Regulated Professions (Health and Social Care)(Amendment) Bill 2019: Second Stage

Minister of State at the Department of Health (Deputy Jim Daly)

I move: "That the Bill be now read a Second Time."

I am pleased to address this House on the Second Stage of the Regulated Professions (Health and Social Care) (Amendment) Bill 2019. The purpose of this Bill is to improve processes within the health professional regulatory bodies and amend their Acts following the amendments to the European Union professional qualifications directive, which provides mechanisms for the recognition of qualifications as well as the conveyancing of disciplinary information within the EEA space.

This is a mainly technical Bill containing seven Parts and 169 sections. The Bill amends the five health professional regulatory Acts, which are the Dentists Act 1985; the Health and Social Care Professionals Act 2005; the Pharmacy Act 2007; the Medical Practitioners Act 2007; and the Nurses and Midwives Act 2011. The Bill also makes some minor amendments to the Health Act 1953, the Health Identifiers Act 2014, and the Children and Family Relationships Act 2015.

When the United Kingdom leaves the European Union, the professional qualifications directive will no longer apply to the UK. The UK becomes a third country, that is, a state other than Ireland and the European Economic Area member states. The Bill includes a number of third country provisions related to qualification recognition and the conveyancing of disciplinary information. These amendments are to give further effect to the requirements of the so-called modernised professional qualifications directive, which Ireland transposed into law in January 2017. The Bill is included in the Brexit legislative programme because the provisions which relate to third countries will apply to the UK post Brexit. These are important given the volume of movement of health professionals between Ireland and the UK. The Bill also makes a number of other important amendments to each of the five Acts in respect of a number of matters, mainly related to fitness to practise and registration.

I will now outline some key provisions of the Bill in more detail. The Bill is divided into seven parts. Part 1 provides for the short title and commencement; and for repeals. Parts 2 to 6, inclusive, contain amendments to each of the five health professional regulatory Acts. Part 7 provides for amendments to the Health Act 1953, the Health Identifiers Act 2014 and the Children and Family Relationships Act 2015. Most of the amendments to the health regulatory Acts are common to more than one Act, and a number of the amendments are common to all of the Acts. These are repeated throughout parts 2 to 6 to effect the relevant change in each Act. In outlining the key provisions, I am therefore grouping the amendments under the headings: fitness to practise; registration; other amendments; and amendments to other legislation.

On fitness to practise and appeal of minor sanctions, currently there is no right to appeal the sanctions of advice, admonishment or censure in writing, called the "minor sanctions". This Bill amends the five Acts to give health professionals the right to appeal the imposition of a minor sanction to the High Court, in line with other sanctions.

With the increased mobility of health professionals, the importance of maintaining patient safety, while supporting professional mobility, is ever important. The alerts mechanism provision of the modernised professional qualifications directive aims to give greater protection to EU citizens, as it requires member states to inform competent authorities of all other member states about health professionals who have been restricted or prohibited from practising their profession, even temporarily, by national authorities or courts. However, the directive does not specify what action a competent authority, i.e. the regulatory body, should take when it receives such an alert. To deal with this matter, I have decided to introduce additional grounds for complaint in each of the five Acts. It will be possible to make a complaint against a person who is the subject of an alert. For the further protection of the public, the Bill provides that such a complaint can be made against a person where the person is working in the health and social care profession they were prohibited or restricted from practising in, or where the person is working in a different health and social care profession. By way of example, the Bill provides that a complaint can be made against a person who is the subject of an alert as a doctor, but who is practising in the State as, say, a dentist.

There is no obligation on third countries, which will include the UK post Brexit, to report to other countries any restrictions or prohibitions on the practise of health professionals in their jurisdiction. However, Irish regulatory bodies need to be aware of such restrictions or prohibitions on the practice of any registrant or applicant for registration, including those from third countries.

The Bill, therefore, provides that all registrants or applicants for registration are required to make a declaration in relation to restrictions and prohibitions on their practise. In addition, all regulated health professionals will be required to make declarations at registration and annually in relation to any sanction or pending relevant proceeding.

I am also making amendments in the fitness to practise provisions of the five Acts to provide that regulatory bodies can use disciplinary information from other countries in fitness to practise cases. Currently, information on minor sanctions imposed by regulators is not published, while information on other sanctions imposed is only published if the regulator is satisfied that such publication is in the public interest. The five Acts also provide that such information is made known to me as Minister of State and the HSE and an employer, where known. I am amending all five Acts to provide that each regulator will be required to publish all sanctions it imposes in the State. I am removing the notification to the Minister as it is not necessary for me, as Minister of State, to receive this information.

