Joint Committee on Education and Social Protection debate -
Wednesday, 2 Apr 2014

Accreditation for the Royal College of Surgeons in Ireland Facility in Bahrain: Discussion (Resumed)

Chairman

By virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the joint committee. However, if they are directed by it to cease giving evidence on a particular matter and they continue to so do, they will be entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against a person or an entity by name or in such a way as to make him, her or it identifiable. I advise witnesses that the opening statements they have submitted to the committee will be published on its website after the meeting. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable.

The purpose of the meeting is to resume deliberations on the accreditation of the Royal College of Surgeons in Ireland's facility in Bahrain. A report on this matter was prepared by Ceartas, Irish Lawyers for Human Rights, in May last year. Ceartas requested that it be given the opportunity to raise the issue with us and the committee afforded it such an opportunity in November. We will give further consideration to the matter at this meeting. I am pleased to welcome from the Royal College of Surgeons in Ireland Professor Cathal Kelly, CEO and registrar; Professor Jim Finucane, recently retired professor of medicine; and Professor Paddy Broe. Also with us from the Irish Medical Council are Ms Caroline Spillane, CEO, and Dr. Audrey Dillon, vice president; from the National University of Ireland Dr. Attracta Halpin, registrar; and from the Department of Education and Skills Ms Mary Doyle, Secretary General, and Mr. Keith Moynes, assistant principal officer.

I invite Professor Kelly to make his presentation on behalf of the Royal College of Surgeons in Ireland.

Professor Cathal Kelly

I thank the Chairman and members of the joint committee for inviting us to make a presentation to them.

The Royal College of Surgeons in Ireland, RCSI, is a long-established health sciences institution with an international reputation for the delivery of high quality medical programmes nationally and internationally. It is Ireland's truly international centre of higher education in medicine and health sciences. It is an international organisation. Our campus in Dublin has over 3,800 students and 1,000 full-time members of staff, mainly graduates. In collaboration with Irish Aid, we are the largest international surgical trainer in sub-Saharan countries. In addition, we run training programmes throughout the Middle East, with a training campus in Dubai and a university in Bahrain. We also run undergraduate and postgraduate programmes in the Far East, mainly in Malaysia. While the RCSI has traditionally been acknowledged as the lead higher education institution in attracting international third level students to Ireland and bringing Irish education to international settings, this is now an important aspect of the work of many higher education institutions and a key part of Ireland’s development as a knowledge economy.

The RCSI has worked closely with Enterprise Ireland and we are proud that many of our graduates have played a key role in opening doors for Irish business in the Middle East and worldwide. It has had a relationship with Bahrain for over 30 years. The college established the Medical University of Bahrain in 2003 and the students who attend RCSI Bahrain are now drawn from more than 30 countries across the globe, including the United States, Australia, Canada, France, New Zealand and the United Kingdom. There are 1,240 students enrolled in medicine, nursing and masters programmes. There are over 130 academic and administrative staff drawn from across the globe at RSCI Bahrain. In addition, there are over 200 associated clinical faculty staff who support the training of our students in the hospital environment.

The RCSI delivers the same curriculum across three campuses in Dublin, Bahrain and Perdana. When it comes to examinations and despite significant logistical challenges and differences in time zones, a medical student in Dublin will turn over his or her examination paper at 8 a.m. local time and his or her counterparts in Bahrain or Kuala Lumpur, Malaysia, will turn over the same paper at 10 a.m. and 3 p.m. local time, respectively.

Papers are jointly set, centrally reviewed and moderated, and external examiners are appointed by the National University of Ireland and the RCSI and shared across the campuses. Examination boards are held jointly using video conference facilities. Graduates from the School of Medicine of RCSI-Bahrain are conferred with the degrees of MB, BCh, BAO from the National University of Ireland, NUI, and in addition they will receive licentiates of the Royal College of Physicians of Ireland and the Royal College of Surgeons in Ireland.

The RCSI (Charters Amendment) Act 2003 included a provision that allowed the Minister for Education and Skills to commence RCSI independent degree-awarding powers. Since 2010, as directed by the Minister, the RCSI is both an independent degree awarding body and a recognised college of the NUI. As a designated awarding body under the terms of the 2012 Act, the RCSI deals directly with Quality and Qualifications Ireland, QQI, and other State agencies. The RCSI and the NUI operationalise the provisions of the 2012 Act through the RCSI-NUI working group executive, established in 2013. A key point here is that the academic qualifications awarded to RCSI-Bahrain graduates are identical to those awarded to all RCSI graduates, including those in Dublin. These are subject to both internal and external oversight which I will now describe in some detail. The RCSI medicine and health sciences board is responsible for oversight of the degree-awarding activities of the college. The RCSI awards and qualifications committee has the authority and operational responsibility to evaluate and consider programmes which fall under the National Framework of Qualifications, NFQ, for approval, accreditation and periodic review.

At the RCSI we believe that providing an accessible, high-quality education and experience for all our students will ultimately translate to better health outcomes for patients. The RCSI has invested heavily in a quality agenda both in Ireland and overseas. In recent years we have come through many quality assessments, including the rigorous assessment mentioned earlier in regard to independent degree awarding status in 2010. All RCSI activities, nationally and internationally, are subject to oversight by QQI, the statutory body which was established by the Oireachtas in 2012.

We have just recently come through an institution-wide review by a six-member international review panel, commissioned by QQI. This review encompassed our RCSI-Bahrain campus and included a review of our undergraduate, postgraduate and research activities. The report is expected shortly, but the chairman, Professor Simon van Heyningen, honorary fellow and emeritus professor at the University of Edinburgh, commented at an exit meeting that it was a privilege to conduct the review in such an impressive institution with a pervasive culture of quality.

As our awards are professional in nature, they are subject to what I describe as a triple-lock approach to quality. First, they are subject to our own internal quality assurance and enhancement procedures; second, they are subject to external oversight in Ireland by the NUI and QQI, and in Bahrain by the Higher Education Commission and the national authority; and, third, because they are professional in nature, they are subject to professional accreditation by the relevant authorities such as the Irish Medical Council and, in Malaysia, the Malaysian Medical Council.

The Irish Medical Council’s accreditation mechanism is highly valued by all of the Irish medical schools with international activities. The RCSI believes that the Irish Medical Council review helps to support the ambition and strategy of the Department of Education and Skills to internationalise Irish higher education. Importantly, it helps to protect and further enhance the overall reputation of Irish higher education institutions in the competitive international market where evidence of the quality of transnational activity is essential. The primary purpose of accreditation by the Irish Medical Council is to provide additional external assurance in relation to the quality of the qualification. Accreditation of RCSI-Bahrain by the Irish Medical Council will be based on the World Federation of Medical Education Standards. RCSI-Bahrain has completed a self-assessment report and we are confident that it meets these standards and that the resources available to staff and students meet the requirements specified. The RCSI-Bahrain campus is a state-of-the-art medical campus, completed in October 2008 with a built-up area of more than 15,750 m2.

It is important to note that the accreditation of RCSI-Bahrain by the Irish Medical Council gives no legal advantage to graduates of RCSI-Bahrain, nor does it improve access to employment opportunities, but we believe that accreditation by the Irish Medical Council would be a further demonstration of our commitment to quality. In addition to seeking accreditation by the Irish Medical Council, RCSI-Bahrain has previously been accredited by the Gulf Co-operation Council, GCC, committee of medical school deans; it is included in the World Health Organization directory of medical schools, the International Medical Education Directory of the Foundation for the Advancement of International Medical Education and Research, FAIMER, and the health profession education directory of the World Health Organization; and is recognised by the Medical Board of California and the UNESCO-run International Association of Universities. The National Health Regulatory Authority, NHRA, is the licensing authority for medical graduates undertaking internships in Bahrain. As a testament to the educational standards in RCSI-Bahrain, I am pleased to advise the committee that the pass rate in the last licensed exam for RCSI-Bahrain was 100%, compared to a national pass rate of 40%.

Our RCSI-Bahrain graduates have been accepted into postgraduate training posts in the GCC countries, the United States, Canada and several European countries, including the United Kingdom. Earlier this year, the Canadian federal authorities designated RCSI-Bahrain as an eligible institution for student financial assistance purposes in the different provinces.

