Private Business. - Medical Practitioners Bill, 1954—Second and Subsequent Stages.

Question proposed: "That the Bill be now read a Second Time."

On the Second Stage of this Bill, I think it would be of assistance to Senators if I give them a brief indication of the content of the Acts which this Bill proposes to amend and extend.

Up to 1927 the registration and professional supervision of medical practitioners in Ireland was undertaken by an Irish branch of the General Medical Council. The Medical Practitioners Act, 1927, provided for the establishment of a national body to carry out these functions. This body, the Medical Registration Council, consists of a representative of each of the universities and bodies awarding recognised degrees in medicine, two representatives nominated by the Government and two medical practitioners elected by doctors practising in this country.

The main functions of the council are to keep a register of medical practitioners and to satisfy themselves that the courses of study and the examinations of the colleges and bodies awarding degrees are satisfactory. The 1927 Act gives the council power to inquire into allegations of professional misconduct by medical practitioners either by holding an inquiry in this country or by acting on a report of an inquiry held by the British General Medical Council. If the council are satisfied that the allegations are proven they can remove the medical practitioner's name from the register.

To enable them to carry out their functions, the council were given power, subject to the approval of the Minister for Local Government and Public Health, to recruit and pay staff. These functions of the Minister for Local Government and Public Health were later transferred to the Minister for Health.

The main purpose of the Medical Practitioners Act, 1951, was to require medical practitioners after graduation to spend a period of internship in a hospital and provide for their provisional registration during this period.

Most of the amendments to the 1927 Act proposed by the present Bill are designed to remove ministerial control over the council's activities. During the course of the Dáil proceedings it was represented to me that there was scope for a number of further amendments similar to those I had first sponsored, and I accepted most of the suggestions made. If this Bill is enacted the Minister will retain only three powers in relation to the council's activities. The first of these will be his power to amend, should it be necessary, the rules in relation to the election to the council of the two representatives of medical practitioners. Secondly his approval must be obtained to the fees to be fixed by the council for the registration of medical practitioners, and, finally, any alteration in the length of the period of internship fixed by the council under the 1951 Act will be subject to the Minister's consent.

On these three matters, I think that it is proper practice for some control to be retained by the Minister. I am sure that, in practice, the council will not find the little remaining control in any way irksome

Apart from the amendments removing ministerial control over the council, the only one which I think calls for comment at this stage is contained in sub-section (5) of Section 6. As I said earlier, the council could, under the 1927 Act, examine charges made against a medical practitioner either by holding an inquiry themselves or by acting on the report of an inquiry held by the British Medical Council. The British Medical Act of 1950 transferred the function of holding inquiries in Britain into allegations of professional misconduct from the General Medical Council to a special medical disciplinary committee of that council. As the law stands at present, the Medical Registration Council cannot take cognisance of a report of the Medical Disciplinary Committee and to enable it to do so this provision is included in this Bill. So much for the proposed amendments to the earlier Acts.

An innovation in medical registration, in so far as this country is concerned, is contained in Sections 3, 4 and 5 of the Bill which provide, for the first time, for temporary registration of foreign medical practitioners. There is at present power to make arrangements with other countries for the permanent reciprocal recognition of medical qualifications. The procedure is slow and involves an amount of work which, except in a few cases, is not justified by the numbers likely to be affected by it. The provisions in this Bill will simplify matters considerably for foreign practitioners desiring to obtain hospital experience or to aspire to post-graduate qualifications in this country. Such practitioners will be able to register temporarily for their particular purpose. These sections have been inserted in the Bill at the request of the Medical Registration Council, whose members have practical experience of the difficulties which they are designed to obviate. I should like to make it clear that temporary registration will not entitle anyone to practise medicine generally in this country. I recommend the Bill to the Seanad for a Second Reading.

Ní dóigh liom gur féidir linn mórán a rá i dtaobh na moltaí atá ceapaithe ag an Aire san mBille féin. Is léir go bhfuil an t-am tagaithe le leasuithe a dhéanamh ar an bpríomh-Acht agus ar na hAchta eile; ach sílim nach ceart an ócáid a scaoileadh thart gan beagán a rá i dtaobh scéal na ndochtúirí nó i dtaobh scéal an leighis mar tá faoi láthair san tír. Ba mhaith liom a rá faoi rud ar bith adéarfas mé anois go n-abraím uaim féin é. Mar is eol don Seanad, is ball den Ollscoil mé ach rud ar bith adéarfas mé anois ní le údarás ná le comhairle na hOllscoile in aon tslí adéarfas mé é.