The Bill includes a number of amendments to increase the effectiveness of the fitness to practise processes set out in the Medical Practitioners Act and the Nurses and Midwives Act. Currently, complaints are made directly to the preliminary proceedings committee for investigation and progress in investigations is dependent on when and how often the committee meets. To expedite investigations, the Bill provides that complaints will be made to the CEO and investigated prior to being referred to the preliminary proceedings committee. Transferring responsibility to investigate complaints to the CEO who will then refer them to the preliminary proceedings committee for decision will shorten the time it takes to process complaints and mean the preliminary proceedings committee’s time can be used more efficiently in making decisions on complaints. The Bill also amends the Acts to provide that an undertaking or consent to a sanction can be given by a registrant at the earlier preliminary proceedings stage rather than having to wait until the fitness to practise stage to do so.

One of the grounds for complaint in relation to fitness to practise is a conviction for an indictable offence. The process to obtain evidence on convictions can be difficult and sometimes requires the garda involved in a case to appear before the fitness to practise inquiry to give oral evidence about a conviction. That is not always a good use of Garda time. I am, therefore, amending each of the five Acts to allow the CEO or registrar of each regulatory body to request information on convictions from An Garda Síochána when dealing with a complaint. The CEO can also seek information from the relevant court which convicted the person. I trust this amendment will result in better use of Garda time and more efficient processes in fitness to practise inquiries.

I am providing for the separation of qualification recognition from registration in the Acts where it is not currently provided, namely, the Dentists and Medical Practitioners Acts. The Acts currently provide that a professional whose qualification has been recognised must be registered. Separating qualification recognition from registration will allow the regulators to introduce language and fit and proper person checks prior to registration. Currently, the Medical Practitioners Act requires doctors whose qualifications are from non-EEA countries to hold the equivalence of the certificate of experience to access specialist training in Ireland. The certificate of experience is evidence of satisfactory completion of internship. This is limiting the career pathway of some doctors who wish to advance their training in this country, notwithstanding the fact that they are registered as medical practitioners in Ireland. I have, therefore, decided to remove the equivalence of the certificate of experience as one of the requirements for entry to the trainee specialist division of the register of medical practitioners. I am also removing the equivalence of the certificate of experience as a route to registration in the general division of the register of medical practitioners, given the possible patient safety concerns raised by the Medical Council in relation to this route to registration. Henceforth, such a person will need to either sit an examination or have his or her qualification recognised under another part of the Act.

Currently, the Medical Practitioners Act provides for only one register, it being the register of medical practitioners. The Bill is providing for the creation of two new registers, namely, the register of interns and the register of adapters. The registers are for those who are in training to be medical practitioners or whose qualifications are not yet recognised. All interns will be registered on the register of interns. An intern is a person who holds a medical degree and is undertaking a period of clinical training and practice before he or she is a fully qualified medical practitioner. Currently, interns are registered in the trainee specialist division of the register of medical practitioners. The amendment will not affect an intern’s ability to perform any function associated with being an intern such as prescribing.

Under the professional qualifications directive, a person who has been assessed under the general system of the directive may, before their qualification can be recognised, be required to undertake a period of adaptation. It is, therefore, proposed to establish a new register of adapters. Persons will be registered on this register while they undergo such period of adaptation as may be prescribed by the Medical Council under the directive. It is not expected that a high volume of applicants will use this qualification recognition route because of the existence of the directive’s automatic recognition route and other routes for registration in the legislation, but it is necessary to provide for it in order to give full effect to the directive.

I will briefly outline some of the other key amendments. The Pharmacy Act is being amended to allow the council to make rules under which it can recognise professional qualifications in pharmacy from other countries which it cannot recognise at present. Currently, under the Pharmacy Act, a pharmacist who is an undischarged bankrupt is precluded from registering and, therefore, working as a pharmacist during the period of his or her bankruptcy. I am removing this provision from the Act, as it unfairly prevents such pharmacists from earning a living.

The Bill amends the Health Act 1953 to remove specific requirements regarding the composition of interview boards for medical consultant posts. The amendment should speed up the recruitment process.

The Children and Family Relationships Act 2015 requires an amendment to include a definition of registered midwife and provide that registered midwives are persons who can perform donor assisted human reproduction procedures. A minor technical amendment is also being made to the Health Identifiers Act 2014 consequent on an amendment being made in the Bill to the Dentists Act.

That is an overview of some of the key provisions included in the Bill. I look forward to discussing the Bill in more detail on Committee Stage. I commend it to the House.

Deputy Stephen Donnelly

I was talking to someone earlier today who had read many more books than I had and gave me the following quote: "The truth starts with the truth and ends with the truth." It is from the Nepalese poet Santosh Kalwar. I once meditated with Buddhist monks in the monkey temple in Kathmandu, but I am afraid that my knowledge of Nepalese poetry is somewhat limited. The poet was obviously not referring to the Irish health service when he said it, but it cuts to the nub of the Bill and speaks to some of the serious changes we need to make in healthcare. Patients and their families need to know the truth, while it is critical that medics be free to provide that truth without fear of sanction or penalty for doing so. I put it to the Minister of State than in the healthcare system neither of these conditions is met in a broad range of areas. As the Bill will go some way towards addressing the issues on both sides, Fianna Fáil will support it.