Since 2010, in conjunction with the NUI, we have graduated four cohorts, a total of 611 graduates, in the different programmes offered by the university. As in Dublin, each RCSI-Bahrain graduate proudly stands at the graduation ceremony and recites the Declaration of Geneva. I will not read this in its entirety, but it contains the following points:

I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;

I will maintain the utmost respect for human life;

I will not use my knowledge to violate human rights and civil liberties, even under threat.

As Irish companies and universities increase their activities abroad, as we all must do, we will find ourselves working in countries with very different political systems and cultures from our own. To work in these countries, we must find a way to be true to ourselves and our core mission while being respectful to the cultural, judicial and political norms of the countries in which we work. We at the RCSI are proud of our staff and students in Bahrain, where we provide a high-quality medical and nursing education in a non-sectarian environment. It is our intention to continue to contribute to the future of Bahrain through the provision of high-quality education in the health sciences. With respect, I would say to the committee that the proposed Irish Medical Council visit is a mark of quality for our students. It confers no legal advantages. If it does not go ahead, the only people punished will be our students. While all of us in this room may have different views, I hope we are united in wanting the best outcome for these students.

Ms Caroline Spillane

On behalf of the Irish Medical Council I welcome the opportunity to address the committee on this important topic. I am joined by the vice president of the Irish Medical Council, Dr. Audrey Dillon.

The role of the Medical Council is to protect the public by promoting and better ensuring high standards of professional conduct, professional education, training and competence among doctors. The Medical Council is responsible, under Part 10 of the Medical Practitioners Act 2007, for setting and monitoring standards in undergraduate, intern and postgraduate education and training in Ireland. We also ensure that doctors engage in lifelong learning and skills development activities by monitoring the ongoing maintenance of doctors' professional competence. We accredit the bodies that deliver medical education and training and professional competence schemes against robust and validated international standards; and we ensure through a monitoring process that accredited bodies maintain and improve their standards. Where education, training and professional competence standards are not met, the Medical Council can take action in the public interest by applying conditions or refusing to approve relevant bodies and programmes. External accreditation ensures education and training is delivered to defined high quality standards, while also fostering institutional improvement and promoting a high-quality experience. It encourages organisations to think about, respond to, and deal with the strengths and weaknesses of their programmes.

In line with the Medical Practitioners Act 2007 and Medical Council rules, globally recognised standards are used in accreditation. We use the World Federation for Medical Education Global Standards for Quality Improvement in Medical Education: European Specifications 2007.

A standard procedure is used by the Medical Council in the application of these standards to its consideration of any programme of basic medical education. That procedure, and the approach of the Medical Council, has been externally reviewed and benchmarked by the US Department of Education’s National Committee on Foreign Medical Education, which provides assurance that a proper approach is taken by the Medical Council. The principles underpinning these accreditations ensure that they are based on a sound legal footing; are independent from the medical schools, the medical profession and government; are trustworthy and recognised by all; are fair; possess a high degree of transparency; and involve assessors who are respected in the field, and are recognised as such internationally.

The council’s accreditation teams normally comprise a combination of lay and medically qualified members of the Medical Council and external independent assessors. The external assessors have expertise in medical education or quality assurance, or represent the public interest. They are drawn both from within Ireland and from other jurisdictions. Dialogue with students is an important part of accreditation visits. We aim to meet students in every year of the programme. One of the key elements of the dialogue is that it is confidential. That is emphasised to students at the start of every session. Professionalism and ethical issues always feature in the discussions, particularly with students at the later stages of their training, who for that reason are experiencing real life on the ward or in a general or community-practice setting. The types of scenario they met in a more theoretical way earlier in the course are teased out in a more practical sense at a later point in the course.

Many medical schools in Ireland, approved by the Medical Council for the purposes of the delivery of programmes of basic medical education, have expanded operations to deliver medical education globally. The Joint Committee on Education and Social Protection will be aware of increasing delivery by Irish universities of third and fourth level education around the world and of the support of the Department of Education and Skills for such overseas activity. As the responsible body for approving programmes of medical education and training, and the bodies that deliver those in Ireland, the Medical Council has been invited to consider the same bodies' delivery of medical education internationally for the purposes of quality assurance. In the case of some programmes, these are co-delivered in Ireland and in another country; some are delivered in totality outside the State. The Medical Council has considered how it should approach such requests. In the context of increasingly globalised medical education and training, the Medical Council takes the view that, in safeguarding the reputation of Irish bodies’ role in medical education and training, it does consider requests to review programmes delivered by Irish bodies outside the State. We understand from the bodies that make this request that the quality assurance role of the Medical Council is highly valued. Indeed, the Department of Health has expressed to the council its view that programmes delivered under the auspices of an accredited Irish education body should be of equivalent standard and quality to a programme delivered within the State.

Medical education and training is increasingly globalised. Medical schools in Ireland welcome students from around the world, who enrich medical education in the State. Their study at Irish medical schools also makes an important contribution to the funding base for medical education in Ireland. The Medical Council has received and is processing a request to review the programme of basic medical education delivered by RCSI-Bahrain. The WHO standards and procedures will be used by the Medical Council to review the programme of basic medical education at RCSI-Bahrain and to inform a decision by the Medical Council in respect of that programme under section 88(2)(a) of the Medical Practitioners Act. At this stage, a review has not taken place but is being planned. An assessment team is being identified and pre-assessment visit information has been requested by the Medical Council from RCSI-Bahrain.

The Medical Council is conscious of the political developments in Bahrain; indeed, our earlier plans to review the basic medical education programme at RCSI-Bahrain were postponed owing to the political situation. The former president of the Medical Council, Professor Kieran Murphy, and the current president of the Medical Council, Professor Freddie Wood, have both written to a number of political leaders, including the Taoiseach, the Minister for Foreign Affairs and the Minister for Health, and to the Higher Education Authority expressing the Medical Council’s concern about the situation. In this accreditation visit, we will apply our standards and procedures to review the programme of basic medical education at RCSI-Bahrain and to inform a decision by the Medical Council in respect of that programme. That decision will, as with every decision by the Medical Council, be made in an independent, informed and objective way. The outcome of the decision and the report based on the review which informs it, including discussion of all issues germane to the standards and procedure used by the Medical Council to review the programme of basic medical education at RCSI Bahrain, will be available for public scrutiny.

I thank members for the opportunity to explain the role of the Medical Council in medical education and training and to set out for them the Medical Council’s process for considering the accreditation of programmes of basic medical education and training and the bodies that provide the programmes. At the present time, we must be careful not to pre-empt our visit and its findings, so as such we are somewhat limited in the information we can provide as we are constrained by the requirements of our work. As previously stated, the council has plans to visit RCSI-Bahrain later this year and we would be pleased to provide an update to the committee later in the year.

Chairman

I thank Ms Spillane. The next speaker is Dr. Attracta Halpin on behalf of the National University of Ireland.

Dr. Attracta Halpin

I thank the Chairman and members of the joint committee for inviting me here this afternoon to address the committee on this topic on behalf of the National University of Ireland, NUI. It may be helpful to the committee if I give some background information first. I will start with some general information on the National University of Ireland and explain the relationship between NUI and RCSI. I will outline the process through which programmes at RCSI-Bahrain have been approved by NUI and are continually monitored. I will mention the growing importance of internationalisation for Irish universities and the steps taken by NUI to support the NUI institutions in their international engagements. I will refer specifically to the extremely difficult situation which developed in Bahrain in 2011 and the serious human rights concerns that had to be addressed. I will conclude by setting out the NUI senate’s view of RCSI’s educational provision in Bahrain and of the response of the college to the difficulties experienced there.

The National University of Ireland is a federal university. It constitutes the largest element of the Irish university system, with campuses spread across the country and in the region of 70,000 students enrolled. Established under the Irish Universities Act of 1908, the university received its charter in that year. NUI was restructured under the Universities Act 1997 and now comprises four autonomous constituent universities - UCD, UCC, NUI Galway and NUI Maynooth. Under its founding legislation and charter, NUI is empowered to recognise programmes of study and award its degrees and other qualifications in other higher education institutions which are granted the status of ‘recognised colleges’ of the university. Over the course of its existence, 13 higher education institutions have, at various times, been granted the status of recognised college of NUI. The NUI constituent universities are fully autonomous self-governing institutions, with each constituent university having its own governing authority. Degrees and other qualifications of the National University of Ireland are awarded by each of the NUI constituent universities. These degrees and qualifications enjoy high standing and wide recognition nationally and internationally. Overall, we estimate that there are more than 300,000 NUI graduates spread across the globe.

