I welcome this legislation and the opportunity to speak on it. I thank the Library and Research Service for its detailed paper on the Bill and for the brief we got, which has been very helpful.
It has been said many times what the Bill involves. There are really six kernel points that have been set out for us. The Bill proposes to give effect to them. First, it makes amendments to the Health and Social Care Professionals Act 2005. For the benefit of people who might not have grasped what this is about, I will explain. I am going to go around in a circle in a moment as to why this is necessary and I will mention the report following the Dr. Neary scandal. Then I will come to the dentists, who have identified serious gaps in the regulation. The Minister of State may be aware of this in the context of Oranmore, County Galway, and what has been brought to our attention. It is important to point out what is good. There are six points. The Bill seeks to ensure that social care workers applying for registration are required to meet the same standards as other professions registered with CORU. That is very basic. It seeks to provide that the Minister for Health may prescribe or vary by order the qualifications required by designated professionals. That is very practical and we need that. Then there are amendments to the Medical Practitioners Act 2007, which I understand arose directly from the Neary scandal, among other changes the Government was trying to bring in. In that regard, the Bill seeks to provide that persons operating under the functions of the Medical Council will have appropriate immunity, which is absolutely necessary. Then the Bill seeks to provide that holders of UK medical degrees can access intern training posts in Ireland. That is absolutely vital. The Bill seeks to provide for the continued provision of a route to registration on the general division of the Medical Council register for certain cohorts of internationally trained doctors. I am not sure if I will get a chance to come back to that, but it is something I will keep a close eye on in respect of certain doctors and certain countries. Finally, the Bill seeks to provide for amendments to support the performance of triage, investigation and adjudication of complaints under the principal Act. Again, that is very important and something that is clearly missing when we come to the Dental Council of Ireland and what it identifies in its submission, which we all have. I welcome that and, as I said, I am grateful for the work that has gone into this.
I am not sure why there has been such a delay. It is now 2022. There was a health strategy in 2000 and then an Act in 2005. CORU was set up in 2007 and we are still struggling to bring openness, accountability and monitoring and to ensure competence and ensure there is a proper complaints procedure that is able to deal with complaints quickly and to the satisfaction of those making the complaints, once they are bona fide complaints. It has taken this long to do it, and I am not sure why.
Let me deal with the inquiry and the Medical Practitioners Act 2007 to give context to this. I know that the Minister of State is multitasking again, and I say "well done" to her on doing so in so many roles. I have before me some of the report of the inquiry that was set up and signed by Judge Harding Clark at the time. I think that was in January 2006.
The Medical Practitioners Act was enacted in 2007 and now we are seeking to amend that legislation to make the system better. Back in 1998 a very brave midwife broke ranks. Of course she was educated outside of the country, in Northern Ireland or England, and she drew attention to the high rates of Caesarean sections being performed in Our Lady of Lourdes Hospital. Finally, a non-statutory inquiry, with one member, was set up and we have the final report from Judge Harding Clark. I would advise every woman and man to read that report because it highlights how this happened and how it could happen again tomorrow if we do not learn from it, if our regulatory system is not fit for purpose - and we are trying to make it fit for purpose - and if there is not a duty to speak out. When I quote from the report, it will be clear why I say that. The process began in 1998 and continued up to the point at which the report was published on 25 January 2006. The inquiry was set up by order in 2004 and took less than two years to report.
Given that I have the time, which is unusual, I am going to read out what the inquiry established. Judge Harding Clark writes:
It is a story set in a time of unquestioning submission to authority, whether religious or civil, when nurses and doctors were in abundant supply and permanent jobs were few and treasured.
The point being made is that precarious employment was a feature in the medical profession, so there was an extra burden on people not to speak out or they would lose their jobs. Indeed, one or two brave souls who did raise questions found that their contracts were not renewed. This happened not too long ago in Ireland. Judge Harding Clark, having described it as "a story ... of unquestioning submission to authority, whether religious or civil", continues:
It is the story of a relatively small but very busy hospital which operated by a separate and unique set of rules, and was accountable to a religious community rather than to objective medical standards.
That is what we are trying to do here. I will come back to that in the context of the Dental Council. The inquiry found that establishing the rate of Caesareans carried out, which was unacceptably high, was difficult because "key registers were missing" but that the "numbers are truly shocking". I will not take up time reading out the numbers but Judge Harding Clark described them as "truly shocking". The report goes on to say that "No one made a formal complaint and no one questioned openly", except the brave midwife who went along with her friend to the solicitor for the then Eastern Health Board. I want to compliment the man in charge at the Eastern Health Board at the time who took the whistleblower's disclosure very seriously and followed up on it. It was the former Eastern Health Board, from what I understand, although I never met the man and do not know him.