At its most basic, the Bill will ensure clinicians will inform patients of previous professional issues, which is to be welcomed. It will ensure doctors, nurses, midwives, pharmacists and other health professionals will, by law, have to supply details of sanctions imposed on them. It means that when registering with a professional body, these health care professionals must declare in their application whether they have had any conviction imposed by a regulator and that information will have to be updated every year, which is to be welcomed. It also means that any allegation of wrongdoing in another country can be used as evidence in fitness to practise proceedings in Ireland. Crucially, patients will have more access to information on the people treating them as all of the details will be made public. Patients will be able to look up the history of their treating clinician.

There has always been an imbalance of power in Ireland and, I imagine, everywhere else between doctors and patients. Economists call such an imbalance "power asymmetry". Patients are sick, vulnerable and worried and sit down with someone who they hope has all of the information and knowledge. It is a completely unequal relationship. A good friend of mine, Sinead Gleeson, recently published a book of short stories entitled, Constellations. In some of the stories she recounts her experience of the healthcare system as a young woman who needed help with her hip. She has written in articles in various newspapers about some of the awful encounters she had, including having to go to clinics to talk about very sensitive issues, only to be met by some overbearing, obnoxious, satisfied older men. I do not apply that description to every consultant, or the vast majority of consultants, as I believe we have extraordinary consultants in this country. However, I have been in that position. When I broke my back many years ago, I remember sitting in a consultant's office, utterly exhausted, frustrated and in constant pain. The eminent consultant told me that at some point my spine would rupture, that I would know what that meant when it happened and to come back to him when it did. He then asked me for €200 and ushered me out of his office. Many of us have been in that position or know someone who has or we have been in a room where people have done this.

I imagine the Minister of State has had the same experience in his brief. As health spokesperson for my party, I have met families who have had horrific experiences in our healthcare system, where people, including children, have died or where very serious lifelong conditions have occurred. In some of these cases the doctors involved have been struck off in other jurisdictions and should never have been practising in this country. In other cases, the doctors involved had a plethora of complaints against them going back over years. This tiny number of people were going about their business destroying people's lives. I am sure the Minister of State meets them and I meet them. It is so frustrating. These people found out afterwards that there had been complaints against these doctors for decades but nobody ever knew and they had no way of finding out. We can be damn sure that if people knew, no one would go near these doctors and they would be removed. Obviously this is about a tiny number of people, but a tiny number of people can cause extraordinary pain.

The Bill is welcome because it will address that issue head on. Knowledge is power and the Bill gives some more knowledge to patients and their families, which is powerful and will help address some of the imbalance. In essence, the Bill puts into practice an idea in which Fianna Fáil strongly believes, which is the need for transparency. In fairness to the Government, its recent credentials are to be acknowledged.

Quite a large number of doctors are working as consultants in Ireland but are not on the specialist register, and that number is increasing. We are being told openly by people in the HSE that if it needs a consultant post in the hospital and it cannot fill it, the service goes away. Therefore, it puts in someone who is pretty well qualified but has not completed their specialist training, which is not acceptable. We should watch this space. It is highly possible that the State will be taken to court in years to come. If these doctors make mistakes and patients and their families find out that the consultant they were sent to had not completed his or her specialist training and nobody told the patients or their families, it sounds like a court case to me. People need to be told and it needs to happen soon. I have raised the issue with the Minister and in fairness he has said he is awaiting a report. However, this kind of thing needs to happen now.

We support the changes to the Health Service Executive (Governance) Bill. I am not convinced that the culture of openness, perestroika, has arrived throughout our healthcare system. I think there is some resistance to this within parts of the Department and the HSE, and among some clinicians. I do not think all of the resistance is illogical. Clinicians believe they are getting sued left, right and centre. If they are faced with a hostile environment, people want to hold the information. It has to be safe for officials, HSE managers and our doctors.

At the Joint Committee on Health today we discussed CervicalCheck with the Minister, Deputy Harris, at length. I put it forward as an example of what not to do. What happened? Dr. Flannelly set up CervicalCheck, built it up from the ground, implemented and ran what is recognised as one of the best cervical cancer screening programmes that has ever existed anywhere in the world with what is acknowledged to have the greatest level of transparency, which is ironic because that is what it fell on. It was trying to achieve a level of transparency and look-back that no other screening programme in the world was trying to achieve. What happened? Details of Vicky Phelan's case broke on a Wednesday. On the Friday morning, Dr. Flannelly went into RTÉ and gave a bad interview. She could not say for certain that the 221 women had been contacted, but she was honest about it. She gave a bad interview partly because she was honest in saying that the people in CervicalCheck were working really hard on the issue and they would get to an answer. She ran and built a screening programme that identified 65,000 high-grade anomalies in its first ten years. She was thrown under a bus publicly by the Minister for Health. He never met her. He never asked to meet her. He never asked to meet the head of the national screening service. A few hours after Dr. Flannelly gave a bad interview but was honest about what she did and did not know, the Minister for Health said he had no confidence in her and she resigned the next day.