Recognised colleges of NUI are also autonomous, self-governing entities, responsible for their own strategic and operational management. However, in the case of the recognised colleges, NUI is the awarding body. NUI-recognised colleges are required to seek approval from NUI in respect of their degree and other programmes and these programmes are subject to ongoing academic monitoring by the university.

In approving and monitoring programmes, the concern of the NUI is to ensure that they are comparable in standard and quality with the programmes offered in the constituent universities, that their quality is maintained and enhanced over time and that the integrity and reputation of NUI awards are secured.

The central forum within the National University of Ireland, representative of all the NUI member institutions, is the NUI Senate. The senate is chaired by Dr. Maurice Manning and, as registrar of the NUI, I act as its secretary. The Royal College of Surgeons in Ireland, RCSI, has been a recognised college of the NUI since 1977. Since then, the NUI has approved programmes of study at the RCSI and awarded degrees and other qualifications to RCSI students on satisfactory completion of those programmes. The relationship between the NUI and the RCSI has developed and grown stronger over the intervening period. Recent legislation has renewed the legal basis for the relationship between the NUI and the RCSI. The Qualifications and Quality Assurance (Education and Training) Act 2012, which commenced in November 2012, defines both the NUI and the RCSI as designated awarding bodies under the Act. However, the Act also provides for the RCSI to continue as an NUI-recognised college and for the degrees and other qualifications awarded by the RCSI, where approved by the NUI, to be NUI degrees and qualifications. Accordingly, the RCSI remains a recognised college of the NUI and the NUI’s quality assurance policies and procedures continue to apply to RCSI programmes. The working arrangements between the NUI and the RCSI take full account of the new legal framework underpinning the unique relationship between the two bodies.

The NUI has had an involvement in Bahrain since 2006, when the Senate approved the delivery of two master's programmes offered by the RCSI’s Institute of Leadership in Bahrain and Dubai, as well as in Ireland. NUI master's degrees were conferred for the first time in Bahrain in January 2008 on the students graduating from those programmes. In 2008, the RCSI council decided that NUI recognition would be sought for all programmes delivered in RCSI-Bahrain. Following that, applications for the approval of programmes were received and processed by NUI in accordance with its normal policies and procedures. RCSI-Bahrain was officially opened by President Mary McAleese in February 2009. Later that year, the senate approved the extension to Bahrain of the RCSI undergraduate medical programme, the BSc degree in nursing and a further MSc programme. Since then, the extension to Bahrain of several other NUI qualifications based on RCSI programmes has also been approved. NUI degrees and other qualifications have been conferred on students at RCSI–Bahrain annually since 2008. The approval of programmes and the awarding of qualifications of the National University of Ireland in RCSI-Bahrain are wholly dependent on the status of the RCSI, a recognised college of the NUI. RCSI-Bahrain is viewed by the NUI as a transnational location where RCSI delivers programmes approved by the university. Most RCSI programmes offered in Bahrain have previously been approved for delivery in Ireland, but in a few cases approval for delivery in Dublin and in Bahrain has been simultaneous.

The process for the approval of programmes by the NUI is well developed, rigorous and consistent with European standards and guidelines for quality assurance in higher education. Applications submitted to the NUI for the approval of new programmes or for significant changes to existing programmes, whether delivered domestically or internationally, are assessed by independent peer review, undertaken by external experts. The reports of the programme assessors are processed within the NUI and recommendations are made to the Senate regarding programme approval. In the case of the RCSI, as Professor Kelly has mentioned, we have a working group, which is the main forum for the conduct of academic and other business between the NUI and the college. External examiners are appointed annually by the NUI to oversee taught programmes leading to NUI qualifications at undergraduate and postgraduate levels. They play a vital support role to the university in assuring and enhancing academic standards and the quality of teaching, learning and assessment at home and abroad.

Chairman

As we have a timeframe of approximately six minutes and Dr. Halpin is at approximately eight minutes, I ask her to summarise the rest. When it comes to the questions, there will be a chance to go into greater detail.

Dr. Attracta Halpin

Very well. The RCSI enterprise in Bahrain reflects the imperative for universities today to become increasingly international. Like other universities, NUI institutions seek actively to internationalise their campuses and increase their impact internationally. Moreover, the NUI supports its member institutions in that endeavour. As has been mentioned, NUI institutions frequently operate in countries with different human rights cultures, and human rights issues arise. To support our institutions and on the initiative of our chancellor, Dr. Maurice Manning - who, as members of the Committee will be aware, chaired the Irish Human Rights Commission - the NUI sought expert advice and drew up a document, Human Rights Principles and Code of Conduct, for NUI and its member institutions, which was published in 2013. The document is intended to help the NUI institutions in their international engagements in places such as Bahrain, but not exclusively in Bahrain.

The outbreak of civil unrest and violence in Bahrain starting in February 2011 was viewed with great concern by the NUI. The RCSI kept the university fully briefed on what was happening and Professor Cathal Kelly addressed the NUI senate on the situation in June 2011. Following his address and having noted the college’s unequivocal commitment to the safety and welfare of its students and staff, the senate endorsed the approach adopted by the RCSI and expressed confidence in the college’s handling of a very difficult situation. Based on its experience since 2006, the NUI has full confidence in the academic standards and quality of the programmes leading to its degrees and other qualifications in RCSI-Bahrain and the performance of students graduating from RCSI-Bahrain. The Senate has confidence in the leadership provided and the judgment exercised by the RCSI in the continuing operation of its campus in Bahrain. The University remains committed to the pursuit of knowledge and the promotion of learning nationally and internationally. We will continue to support the RCSI and other NUI institutions in pursuing international opportunities. Through the delivery of excellent academic programmes leading to NUI qualifications both within and outside Ireland, we believe the reputation of the university and of Irish higher education in general will continue to grow. We are of course aware of the risks involved and will continue to develop our policies and processes with a view to minimising those risks.

Chairman

I thank Dr. Halpin and invite our final speaker, Ms Mary Doyle of the Department of Education and Skills, to make her presentation.

Ms Mary Doyle

I thank the Chairman and members for the opportunity to address the joint committee on the accreditation of the Bahrain facility of the Royal College of Surgeons in Ireland. I am accompanied by my colleague Mr. Keith Moynes. In my presentation I would like to focus on four areas. The first is the statutory framework for quality assurance and accreditation, which is relevant to the issues under discussion. The second is the broad policy context in which the international activities of Irish higher education institutions are undertaken. Third, I will outline the Government’s perspective on the situation in Bahrain, which has been articulated consistently by the Department of Foreign Affairs and Trade. Finally, I wish to state the position the Government has taken on the RCSI’s presence in Bahrain, again as articulated by the Department of Foreign Affairs and Trade.

On the first set of issues, namely, the statutory framework for quality assurance and Medical Council accreditation, a core mission of the Department of Education and Skills is to provide a strong framework for high-quality educational opportunities and outcomes across the spectrum of educational provision. The Qualifications and Quality Assurance (Education and Training) Act 2012, which has been alluded to by a number of speakers, among other things makes Quality and Qualifications Ireland, QQI, responsible for the external quality assurance role formerly undertaken by the Higher Education and Training Awards Council, HETAC, and the Further Education and Training Awards Council, FETAC, in the higher and further education and training sectors, respectively. Furthermore, QQI was assigned this role in respect of what are termed designated awarding bodies - that is, the NUI, the universities, the Dublin Institute of Technology and the RCSI.

The Royal College of Surgeons in Ireland (Charters Amendment) Act 2003 made provision for the RCSI to award its own degrees, subject to the relevant by-laws being agreed by the Minister for Education and Skills. The RCSI submitted draft by-laws for approval in 2009 and the then Minister requested that the Higher Education Authority and the National Qualifications Authority of Ireland, which is a predecessor body of QQI, conduct a review of the RCSI and advise him on the question of approval of the by-laws. Following that review, the by-laws were approved in 2010.

The RCSI, similar to all other higher education institutions referred to in the 2012 Act, is subject to review and oversight by the relevant national external quality assurance body, QQI. Review, in this context, refers to the formal review of the effectiveness of the institution-wide quality assurance policies and procedures established and implemented by the RCSI. A further review of RCSI by QQI, in accordance with the provisions of the 2012 Act, was undertaken in 2013, and I understand that the report is due to be finalised and published by QQI in the coming weeks.

Dr. Halpin outlined the NUI role and I do not propose to repeat the provisions on NUI.