Ar an gcéad dul síos, is dóigh liom go bhfuil an t-am tagaithe anois le gnéithe áirithe de chúrsaí leighis, cúrsaí lia-chleachtóra, do bhreithniú go poiblí. Tá rudaí ag titim amach in Éirinn agus tá rudaí ag titim amach thar sáile go gcaithfimid áird a thabhairt orthu agus is rudaí iad sin atá ag dul i gcionn cuid mhaith ar chúrsaí tréanála dochtúirí sa tír seo. Ní féidir liom féin aon rud a rá faoi chaighdeán an oideachais nó caighdeán na gcúrsaí atá ann le haghaidh liachleachtóirí—níl mé cáilithe chuige— ach tá fhios ag gach duine go bhfuil spéis mhór á cur sa scéal agus go bhfuil imní ar go leor daoine i dtaobh an scéil. Tá fiosrú á dhéanamh; tá taighde á dhéanamh; agus tá speisialacht de gach sórt á dhéanamh ar chúrsaí leighis. Bhfuilmid ag déanamh an oiread agus ba cheart dúinn a dhéanamh le cuidiú leis an obair sin ar fad?

Is ceist í agus is ceist achrannach í an bhfuil an iomarca dochtúirí á dtréanáil againn? Beidh a thuairim féin ag an Aire faoi sin agus beidh mo thuairim agam-sa faoi, ach ní theastaíonn uaim faoi láthair ach a mheabhrú don Seanad gur ceist í sin, an líon dochtúirí atá á dtréanáil, go bhfuil spéis an-mhór ag muintir na tíre inti faoi láthair agus le tamall. Tugaimid faoi deara óráideacha ó lucht ceannais na ndochtúirí; tugaimid faoi deara díospóireachtaí poiblí agus litreacha á gcur sna páipéirí nuachta i dtaobh an scéil ar fad. Níl mise á rá cé aige a bhfuil an ceart. Ní fhéadfainn, mar adubhart cheana nílim cáilithe chuige, ach sílim go bhfuil an scéal ag éirí chomh tábhachtach go dteastóidh treoir údarásach éigin ón bpobal faoi, agus an bealach a bhfeari le sin a dhéanamh, dar liomsa, go ndéanfaí fiosrú poiblí neaspleách air agus go ndéanfaí sin chomh luath agus a bhféidir.

Maidir le cúrsaí idirnáisiúnta, ba mhaith liom a mheabhrú don Aire, go bhfuil rudaí ag titim amach nach féidir linn gan áird a thabhairt orthu. Mheabhraigh an tAire dúinn go mbíonn ceisteanna ann ó am go ham faoi aithint cháilíochtaí dochtúirí na hÉireann agus aithint a thabhairt do cáilíochtaí dochtúirí ón gcoigrích. Faoi láthair tá Cumann Idir-phairliminte, an Cumann Idirnáisiúnta go bhfuil Oireachtas Éireann féin páirteach ann, tar éis coiste speisialta a bhunú agus an gnó atá idir lámha acu an scéal ar fad faoi chéimeanna agus cáilíochtaí lucht ollscoile do scrúdú agus féachaint an féidir aon tseift a cheapadh ionas go gcuirfí ar chomhchaighdeán iad agus go mbeadh aithint le fáil sna tiortha éagsúla ar na céimeanna ó na h-ollscoltacha éagsúla. Ba mhaith liom a mheabhrú don Aire go mbeidh an coiste speisialta sin ag fiosrú na gceisteanna sin faoi Cháisc, an Cháisc seo chugainn, agus is cinnte go dtiocfaidh tortha fiosrúcháin an choiste sin ar aghaidh ag an gcomhdháil bhliantúil a bhéas i Helsinki amach ins an bhFomhar. Nílim ag lua an méid sin ach le taispeáint gur ceist í seo faoin aithint a dtabharfar do na céimeanna agus do na cáilíochtaí go mba cheart dúinn áird faoi leith a thabhairt orthu.

Anois, ba mhaith liom tagairt a dhéanamh do scéal an airgid. Tá ceisteanna ann i dtaobh cúrsaí taighde, agus i dtaobh chomhoibriú idirnáisiúnta, mar gheall ar scoláireachtaí agus mar sin de agus is ceisteanna tábhachtacha, iad. Is ceisteanna iad go mbaineann scéal an airgid go mór leo. Maidir le scéal na Coláiste Ollscoile i nGaillimh, agus sílim go bhfuil na Coláistí eile ar an gcaoi chéanna, tá na scoltacha leighis ag cur na gcoláistí go mór i sáinn airgeadais. Toisc go bhfuil na scoltacha leighis ag cur na gcoláistí i sáinn, sílim go bhfuil an t-am tagaithe le scéal na scoltacha leighis ar fad do scrúdú, féachaint an bhfuil an t-airgead á chur ar fáil acu ar an mbealach ceart.