Today in the committee, the Minister was again attacking her reputation, using very strong language and even stating things that I have since looked up and found to be untrue. He claimed that in cases where the woman had died tragically, she had directed consultants not to tell the husband. It turns out she had not said that. She said that consultants needed to exercise judgment and get the balance right between telling people the results of the audit and potentially causing more harm. I accept we have had the discussion as to whether that was appropriate. If the sitting Minister for Health is willing publicly to throw senior clinicians, who spend their entire lives saving lives, under the bus for telling the truth, it sends out a very bad message right from the top of Government. It is not to say the audit loop should not have been closed. It should have been closed. We have all agreed the women should have been told. In passing this Bill, which is a good Bill, we need to change the tone and culture. Public executions of senior clinicians for telling the truth by a Minister for Health set exactly the wrong tone.

I am glad the Bill provides for clinicians to appeal against minor sanctions. However, the bar for them doing so should be lowered. My understanding is they have to go to the High Court, which is a pretty high bar for anyone, incurring God knows what expense for lawyers. Could we find a way for such appeals to happen with a lower bar, still obviously at the highest level of scrutiny but with a lower bar than the High Court?

We should all work together to address the issue of healthcare litigation in Ireland which seems to be completely out of control. The costs for the State Claims Agency on healthcare are spiralling. There are legitimate cases, which obviously need to be respected with payments made. However, the costs have reached such a level that it must be affecting the provision of services which need that money. Again on CervicalCheck, I am told that GPs are over-referring to colposcopy because they are scared of being sued. The labs are over-referring to colposcopy because they are scared of being sued. HSE officials have confirmed to the committee that one of the great challenges in getting labs to clear the backlog of 80,000 women waiting up to eight months is that the labs are scared of coming to Ireland because of the legal environment. Better safe than sued seems to be where people are at. I think these are rational decisions the clinicians have to make.

I would like us to go further. We need to figure out how to create an appropriate legal environment whereby when there is negligence, the person affected and their family can be treated with compassion and decisions can be reached quickly and cost-effectively both for the patient and for the State. Of course, a patient who loses can end up with a bill for €500,000. They could decide to take a negligence case legitimately, lose it and end up having to sell their house over it. That is not acceptable. It is not really recourse to the courts. In the spirit of creating more transparency and more knowledge, and balancing the power between clinicians and patients, ensuring clinicians are working in an environment where it is safe for them to tell and to disclose, we should make it less onerous on them to appeal against sanctions.

I believe the High Court is too onerous. Let us do that and let us find a way to ensure the money that should be spent on healthcare is not filtered away to the legal profession. Let us make sure it is spent on the patients.

We wish the Minister of State the very best with this Bill. It needs to be looked at in the context of Brexit. I am not sure it is fully Brexit-proofed. That is something we might tease out on Committee Stage. The UK will no longer be part of the automatic procedures in which EU member states inform one another of clinicians who have been struck off so we need to make sure that our State agencies are watching and that agreements are put in place with the UK to ensure that information continues to be flow. Obviously, that is something we need to have in place as well.

Deputy Margaret Murphy O'Mahony

The gravity of the provisions as set out in this Bill are all the more real when one considers that after Friday the UK could, although unlikely, be considered one of the so-called third countries referred to in the Bill. Tonight will tell a lot in that regard. The movement of health professionals between the UK and Ireland is significant and if the reporting or monitoring of medical professionals is no longer regulated, steps must be taken immediately to ensure best practice in this country.

It is imperative that patients have every confidence in their healthcare professionals and access to information pertaining to fitness to practice ensures that. However if healthcare workers feel aggrieved by a decision it is only fair that there is an appeals process in place. Fianna Fáil agrees that an appeal to the High Court provision should form part of this Bill.

In terms of the disciplinary investigative process, it is important that a solid, transparent structure is in place. We therefore welcome the fact that the chief executive officer, CEO, of both the Medical Council and the Nursing and Midwifery Board will assume responsibility from the proceedings committee and an authorised officer will process and investigate complaints against members. The additional controls bestowed upon this authorised officer will compel information, as required, to enable completion of his or her report for the relevant CEO. It is also expected that this process will hasten the disciplinary procedure, given that the authorised officer will no longer need to refer to the proceedings committee for direction.

