other way: what they should not be allowed to do if they are not registered.
It depends which side you look at it. The Minister must be aware of the anxiety of Members on this matter which arises under this section and, perhaps, even on subsequent sections. This will have to be cleared up. It is not enough to say that as long as a doctor is registered everything is all right, and if he is not registered we are into shades of grey. The Minister has made it clear that if he is not registered we are in shades of grey as far as his right to prescribe drugs is concerned. He will not be allowed to prescribe the dangerous drugs specified by statutes. He is not prevented in any way from prescribing any dangerous drugs which have come on the market since that Act was passed. As I said, I am not sure he is prevented from practising as a surgeon or as a physician of any sort.
I think this section will be declared unconstitutional by the courts. We would be very foolish, where there is the slightest doubt about it, to proceed with a section if the question of its constitutionality arises. We are talking about a small council who are elected for five years and if a doctor feels dissatisfied with the annual retention fee being demanded by the council—I am sure Deputy Browne will come in with me on this issue because of its importance —and he does not like the representatives on the council he can do nothing about those matters for five years. The council can charge an exorbitant fee because there is no limit. If a doctor does not pay the annual retention fee —I assume it will be annual because the Minister gave every indication that it would be—his name is removed from the register and he is deprived of the right to practise. What happens if he is a surgeon? Has he the right to work in a hospital? Will he be deprived of his livelihood? The question of whether or not he has a right to practise is a serious constitutional issue.
In this regard the question of prescribing drugs also arises. Can he prescribe life-saving drugs for a patient? Such a person is competent to deal with these drugs, knows about them and has been trained in the use, the benefit and the adverse effects of drugs. Such a person may have had ten years post-graduate experience as a surgeon or physician but he is deprived of the right to practise here by virtue of this section because he considers, as a matter of principle, that the Medical Registration Council were charging too much to keep his name on the register. Because this raises a serious constitutional issue the Minister should have another look at this section.
The point raised by Deputy Boland about notifying the doctor is a good one. I suggest to the Minister that a copy of the letter notifying the doctor be sent to the relevant medical organisations also. In this way they would make contact with the doctor and it is another way of ensuring that the doctor is notified. I suggest that an amendment be inserted for Report Stage on the lines that the retention fee must be approved by the overwhelming body of the medical profession.
Would the doctor not be entrusting too much to human nature in that way?
If this Bill is passed, the Medical Council are set up and if they decide to charge every doctor £100 what is the position?
I have to consent first to it.
Would it be fair if the Minister had to make a draft regulation concerning this which had to be laid before both Houses of the Oireachtas?
The Minister may say that the fee is justified by virtue of all the expense we have called for in the work of the council but if 70 per cent of the doctors decide not to pay this fee we would then have that number of unregistered medical practitioners. That would be serious. If that happened there would be dismissals en masse from the health boards because the doctors would be dismissed automatically if they were not registered. The health service would then be in a state of chaos and the Minister would have to introduce a new Bill to regularise the matter. This is not a hypothetical case because I can see doctors objecting strongly to anything that would infringe on their rights to practise. They might find that they are not getting value for money. It should be remembered that this Bill is to protect the public as well as the doctors. If 70 per cent of the doctors decided not to pay the fee an emergency situation would arise and none of us wants that to happen. I do not wish to pose problems for the Minister all the time but there is a danger that this would be declared unconstitutional. The section should be amended to relieve the problem.
I can allay the fears of the House on a number of issues. First, the House need not worry about the constitutionality of the section. The section has been carefully drafted from the constitutional point of view in full consultation with the Attorney General and the legal advisers. The bringing of the High Court into section 40 ensures the constitutionality. The fact that subsection (3) provides that a person has immediate access to the High Court, I am advised, ensures the constitutionality of section 40. I ask the House to accept that as the position. However, these are matters which can only be resolved in practice as the legislation comes into effect over the years. On the other issue of the retention fee. I believe Deputies Boland and O'Connell are straining at gnats. Deputy Boland kept reminding me that I mentioned an annual fee on many occasions. I visualised that it would be an annual fee particularly in the context of the issuing of a certificate and so on. Of course, there is nothing in the Bill to stipulate that it need be an annual fee and, perhaps, it will not be an annual fee. First, to a large extent this is a democratically elected council. The doctors will elect their own body from now on and it is going too far to suggest that such a body with a strong representation of elected general practitioners would, in the first instance, attempt to promulgate an onerous, draconian or excessive fee on the profession. It is going too far to think that that would happen.
Even if the council proposed doing that they would still have to get the Minister's consent to the level of the fee they proposed. If any further safeguard can be built into section 25 I will put it in but at this stage I am not convinced that anything further is necessary. The idea of a retention fee is pretty well inherent in this whole new concept of this council. Deputy O'Connell pointed out that the existing situation is absurd, that a doctor comes into contact with his council the day he qualifies and from then on he never hears of them again, he does not even know where their head offices are.
I did not say doctors; I said the public do not know.
We are trying to get away from that. We are going to have elections every five years.
We always had those.
I am just painting the general picture. We are going to have more comprehensive and meaningful elections every five years. Doctors will be issued with certificates which they will display in their consulting rooms and guidelines will be issued for their information. Hopefully, there will be a great deal more communication both ways between the council and the profession. In those circumstances a retention fee makes sense. Deputy Boland made a point about the level of the retention fee and felt that it might be onerous for a young doctor starting off in practice. The whole idea of a retention fee is to deal with that situation. If we did not have an annual, bi-annual or tri-annual fee then the initial registration fee would have to be all the higher. Hopefully, the initial registration fee can be brought down if there will be a subsequent retention fee at periodic intervals. From that point of view, the idea of a retention fee is a good one. Deputy O'Connell is worried that doctors as a whole might not accept this. I would contrast the situation in regard to doctors with what happens in the case of solicitors. They not only have to pay an annual subscription to their governing body but every solicitor in practice has to contribute very heavily to a compensation fund.
So do doctors, otherwise they are not allowed to practise.
Not under this legislation.
The Minister has got to know that doctors have to take out special insurance in order to be allowed to practise or to work in any hospital.
The Minister is in possession. Deputy O'Connell may speak afterwards.
That is an entirely different matter. By statute there is established a compensation fund which must be adequate fully to compensate any person who is defrauded by a solicitor in practise. Solicitors not alone have to pay their annual registration fee but have to contribute a varying sum every year to make sure that the compensation fund is adequate. We are not providing in this legislation any compensation fund for the general public.
Doctors do not hold money for patients in the way that solicitors do for their clients.
That may be but I am talking about the respective contributions that professional people must make. All we are asking here is that doctors will pay some retention fee to have their names retained on the register. I am contrasting that with the fact that solicitors must pay a fairly substantial annual registration fee and, in addition, have to make a statutory contribution to a compensation fund which must be adequate to compensate anybody who is defrauded by a solicitor. Deputy O'Connell says that doctors do not hold money; they hold something far more precious—the lives of their patients.
Money will not compensate for life.