Under the legislative framework, separately to the external quality assurance role of QQI, the Medical Practitioners Act 2007, which falls under the remit of the Minister for Health, sets out the role of the Medical Council in assessing the fitness for purpose of programmes of basic medical education and training and the bodies, including the RCSI, which deliver those programmes.

The Medical Council has already outlined the relevant processes under that Act, but it is germane to mention that section 88 provides for consultation by the Medical Council with the Minister for Education and Skills as part of their process for approving or not approving programmes and bodies. The Medical Council met, at its request, the Minister for Education and Skills on 6 February 2014 to "discuss its programme of accreditation and in particular the accreditation programme in 2014 including Royal College of Surgeons Bahrain". At that meeting, the Medical Council outlined to the Minister and the Department its intended programme of accreditation and the general principles which underpin its approach. The Medical Council has not yet formally sought to consult the Minister for Education and Skills under the terms of the 2007 Act in respect of RCSI-Bahrain.

The second issue is the national policy context regarding the internationalisation of education. The Department of Education and Skills has lead responsibility within Government for developing and implementing national policy to facilitate the internationalisation of higher education, in collaboration with other Departments and agencies.

Internationalisation is one of the major trends in modern higher education. The OECD pointed out that "in today's age of global knowledge and technology, an interconnected network and global awareness are increasingly viewed as major and sought-after assets." In principle, Government policy is supportive of high-quality internationalisation. It is important for Ireland, as an open economy which fundamentally relies on international engagement, to have institutions which are globally competitive and internationally oriented.

The ambition to enhance international collaboration and engagement by our education institutions is one of the seven key system objectives set out in our higher education performance framework for the period 2014 to 2016. Our national policy document for enhancing internationalisation, Investing in Global Relationships: Ireland's International Education Strategy, identifies a range of benefits for Irish and international learners but also for Irish society more generally and the societies of our overseas partners. In this context it is clear that many societies rely on international provision to fill gaps in their capacity to provide particular types of advanced education and training. This is particularly the case in highly specialised and crucial areas, such as medical training.

Particular complexity arises in the delivery of programmes outside the jurisdiction. To assist institutions in ensuring strong quality assurance in these circumstances, the Guidelines for the Approval, Monitoring and Review of Collaborative and Transnational Provision have been developed by the Irish Higher Quality Network, which comprises representatives of higher education institutions. This builds on work previously done by HETAC and international bodies, including the OECD and UNESCO.

In the specific area of human rights, the National University of Ireland has developed, in co-operation with the Irish Human Rights Commission, guidelines entitled Human Rights Principles and Code of Conduct for the National University of Ireland and its Member Institutions, which sets out five core human rights principles that should underpin international engagement by the relevant institutions. The Department of Education and Skills and the Department of Foreign Affairs and Trade were supportive of this and met the NUI in the course of the development of these guidelines.

The third issue I will address is the Government's position on the situation in Bahrain as articulated by the Department of Foreign Affairs and Trade. It is also important to say that at national level we align our internationalisation strategy closely with Ireland's foreign policy and with any EU and international obligations, including restricted measures such as sanctions that may be in force in respect of particular countries. Individual higher education institutions, including RCSI, also keep in close contact with that Department and Ireland's diplomatic missions overseas.

On the specific question of the Government's position relating to the situation in Bahrain, this has been articulated by the Department of Foreign Affairs and Trade, which has been consistent in conveying its concern at every suitable opportunity regarding the human rights situation in Bahrain, including the Government's concerns regarding the cases of medical professionals and human rights defenders. The Minister for Foreign Affairs and Trade most recently articulated what has been the Government's consistent position in Dáil Éireann in response to parliamentary questions on 2 October 2013, stating:

The overall human rights environment in Bahrain continues to be of serious concern. Ireland shares the concerns recently expressed by the United Nations Office of the High Commissioner for Human Rights regarding the deep polarization of society in Bahrain and the harsh clampdown on human rights defenders and peaceful protesters. Such actions continue to make a durable political solution based on reconciliation and dialogue more difficult to secure.

The Tánaiste also stated that he has:

ensured that Ireland's concerns on human rights issues in Bahrain have been conveyed regularly to the Bahraini authorities and [he] will continue to do so. Ireland was one of 47 member states who participated in a joint statement expressing serious concern over the human rights situation in Bahrain at the ... UN Human Rights Council on 9 September. In the statement, the signatories expressed their concern regarding the protection of human rights in Bahrain and called on the Government to expedite the implementation of the recommendations received from the Bahrain Independent Commission of Inquiry in this regard.

Finally, I will turn to the Government's position on RCSI's presence in Bahrain, again as articulated by the Minister for Foreign Affairs and Trade. At the outset of the crisis in Bahrain, the Tánaiste stated in Dáil Éireann on 6 July 2011 that he regarded the activities of the RCSI

... in assisting with the training of foreign medical personnel overseas as a highly worthwhile activity through which the College makes a significant contribution to the quality of life of millions of people around the world. The RCSI, as an educational provider, also has a responsibility to all of its students and ensuring they are able to complete their medical training.

The Tánaiste reiterated this position in the Dáil on 17 October 2012 when he noted:

The Royal College of Surgeons in Ireland, RCSI, the Royal College of Physicians of Ireland and the Medical Council are independent organisations involved to varying degrees in the education of medical professionals in Bahrain. It is important to distinguish between the involvement of Irish institutions in the education and training of Bahraini medical personnel, which is entirely positive both for this country and Bahrain, and the case of the imprisoned Bahraini doctors.

Chairman

We will now go to questions. I will take two questions first and then go back to the witnesses.

Senator Averil Power

I will start with a bit of background for members who were not at the Ceartas briefing. In fairness, the last speaker, Ms Doyle, referred at least to the human rights context.

Chairman

We were present.

Senator Averil Power

A lot of latitude has been given to those making presentations.

Chairman

I am merely saying that the members here are aware of the background.

Senator Averil Power

For those who were not at the Ceartas meeting on the last occasion, the background to this is the violent crackdown on peaceful protestors in early 2011 in Bahrain, and that those protesters were then brought to the hospital for treatment and the doctors, seeing that protesters had been shot in the back of the head, that they had been unarmed and that they were clearly just making a peaceful statement in the context of the Arab Spring and protests elsewhere, criticised that. Some of them stated in television interviews that they could not believe this was happening in their country and it was a disgrace. Those doctors, for speaking out against what had happened, were arrested and thrown in jail, as has been documented in the independent commission into those events, and were also tortured. I have met those doctors, both male and female, who were tortured. I travelled to Bahrain with an Irish group and spoke to them. That is the context to all of this and it is important to remember that.

No-one is denying the importance of the internationalisation of Irish universities or the valuable role that Irish institutions can play in other countries in providing a high-quality education, and we are not questioning RCSI's presence in Bahrain, but internationalisation should not overlook basic human rights.

It is notable in both submissions, particularly that of the college, that there is no reference to the human rights aspect. The submission of the college is all about the quality of the academic education provided. Half of the education provided is academic and delivered in lecture halls, but the other essential component is education provided on placements in hospitals. As has been documented by international human rights bodies, the hospitals, as institutions, are not independent of the government in the way the Medical Council would prefer. They are militarised and run by the Bahraini defence forces. I have visited them. There was a tank outside Salmaniya Hospital when I visited it.

There has been discrimination in the employment of RCSI students. Forty students trained for jobs in King Hamad University Hospital, but only 15 were given jobs. When they started, their expectation was that they would all be given positions. The 25 who were not given jobs were all Shia. Therefore, there has been sectarianism in the appointments process and the way both staff and students have been treated by the Bahraini regime. There has been militarisation, as we said, and there are serious concerns about the safety and welfare of students and staff in RCSI Bahrain.

That the college’s presentation does not mention these issues gives the sense that one can be apolitical and not comment on the political environment in Bahrain. However, the silence is not non-political. It is deeply politicised because it is an endorsement of the status quo. The key aspects of medical training include medical neutrality, an essential part of the RCSI's code. The documentation referred to non-discrimination in the provision of medical services. It is precisely for such non-discrimination that the doctors were arrested for treating unarmed protesters. The president of RCSI Bahrain found it necessary to resign over this issue. He felt he could not stand over the circumstances involved when he went to Bahrain and saw what was occurring. He could not stand over commitments to ensure the safety and welfare of his staff and students. Mr. Tom Collins is a good man. We have had him here to make presentations on other issues. He is very well respected in the education sector.