It is welcome that section 39 would be deleted under this Bill. With 479 consultant vacancies, it could be argued that the need to provide a certificate of experience was hampering the recruitment process. The introduction of a new register of interns is also welcome as it provides a clear account of a medical practitioner's credentials.

Clarity is needed at this time and this Bill goes some way in providing that.

Deputy Donnchadh Ó Laoghaire

I welcome the opportunity to speak on this large and complex item of legislation. The Regulated Professions (Health and Social Care) (Amendment) Bill 2019 relates to transposition of Directive 2005/36/EC, as amended by Directive 2013/55/EU, on the recognition of professional qualifications, which it must be pointed out was agreed under the Irish Presidency of the European Union in 2013. It is quite important that we transpose these directives, especially with the looming prospect of Brexit, and that we provide the mechanisms for the recognition of professional qualifications.

This legislation affects a number of professions and, indeed, some more than others. I will structure my observations and questions by profession first and foremost. On the section pertaining to pharmacists, there are some welcome changes to outdated aspects of standing legislation. Part 4, which seeks to amend the Pharmacy Act 2007, is very important. The Irish Pharmacy Union has consistently called for the 2007 Act to be updated. In particular, it has vocally called for the removal of the prohibition of a pharmacist to be declared bankrupt from registering as a pharmacist, for a complete overhaul of the fitness to practice regime to a less formal and adversarial model, as recommended by the Pharmaceutical Society of Ireland’s review in 2015, and for the implementation of the Supreme Court recommendations following the Corbally case. We can and will agree or disagree with various calls the representative bodies have made regarding this Bill and I have no doubt it will be an interesting debate on Committee Stage. It is important, however, that we are aware of what the representative bodies are seeking and saying.

When Deputy Jan O'Sullivan was Minister for Education and Skills, her officials had meetings with representatives of unions on the issue of the Corbally case and concerns around public hearings, and what matters should be brought to a public hearing. In the Seanad in 2015, my former colleague, the then Senator Kathryn Reilly brought forward amendments to the Teaching Council (Amendment) Bill which invoked the Corbally judgment. We know these issues have been debated at the highest level, so it is important and interesting that changes are forthcoming. However, there are a few observations, and perhaps criticisms, that I will articulate. There are still many outstanding issues with which the legislation has not sought to deal. This is an all-encompassing item of legislation and the opportunity should be seized to use it to amend primary legislation as such an opportunity does not come about often.

The Minister of State should give clarification as regards the decision of the council of the Pharmaceutical Society of Ireland, PSI, to approve rules on the temporary absence of a pharmacist from a pharmacy which have been sent or are being sent to the Minister to be signed. First, those rules are unnecessarily restrictive in that they undermine and restrict the professionalism and the employment prospects of almost 300 pharmaceutical assistants, most of whom are women over 50 years of age. Perhaps more equitable rules could have been included here in primary legislation where we could have debated them and they could be fed into by stakeholders to ensure they delivered for all involved. The Pharmacy Act 2007 could have been amended to develop a core competency framework for pharmaceutical assistants. It could have had a requirement that all pharmaceutical assistants on the PSI register undergo a practice review with the Irish Institute of Pharmacy. There are many things which could have been done, and still can be done, so I would urge the Minister to not sign those PSI rules and instead use Committee Stage of this Bill to bring forward amendments to the 2007 Act which protect pharmaceutical assistants and the public and let us debate it fully here so that no adverse outcomes materialise.

I spoke with members of the pharmacy profession and they raised questions around the amendment to section 52 of the Act, which allows the High Court to direct how the costs of an application for confirmation of a sanction are borne. They stated that this opens the possibility that a pharmacist who has been through a fitness to practice inquiry would then be required to pay for the High Court to confirm any sanction handed down, even in circumstances where the sanction is not being appealed, thus adding an additional financial penalty to the professional sanctions laid down in the Pharmacy Act. They are querying who should bear these costs, and I would appreciate if that could be clarified.

In the section pertaining to dentists there is also much welcome movement. Regarding section 17 where it proposes that the Minister is no longer notified of sanctions and that the HSE and other appropriate persons, including an employer, will now be notified, what are the reasons for this change, particularly given that a large number of dentists are not employed by the HSE and do not hold contracts with it to provide dental care? Are there difficulties arising with the existing reporting arrangements or is this to centralise these matters across the board? Clarification on that would be welcome.

Finally, on this Part, in section 18 it suggests that the Dental Council would, if it is in the public interest, publish part of all of the fitness to practice proceedings. This differs considerably from the existing provisions whereby only proven charges are published. I would also like to hear the reasons for that change. Has there been an issue with current arrangements or is this again an effort to centralise and streamline all reporting in the interest of the health service?