Deputy O'Connell may speak when the Minister is finished.
Doctors could by their negligence cause injury to a patient which could be far more serious that the loss of the patient's worldly goods.
That is why they have to pay for insurance.
Is the Minister suggesting the setting up of a compulsory fund?
No. There is no compulsory fund involved in this legislation. I simply wanted to contrast the situation of doctors and solicitors. Deputy O'Connell suggested that this is unnecessarily onerous on the medical profession and that they might reject it. I have no fear that they will reject it, provided that it is a reasonable fee. The fact that the council are to a large extent democratically elected and, secondly, that ministerial consent must be forthcoming with regard to the level of the fee will ensure that the amount of the retention fee will not be excessive, onerous or draconian.
I will have another look at section 35 to see if there is any further safeguard which should be built into it. Deputy Boland reiterated his argument about the removal of a doctor's name when he had been given notice only once of his failure to pay the retention fee. If it were left to myself, I would leave that matter to the commonsense and sense of fair play of the council. We must assume that they will be a reasonably responsible council, having the interests of the profession at heart just as much as any other obligations. I think they will not act irresponsibly but perhaps there should be some intermediate stage between the two months' notification and the High Court. I will see if something else can be inserted there which would be a protection for the doctor who might be remiss in paying his retention fee, but something which would not be administratively onerous on the council. This has been my fear. I do not want to load this council with too many statutory restrictions on their day-to-day operations but if it is possible to build in some intermediate stage between the initial notice and the removal of the doctors name, then I will do so.
The Minister makes the analogy with the solicitors which I consider is not a good one. Before a doctor is allowed to work in a hospital he must take out indemnity insurance with the Medical Defence Union or the Medical Protection Society. They are the two bodies to which he pays a hefty annual fee because of litigation dangers at the moment. He pays into a compensation fund. It is the first thing he does. Last year as much as £33,000 was paid by way of compensation in respect of negligence in Ireland. Every doctor contributes towards this, whether it is called a compensation fund or litigation insurance.
Solicitors pay a registration fee to the Incorporated Law Society, who also represents their interest. Doctors have two bodies representing them as well as the council. They are negotiating bodies, the Medical Union and the Irish Medical Association. It is not correct to say that doctors do not have to pay into a compensation fund. The body to which the solicitors contribute also represents them. I cannot vouch for that fact but I assume that this is the situation because I do not know of any solicitors' protection body or association which represents them in negotiations with the Department. I am open to correction on that.
I hope that something can be built into this on Report Stage which will meet Deputy Boland's point that a doctor may not have been informed, even though the letter may have been sent. Perhaps a copy should be sent to the medical organisations representing the profession. This might be a way of meeting this point.
With regard to the retention fee, we must decide whether it is to be annual, bi-annual or tri-annual. This should be stated in the Bill. Secondly, the consent of the Minister is not necessarily the best guarantee that this will be a normal fee. Perhaps we could provide that the Medical Council in consultation with the medical organisations representing the profession would ensure that the fee would be acceptable to the entire profession. This may not be the answer and the Minister may come up with something much better.
Regarding the Minister's statement that he knows this is constitutional, none of us can know. How can we know? How often have Bills gone through this House the constitutionality of which we all felt sure could never be contested? We cannot state categorically that we know a Bill is constitutional. The Attorney General has been wrong on many occasions.
Not this one.
If I may say so, the present Attorney General was not involved in the drafting of this Bill.
On this point he was.
He is fallible like the rest of us and we cannot say definitely that it is or is not constitutional because it can only be decided in court. We should remember and take into account the fact that it may not be constitutional. Perhaps some safeguard could be built into it because I should hate to see a situation arising here as in England. It does not matter to me personally—we are not all immortal.
Perhaps the Deputy is anticipating some political development.
A man who thinks he is immortal is a fool. How can we seek registration in another country if we are not registered in Ireland?
Is the Deputy thinking about Strasbourg?
Far from it. I am thinking about my age——
The Deputy should not tell us anything damaging about his age.
The Deputy's age does not arise on the section.
When this problem arose in Britain there was a great danger of a complete breakdown in the hospital service when doctors refused to pay the retention fee. If 78 per cent of the doctors here took a similar attitude our hospitals would not be manned and there would be chaos. We should legislate for all eventualities. We should anticipate situations like that in Britain arising here. The Minister may say that the council would be reasonable, but I do not think this is the right way to legislate for a situation like that.
It might seem irrational to some people if one took up a position against what the section provides. It states that the Medical Council may decide, and that presumably means giving discretion to this predominantly medical body. The Minister could say reasonably that the profession need not have any fears because they will be judged by their peers. I do not understand why such power is given to the Medical Council. The section, in subsection (1) (a), deals with the Fitness to Practise Committee, and inability or omission to pay by doctors is being put on a par with criminal activities by doctors. We could deprive a person of his ability to practise as a doctor, simply because he had not paid his bills.
It seems to me to be terribly unreasonable and the penalty is grossly disproportionate to the offence. A person might not have the money to pay or he might not like to admit that he had not or he might forget to pay his bills and we should not equate such inability with criminal activities, with malpractice, with the various crimes of which doctors can be guilty. This could lead to very serious consequences for doctors and it seems to be completely irrational. It is like telling a Deputy if he cannot pay his restaurant or bar bills he cannot be a Deputy any longer.
I cannot see the purpose of this. Is the idea behind this provision to give power to the Medical Council, set up by law, to force the medical profession to pay? Let them pay if they want to. The Minister referred to the tolerance, understanding, wisdom and all round knowledge of the Medical Council and the work they would have to do, and he asks if they cannot be trusted to decide on this question of payment. Then, why must this power be incorporated in the law? The Medical Council can be reminded that they are not discharging one of the provisions of the law under which they were established, but the Minister may have a successor who would not have good relations with the medical profession. He could penalise them, reminding them of this clause.
Leaving all that aside, it does not seem to me to make sense to provide that you can take away a man's practice because he cannot pay his bills. This power is to be given to a body which will monitor the course a doctor has taken, involving six or seven years to get his MB and another four or five years to get a consultancy. The Medical Council must decide such a person is competent and skilled before being allowed to practise and then, because of some quirk on the part of some person who says he will not pay, or because somebody cannot pay and does not want to admit it, his right to practise is to be taken away.
It is his retention fee that is in question.
You cannot take his qualifications away.
He is entitled to earn his living.
He cannot be prevented from practising for this reason. He is only being deprived of the benefit of registration.
In effect he is being deprived of the right to practise.
The benefits of registration are considerable. We all know that a doctor could not get a local authority appointment or any other prominent job without being registered. Therefore, registration is an important function for a doctor but if the clause is unimportant why include it in the Bill?
The provision is that the council may charge, but they may not charge this fee at all.
In those circumstances why not leave it to their discretion?
That is what we are doing.
Why include it then? A Minister may decide at some stage to say to the council: "I cannot pay your bills for you. You can collect from these people. Charge them, say, £100 per year. I will pay 60 per cent and you collect the remainder." That would leave the council with no alternative.
