I move: "That the Bill be now read a Second Time."
I wish to start by thanking Opposition Members for their support for this urgent legislation to address the shortfall we are currently experiencing in non-consultant hospital doctors who are essential to the running of hospitals and the safe delivery of care to patients.
The provisions of the Bill before the House enable the Medical Council to register doctors in a newly created supervised register where those doctors registered will be assigned for a defined period of time not exceeding two years to identifiable, supervised posts to which specific criteria will be attached. Given the seriousness of the shortage of non-consultant hospital doctors, NCHDs, in our hospitals this legislation is being debated against certain time constraints and I appreciate the co-operation of the House in this regard.
The shortage of NCHDs in Ireland is not related to funding, any recruitment embargo, moratorium or reorganisation of hospitals but to an inability to attract enough doctors to work in our hospitals. In this regard, we are not unique, as much of Europe, including the United Kingdom, is encountering the same problems. Some 450 posts, including approximately 180 non-consultant hospital doctor vacancies, mostly in service rather than training posts, are due to be filled from 11 July when the next rotation takes place. The number of vacancies is decreasing on an ongoing basis as doctors are appointed via the HSE centralised recruitment process. Following an intensive recruitment drive by the HSE, more than 200 doctors from India and Pakistan have applied to fill these vacancies, but it is unlikely they will all be in a position to meet by 11 July the new registration requirements of the Medical Council provided for in the Bill, resulting in take up of duty being phased over a period of weeks.
I have previously stated in the House and take the opportunity to reiterate that I will not oversee any process that results in the employment of non-consultant hospital doctors who are not capable of safely providing the services required. Certain specialties such as emergency medicine will be most affected by non-consultant hospital doctor vacancies. I am working with my Department and the HSE to devise arrangements which can be implemented in hospitals if and as required to ensure any resulting impact on services is minimised and that patient safety is maintained. Patient safety must be at the top of our agenda and our utmost priority.
Current legislative provisions under the Medical Practitioners Act 2007 do not facilitate the registration by the Medical Council of the doctors from Pakistan and India who have applied to work in Ireland. This relates to the requirement to sit the pre-registration examination system, PRES, which is best suited to those recently qualified rather than those qualified for some years who have worked in specialty specific posts for the greater part of their career. The task that I, as Minister for Health, have been dedicated to in recent weeks is to see how best to secure these doctors to work in Ireland in a manner that will give complete assurance regarding the safety of patients and compliance with the regulatory standards required. The Medical Practitioners Act 2007 which provides the current statutory framework for the regulation of the profession is very robust legislation in terms of the protection of the public and great care has been taken in the preparation of the Bill to ensure it not be undermined in any way.
I have been working intensively with the HSE, my Department, the Medical Council and the Forum of Irish Postgraduate Medical Training Bodies to introduce regulatory arrangements that will facilitate recruitment of suitably qualified doctors, in particular, those from India and Pakistan, without delay. All involved have shown great willingness and ability in working towards a resolution of this matter. I am confident that all involved will embrace and support the changes proposed in the Bill. I take the opportunity to express my appreciation and gratitude to the Medical Council and colleges for their co-operation in this regard and their speedy attention to the matter.
The Medical Practitioners Act 2007 provides for the registration and regulation of medical practitioners in four divisions of the register which include the general division, the specialist division, the trainee specialist division and the visiting EEA practitioner division . The Bill provides a legislative basis to establish a fifth division to be known as the supervised division. This new division will allow the Medical Council to assess applicants under a range of headings and link a doctor’s registration with an identifiable supervised post in a specific specialty and for a contract specific period not exceeding two years in aggregate. This will enable the council to fulfil its core statutory responsibility as the regulatory body accountable for the protection of the public. It will also support the HSE in putting in place arrangements to facilitate recruitment on a basis that meets the objectives of service delivery and the provision of safe high quality care. To further strengthen the role of both agencies in safeguarding the public, the council is finalising statutory rules to underpin the operation of the new supervised division.
I am acutely aware of the need to ensure any doctor from India or Pakistan seeking registration by the Medical Council is proficient in the English language. I have sought and received written assurance from the HSE that with regard to those selected for recruitment, the entirety of their medical education has been conducted in English and that many have also acquired postgraduate qualifications through the English language. They were interviewed through English using the standard HSE interview, marking and scoring process, but in this case the pass mark was raised from 40% to 60% in each domain, including language and communication skills. We have set these doctors an even higher target. In addition, language and communication skills will also be assessed in the course of the new knowledge and clinical skills assessment process particular to the new supervised division. When in post, the ongoing supervision criteria attaching to each post will facilitate ongoing monitoring of language and communication skills. It is important to note that this supervision will include training in order that doctors who come to this country will leave here enhanced and suitably upskilled.
Part of the solution in addressing the underlying problem of sourcing and retaining doctors in the health service is being addressed by the HSE which in recent years has created a significant number of additional consultant posts and will continue to build on this in parallel with reducing the number of non-consultant hospital doctor posts in the system, particularly non-training posts. It has also taken steps to improve the quality of all NCHD posts and continues to do so. As of 11 July, 80%, 3,750, of the 4,660 NCHD posts will be part of structured training schemes run by the postgraduate training bodies and funded by the HSE. This contrasts with the situation in 2007 when 53%, 2,248, were in structured training, 31% were in stand-alone training, while 16%, 763, received no training at all. As I said, this is only part of the solution. As Minister for Health, I am committed to addressing the wider issues which have contributed to the situation confronting us. These issues include a requirement for a better skills mix, new and more flexible rostering arrangements and the reorganisation of health services, all of which form part of the ongoing reform of how we access and deliver health services.