Regarding the section which pertains to interns, I have a question on it as this section is of particular interest. The Bill seeks to amend the Medical Practitioners Act to remove the requirement for interns to hold the equivalence of the certificate of experience for entry to the trainee specialist division of the register. I would be grateful if the Minister of State could reassure the House that checks and balances are not being removed. Will there be a similar measurement of experience, so we can be sure that our high standards in the medical field are upheld? I understand the requirement of internship equivalence is preventing some non-EU doctors from accessing training posts, even where they may hold memberships of Irish postgraduate medical colleges. However, this is a complex issue and there needs to be the appropriate evaluation of medical proficiency to ensure that the doctor in question has the requisite skill set.

The current recruitment and retention crisis has meant that the health service has not been able to attract and retain enough highly educated and trained doctors and sometimes to fill these gaps, under-qualified doctors have been appointed to roles in the health service, which is wholly inappropriate. We saw that last November during High Court proceedings where Mr. Justice Peter Kelly stated that defective procedures for recruiting doctors represented a danger to patients and laid bare the implications of the Government’s failure to address the doctor recruitment and retention crisis and the failures of the HSE in that regard.

To refresh people’s memories, this was where a non-consultant hospital doctor in a hospital maternity unit was suspended from practising by the High Court after other doctors had raised serious concerns within days of his starting employment on the basis that he lacked basic medical competency and was a danger to patients. The doctor had graduated from a medical school outside Ireland and his basic medical training was found to be seriously flawed and not comparable to that of the doctors who had trained here. I know that the Medical Council and the Irish Medical Organisation welcome this move and I bow to their knowledge and expertise. However, I would like the Minister of State to explain to me how any new system will operate for interns in order that we can ensure we will have the best medical professionals working in hospitals.

As with all parts of the Bill, there are a number of amendments to the fitness to practise provisions of the Medical Practitioners Act which should result in a speeding up of the fitness to practise process, which is to be welcomed. The Bill encompasses all professions - nurses, midwives, dentists and doctors - and it is welcome that declarations of convictions and criminal sanctions will be necessary before being registered to practise here. Also welcome is the allowance of disciplinary inquiries in other jurisdictions to be used as admissible evidence in Irish fitness to practise proceedings under the new proposals. It is welcome that there are extra protections for medical and healthcare professionals in that fitness to practise committees will be given the power to order that some or all of the information given at a hearing not be published. The allowance of a right of appeal to the High Court against sanctions of advice, admonishment or a censure is also an interesting inclusion, given that currently there is no right of appeal against these sanctions.

I welcome the provisions which will allow the chief executive of the Medical Council to investigate complaints made to the council in order to ensure frivolous or vexatious complaints will not proceed to the preliminary proceedings committee.

With regard to section 103 as it relates to fitness to practise hearings, I have spoken to doctors and their representative bodies. They hope, given that fitness to practise hearings can be extremely stressful for individual doctors and have severe consequences for their health, reputation and livelihood, that the idea of proceedings being held in camera will be looked at and that no information, including on the identity of the doctor, will be made public until poor professional performance has been proved.

As we seek to implement these European directives, it is important to look at areas where our medical professionals may have scope to learn from their European colleagues. There are many opportunities to impart wisdom to their European colleagues and vice versa. In particular, there is scope for our medical professionals to learn more about social prescribing, different physical activity regimes as part of a broader chronic disease management policy and the use of medicinal cannabis, to name but a few. Such improvements would benefit medical and healthcare professionals, as well as patients.

While we will be supporting this legislation, we hope to work further with the Minister of State and others to amend it on Committee Stage.

An Ceann Comhairle

Deputy Mattie McGrath is sharing time with Deputies Michael Healy-Rae and Michael Collins.

Deputy Mattie McGrath

I am happy to speak to the Bill. To be fair to the Minister of State, Deputy Jim Daly, he met a delegation from County Tipperary today to discuss mental health issues. He is doing his best and I acknowledge his bona fides. It is a pity that he is not the senior Minister.

The Bill amends the five health professional regulatory Acts, in particular, in the areas of fitness to practise and registration. It is disappointing and sad that we see people who do not have the proper qualifications, make mistakes and carry out different procedures when they are not qualified to do so and do not have the experience needed. The key amendments include the following. First, applicants for registration must declare in their application and annually thereafter any conviction or sanction imposed by a regulatory body inside or outside the State. That is important. In a world where people move from state to state and there is ease of access and so on, it is vital that we look outside the State also.

Second, disciplinary inquiries in other jurisdictions can be used as admissible evidence in fitness to practise proceedings in Ireland. All sanctions will be published to ensure the public will have access to information on disciplinary sanctions imposed on doctors, nurses, midwives, pharmacists and other regulated health professionals.