We accept totally that a doctor who is found guilty of a serious charge should have his right to practise taken away. This is provided for in paragraph (a) but is it proper to include in the same section under paragraph (b) the provision to have removed from the register a man who has not paid his registration fee? Is this not disproportionate? As Deputy O'Connell pointed out in the case of auctioneers and solicitors, for instance, there are considerable sums of money involved. Consequently, a considerable pool of money must be established in order to ensure that in the case of a defrauding solicitor, for example, clients will be compensated. What is the purpose of the change here? I do not recall paying a fee since I paid my registration fee initially, which was then about £5.
Perhaps I could intervene here to remind Deputy Browne that a fee of the nature we are talking of here is paid by such people as dentists and opticians. The provision is in line with modern developments. It is our wish that there be an active council. I have been trying to explain all morning that we wish to bring about a situation where there will be communication between the profession and the council. This democratically-elected council will have many functions to perform in relation to the profession in regard to guidelines, controlling behaviour, controlling professional conduct and so on. Surely in such circumstances it is legitimate that some sort of ongoing fee be paid by the members of the profession in order to keep in being what is their council. A register must be kept. Therefore, a registrar must be paid.
A registrar has been paid during the past 50 years.
There will be annual outgoings. Therefore, is it not a simple self-explanatory concept that a profession pay some ongoing fee? I have been talking about an annual fee but that has been objected to. Should they not pay some continuing periodic contribution to meet the expenses of the council who govern their affairs and who exist largely for the benefit of the profession? It is a principle of general application throughout the whole professional world and throughout the trade union world that if one is a member of a body of this sort, one's own professional or vocational governing body, one pays a continuing fee to meet the expenses of that body.
But there are bodies doing that.
Deputy Browne is in possession.
I am sorry but I intervened merely to explain the position about putting the two provisions in juxtaposition. Of course they have no relationship to each other in terms of degree of importance. One relates to a situation in which a doctor is found guilty of professional misconduct and as a result is struck off the register, perhaps for life, while the other relates to a simple inadvertance to pay a retention fee in which case the doctor is restored to the register by paying the fee. Both provisions are in this section purely from the point of view of convenience of drafting. Because of the constitutional issues to which Deputy O'Connell adverted both provisions have related to them the right of access to the courts for restoration. Without this provision the Bill would be unconstitutional. In other words, in relation to an erasure from the register, if there were not the right of access to the court for the purpose of restoration, the section would not stand up. Deputy Browne knows enough about drafting and legislation to know that this is common practice. The fact that different provisions are included in subsections that are adjacent to each other is of no consequence in relation to the severity or to the importance of the provisions.
Deputy Browne is in possession.
This is an ideological principle. There is no rationale other than the sort of idea that everybody must pay for everything he gets, that otherwise, he will not appreciate fully what he is getting. There is nothing to prevent the Minister from setting up a disciplinary council of this kind to decide on levels of practice and training. There is nothing to prevent him from funding such a council. I do not expect that the fees that will be payable under this legislation will be sufficient to pay for what I would imagine would be enormous expenses in respect of the personnel and the administrative services of an organisations such as this. Therefore, there is no rationale other than a political or an ideological one in the provision. In a sort of actuarial sense has the Minister any idea of the percentage he will be expecting the medical council to raise——
Everything.
——and does he think that there will be permission for this to be varied? The Council could, for instance, ask for a nominal fee of £5 in the event of a statutory fee not being imposed. If I were on the board, perhaps I would get round the matter by asking for a fee of about 50p, thereby making the whole thing so ridiculous as to be irrelevant. In such circumstances, what could the Minister do? I would be paying something like 0.001 per cent of the actual cost of running this institution and the Minister would not have the power to do anything about it.
Doctors are being put in the position that in the event of their not accepting whatever the Minister decides on, they will be denied, effectively, the right to practise. That is most unjust. Many doctors would gladly pay a fee voluntarily. We do this already in respect of the Medical Defence Union, the Medical Association and the Medical Union of which all of us are members.
We accept that we must pay fees; if a body like this is set up by the Minister and decides that there will be a fee of some kind the majority would pay that fee. For the minority why cannot we just leave it that they take action in the courts to recover money if they want to? There should not be this draconian decision to deprive a person of his right to practise. There are other ways than depriving a person of his professional status because he does not pay his bills.
Some time ago Deputy O'Connell said that the only person who could say whether a Bill was constitutional or not was the Man Above.
I did not say that. I said it was the courts. I said that we are not infallible, that it is only the Man Above who is infallible.
The Deputy did say that the only one who could be certain that it was constitutional was the Man Above. The Minister twice said that he was certain that the Bill was constitutional. Wherever the Minister is going on this section I do not think he has got up there yet. I am a little taken aback that he was so emphatic.
I am sure I did not say that.
I am afraid we have no appeal to that court.
On a point of information, if I said that, I should not have said it. I hope I did not say it. All I meant to convey was that I am fully advised by my legal advisers that this Bill is as constitutional as it can be.
We will have a look at the record. My recollection is that the Minister stated that the Bill was constitutional, that the Attorney General had said that it was constitutional and that the Attorney General was right. The reason for the delay of the appearance of this Bill for a long time was the doubt about the constitutionality of the entire section 25 of the Bill. Last week the Minister spoke about this being his Bill and his decision. It is now, but it was kicking around for a long time while the constitutionality of these sections was being considered and the sort of questions being asked in the House for the last hour or so, were being asked in private.
I went into all those issues in 1960 on the Solicitors Bill.
If the Bill was delayed for months to check this out the House should be entitled to talk about it. Section 25 provides that the council may charge fees with the consent of the Minister. The House might feel happier about it if that section provided that whenever the Minister gave his consent he did so by way of making regulations which would be laid before the House, under section 25. That might be a way of meeting the objections that have been brought up. Members are concerned that the fee might be so repetitive and exorbitant as to persuade doctors not to pay it.
The other and more vital question on this section still has not been answered. If a person is removed from the register and is no longer a registered medical practitioner is he entitled to practise as a surgeon? Is he entitled to prescribe any drugs that are not mentioned in statute as being dangerous drugs?
The answer is yes. The provisions are in sections 52 and 53.
That is what we have been shying away from. The Bill purports to decide whether a doctor can practise or not, but when it becomes law it does not really decide. Under the provisions of section 39 the Medical Council is going to set up a Fitness to Practise Committee which will not be a Fitness to Practise Committee at all but a Fitness to be Registered with the Medical Council Committee. If the person is removed from the register he is still entitled to practise. We are purporting to represent to the public by the terminology used in earlier sections that the person who is removed from the register under the provisions of section 25 or who is temporarily suspended from the register will no longer be able to practise as a doctor in any shape or form and that in that way we are protecting the general public against the doctor who, for one reason or another, should not be allowed to practise. We are not really protecting them at all. I spoke about this at length last week. At the time the Minister said that this was not a Bill to do it. I would like to know what is the appropriate legislation whereby the public should be protected if it is not legislation that talks about a Fitness to Practise Committee.