The report goes on to talk about Dr. Neary's fall from grace but I am not going to go into any of that at the moment. The report also refers to inadequate supervision as follows:
He came to work in a unit which lacked leadership, peer review, audit or critical capacity. It is the story of a doctor with a deep fault line, which was recognised early but never corrected. It is a story [in the Judge's view] of a committed doctor with a misplaced sense of confidence in his own ability. It is a story of deep misunderstanding and misapplication of clinical independence.
These are the actual findings and the consequences of same.
There was very little turnover of staff during that period. Job insecurity may have influenced a climate of silence. Consultants could, and did cause nurses to be transferred. Many witnesses recounted to us that a junior paediatrician encountered Dr. Neary’s displeasure causing her contract not to be renewed.
The report goes on to deal with statistics and so on and finds that "No one seemed to know the actual numbers or suspect that anything was amiss or unusual". Of course, we had the usual internal review by three colleagues, who upheld everything that Dr. Neary did. They subsequently regretted that and Judge Harding Clark acknowledges that regret. However, they upheld everything he did and said there was nothing out of the ordinary. Through all of that, the person from the Eastern Health Board persisted, as did the whistleblower, even though it was very, very difficult.
I will finish with this point in the report: "Dr. Neary and Dr. O’Brien were reprimanded on a number of occasions for rudeness or abrupt manner". One of the recommendations was that they would learn how to say "hello" and shake hands with patients. That puts things in context. According to the judge, "Very few midwives volunteered to speak to us." She also found that notes had "mysteriously disappeared", which meant that a considerable number of former patients were "unable to have a review". I mention all of that, and there is more in the report that I am not mentioning, because it is really worth a read in the sense of explaining the blinding silence and the failure to recognise mistakes. The point is that no matter what legislation or regulations we bring in, they have to be matched by courage and, more importantly, by the creation of an atmosphere that rewards people who come forward. That is the challenge for every institution and we are utterly failing.
In that context, I want to turn to Galway, not to be parochial but because, as the Minister of State knows, a serious problem has arisen there in relation to an orthodontist. This is currently the subject of an application to the High Court which I will not mention. In the meantime, the person is not able to practise, by their own admission. More than 200 families are affected, with people at various stages of orthodontic treatment left in the lurch. We have all been at meetings about this in Galway. My colleagues Deputy Grealish and Senator Kyne have both raised it in these Houses. Cross-party, we have listened to the concerns of the people on the ground who have been left without an orthodontist. Not alone is it terrible for the families who have paid money and lost it, and will now have to incur additional expense, but the difficulty is that the Dental Council has told us that the obligation is on that person, who clearly cannot practise. I am not commenting on a court case; it is accepted that the person cannot practise. How could the ethical obligation be on that person, be it a man or a woman, to sort out the problem when they are in trouble? There is a huge gap here. I will be using the word "gap" a lot in relation to dental services, which is not helpful and is a bad pun.
I will now turn to the Dental Council's submission regarding legislative change in dental regulation. We are being told that the legislation before us today is going to help with that. I see a reference to the 1985 Act for dentists but I see nothing since in relation to dentists. The executive summary of the submission points out that the council has an obligation to bring matters to the Minister's attention. The Dental Council is making this submission to the Minister under the relevant section of the Act. It is obliged to advise the Minister on all matters. The submission argues that there are two gaps in the 1985 Act that pose a significant risk to public safety. The first is the failure to oblige registrants to maintain their ongoing competence and the second is the failure to regulate dental practices. The submission holds that patient safety cannot be assured and patients have been harmed because of this failure to regulate. The council goes on to look in detail at how this happened. Indeed, it mentions Dr. Neary in the context of the Medical Practitioners Act 2007. Luckily and fortunately, we do not have the equivalent of a Dr. Neary in the dental profession, or at least not identified. However, I hope we do not need that to happen for us to take the appropriate action and update the 1985 Act, which we have utterly failed to deal with thus far.
While registrants, that is, dentists going on the dental register, are ethically obliged to maintain an ongoing competence, this is not underpinned by legislation. The council goes on in its detailed report, which I have read, to highlight the fact that two thirds of dentists in Ireland are not Irish-trained.
That is not a fact to comment on, except it makes it more complex to recognise the training and whether people are competent. There is no legal obligation in the Bill to keep up with competency.
The smile agus sláinte dental strategy is 22 years old. It is a bizarre name. There are gaps in my memory regarding it. I am highlighting this today. How could this be allowed to happen? What has happened since this was presented to the Minister in October 2021? Was there any possibility in the Bill to make provision for this? I find it very difficult to have somebody from the Dental Council telling us that the obligation is on the dentist who is in trouble and clearly cannot perform, for whatever reason, to take the appropriate action. That is a major gap in the system. What is to be done about that? Perhaps someone could give us an update on that.