Third, practitioners will have the right of appeal to the High Court when minor sanctions of advice, admonishment or a censure in writing are imposed on a practitioner. There is currently no right of appeal against these three sanctions. In fairness, any justice system must provide for a right of appeal. We cannot have cursory justice and must provide for a right of appeal. It is, therefore, a good amendment.

All of the amendments strike me as being perfectly reasonable. We must have strong and robust protections for the public. While they are generally excellently served by the quality of our doctors and healthcare professionals, sometimes they do experience an horrendous level of care. We cannot lose sight of this, although the vast majority are well served by health professionals, nurses and front-line staff. For whatever reason, the few bad apples in a barrel can cause rot which can have bad consequences, including, for example, the eagerness of the legal eagles to become involved in many cases in an over-zealous fashion. In some cases there is malpractice, for example, in the case of the cervical smear tests, although it did not involve clinicians in the main but a systems failure. The Tánaiste was trying to explain to the House about a systems failure in the case of the national children's hospital, but there are systems failures every minute of every hour of every day of every week of every month of every year due to the monstrosity that is the HSE which is too big to function properly. I have said the Minister of State is doing his best to grapple with the problems and as we saw today at the meeting, there are many excellent people involved. However, there are too many design teams and people running and managing that it is nearly impossible to move forward because everything is too slow. While we have discussed the approval of a €2.2 million unit, because of the rate of inflation since 2015, the cost is now €2.6 million and the matter has to be referred back for approval. I know that the Minister of State will push the project and do his best, but, surely to God, when they are processing approvals, they should be able to index link the cost and not have to go back to the drawing board all of the time.

We must, as I said, have strong and robust protections. We must also, above all else, have accountability. Only recently we read that the President of the High Court had struck off a radiographer when he was satisfied that "she is a danger to the public" owing to her substandard knowledge of the basics of radiography. We are all sent for X-rays, including our parents, children and siblings, and expect to be seen by a competent person. I say, "Well done," to the High Court and Mr. Justice Peter Kelly for saying it and putting the matter into the public domain. As he said, she was a danger to the public owing to her substandard knowledge of the basics of radiography. I would love to know who interviewed her and how she got through the process to get into the X-ray room where she was unable to read X-rays. It is appalling. We now have managers where at one time we had a matron running a hospital and, by God, no one fooled her. The place was clean and tidy; patients were looked after and everything was done right. No one crossed her either. In her place we now have area managers, ward managers, floor managers, bed managers, linen managers, hygiene managers - the place is not even clean - and food managers. I have only mentioned half of them and they are going around with flip charts, while patients can be sent for an X-ray. I remember going to Cashel hospital with Mary T. who is now deceased. We knocked on the door and were given directions to where the doctor was. Patients now have to go to different reception areas and so on. It is a bureaucratic nightmare, instead of making sure the people who are doing the work are competent to do it. Mr. Justice Peter Kelly said the case involved a person who worked for a short period in 2017 at University Hospital Waterford in my area before she was let go. He underlined his concerns about the procedures used in recruiting professionals to work in hospitals. They are not my words, although I have the same concerns, but those of the eminent High Court judge Mr. Justice Peter Kelly.

It is vital that we do all we can to create a healthcare environment where people can trust those who are treating them and have certainty in their expertise. That is a basic prerequisite.

It is also clear that it is not only healthcare professionals who can be a threat to the public. This is also true of the health system itself. Last year the Irish Association for Emergency Medicine, IAEM, issued the dire warning that up to 350 people would die needlessly in hospital emergency departments in the next year unless the Minister for Health, Deputy Harris, definitively addressed the trolley crisis. This crisis has got worse. The Taoiseach told us yesterday that it is not as bad as last year or the year before. Conditions in my county are appalling. Cork University Hospital was nearly closed last week. A man lay in the street for two and a half hours after a fall because eight ambulances were tied up at Cork University Hospital.

What sanctions should we pursue against the Minister when his lack of action allows a scenario to continue where hundreds of unnecessary deaths may be occurring? That is a shocking statistic. We are not in a war, but when one looks at accident and emergency departments it seems like a war. If we seek to hold the doctors to account, the same should obviously apply to the Minister who has overall responsibility for the health service. He can squirm. He went on "Six One News" on his own yesterday to try to account for something that is inexcusable. Our colleagues in Fianna Fáil give him a pass. Deputy Micheál Martin and others come in here and criticise him every day, but when it came to a vote of no confidence they sat on their hands. They have been sitting on them so much we will need to get therapists to fix their hands before this Government is finished. It is a good job the seats are soft and they are not getting hurt, but they will definitely be badly damaged and may be unable to press the buttons when the time comes. This carry-on is unbelievable. Responsibility to the people does not matter. No Minister is held accountable.