We are on section 40 at the moment.
We are talking about the erasure of doctors from the register, and I am suggesting that doctors being erased from the register are not being prevented from practising. If the Medical Council sees fit to remove a doctor from the register for any reason his removal should prevent him from practising and certainly from prescribing dangerous drugs and carrying out dangerous operations.
With regard to dangerous drugs, it does.
Those are drugs known to be dangerous at the time of the passing of the Act. He is not prevented from prescribing any that will come on the market subsequently. He is not prevented from practising as a surgeon. I suggest that he should be. I appreciate the constitutional difficulties, but if in section 25 we are representing ourselves as protecting the interests of the public as well as the interests of the medical profession. some attempt should be made to ensure the public's right to feel that if a person is, as they know it, a doctor, he is really a registered medical practitioner and that, if they are placing their life in his hands, there is some form of legislative control over how he goes about his business. This section, with the power of removal, purports to do that and it does not do it. I do not know exactly how it could do it, but I am suggesting to the Minister that before the Bill comes back on Report that area must be looked at again.
This section of the Bill will hold us all up to ridicule and it can have very serious implications. The constitutionality of it is in question. I am not infallible, but it seems that if I do not pay the registration fee or the retention fee of say, £5, I am a fully qualified, competent and practising doctor, and if some Member of this House has an acute heart attack and I rush with my supply and give him a shot of morphia, I can find myself in prison. I can find myself in prison if I carry out some life-saving measure as a competent, qualified, practising doctor, because I am prescribing a dangerous drug. Morphia is a dangerous drug, so I am precluded from prescribing a life-saving drug which will prevent shock in a seriously ill patient. If a surgeon does not pay the £5 or whatever the retention fee is and he arrives at the scene of some serious accident and he gives an injection of a life-saving drug he can find himself in prison. We are trying to equate this with professional misconduct, and this is the danger.
The Minister is inclined to confuse the Medical Council with a medical protection body such as the Irish Medical Association or the Medical Union. There is no comparison. They represent the interests of doctors. This represents the interest of the public. This measure is to ensure that standards are high. This body want to ensure that doctors are properly qualified, not that they are not registered. They want to ensure that doctors are educated and trained properly and have the proper experience and skill and that they behave properly in a professional manner. That is what this council is all about, but then they decide to put a man in prison because he does not pay the fee. They have decided the standards for that doctor. If he does not pay £5 a year or whatever the fee is, he can go to jail for carrying out functions the standard for which they have laid down.
It is absolutely ludicrous to incorporate this in a Bill. There is no parallel for it. The Minister may find himself in a very serious situation if the doctors refuse to pay this money. I believe the constitutionality of it is in question. I know of a taxidriver who was deprived of his right to drive a taxi because there was a question about his morals. He appealed the case to the court and won his right to carry out his work. He got his taxi licence back. I remember making representations on his behalf and failing. The only suggestion I could make then was that he would take his case to court, which he won.
I believe a doctor could take his case to court and prove that he was being deprived of his right to practise. What would happen in a case like that? Would we look foolish? We must make sure that anything we do in the House does not conflict with the Constitution. I believe this is one area where it can. If I do not pay my yearly fee of £5 I could go to jail. If the Minister was ill and I went to his aid and prescribed a drug which I am competent to do——
Which the Deputy has done.
I would do it over and over again with anybody because that is my duty as a doctor. I could then find myself in jail under the provisions of this Bill. The body is set up to decide standards and professional behaviour. It suddenly jumps in with deciding an annual fee.
I do not want to create problems for the Minister but I see a problem arising here. I would rather see the council taking more care of the public, acting more on their behalf and making sure that standards are high and in return let public money go into it. I want the public to be involved in this. I want the public to be represented on this body. When the council act on behalf of the public, public money should go into it. The Minister could then decide what would be adequate remuneration for officers of that body. I ask him to have a look into this matter and in some way protect the doctor who is fully qualified. I am sure that Deputy Boland agrees that there is no comparison between a fully qualified doctor who is not registered and one who is not qualified. He is a surgeon or a cardiologist but he cannot go to the aid of the public.
I want to make my final intervention. This is my last word on this matter. First of all, does Deputy Browne realise what he is suggesting? He suggests that the cost of running this council from year to year should be inflicted on the taxpayer. If there is no retention fee or some other way of getting money to run the council, received from the profession, the taxpayer will have to pay the cost. I do not believe anybody would accept that.
We are giving the profession the right to govern themselves, as I have already said, to control their own affairs, control their own behaviour, control their professional standards and control their own education. The least they might do is pay for that. That is the whole principle in the Bill. We propose to do it by means probably of an initial registration fee and a subsequent retention fee. I cannot see any great difference in principle between a registration fee and a retention fee. If you pay to go on a register there is no great difference in principle in paying to stay on the register, particularly if the two can be used together to ensure that the burden does not lie all that heavily on the young man or woman coming into the profession for the first time.
One could, as happened in the old days, pay £1,000 on one's initial registration and never pay anything after that but I do not believe the House would like that. I believe the idea of a registration fee and a retention fee to pay the outgoings of the council is a common-sense approach to this matter. I have already pointed out to Deputy Browne that this principle applies to dentists, opticians, and, I am sure, to many other professions. It certainly applies in the case of solicitors. Who else is to pick up the bills for the annual outgoings of this council if not the taxpayer?
Those are the two options. It is very fitting that we entrust the profession with the regulation of their own affairs and therefore they should pay for it. If I came along to the council, as Minister for Health and said that I wanted them to do this that or the other in the public interest I should pay them for that. If there is something not in the Bill which I want them to do over and above their normal duty of regulating the profession then I should provide money out of the taxpayer's pocket for that purpose. The sensible, practical way of running this council in the normal course of events is for the profession to provide the money to pay the outgoings and expenses. If Deputies accept that a registration fee should be payable on registration, then in principle there is not one iota of difference between that and paying over a period of years by way of retention fee.
I want to come to the constitutionality of the matter, and I hope clear up the issues here. I believe the Bill goes as far as it possibly can in seeking to ensure its own constitutionality. The provisions of section 40 are very clear and explicit. First of all, if the council wish to remove the name of a practitioner from the register for either of the two reasons—because of a finding of the Fitness to Practise Committee or because the practitioner has failed to pay his retention fee—it must go to the court. There is no question of removing people facilely from the register. The procedure must be as follows. First of all, the person concerned must be notified. That person then has 21 days in which to go to the High Court and ask that the removal is not proceeded with. If the person does not do that the council must go to the courts, ex parte, and ask that the removal be proceeded with. The court must come into it. If that falls down constitutionally I should be very greatly surprised.
Could I ask the Minister to go over that again?
Certainly. The procedure is as follows. If the council, for one of the reasons which we know of, decides to remove the name of a person, the council must notify that person. That person then has 21 days to go to the court and ask for an order that his removal is not proceeded with. If the person does not do that the council still has to go to the court ex parte and ask that the council be allowed to go ahead with the removal. One way or another the court is involved in the procedure. The person's name cannot be removed from the register without the authority of the court to do so. Constitutionally that is as far as we can possibly go in this area.