Deputies have been provided with an explanatory memorandum which sets out in detail the contents of the Bill. However, I will briefly outline the Bill's provisions. In summary, it provides for a new division of the medical practitioners register, to be known as the supervised division. Registration in this division will be limited to two years and is linked to employment in a post and the medical practitioners will be supervised by their employer. Medical practitioners who apply to be registered in this division will undergo an assessment and examination which differs from that for registration in the other divisions of the register. The assessment will be specific to their medical specialty and the fact that the post is supervised.
Section 1 sets out the definitions used in the Bill. It provides that any reference to the Act of 2007 means a reference to the Medical Practitioners Act 2007. Section 2 amends definitions used in the Medical Practitioners Act 2007. The provision amends the definition of "registered" to include a reference to the new supervised division. It also amends the definition of "registered medical practitioner" to provide for the new section 56A and that medical practitioners cease to be on the register after a period. A definition for the new division is also included.
Section 3 amends the functions of the Medical Council to allow it approve posts for the purposes of the supervised division. Section 4 amends the council's power to make rules to provide that it can set criteria for assessing applications for registration in this new division and to allow it to specify the examinations and assessments for registration in the new supervised division. It is envisaged that this will comprise a two stage process. The first stage will involve providing documentary evidence of medical education, etc, with the second being a specialty specific knowledge and clinical assessment.
Section 5 amends the Medical Practitioners Act 2007 to provide that the Medical Council can charge a fee for registration and retention in this new supervised division.
Section 6 provides that the register will now have five rather than four divisions, that the new division will be called the supervised division and registration will include the identifiable post to which each registration applies.
Section 7 amends references in the Medical Practitioners Act to include a reference to the new division.
Section 8 is a key section in the legislation. It details how medical practitioners register in the new supervised division. It provides that a medical practitioner must meet the requirements specified in the legislation and the criteria outlined in the rules. It also provides that a person cannot be registered in this division if he or she is able to be registered in another division of the register.
A medical practitioner may only be registered for a maximum of two years in this division. The registration is linked to identifiable posts which have been approved by the Medical Council. Posts must be certified as being publicly funded. The HSE will not certify that a post is publicly funded unless the post is funded substantially by the HSE. The council will only approve posts where it is satisfied that adequate arrangements are in place for the supervision of the medical practitioner and will take into account the experience of the medical practitioner, the seniority of the post and the duties to be performed. The medical practitioner ceases to be registered when he or she leaves the post and the employer must notify the Medical Council within five days of the person leaving. These provisions have been included for the safety of the public by ensuring these medical practitioners are supervised and can only work in specific posts. If a person is found to be unsuitable despite all the due diligence, he or she cannot leave a surgical post in Naas and go to work in psychiatry in Cork, presenting a danger to the public.
Section 9 provides that a medical practitioner who removes himself or herself from the register cannot seek to have the registration restored under the provisions of section 52 of the Medical Practitioners Act 2007.
Section 10 relates to fitness to practise. As the medical practitioners on the supervised division are only registered for two years or until they leave a post, the Bill provides that, unlike other divisions of the register, the Medical Council can investigate complaints made against these medical practitioners, even if they are no longer registered. This is to provide due process for both the medical practitioner and the person who makes the complaint. This means that fitness to practise procedures will apply to the medical practitioners on the supervised division both when they are registered in the supervised division and when they are no longer on the register.
Section 11 is another measure for the protection of the public. It provides that the Medical Council can apply to the court for an order to prohibit a medical practitioner, who was registered on the supervised division but is no longer registered, from applying for registration in any division of the register. This is only done where it is considered necessary to protect the public. The court can make any order it considers appropriate.
Section 12 provides that section 70 of the Medical Practitioners Act, which provides for the steps to be taken by the Medical Council following a fitness to practise report, will include a reference to a new section which is inserted by section 14 of this Bill.
Section 13 inserts a new section into the Medical Practitioners Act to provide that the sanctions provided for in sections 71 and 72 of that Act do not apply where the medical practitioner is no longer registered in the supervised division or in another division. This is because the next section, section 14, provides for the sanctions in these cases. Section 14 inserts a new section into the Medical Practitioners Act to provide for sanctions in cases where the medical practitioner is no longer registered in the supervised division. These sanctions include advice or admonishment, censure or a fine not exceeding €5,000, the attachment of conditions which would apply if the medical practitioner applied for registration, and a prohibition on the medical practitioner from applying for registration in a division or divisions for a specified period.
Section 15 inserts another new section into the Medical Practitioners Act. This new section is linked to the previous section and provides for the council to decide on the amount of the fine, the nature of conditions and the period a practitioner is prohibited from applying for registration.
Sections 16 to 19, inclusive, provide for amendments to sections 73 to 76, inclusive, of the Medical Practitioners Act 2007 which relate to sanctions and the right of appeal. The amended sections now include a reference to the new section 71A which is inserted by section 14 of this Bill and relates to sanctions for those who were registered on the supervised division but are no longer registered.
Section 20, the final section of this Bill, provides for the Short Title and the commencement of the Act. Some sections of the Act will commence on enactment while more will require a commencement order. The sections that require a commencement order cannot be commenced immediately as these sections rely on rules or criteria to be set by the Medical Council prior to commencement.
The Bill will form a major part of the arrangement being put in place to attract doctors to Ireland not just now but in the coming years as we continue with the ongoing reform of the health system and the arrangements governing medical manpower planning and medical education and training. I am seeking the co-operation of the House in the speedy passing and enactment of the Bill and I am grateful for the co-operation to date. Arising from this, the co-operation we have found between the colleges and the council will allow us establish a manpower forum to plan our manpower requirements properly into the future and create clear career paths for non-consultant hospital doctors, both Irish and non-Irish, to avoid us reaching such a situation again. I commend the Bill to the House.