The NUI's presentation makes reference to the responsibility of universities to uphold and promote human rights. I draw attention to a weakness. I would like the delegates to elaborate on what the NUI is actually doing to promote human rights. It seems to have judged the events from afar in some respects and accepted the word of the Bahraini college that there is no issue and that the education being provided is safe and acceptable.

The delegates referred to the NUI's quality assurance guidelines for transnational collaborations. The document submitted makes points not mentioned in the presentation. It suggests organisations should be satisfied that “the proposed environment is one in which human rights can be respected and the ethical values of the institution upheld”. In the light of comments made by the UN special rapporteur on torture, human rights bodies, Amnesty International and Human Rights Watch, I do not know how anybody could accept that there is no serious human rights issue in the case in question. It is a case of protecting and upholding human rights.

Have the RCSI and the NUI taken any real step to become satisfied that these issues are being addressed? What investigations have been carried out? Can they be published in order that we can see what has actually happened? There were recent reports of a sectarian attack on a student on the campus. Has the RCSI investigated that incident and raised concerns with the college as a consequence? Is the NUI, as the accreditation body, aware of it? Is the NUI satisfied that the RCSI is meeting its expectations in Bahrain in regard to human rights, particularly given that even the departmental representatives here have acknowledged there is a problem? The Tánaiste is on record as acknowledging that there is a human rights problem in this case. What steps has the NUI really taken to ensure the problem is being addressed? Has it interviewed staff and students? Has it interviewed the imprisoned medics who actually trained in RCSI Dublin? Some of them are former staff of the college in Bahrain. One of them, Dr. Fatima Haji, has still not been re-employed in her position in the college. It is understood and she has stated the reason she has not been given her job back is that she has been very critical, both in Ireland and Bahrain, of the regime.

With respect to Professor Kelly, his presentation does not refer to the human rights issue. Does the RCSI believe there is a human rights problem in Bahrain? Does it accept that there have been major human rights abuses? Does it accept that what happened in the hospitals on the day the protestors were admitted was wrong? As an organisation representing Ireland in Bahrain, does it accept that it has a responsibility to meet human rights standards?

I will wrap up with a brief comment on the NUI and the Department of Education and Skills. It is one thing for the RCSI to put its own reputation at stake in Bahrain and internationally by having a close relationship with such a dictatorial and violent regime, but it is quite another for the NUI and the Medical Council, if it is to grant accreditation, to put theirs on the line. The same applies to the Department of Education and Skills. I appreciate Ms Doyle's point that foreign affairs issues are generally matters for the Tánaiste who has spoken out about this. However, our policy needs to be consistent. If the Tánaiste is accepting that there is a human rights issue, it is important that the Department of Education and Skills be very careful, particularly in the context of internationalisation. Internationalisation is very important to Irish institutions but reputation is everything. The way the RCSI is behaving in Bahrain is putting the reputation of Irish education in jeopardy. It is important that the Department of Education and Skills step in and ensure the matter is taken seriously.

Let me outline what I would like to see occurring pursuant to this meeting. The only way those who are signing off on the programmes in the NUI and the Department can ensure the education being provided in Bahrain, particularly in the military hospital environment, is up to Irish standards is to have a credible international watchdog. With respect to the college, because it has been so silent on human rights issues and not acknowledged them, it is not good enough for the NUI or the Department simply to accept its word. A body such as Médecins Sans Frontières or some other international group should carry out inspections, if, of course, it can gain access to Bahrain. The authorities in Bahrain routinely refuse access - the UN special rapporteur on torture cannot even gain access to it. The only way one can credibly stand over what is occurring is if one asks an international watchdog to carry out inspections and interview staff and students so as to be satisfied the system is up to scratch. The same applies to Medical Council accreditation. If the delegates’ visit is to be genuine, it is important they say they will meet staff and students and seek to talk to the imprisoned medics who are former staff and students of the college. They should ensure they get both sides of the story. I am very concerned that they will be chaperoned from the airport in Bahrain and hear only the views of the Minister for Health, whom I met when I was there. While she is a very charming, articulate and well educated lady, it is important to hear both sides of the story. The only means of credibly signing off on accreditation is if there is an independent watchdog on the ground to ensure professed standards are being upheld.

I appreciate the latitude given by the Chairman. We are responding to very lengthy presentations.

Deputy Jonathan O'Brien

I have just one question because Senator Averil Power has covered most of the main points. I am interested in hearing the responses. With regard to the Irish Medical Council, I understand we do not want to prejudice the outcome of any accreditation process. Perhaps, however, the council might outline some of the reasons accreditation would not be granted or forthcoming.

Professor Cathal Kelly

I thank the Chairman and other members. I hope I will capture all of the points raised; if I do not, I am sure members will revert to me.

I will begin with a quotation from a press release issued by EU High Representative Catherine Ashton in January this year. It gives a sense of the European Union's view on progress in Bahrain. Obviously, we have stayed in very close contact with the Department of Foreign Affairs and Trade, including through the Tánaiste, and have been working through the United Nations and the European Union.

According to a spokesperson for her:

High Representative Catherine Ashton warmly welcomes the news that HRH Bahrain's Crown Prince Salman bin Hamad Al Khalifa, upon the request of HM King Hamad bin Isa Al Khalifa, held wide ranging talks with participants in the National Dialogue in recent days, including in particular with Al-Wefaq's Secretary General Sheikh Ali Salman for the first time since the events of February 2011.

The spokesperson stated High Representative Ashton also welcomed the positive reaction of the opposition and looked forward to the resumption of national consensus dialogue. On this occasion the European Union reiterated its conviction that there was no solution to the crisis other than a Bahraini one based on compromise and mutual trust. Things are moving on.

I was asked to come to the committee when I was on another Irish trade mission overseas about two weeks ago. My understanding of the question was that it had to do with accreditation and the visit of the Medical Council to Bahrain. Therefore, the thrust of our presentation is about accreditation. I am not an advocate nor an apologist in any way for the government or country of Bahrain, but some credit must be given to the country. If one looks at the UN human development index, Bahrain ranks 84th out of 148 countries. It is ahead of some European countries. It has a better immunisation rate than we do. It offers free primary care and free education up to university level; therefore, in some ways, it has made a awful lot of progress and is an exemplar in the region.

On the points made about the hospitals being militarised, my colleague, Professor Finucane, has worked in Bahrain and could certainly talk more eloquently about that issue. Throughout the Middle East, it is not unusual for a significant part of the public health service to be delivered through either military or police hospitals. There are three public hospitals in Bahrain - Salmaniya Medical Complex, the Bahrain Defence Force, BDF, Hospital and King Hamad University Hospital. Salmaniya Medical Complex is and has always been run by the Ministry of Health. The BDF was a military hospital. It caters for members of the military and their families and the wider local population. For example, it hosts the national heart institute. Again, it has always catered for it. As is common in most countries during the development of a major new public hospital, there was considerable outrage and frustration in Bahrain caused by the delays in commissioning King Hamad University Hospital. Long before any of the events that took place in 2011, out of frustration, the Government of Bahrain asked the military which had a significant record in project management and engineering experience to step in and run the hospital. The military has opened the hospital which has 312 beds successfully and my understanding is that over time it plans to hand it over to the Ministry of Health. In any country, including this one, public hospitals are the bedrock of clinical education and, by their nature, run by the government.

Moving to the issue of jobs, we have said repeatedly that our first responsibility is to ensure our teaching and clinical education environment are non-sectarian and that is certainly the case. Our next responsibility is to secure internships for our medical graduates. Since 2010 only one Bahraini graduate has failed to secure an internship. That individual has repeated the examinations, following which we will work on securing an internship. There is no doubt that there has been considerable polarisation of the medical profession. When people fail to secure a job, it is difficult to determine why they failed to get it. Is it a question of qualifications or other issues? Not that long ago in Dublin hospitals were characterised as Protestant or Catholic and people would frequently interpret appointments to them against that background, regardless of whether it was right or wrong to do so.

The RCSI has repeatedly and publicly endorsed the findings of the Bahrain Independent Commission of Inquiry. We welcomed its findings and publicly requested that clemency be shown to the arrested medic and that they be released. We have continued to advocate in private. My view is that different organisations and individuals have different responsibilities and opportunities. Our responsibility is to our students and staff. Our opportunity is to continue to engage with very senior officials in Bahrain - an opportunity many others in Ireland do not have. We use this opportunity best by maintaining contact and continuing to advocate for just outcomes, which is what we have done.