Where does it say that?
That is the effect of all the subsections. That is the combined effect of subsections (2), (3) and (4). Subsection (4) provides:
Where a person to whom a decision of the Council under this section relates does not, within the period of 21 days beginning on the date of the decision, apply to the High Court for cancellation of the decision, the Council may apply ex parte to the High Court for confirmation of the decision....
They may.
Yes.
Only may. What if they do not? That is important.
For their own protection they will.
Not necessarily. Why do we not say "will" instead of "may"?
In this context "may" is equivalent to "will". To come to the point of my stating I believed this is constitutional, I have been over this whole ground before in regard to the legislation governing solicitors. I know all the discussions and all the to-ing and fro-ing which took place on that occasion. When I was presented with the draft of this legislation, I said I wanted to be abso lutely sure we would not have any constitutional difficulty on this legislation. I went back again to the present Attorney General and ensured that, in so far as he could devise the procedures, they would be sacrosanct from the constitutional point of view. That is the history of the matter.
That is only his opinion.
Of course it is only his opinion. From my own inexpert knowledge of the situation, I do not think these provisions can be assailed from the constitutional point of view. I am reasonably certain of that, and the Attorney General is equally convinced that they are as watertight constitutionally as we can make them. Perhaps we could leave it at that and accept that, in so far as the House can ensure it these provisions with regard to the retention fee will stand up.
Then we are left with the profession. I should be very considerably surprised if this new council, constituted as it will be with a considerable elected element acts in any foolish or improvident manner, or if it even attempted to fix a retention fee at a level which would be unacceptable to the profession. I would be even more surprised if the council fails to measure up to the standard we expect from it in that regard and if the Minister is equally improvident and unwise and agrees to a fee which is unacceptable to the profession, a draconian or unnecessarily onerous fee. If all these things happen, we are dealing with a period of five years only, and the council can be thrown out after the five-year period by the electors and the Minister can be dismissed, as Ministers have been dismissed, by the people.
I really think we are pushing this thing a bit too far. If Deputy Dr. Browne is prepared to accept in principle a registration fee for going on the register, he cannot in principle object to a detention fee, particularly as a man cannot be removed from the register, in effect, without the authority of the court. In effect, you cannot go off this register without the authority of the court.
He could be removed and the court might restore his name.
The person concerned can go to the court and say "Do not permit the council to remove me from the register."
The court would only be restoring his name.
No. The subsection reads:
Where a person to whom a decision of the Council under this section relates does not, within the period of 21 days beginning on the date of the decision, apply to the High Court for cancellation of the decision ...
"cancellation of the decision". He has not been removed. It is only a decision to remove him. What happens is that the council decides to remove him, conveys that decision to him, and he then has the right, if he wishes, to go to the court and say: "Please do not permit the council to remove me" or, if he does not do anything, the council then goes to the court and says "May we now proceed? Please let us confirm our decision to remove this man." I do not think we can go much further than that.
I would have thought from Deputy Dr. Browne's point of view that the fact that paragraph (b) is put in in close conjunction with paragraph (a) is a protection. Even though it is as simple a matter as a failure to pay a retention fee, by virtue of its inclusion in this section it still gets the full protection of the constitutional court provisions. Removal for non-payment of a retention fee gets the same protection, the same safeguards as serious misconduct found to be so by the Fitness to Practise Committee.
Why should the council not have this right to remove a person who does not pay a retention fee? Let us accept for a moment that the retention fee is fixed at a reasonable, sensible, rational level. Is it right in a profession that 70 per cent or 80 per cent of the decent people should pay their retention fee and the council has no way of compelling the shysters to pay theirs? Surely that is not acceptable. Let everybody pay the retention fee. If the retention fee is necessary to run the council, and if it is fixed at a reasonable level, let everybody pay it and let the council have the power to ensure that everybody pays it.
The penalty is disproportionate. Penalise yes, but not that sort of penalty.
The only other alternative as outlined by Deputy O'Connell is to go to the courts and sue. That is cumbersome and undignified. Do we not all know the very fact that the council intimates to a professional person that if he does not pay his retention fee he will be removed from the register means that the retention fee will come by return of post? We know that. It is a simple practical safeguard, a device to ensure that the council can make every person pay a retention fee. Every profession has its own little shyster section who are not prepared to accept their obligations or play their part. The council should have some power and authority to make them play their part.
I listened to all the arguments but I am quite satisfied the provisions set out here are reasonable and will work satisfactorily. The only alternative to having a retention fee from which the council can get the funds it wants is to make the taxpayer pay and I do not think we want that.
Before calling Deputy O'Connell I want to point out that there appears to me to be a fair amount of repetition of the arguments on this section.
This is Committee Stage. Arguments and counter-arguments arise and we could spend all day on one section. Under Standing Orders we are not precluded from going over points once they are valid. That is the first thing I want to tell the Leas-Cheann Comhairle. We had better get things straight.
I want to mention a few points to the Minister because his argument falls flat. His argument falls on its face, if I may say so. He said we are leaving it to the profession to decide but, of course, we are not, because we are asking for public representation. The Minister has accepted that there should be public representation on this body. Therefore that argument is wrong. I would like more public representation on it. The Minister must accept that his argument is wrong. We are not leaving it to the profession to decide their own affairs. I would not like to leave that to the profession, nor would the profession like it. We want public representation and we are getting it.
The Minister says the man who does not pay has a right to go to the High Court. That is testing the constitutionality of it. For what other reason would he go to the High Court if his name was erased from the register by virtue of the fact that he did not pay the retention fee? To me the Minister's argument does not seem valid. Everybody has the right to go to the High Court if they think something is wrong.
We are saying this person can test the constitutionality of this. He is not testing the unfairness of it. It would be different if we were talking about an issue such as professional misconduct. I do not think that by any stretch of the imagination we could call refusal to pay a retention fee professional misconduct. It is very important for us to know that. Professional misconduct is entirely different. This is the payment of a retention fee. The only reason why he would be challenging that case—and he certainly would be challenging it in the High Court— would be to test its constitutionality.
This is for the protection of the public. Because of that I would like to see more public representation on it and therefore, I would like to see public funds devoted to it. Then it would be answerable to the public. That is the whole purpose of it, protection of the public, ensuring qualifications, standards of behaviour and so on, not for the doctors benefit but for the public benefit. I would ask the Minister to look at this again and incorporate some such phrase as "after consultation with the medical organisations that represent ..." I am not concerned about what the fee is. I am concerned about doctors saying they are not paying, resulting in a serious situation. That is the main point.