Deputy Michael Collins

I am grateful to have the opportunity to speak to this Bill, the primary focus of which is patient care and safety. I welcome the amendment to this Bill which will ensure that doctors and other healthcare professionals will have to declare any convictions or criminal sanctions before being allowed to register in the State. This will allow us in Ireland to use findings from disciplinary inquiries carried out in other jurisdictions and countries as evidence in the Irish fitness to practise proceedings.

The important aspect of this Bill is that patient safety is to the fore. For example, all disciplinary sanctions imposed on doctors, nurses, midwives, pharmacists and other regulated health professionals will be published to ensure the public has access to this information. There is no doubt that the people of this country are looking for transparency right across the board. Sadly, many woman and their families have had to suffer unnecessarily in the recent CervicalCheck scandal. Dr. Gabriel Scally's latest progress report on the CervicalCheck affair has stated that the current open disclosure policy is deeply contradictory and unsatisfactory because it does not compel clinicians to disclose any failings in the care of patients. The HSE's open disclosure policy provides that “patients who experience harm as a result of their health care are communicated with in an open, honest, empathic and timely manner and that an apology which is sincere and meaningful is provided”. We can all see that the open disclosure policy was not applied to the hundreds of women with cervical cancer who for years were not told of an audit that showed they had received incorrect smear test results.

We all know that this was completely unacceptable. I want to know what this Government is going to do to ensure that we never see a scandal like this again. Moreover, what is the Government doing for the women throughout this country who have been affected by the CervicalCheck scandal? One measure that should come from this terrible scandal is the automatic provision of medical cards to all cancer patients as soon as they are diagnosed. The number of people getting diagnosed with cancer is frightening. Very sadly, the rate of cancer diagnosis is increasing. Someone gets a cancer diagnosis every three minutes in Ireland, and by 2020 half of us will get a cancer diagnosis in our lifetime. The Government cannot ignore these statistics anymore. It must start supporting people who have been diagnosed with cancer. Issuing a non-means-tested medical card as soon as a person is diagnosed with cancer would be a start in supporting cancer patients through their battle.

It is also important to mention the impact of Brexit on our health service and our health service professionals. There is a possibility that issues relating to the qualifications of our health professionals could arise after Brexit. When Brexit happens, the directives providing for the mutual recognition of qualifications will apply to the UK as a third country rather than as a full member state. This will mean that the UK will no longer report restrictions on the practise of health professionals, as happens under the current alert system. This is a concern and needs to be addressed in this Bill.

This Bill promises reduced delays in establishing interview panels for consultant posts, which should have a knock-on effect on recruitment. The situation with waiting lists is out of control here in the South. Members will excuse me if I do not hold my breath for this Bill to do much to reduce these waiting lists. Deputy Danny Healy-Rae and I have sent 30 buses to Belfast for cataract procedures, with another four ready to go. Does the Government realise that hundreds of people are forced to go to Belfast for a procedure that takes just 15 minutes? This Government should be ashamed of how badly it has let the people down, especially the elderly. How many more people will we have to carry across to the Border? Will this Government listen and take real and adequate steps to reduce waiting lists here in Ireland?

In the past year the health service has hit the headlines repeatedly for all the wrong reasons. We had two major scandals, the national children’s hospital overrun and the CervicalCheck scandal. We have seen some of the longest waiting lists in the history of the State, which include very young children and elderly people. We have seen hundreds of people travelling across the Border because they are on waiting lists of up to five years. Our nursing staff and ambulance staff have been reduced to strike action. Our health professionals abroad, who want to come home, are hitting obstacle after obstacle. Last week an 82 year old man had to lie on the street in Skibbereen for two hours and 15 minutes because ambulances were tied up at Cork University Hospital. That meant that an ambulance had to come all the way from Cahersiveen to Skibbereen. I invite the Minister of State to imagine this happening to a person of 82 years in his own constituency. It is not good enough. These are the things that people see day to day. This Government needs to wake up and give the people the health service they deserve.

Deputy Michael Healy-Rae

I, too, want to speak to this very important topic. It is important to have good governance and to have systems and checks to make sure the people operating in the healthcare service are up to standard. A person driving a digger has to have proper tickets, a Safe Pass card etc. before he or she is allowed onto a building site. That applies to any job of work now, rightly so. We must have standards. If there are standards in every other walk of life, surely to God, we must have the proper checks and mechanisms to prevent situations of the kind that have arisen. This is not confined to any particular place. Throughout the country there have been instances of people operating in hospitals who were not up to scratch and fell far short of the mark. When people enter the health service, they expect to get the very best. They expect radiographers, people reading scans etc. to be excellently trained people with no blemishes on their records. I will be only too glad to put my shoulder to the wheel in any way possible to support the Government in ensuring this happens.

Regulated Professions (Health and Social Care)(Amendment) Bill 2019: Second Stage

Dáil Éireann debate -
Wednesday, 10 Apr 2019