The Bahrain Independent Commission of Inquiry commented on the issue of medical neutrality and made the point that what had happened in Salmaniya Medical Complex was so complex it could not make a judgment on it. It was a very substantial report based on 8,000 presentations and interviews carried out by an international panel that was beyond reproach. It is very difficult, therefore, to give a truly neutral medical view on what happened in Bahrain. No doubt, the profession is polarised and it will take time to heal the wounds. The RCSI provides a valuable bridge in bringing about dialogue and healing these wounds.

Taking into account the Chairman's statement at the beginning, I am loath to comment on individuals and will not do so, but Professor Tom Collins who resigned as president is a highly respected and valued colleague and a dear friend. He resigned because of frustration at the lack of progress in organising a conference on medical professionalism involving MSF, the WHO, the United Nations and local participants. I can understand this and do not think Professor Collins would mind me quoting him. He has consistently been positive about the presence of the university as an agent for good. Having met many members of the opposition, he is often quoted as saying he has yet to meet a member of the opposition who wishes RCSI Bahrain was not there. He is uniformly positive about the university and a huge supporter of the students and would be very distressed by anything that endangered their opportunities or undermined the quality of the programme provided.

We have always acknowledged human rights problems and supported the findings of the Bahrain Independent Commission of Inquiry, as has the Bahraini Government. The government showed great courage in commissioning the report. As ever, there is a frustration at the delays in processing the recommendations, but progress is being made.

In terms of there being some sense of shame or undermining the reputation of Ireland, the RCSI has graduated 20,000 alumni all over the world. The leader of the Chairman's own party has frequently told me that when he has been to foreign parts, the association is frequently an RCSI graduate. Our graduates have opened doors to Irish business and other institutions all over the world. What we are doing is the very definition of soft power. We have demonstrated that when the going gets tough, an Irish institution does not cut and run but recognises its primary responsibility to students and graduate health care professionals to contribute to health care in the country in which it is operating. I am very proud of this. I am really proud of the achievements of our students and the work and commitment of our staff.

I hope I have addressed some of the issues raised.

Dr. Attracta Halpin

I will address one of the points made about the NUI adopting an arm's length approach to the situation in Bahrain. That is far from being the case. We have had direct contact with Bahrain since 2006. Our external examiners have visited the country annually; they have visited the hospital and reported back to us. I have also visited Bahrain annually since about 2006. Therefore, we have plenty of direct evidence. Nobody is trying to pretend that Bahrain is an ideal society or that its human rights record is enviable. I go back to a basic principle that underpins much of the NUI's policy on international engagement dating back to Thomas Davis - "educate that you may be free". Education is a very powerful weapon in improving matters abroad. To refer back to the numbers in Bahrain, we have graduated over 600 students, about half of whom are doctors and half of whom are nurses. Some are postgraduates. I understand a high proportion of the nursing graduates are from the Shia community and would be first-generation graduates. They have been given tremendous life opportunities through their studies in RCSI Bahrain.

We list seven criteria for the accreditation of programmes. There are general criteria that apply across the board and relate to learning outcomes, curricula, student support, resources, assessment procedures and professional requirements. In the particular case of transnational engagement, we also make reference to human rights issues. We would withdraw accreditation if we were to receive evidence from those whom we appoint to monitor our standards that standards were not being met. Our external examiners have been visiting Bahrain every year and the reports have universally been positive. Therefore, we can stand over the education provided there.

Ms Mary Doyle

Ireland has a strong legislative framework of quality control in education, particularly medical education. The number of bodies involved in this discussion is testament to that reality. At the heart of the overall approach to education and quality assurance is the establishment of standards and verification of whether individual institutions are meeting these standards. In my statement I set out the processes by which this was implemented. It is clear that it is widespread in terms of the number of organisations involved and the high level of academic achievement among those involved in qualifications assessment.

On the points raised by Senator Averil Power, I must reiterate the Government's position on Bahrain and the RCSI's presence there. The Government draws a distinction between the actions of the Bahraini authorities and the benefits of delivery by the RCSI of medical education in that country. It has not called for the RCSI to pull out of Bahrain.

Ms Caroline Spillane

I will respond to the question put by Deputy Jonathan O'Brien and Dr. Dillon will respond to Senator Averil Power's question.

In respect of the powers available to the Medical Council, Deputy Jonathan O'Brien asked specifically about instances in which the council might refuse to accredit a programme or body. In this case, it has the ability under the legislation to approve the programme and the body, to approve with conditions or to refuse approval. The first stage of the process followed by the council is to issue a self-assessment questionnaire to the medical school in question. This is based on the WFME standards and evaluated by an accreditation team. A site visit is also conducted by the accreditation team which then draws up a draft report based on the site visit and the findings of the assessment. The draft report is placed before the professional development committee of the Medical Council and the Medical Council. The medical school concerned is asked to comment on factual inaccuracies, but it is not able to alter accurate reflections made in the report. At the end of the process, the Act requires that the Minister for Education and Skills be consulted.

The self-assessment and site visit are predicated on the WFME standards. There are nine standards. Where the accreditation team considers the standards are not met, its opinion will manifest itself in the report and recommendations. It is composed of a combination of international experts in the field of medical education and training and recognised patient safety advocates. Members of the Medical Council, both clinicians and lay members, are also represented on the team. The information we receive is complemented by the accreditation team's ability to meet senior clinicians and managers during site visits. Importantly, it will also meet a significant cohort of students from all years. These meetings take place in private and are completely confidential, with the details of participating students remaining anonymous. All of this information is triangulated to form a report that is sent to the Medical Council. If the accreditation team reports a shortfall in the standards expected, the council will have a range of choices in regard to approval. If conditions are attached, they are monitored on a frequent basis and non-adherence to conditions would threaten the accreditation of the body.

Deputy Jonathan O'Brien

Does the accreditation team have access to all students and can it decide whom to consult? Are all of the conversations between the students and the team members held in private? What would happen if the team asked to meet a specific student and was told he or she was out sick?

Ms Caroline Spillane

That is a very important point. As guidelines are issued to all students, they know the Medical Council is undertaking a visit. It is up to the medical school to notify the students, but the expectation of the accreditation team is that there would be a high degree of participation by students in every year of the programme and that student representatives would also participate. Normally we have a good turnout of students. It is all done in private between the accreditation team and students. As it is completely confidential and anonymised, feedback from students to the team would not lead to anybody being identified.

Deputy Jonathan O'Brien

Are the interviews conducted over a period of time or at one meeting?

Ms Caroline Spillane

They take place every single year. If, for example, the programme is five years long, students from each of the five years would be met separately by the accreditation team. The meetings last approximately one hour per group. For a five year programme, therefore, there would be five hours of meetings between the team and students.

Dr. Audrey Dillon

I wish to respond to Senator Averil Power's concerns. The Medical Council has expressed similar concerns about human rights in Bahrain, particularly in regard to medical neutrality and the fact that doctors are still in prison for providing health care, which we recognise as a basic universal right. These concerns underpin the need for a robust and independent process of accreditation of medical education. As Ms Spillane outlined, we are following that process and cannot prejudice the outcome. We have a rigorous and independent process over which we stand and which will be available for public scrutiny when it is complete.

Senator Averil Power

I wish to clarify one issue.

Chairman

If the Senator does not mind, I will call Senator Jim D'Arcy first.

Senator Averil Power

I seek clarity on one point.

Chairman

Very briefly.

Senator Averil Power

Several speakers have referred to the desirability of the RCSI remaining in Bahrain. I did not call for it to withdraw from there. I made it clear, in fact, that that was not what I wanted. I am asking for an independent structure to be established to ensure the education provided meets the standards we demand here. As long as the college is in Bahrain, we need structures that protect the reputation not only of the RCSI but also the NUI, the Department of Education and Skills and the Medical Council.

Chairman

That is clear.

Senator Jim D'Arcy

I thank the representatives of the various bodies for meeting us. This is an important discussion. It is welcome that the RCSI has established a university structure in Bahrain. Mr. Tom Collins and I are friends.