I think it is a much more serious matter than Deputy O'Connell has made it out to be, and he has made it out to be very serious. My belief stems from a remark made by the Minister in his recent contribution. He said that if the cost of this new institution was not placed on the doctors, it must be paid by the taxpayer, and he dismissed that. This is, I believe, the ideological difference between us. I believe taxpayers are perfectly happy to pay for institutions set up to protect their interests, to provide for their welfare, health, education, old age, housing and so on. That is a long-accepted principle. The Minister tells me that I must pay more as a doctor than the other taxpayer who is not a doctor. I am a doctor and I must pay this additional fee as well in order to run this institution which is directed to look after both our interests, not just mine, not just his.
He is a doctor, too.
I beg your pardon. I am sorry.
The Deputy picked the wrong man.
Yes, I did, I was unfortunate. Why should Deputy O'Connell and myself be penalised as against Deputy Pattison? Why should we have to pay more because we happen to be doctors, having gone to a lot of expense, taken a lot of time out of our lives in order to qualify in this profession?
Why does a trade unionist pay dues?
I do not think that is a valid point. If an institution is being established in order to protect the taxpayer's interest, I do not see why he should not be prepared to pay for that.
A most interesting phrase in the Minister's contribution was "the least they might do is pay for that" and then the most important one of all, "they should provide for the running of this institution". The Minister suggested that I was inconsistent in saying I did not agree with this but agreed with the registration. It was an nominal £5 fee paid those years ago for the running of an office down at the corner of Merrion Street, as far as I remember, with a lady secretary and possibly an administrator or whatever it might be.
That seemed to me to be fair, but, as I said on the Second Stage, there is an enormous expansion implicit in the provisions of the Bill: the establishment and vetting of the courses, the monitoring of the standards in each of the different medical schools, the provision made for this new development of reciprocity with Europe, the expansion in administrative staff, medical and technical personnel, clerical staff, buildings. This will be an enormous institution if it is a bona fide intent by the Minister seriously to protect the public interest as I have outlined.
What are we proposing to do to the medical profession and the Medical Council? We are proposing to them that they will now foot the bill for an enormous expansion involving a very costly institution? Then this Minister, who is very favourably disposed to the medical profession—and there is nothing wrong with that—blandly states now, before they are given any understanding of the size of the Bill, the ultimate price they will have to pay, that they will have to provide for the running of this institution. He considers that a perfectly reasonable thing to do. This is a reasonable Minister, well disposed to the profession.
Then the question arises, what would be an appropriate retention fee during the lifetime of this institution, necessarily a growing fee because it is an expanding institution? It cannot be a fixed fee as is the one we pay. £5. Will this fee be a percentage of a doctor's income? There are various levels of income in the medical profession. There are some of them who could pay an enormous sum per year and it would not mean anything to them. However, there are many young and middle-aged practitioners, particularly those working in the local authority service, with large families and other commitments, to whom other than a nominal fee would be a very serious imposition on them in addition to their contribution to the Medical Union, the Medical Association and the Medical Defence Union. These are all additional taxes that the medical profession pay, all directed towards the protection of the public interest in various ways. There are also Voluntary Health Insurance contributions, as none of us is eligible for the health scheme.
All of these additional taxes are being imposed on the medical profession simply because the Minister is sticking to a doctrinaire ideological position that every institution set up should fund itself and not be paid for by the taxpayer. All our institutions, hospitals, schools, school bus, and so on, are funded by taxes and by rates to cover the various needs of society. If the service is there and if it is the collective wish of the people that these services should be there, then the taxpayer is quite happy to pay for them and, I think, can be asked to pay for them.
As regards the fee, on the one occasion that I was asked to insist on a fee for a health scheme, I said "All right, ten shillings", and that was accepted for a very costly medical scheme. It saved the face of one sector and it was unimportant as far as I was concerned because it was such a tiny fee. Therefore, we have a position where a council says "We object to this". They take this argument up that I have just put, but very much more vehemently than I do because, remember, I am considered to be rather forward looking in my views on medical practice generally. Those in the profession will resent the fact that they are discriminated against in this way and the Minister might easily find himself in trouble if a powerful enough lobby is built up within the profession.
I do not work within the profession at all but those who do will regard it as a very serious imposition on the profession and if a powerful lobby is built up against this imposition one of the planks in the platform will be that the members of the profession will object to the payment of this fee and say that, as far as they are concerned, it will be a nominal fee of 50p for registration. Presumably this institution is being set up by the Minister at the instigation of the Government under EEC regulations. If the Minister wants this institution, let him pay for it. If the Government want this institution, let the Government pay for it. If the taxpayers who put the Government in want this institution, let the taxpayers pay for it. Why should a small section be singled out to pay, not a nominal fee but a continually increasing financial commitment to which there is no perceptible limit, leaving out inflation altogether? At what point will the Minister decide the institution is big enough, costly enough and cannot be allowed to grow any further? In the context of the fee he is suggesting— this is most important—the medical profession will be expected to provide for the running of this institution through this retention fee.
It is the same in every profession.
We are concerned here with the medical profession. Let the dentists and the opticians——
You pay an annual fee to be a member of a golf club.
But one is not statutorily required to do so and one does not find oneself out of a job if one does not pay whatever the fee is.
Deputy Browne is in possession.
You do not pay a fee under the law.
You pay to be a member of the Fianna Fáil Parliamentary Party.
Not by law.
This does not arise under the section.
It would be by law if the Minister could arrange it.
This is both absurd and irrational. The fact that you do not pay your bill in the restaurant or in the bar does not deprive you of your right to be a Deputy. The Minister's suggestion is absurd and outrageous.
This will not be much more than a nominal fee.
The fee will be decided by the Minister. The Minister says it will only be a nominal fee. If I and Deputy O'Connell put down an amendment on Report Stage that the fee will be 50p, will the Minister accept that?
A year?
Yes.
I would laugh.
I know the Minister would laugh and he has proved my point now.
The fee in the UK is £10 a year.
I am not talking about the UK. I have enough worries without bothering about what is going on in the House of Commons. Suppose the Minister is told that the profession will not fund the institution and will allow its members to pay a nominal fee of 50p, what will the Minister do about it? He has a figure in his mind as to what it will cost the profession to run the institution. Is it 5 per cent, 10 per cent, 20 per cent, 30 per cent, 40 per cent, 50 per cent, 80 per cent, 90 per cent or 100 per cent? Where does it stop?
May I answer?
Can the Minister answer for his successors?
It will be a nominal fee.
Write it into legislation.
I will give my view anyway. I do not think it is likely to be much more than a nominal fee and it will certainly be a great deal less than most people pay as members of golf clubs.
That is their own business. Have we an undertaking now from the Minister that he will accept an amendment on Report Stage?
Put it down and see.
This is a very important principle. We now find from the Minister's contribution that this costly institution, ever-growing, will be funded by the profession by means of fees. Even if the Minister gives an undertaking that it will be a nominal fee, unless that is written into legislation, it will not be binding on his successors. We must get some kind of undertaking as to the percentage. The Minister says the profession will pay the total cost. The words are "provide for the running of the institution". The Minister must give us some projected cost. I asked for that on Second Reading. I asked for the immediate, mid-term and long-term cost of this very elaborate institution spread over the registered members who will be expected to provide for the running of the institution through the medium of a retention fee. That could not possibly be a nominal fee. The Minister would regard a fee of 50p as frivolous. He said he would laugh at it. If that was suggested he would tell the profession to come back and put forward a realistic suggestion. What percentage has he in mind for the maintenance of this institution which he, as a politician, is setting up? He talks about going to the High Court. It is the old cliché—the High Court, like the Ritz, is open to everybody. I do not think there are many doctors who would be anxious to take a body like this to the High Court. That is not something they should be lightly asked to do.
