Dáil Éireann debate -
Thursday, 7 Jul 2011

Vol. 738 No. 1

Medical Practitioners (Amendment) Bill 2011: Committee and Remaining Stages

Section 1 agreed to.

NEW SECTION

Deputy Caoimhghín Ó Caoláin

I move amendment No. 1:

In page 3, before section 2, to insert the following new section:

2.—The Minister for Health, upon the commencement of this Act, shall cause to be undertaken a comprehensive monitoring and review of the implementation of the Act as it affects patient care at hospitals, which review shall be concluded after four months when its findings shall be presented and published in report form for consideration by the Oireachtas Committee on Health and Children.".

I propose an amendment to this opening section of the Bill which is self-explanatory. It is essential there is proper oversight and monitoring of the implementation of this Bill, as the amendment clearly states. We are talking about NCHDs coming here in supervisory or supervised roles. There is a list of criteria for the conduct of the positions they are to fill over the duration of their service here. It is very important in the early stages of their introduction in service at hospital sites throughout the country that there is monitoring of and a report back in regard to the impact of their presence at various hospital sites, that it must be over a specified period of time — I have chosen a short but reasonable period of four months — and that the findings of that monitoring exercise and review would be presented not only to the Minister but would be published in report form for consideration by the Oireachtas Joint Committee on Health and Children.

We are all committed to the passage of this legislation. What I have chosen to do is to endeavour to highlight what I believe to be a necessary undertaking on the Minister's part in regard to the outworking of the Bill's intent. I hope he recognises the value in having the new situation applying as of next Monday properly evaluated and that the impact in regard to patient care should be assessed not by observation alone but in consultation with patients in the various hospital settings where the NCHDs will present. That is in real terms a best practice approach and one that will highlight any deficiencies, weaknesses or flaws within the whole approach. I hope there will be none but there may be some. It is an efficient and effective way of learning what may be amiss and of having the problems addressed in the early stages in order that they do not become an issue or an ongoing sore over the course of the two year duration of the service of any of the NCHDs involved.

I commend the amendment to the Minister. I believe he will understand its purpose and intent, will view it positively and I await his response.

Minister for Health (Deputy James Reilly)

I take the amendment in the spirit it is offered but, unfortunately, it is not appropriate. We do not require legislation to review the effect of this Bill, but I will give the Deputy an undertaking that it will be reviewed regularly. Indeed, the HSE keeps patient care and impact on hospitals under review on an ongoing basis and the Deputy will be able to consider the impact of this Bill, in particular.

I mention the HSE which has been spoken of in not terribly congratulatory terms in the House today. It has not delivered the care we would have liked it to have delivered over the years and that is why we promised to abolish it. The HSE, as currently constituted, will change rapidly but whatever replaces it will continue to review. The patient safety authority which the Government intends to put in place and which is a key priority of mine will, along with HIQA, be very much responsible for keeping an eye on standards and the impact of changes such as this. However, I will undertake to come back to the Deputy with a review of the operation of this legislation and he will be able to avail of that in six to eight months time because a shorter period would be too short a time to know how it is impacting.

As part of the legislation, the HSE must supervise these doctors. That would be done by doctors in the hospitals. People can be very much assured that these doctors are of a very high quality. They have already been screened and assessed by our consultants and they will be assessed again by the colleges and the Medical Council and on a two-week basis in their location of work. That is a really comprehensive assessment. I have the utmost faith in our system to safeguard our patients when it comes to this group of doctors. I echo what Deputy Kelleher said earlier that there is no way these doctors could be, in any way, construed as being inferior. In fact, they are going through a far more stringent assessment than many of the doctors who work in our system.

Deputy Caoimhghín Ó Caoláin

I certainly would not want to suggest, or subscribe to a view, that the doctors being recruited are in any way deficient. I want to make it very clear that I would want to be supportive of every effort to give confidence to patients presenting at our hospital sites throughout the time of their respective service.

I note the Minister's undertaking, a word he used on two or three occasions in his response. I am a little concerned about the period of time. The Minister talked about six to eight months. If there are issues or difficulties, one would certainly not want them going on for that length of time which is more than one quarter or one third of the entire expected period of service. We are speaking of two-year contracts. I would like the report presented earlier than this.

I noted that the Minister indicated fortnightly assessments. The only little element not there, and it is not small at all, is the engagement with patients. I would be willing not to press my amendment if the Minister could give me some assurance that this is not only done in terms of a clinical oversight but that there is also an element of engagement with the patient's experience. That is very important. In our earlier discussion the Minister gave assurances in relation to language and communication skills. Patients cannot be left out of the loop in any assessment of what will unfold from next Monday.

I know a significant effort has been made to recruit the outstanding numbers to fill the vacant posts. However, there is a considerable way to go. I hope for success in that regard in the short time preceding Monday, 11 July. As a final assurance, will the Minister respond with a shorter timeframe and engagement with patients? I would be willing to accept his undertaking that he will report to the House, the committee and designated health spokespersons if this was done within a reasonable timeframe.

Deputy James Reilly

I can certainly provide for patient feedback, which is very important. I will write to the HSE and ask for this to be done quarterly.

Amendment, by leave, withdrawn.

Sections 2 and 3 agreed to.

SECTION 4

Question proposed: "That section 4 stand part of the Bill."

Deputy Billy Kelleher

This section deals with the setting of criteria for the assessment of applications for registration in the supervised division. Deputy Fleming mentioned proper assessment and examination in specialties, but there was no mention of Garda vetting. Is there an exemption for the medical profession, or are other checks made in that context?

Deputy James Reilly

Garda vetting takes place in the case of non-consultant hospital doctors. Doctors from outside the European Union or a different jurisdiction may bring their own vetting documentation and will have police clearance before entering the country. It would not make sense for Departments to vet them. Our own doctors are vetted here, while those entering the country are vetted by the authorities in their own countries.

Question put and agreed to.

Sections 5 to 20, inclusive, agreed to.

Title agreed to.

Bill reported without amendment, received for final consideration and passed.

Sitting suspended at 2.15 p.m. and resumed at 3.30 p.m.