As Professor Kelly might know, he served as a very good president of Dundalk Institute of Technology, DKIT, of which I was a board member. Then he went to NUI Maynooth and he has a great reputation. I was very sad when I met Professor Collins and he was very distressed about what had happened. He felt diminished by what had happened in Bahrain. Not the RCSI, the Department of Education and Skills, NUI or anybody else can solve the political problems in Bahrain or the Middle East, no more than they can solve the problems here. That is not their function. The RCSI would not cover up or underplay the significance of anything that might be happening and which would be connected with the university. I would like to comment on that. Last week I met members of the Shura Council at the Inter-Parliamentary Union in Geneva. I met Dr. Jamal Fakhro, who was closely involved in establishing the structure in Bahrain. As was said here today, he said there were no problems, that there was free medical care and education, nearly everybody drove a Mercedes and everything was fine. "What more do they want?" he said.

Chairman

To be fair, the Senator cannot speak for somebody else. That is important.

Senator Jim D'Arcy

I thought, maybe they want what we need here, namely, justice. At the lunch Dr. Jamal said my friend had got involved in politics-----

Chairman

The Senator is stepping over the line. We cannot make charges against people or speak for them second hand unless they are here.

Senator Jim D'Arcy

I found he was open about the problems in Bahrain and he said they are working on them. He said if anybody wanted them to come over here, they would. He said he would give access to the Crown Prince Salman bin Hamad Al-Khalifa, who was mentioned, and he would talk to people about the problems. They are also afraid. I am trying to give a balanced view and explain that it is a difficult situation.

Chairman

I know.

Senator Jim D'Arcy

My main point is that the problems should not be brushed under the carpet. Whatever positive effect the RCSI could have in the operation of the facility, within the limits and tolerance of what can be done, should be used to a positive effect so that what we operate is working hard to solve the problems that were very eloquently outlined and compared to the historical situation with Protestants and Roman Catholics in our hospitals. We cannot say it does not exist. In 2006, when we last visited Bahrain, Giovanni Trapattoni had not yet been appointed manager of the Irish soccer team. Maybe it is time to get back out there again. The NUI has external examiners out there, and that is very good, but maybe they could pay another visit.

Chairman

They go every year.

Senator Jim D'Arcy

I know that. I suggest a visit to make a major report.

Deputy Brendan Griffin

I thank the witnesses for their presentations. Based on the presentation and particularly Senator Power's contribution there seems to be a conflict between what is happening in Bahrain and the NUI's human rights principles. The NUI cannot set out these principles and continue to bury its head in the sand regarding the situation in Bahrain. The RCSI website does not mention the situation in Bahrain at all except for a letter from Professor Kelly in 2011. If the NUI holds the promotion of human rights as a priority, the situation should appear more prominently on its main website. Could that be reconsidered?

Chairman

Dr. Halpin said education makes one free. How would the NUI try to address human rights issues in education?

Dr. Attracta Halpin

I disagree with the Deputy that there is any disconnect between our human rights principles and what is happening in Bahrain. Nobody denies that there have been human rights abuses. A specific section in our document relates to the situation where human rights abuses occur during the time in the country. It states:

Where human rights abuses occur during a partnership agreement, NUI institutions should have a clear policy for action. Where the international community has identified and criticised gross human rights abuses such as attacks on civilians, NUI institutions should ensure that they take appropriate action, whether publicly or privately.

Members can read the rest of what we say there. RCSI has acted in accordance with our code of conduct. We have been briefed fully. Professor Kelly addressed the NUI twice and has sent written communications from time to time setting out what RCSI has been doing in Bahrain. We are satisfied that the actions they have taken are consistent with our principles.

Deputy Brendan Griffin

Is any association between RCSI and any institution in Bahrain not seen as a support of those institutions?

Dr. Attracta Halpin

That is the critical issue. We say that, as a core value, an NUI associated institution should not be seen as propping up an undesirable regime. The RCSI in Bahrain, which has gone to extreme lengths to make itself a non-political zone, cannot be seen as propping up the regime.

Deputy Brendan Griffin

Each of the five principles seems very shallow when we consider the overall context here.

Dr. Attracta Halpin

They reflect the UN principles which have been adopted in the case of business. We got expert help from the Irish Human Rights Commission. We consulted the Departments of Foreign Affairs and Trade and Education and Skills in drawing up these principles. We have broken new ground with the document and it has been well received. It is not the last word and we will work further on it.

Professor Cathal Kelly

I thank Senator Jim D'Arcy, Deputy Griffin and the Chairman. The New York Times columnist, Thomas Friedman, has said the best lesson from the Arab spring is that evolution is more effective than revolution. Graduating, year in year out, a cohort of young professional people, doctors and nurses, is a very significant contribution to evolution in those countries. That is where we hang our hat.

In terms of Deputy Griffin's comments about our website and so on, I must look at it again. RCSI Bahrain is a separate website. There is a lot of stuff on YouTube from our various students which is quite informative and uplifting. We are not an NGO; we are a medical health sciences institutione are not human rights activists and we do not set out to be human rights activists. I will elaborate on that to address the Chairman's comments. Our curriculum is hung around our medical graduate profile and what we are trying to address there is first knowledge in biomedical sciences, knowledge in the clinical sciences, knowledge and skill around clinical competencies, knowledge and skill around public and international health and then perhaps, most important, personal and professional development, which takes into account communication, teamwork and medical ethics. I could happily read our ethics teaching document.

In terms of Deputy Griffin's comments about our website and so on, I must look at it again. RCSI Bahrain is a separate website. There is a lot of stuff on YouTube from our various students which is quite informative and uplifting. We are not an NGO; we are a medical health sciences institution but we are not human rights activists and we do not set out to be human rights activists. I will elaborate on that to address the Chairman's comments. Our curriculum is hung around our medical graduate profile and what we are trying to address is, first, knowledge in biomedical sciences, knowledge in the clinical sciences, knowledge and skill around clinical competencies, knowledge and skill around public and international health and then perhaps, most important, personal and professional development, which takes into account communication, teamwork and medical ethics. I could happily read our ethics teaching document.

Chairman

Will Professor Kelly refer to the human rights aspects?

Professor Cathal Kelly

The main emphasis in human rights is personal autonomy and individual rights, as elaborated in medical ethics. The medical ethics programme is part of our professionalism programme that is given throughout the programme beginning in foundation year, ramped up all the way through the graduation class, which is senior cycle 2. It applies to different scenarios. For example, the Chairman can imagine the human rights and medical ethics that apply to obstetrics in terms of female genital mutilation and so forth. We try to make our teaching practical and relevant for the medical professional. In each area we try to find the appropriate utilisation to make those points.

Senator Marie-Louise O'Donnell

I thank the witnesses for their presentation. I do not want to get involved in this argument. I have not been to Bahrain. I have read about it and I have listened to my colleagues. Is education not meant to be about, above and outside politics? Is not one of the principles of education to be about knowledge, training, skill and the development of freedom? I agree with Professor Kelly that one of the best ways to bring about peace, ease, communication, equality of opportunity in education, justice and freedom is the training and nurturing of young people, especially in the area of medicine, which sometimes supersedes sociology, philosophy and psychology because it is about life and death and holding human beings sacred, as it says in one of the RCSI's charters, regardless of age, creed, colour, prejudice or sexuality. Education through medicine is one way to bring about what Senator Power is correctly seeking. I commend Professor Kelly on what he does given all the troubles in the country in which the RCSI finds itself. Education, especially in medicine and all the tributaries that it allows, is for new generations consistently assessed and accredited every five to six years and that is the only way sometimes to get through regimes that are caught in old ways and mores.

Senator Averil Power

I am due in the Seanad for an education debate in a few minutes. I agree with Senator O'Donnell but that is only true if there are genuinely equal opportunities for education and employment and I do not accept that there are.

Senator Marie-Louise O'Donnell

I never said there were. I said it is a philosophy of education that we strive towards that. In our own country we strive towards that. It is not an "or" or a "not"; we strive towards.

Senator Averil Power

The problem is, as I have outlined, I met a group of students who said they had been discriminated against on the basis that they are Shia and not Sunni. Professor Kelly referred to the distinction between the different hospitals. No Shia muslims work in King Hamad hospital. For anybody wondering why someone did or did not get a job, whatever about saying that the qualifications of a particular Shia individual might not stand up when applying for a job, the notion that no Shia Muslims would be qualified for a job is hard to believe. We have to take that into account. There is active discrimination and that is accepted by the international community. Bahrain has rightly been criticised by independent groups for that.