My main difference with the Minister is on the issue of the enormity of the penalty imposed, namely, depriving a medical doctor of his right to practise simply because he has not paid his bill. That is the first point. The second point is the handing over of this body to the medical profession to run. I disagree with that for my own ideological reasons. Obviously, the Minister is giving it over not just for his own personal political reasons but as a kind of quid pro quo. He now says——
No.
Oh, yes. The words the Minister used were "They are allowed to govern themselves; the least they might do is pay for that." It is all on the record and they can be told that, that this was passed through this House——
That is not the reason.
——after open discussion, that they will have to pay for this institution. They must be made clearly aware of the undertaking the Minister is demanding from them as a quid pro quo for allowing them to be the predominant management within the Medical Council. If the Minister would give an undertaking that he would strike out this provision or, alternatively, allow it to be simply a nominal provision——
Would the Deputy accept a reasonable——
No——
The Deputy is not a reasonable man.
Without any disrespect to the Minister, what is reasonable to him and what is reasonable to me might be vastly different.
Reasonable for the profession.
I believe that the Minister, for doctrinaire reasons— there is no other reason—is doing this. All he has to do is amend it as we suggest.
The Deputy is doctrinaire; I am not.
Not at all. Right wingers always say the left wing is doctrinaire. In the beginning I thought this was simply the old idea with which I was faced at one time—you will have to pay because you must pay for what you get, a kind of ideological thing—when I had this row with the Church on that occasion. I said I would go half way and charge ten shillings for the service and so on. We had a kind of dog licence arrangement whereby people could go to the post office, pay ten shillings and their faces were saved and I was happy to see them getting good service. I thought the Minister was trying to cling to that principle in a very right wing sort of way. But it is a very much more serious one from the point of view of the medical profession: he is trying to get the medical profession to pay for this very costly, expensive institution. That is what he said. I have asked him if the fee would be a percentage of a doctor's income.
No, definitely not.
Would the retention fee represent a percentage contribution by the medical profession, a fixed percentage for the maintenance and running of this institution?
In the normal course it will be equivalent to meeting the outgoings of the council.
Therefore, they are going to fund all the activities of the council?
In the normal course, yes.
Then, I think they should deal with that because certainly this is a very big commitment.
As a self-disciplining, responsible profession I am just applying to them the simple rule which we apply to professions generally. We have already applied it to the dentists, the solicitors, the opticians. We say "You are a responsible profession; we are entrusting you with the governing of you own affairs, running your own profession, disciplining yourselves, setting standards of education and training and professional behaviour and as such we ask you to finance the council which does this". I do not think this will be an enormously expensive council. I hope it will give a good service, have plenty of communication with the profession, but I do not see the expense of it amounting to a great deal. It will be well within the competence of the profession to meet its annual outgoings by a modest, reasonable, retention fee which will not be outrageous or excessive and which will be exactly the same in principle as what the Deputy doctors here have already accepted willingly and enthusiastically, a registration fee. There is no difference in principle.
Would the Minister consider including in the Bill on Report Stage a provision that the Exchequer shall provide funds as may be necessary to defray the costs of this council?
I certainly will not rule out an Exchequer contribution. If I am asking the council to do certain things in the public interest I think I should be entitled to pay them for it.
That is right. That is what I said at the beginning. I said this was all in the public interest. I should like to see the Minister putting more lay members of the public on the council and that is what I suggested. But the Minister will agree that because the public interest is now represented as it never was before there is justification for public moneys being made available. I am not concerned about the professional charge but I am concerned with the principle that in the event of doctors refusing to pay——
May I elaborate? I would visualise the initial fee and the retention fee as paying for the normal costs of this council as a registration body. If in the future under section 36 I ask the council to carry out some other functions in the public interest then I should consider paying them for that.
As a result of our deliberations, the Minister will agree, we have now decided that the Medical Council shall undertake more functions than were originally envisaged in the Bill. It will now undertake work of a public information type. It will be keeping doctors informed, keeping the public informed and compiling a set of guidelines that will ensure that doctors maintain a high standard of professional behaviour in the public interest. This is different from its predecessor, the Medical Registration Council. The council now has members of the public on it, protecting the interests of the public and I disagree with the Minister in saying that this is a body by the profession to regulate the affairs of the profession. It is not a body for that purpose because of the fact that, with our persuasion, the Minister has agreed to include a number of lay people on it. That is very desirable but because of it I should like to see public moneys being applied to it to expand the work of the council in the public interest. The Minister says that he will if ... Could we not provide in the Report Stage that this will be done?
Put down an amendment.
Good. But I would prefer that the Minister did.
Between now and then suggest an amendment to me that I might include.
Great. I do not want to see the Minister as Minister for Health finding himself without a health service if the doctors resign en masse. That would be very serious, We suggest altering the section which says that a doctor's name will be erased unless he pays the annual retention fee. The Minister will agree that there is no comparison between a doctor's right to practise and being disbarred from a golf club. The Minister says you must pay membership fees to your golf club; this is not the same; this is your right to practise, to earn a livelihood. Could the Minister consider altering that section so as to ensure that the consensus of the profession is obtained and not merely the views of the council? It is not because I want to protect doctors. I am thinking of the public being deprived of a medical service if all the doctors decide they will not pay and are all disbarred. Could we have something to provide that you get agreement of the doctors? If the Minister can include such a provision in an amendment— it is not easy, I know—he would ensure that situations like that would not arise.
If there could be consultation with the medical representative organisations it would ensure that such a situation would not arise. If the retention fee could be decided on after consultation the Minister would be relieved of a big burden. Because of the nature of the work the Minister should provide the necessary funds to help to defray the costs of this body. This would ensure that the Oireachtas would have greater control over it. Public expenditure means public accountability and that is good in the interests of the public.
I appreciate the Minister's patience in relation to this matter but if he is helped by the discussion now it will save him trouble later on, as Deputy O'Connell says with a profession notorious for making trouble for their Ministers. The Bill is to provide a new body to register and control those engaged in the practice of medicine and to regulate medical education and training at undergraduate and postgraduate levels. There are enormous implications here. The Minister may be bringing this in because he is impelled to due to outside pressure. Of course, it is likely that the Minister's successors will decide to make the Medical Council into a body which will do its job, will be particularly conscientious about the level of vocational guidance in relation to intake, about the quality and scope of services, the expansion and removal of different kinds of services.
These are all contentious issues which will require people of the highest calibre to deal with them. It will require all sorts of administrative facilities and physical building facilities to do that. To update and extend disciplinary provisions is easy enough, but to make consequential provisions arising from the accession of the State as a member of the European Community and to repeal existing legislation—Heaven knows what the provisions arising out of accession to the European Community may lead to, but they must lead to a considerable expansion in the existing services of the Medical Council which hitherto were simply the keeping of a register. With the best will in the world, even knowing his own mind, the Minister cannot possibly say what his successors in office may decide working within the context of this Bill. They will all have to work within the context of this Bill and any undertakings given which are not written into this Bill are worthless. They will be guided by the provisions of this Bill.
Under section 24 all expenses incurred shall be defrayed by the council out of funds at the disposal of the council and then the administrative costs will be paid for out of moneys voted by the Oireachtas to the Minister. Unless the Minister amends section 24 as well as amending section 40, the council will have to pay for any expansion of our services. I cannot see why the members of our profession should have to pay for the maintenance and expansion of this body. I can understand them paying a subscription to a registration institution. Matters in relation to the functions of the institution, such as deciding who shall be admitted from the European countries and who shall not be admitted, which standards are acceptable in relation to the amendment of laws and so on, are matters of State and not the business of the medical profession. All of this work, which is inevitable to maintain high standards, has nothing to do with the medical profession.
A medical practitioner goes through a very complicated expensive, long and tedious training to become a general practitioner. That takes a tremendous lump out of any man's life, making enormous demands on himself and his family. That he should be accepted and recognised at a certain level by a reputable body everybody accepts; that there should be a nominal fee to pay for the expenses of keeping this register is also acceptable; but that he should then be told that he will have to maintain a costly expanding institution whose function is directed towards the maintenance of a particular vigilance in the public interest at the request of a Government Minister is outrageous.
I cannot see any rationality in that at all. This is an unlimited commitment because under section 25 the council will find the money themselves —in the retention fee presumably— and under section 40 the retention fee must be approved by the Minister. If the medical profession do not agree in principle and make all the arguments that we have made here more eloquently and more persuasively, what will the Minister do about it? There is a discrepancy between what one considers reasonable and what another considers reasonable. There is no reasonable figure; it depends on individual circumstances. It is vague in its implications from the point of view of expansion and expenditure, but it is not vague in its implications for the members of the profession, for their inevitable commitment under the provisions of this Bill. They will have to fund this service even though it is no longer simply a registration or disciplinary body. It has become very much more than that now because it has got to deal with the whole question of establishment of courses, the maintenance of the quality of the courses and then inspecting universities all over Europe. It must be a very greatly expanding body, if not in the Minister's time, as time goes on. If you like, it is an infinite commitment. There is no limit to the commitment for the retention fee if the provisions of this Bill are to be honoured—all expenses incurred by the council shall be defrayed by the council out of the funds at its disposal. The Minister is giving them nothing except the cost of administration of the Bill, and that he will get from the Oireachtas, from the taxpayer. Why not ask the doctors to pay for that? Why bother to come back to the Oireachtas for that money? Why not let the doctors pay the whole lot?
I give the Deputy this assurance: that if I, or my successor, ask this council to perform any function which is not covered within the general jurisdiction of this Bill the Exchequer will pay for it.
Could the Minister not accept that there is a case for maintaining the position as it was, that there was a registration body and that one would pay to this registration body a nominal fee for keeping one's name on the register, that that nominal fee would be a fixed fee, that it would not vary, that it would bear no relationship to the extension of the scope of the services of the council, that there should be some protection for the members of the medical profession to ensure that they are not given this extra tax paying function which no other taxpayer will have for the provision of a service? I am not complaining at all about the simple question of registration; I accept that. But I do resent the fact that a very elaborate service must in time grow out of this Bill, a costly service, for which the Minister is asking the medical profession to give him carte blanche.
I am not.
Well, will the Minister put a fixed fee or contribution on it then?
It will be a fixed contribution.
Can the Minister say that they will not pay more than this amount?
This will be a council representative of the profession.
And the public.
It will be the profession's own council; the profession will be three out of 25. By and large, almost exclusively it will be a Medical Council governing the medical profession. Does Deputy Browne have no trust or faith in his own profession? Does he think they are going to do all sorts of outrageous things, build up a bureaucracy the profession could not possibly sustain? For heaven's sake let us exercise our common sense. This council will represent the profession. It is not going to be something totally unacceptable and repugnant to the profession. Its very composition and elected element will ensure that it will not and, if it goes mad, the Minister is there to ensure, by his consent written into all the financial sections, that it will not do outrageous, ridiculous things.
It is the watch dog of the public.
I have given this House the assurance that if I, or a successor of mine, come along and say to this council "I want you to undertake this function or work; it is not within the terms of your legislation as laid down," we will add "In so far as you will do it, I will give you funds to do it".
But the Minister will agree that there is extension already in this Bill.
Of course there is; the retention fee is new.
The work and the functions differ enormously from those provided in the existing Act.
Not enormously.
They do. I will tell the Minister why, because they will be involved in EEC legislation on doctors. That is the first thing.
The Department of Health will do most of it.
They will be involved in the register. It is all embodied in this Bill. Firstly we are ensuring that there is information available to the public. We have done all this. We have already decided on expansion of their work. Expansion of the work is already embodied in this Bill.
This is a case of very special pleading.
Deputy Dr. Browne: was in possession and the Minister intervened.
I merely wanted to make a suggestion that might be helpful. Would the Minister be prepared to agree that the consent that he gives under section 25 might be given by way of regulation which would be put before the House? If people felt then that the fee was excessive they could raise the matter.
No, I would not be prepared. There are enough safeguards.
Would the Minister consider including "after consultation with the medical organisations" and also that the Minister may from time to time——
I will consider considering that.
And the other is: providing funds as may be required partly to defray the costs of the body. That will make it accountable to the Oireachtas. That is the important thing, and should be, because it is there to protect the public interest.
No, I do not want it to be accountable to the Oireachtas. I want it to be accountable to its own profession.
Deputy Dr. Browne was in possession when the Minister intervened.
There is no quarrel with the Minister on the simple question of registration, the calibre of persons coming into the profession, staying in the profession and practising the profession and the whole question of discipline. The difficulty is that the Minister is trying to get, on the cheap, a very elaborate institution which is an extension of the existing registration mechanism. Like architects, dentists, opticians and so on, nobody opposes that at all.
The side note to section 35 reads:
Functions of the Council in relation to Directives adopted by the Council of the European Communities as to education and training.
The possible scope of that is immeasurable. Then the side note to section 36 reads:
Duty of Council to promote post-graduate education and training.
This is the same thing.
I have already indicated that section 36 will probably be withdrawn.
We are on section 40 at present.
Yes, but I am trying to make the point that the Minister, first of all, is telling the council that they must find all their own funds and, secondly, that he is giving them additional duties which will require an expanding institution, that the medical profession must pay for this in addition to paying for the right to be on a register.
Progress reported; Committee to sit again.
Business suspended at 1.30 p.m. and resumed at 2.30 p.m.