The key issue is the interaction between education and the political environment. Ms Doyle made a point about drawing a distinction between the political situation and education. I can understand that but there is only a logic to that if the two are distinct and separate. The problem with Bahrain is that they are not. Whatever about the academic aspect of the campus - there are concerns from that point of view in terms of the safety of staff because the security forces have had interactions with students and complaints have been made - the hospitals are also a key learning environment for students in RCSI colleges. They are not independent and what medics went through has been well documented. The treatment of injured protestors and giving television interviews are imprisonable offences in Bahrain. I welcome any developments that might make it a more democratic or fair society.

One of the doctors, Dr. al-Ekri, who was arrested, had trained and worked in Dublin and he is still in prison for treating injured protestors and talking about it in 2011. Another human rights defender, Nabeel Rajab, is in prison for sending a tweet. This is not a free society. I do not dispute that, economically, it is a good society. It is a well off country and traditionally women have been well educated, which is positive in the Middle East, but it has had the same prime minister since 1971 and power in the country is held by one family. I appreciate that is a characteristic of the Middle East. While there has been good aspects to political progress in Bahrain, the repression over the past few years has been appalling and it has not improved. Talks have been on and off for the past three years.

One cannot distinguish between the political and education and training environments when they are intertwined. I am not calling on RCSI to withdraw from Bahrain but I am calling for a proper independent system to ensure the education being provided there is up to standard. I am not basing my comments on my short visit to the country or my political views but on the independent commission and the international criticism of human rights in the country. I do not see how what is happening there could be consistent with the NUI code of conduct, given the militarisation of the learning environment. This is a serious issue and it is damaging to the reputation of Irish education. I urge the Medical Council to be careful in respect of its involvement. While internationalisation is positive, anything that puts our reputation at risk also damages the overall project.

Deputy Brendan Griffin

I concur with Senator Power. Arising from the serious concerns raised by members, will the RCSI issue a statement to address them?

Chairman

Professor Kelly said he would be visiting Bahrain. Will he outline the timescale for the process?

Professor Cathal Kelly

Does Senator Power believe that the Medical Council has an independent assessment of the situation in Bahrain?

Senator Averil Power

I am not sure. I would like more detail. Professor Kelly referred to making sure he had a good sample of students. I would like to see that it is not just the college which is involved in offering him enough students. I have no problem with the fact that he is being given enough but it is important that he would speak to former students, visit and talk to Ali al-Ekri, whose background is with the college and who is still in prison, and talk to former students and staff who will say the reason they have been denied jobs is purely on the basis of their ethnicity and religion and not their qualifications. I would need more reassurance regarding the process involved and how it would apply here. I would like Médecins Sans Frontières and other internationally recognised organisations to be part of the visit. I do not want to say "No" but I would like to see proper independence. I have a concern. I visited Bahrain and I met Ministers. I visited China years ago and people gave me what they wanted to give me. The government rolled out a professor of human rights to tell us everything was great.

If he was going to tell us everything was not great in China, he would not have been allowed into the meeting. I would have concern that the witnesses would be given a balanced point of view of the real situation on the ground and not just a nuanced or glossed one. I would like to take that up further with the witnesses. I ask that they would talk to other people who have concerns to bring that process forward.

I am genuinely sorry that I need to leave. I am my party's spokesperson on education and the Minister of State will be in the Seanad at 3 o'clock and I am supposed to be in there responding to him. However, I will get the transcript of all the comments made here after I leave. I thank the witnesses for their time, because we have been here for two hours.

Chairman

I will take the concluding comments from our guests. Is there any information we can be given about the timescale and what will happen when?

Senator Marie-Louise O'Donnell

I wonder if the witnesses would like to respond-----

Chairman

That is what I am going to do.

Senator Marie-Louise O'Donnell

----- to Senator Power's contribution.

Dr. Attracta Halpin

Senator Power disputes that the standards in Bahrain could possibly be acceptable given what has been going on in the background. From the NUI point of view, the evidence we have is to the contrary. The overall thrust of the numerous external examiners we have had there is to the effect that standards are fine.

Ms Caroline Spillane

With regard to Senator Power's comments about independence, in the presentation I stated that independence is one of the hallmarks of the process the Medical Council would use. All the work we do on accreditation is published on our website. As I outlined earlier, the accreditation team is not just picked from the Medical Council but is picked from a wide pool of international experts, who in turn are drawn from independent organisations. We select the team based on specific criteria in order that we know that when an accreditation is undertaken in Ireland or abroad, it is done in an independent and objective fashion.

The Medical Council will undertake a programme of accreditation of RCSI Bahrain this year if circumstances do not change. Much of what has been discussed this afternoon underpins the necessity for an accreditation of the standard we have outlined to be undertaken and for that to be independent, objective and transparent. I have outlined the process the Medical Council will use and the choices before it consequent on receipt of a report. Everything the Medical Council will consider in respect of this task will be available for public scrutiny and we would be very happy to come back before the committee and explain the process later in the year if that is appropriate.

Professor Paddy Broe

I challenged Senator Power on the basis that I got the distinct impression that she was questioning the independence of the Medical Council. As a medical practitioner still in practice, I can attest to the absolute independence of the regulator in how it does its job.

Professor Jim Finucane

It seems we have barely touched on the issue I thought we were here to discuss. We are not asking for accreditation by the Medical Council. We are asking for an evaluation of our suitability for accreditation, which is long overdue. It was promised and planned for two years ago. It is a matter of considerable concern to my colleagues and my students that I finally left in July 2013.

I was professor of medicine and chairman of the department for five years between 2008 and 2013. One of the planks on which Ceartas has sought to have this evaluation suspended is that it alleges that there has been torture of individuals within the hospitals. I was in these hospitals every working day for the five years I worked there. It is inconceivable that individuals were tortured within the precincts of these hospitals. I cannot believe there is any basis for that very serious allegation.

Is it important for our students that they do not have accreditation by the Medical Council? Yes, it is. They are being penalised as a result of this failure in some EU countries, particularly Germany and they also have difficulty in Canada from where many of our students come. We cannot make our dedicated and talented students the whipping boys for the perceived problems of the regime in Bahrain. We are there, win, lose or draw. We are stuck to it. The last thing on God's earth that would be morally acceptable would be to leave 1,000 students in the lurch.

Professor Cathal Kelly

I think that my colleagues have covered it very well. I believe Professor Finucane is correct. These students are working and training under very difficult circumstances. They are doing a very difficult professional degree in a second language - they are not native English speakers - and they deserve our support. I believe they deserve that quality stamp from an inspection visit by the Medical Council if they merit it. Then let the Medical Council judge them and us on our merits.

Ms Mary Doyle

A wide range of issues have been discussed. The main concern is to uphold the standards in medical education. Regarding Bahrain, the Department has sketched a very robust statutory framework within which accreditation and evaluation take place. The 2007 Act provides that the objective of the Medical Council is to protect the public and deliver improvements in patient safety by promoting and better ensuring high standards of professional conduct and professional education, training and competence among registered medical practitioners. That legislative framework is in place and there are a number of rigorous processes regarding the accreditation of the work that RCSI is doing in Bahrain. It very much welcomes the Medical Council comments on public scrutiny of the work it will be doing.

Dr Audrey Dillon

I dispute Professor Finucane's last point, which I believe was alluded to earlier in Professor Kelly's presentation that the medical students in Bahrain have no particular legal advantage or disadvantage to our accreditation process. I dispute that they are not able to get jobs in Canada or Germany due to some failing on our part. Our main priority is to ensure high standards with regard to medical education in line with international best practice are being maintained throughout all bodies we accredit for medical education. That is our main priority in the planning of our accreditation work.

Professor Jim Finucane

I would like to reply if that is acceptable. If I gave the impression that I was in any way critical of the Medical Council, I apologise. That was certainly not my intention. I very much value its engagement in this process. We very much value its stamp or seal of quality approval. In mentioning legal advantages or disadvantages, I wanted to make the point that this is not a way of giving the students some kind of underhanded access to Ireland or anything like that. They have no more access to Ireland than anyone else. It would be a privilege for them and we would be delighted if the Medical Council were in a position to pass commentary on the quality of the programme. In no way was I suggesting any criticism of the Medical Council.

Chairman

I thank all the witnesses and those in the Gallery. We had a previous meeting with Ceartas on the matter and the intention of this meeting was to have a balanced and informed-----

Senator Marie-Louise O'Donnell

Right of reply.

Chairman

----- scrutiny of the whole situation. As Ms Spillane has suggested, we probably will have further meetings on the matter and we would like to be kept updated on developments by all concerned.

The joint committee adjourned at 3.10 p.m. until 1 p.m. on Wednesday, 9 April 2014.