Bhéarfaidh mé sompla ar an rud atá ar intinn agam. Tá fhios ag an Seanad chomh mór agus atá scoil leighis Choláiste na hOllscoile i nGaillimh molta agus táimíd anbhródúil ar fad as an scéal a bheith mar sin. Ach ní féidir aon airgead bheith againn, ar éigin, lena chaitheamh ar dháimheanna éagsúla na hOllscoile ach amháin ar an scoil leighis.

Dá mbeadh £100 ag an Choláiste maidin amáireach, tá an Scoil Leighis ag fanacht le go bhfuighe siad é. Tá an Choláiste an tsásta cuidiú leis an scoil. Tá a fhios ag an Aire féin pé ar bith airgead a bhí againn sa Choláiste i nGaillimh, an méid a bhí againn— timpeall £24,000—gur chaitheamar ar an Scoil Leighis é nuair a d'iarr an Scoil Leighis orainn é, le go bhfeabhsóchthaí an scoil agus a cuid saotharlann. Thugamar an t-airgead le fonn agus fáilte. Ná ceapadh an tAire nó aon tSeanadóir go bhfuil mé ag fáil locht ar an Scoil Leighis. Níl mé, beag nó mór. Aon locht a bheadh agam ar an scéal ar fad, is é nach bhfuil leath ár ndóthain airgid againn le tabhairt don scoil. Airgead ar bith a bhí againn le haghaidh na Coláiste go hiomlán, b'éigin dúinn é chaitheamh ar mhaithe leis an Scoil Leighis. Tá Dáimh na nDán ann, tá Dáimh na Tráchtála ann, tá Dáimh na hInnealtóireachta ann, tá Dáimh na Dlí ann agus na scoltacha éagsúla éargna ann, agus iad gan an t-airgead ba chóir a bheith acu agus atá riachtanach le forbairt a dhéanamh agus le forfhás a dhéanamh ar a gcuid oibre. Ní dóigh liom go bhfuil cothrom na féinne ann agus an scéal a bheith mar sin. Níl an milleán agam ar an Scoil Leighis go mbíonn siad ag iarraidh an airgid. Molfhaidh an Medical Council in Éirinn nó molfaidh an Medical Council i Sasana, nó in áit éigin eile, go ndéanfar seo nó go ndéanfar siúd sna Scoltacha Leighis, agus mara ndéanfar é sin beidh an chontúirt ann nach mbeidh aithint le fáil ar na céimeanna a bronntar ar na doctúirí. Ach tugaimid faoi deara an chaoi a bhfuil na coláistí, go háirithe an choláiste i nGaillimh i sáinn mar gheall ar chomh minic agus chomh trom a thagann sé ar an Choláiste airgead agus cúnamh speisialta a thabhairt don Scoil Leighis.

Is dóigh liom go bhfuil an t-am tagaithe le go ndealófaí airgeadas na Scoltacha Leighis amach glan ó airgead na nOllscol i gcoitinne.

Tomás Ó hUiginn

Is deacair an chúis sin a phlé ar an mBille seo.

Ach amháin go bhfuil tagairt déanta ag an Aire do chumhachtaí na Comhairle maidir le oibreacha dochtúirí, maidir le aithint chéimeanna agus mar sin de. Is ar an ábhar sin a mheasaim nach mbéinn as ordú agus tagairt a dhéanamh do na pointí seo.

Ar an chaoi chéanna, ceapaim nach bhfuilimid chomh neaspleách in Éirinn san Ollscoil agus adeirtear. Deirtear go bhfuil an Medical Council in Éirinn neaspleách amach agus amach. Ní dóigh liom go bhfuil sé sin fíor. Tugaim faoi deara go bhfuil tionchar mór ag Comhairle an B.M.A. ar chúrsaí tréanála Dochtúirí in Éirinn. Má abraíonn an B.M.A. go gcaithfear é seo a dhéanamh nó é siúd a dhéanamh caithfimid géilleadh agus an rud sin a dhéanamh. Nílim ag fáil locht air sin, beag nó mór, ach tá mé á lua sin mar thaca leis an moladh atá mé a dhéanamh, go ndéanfar idirdhealú feasta idir airgeadas na Scoltacha Leighis in Éirinn agus airgeadas na ngnáth— imeachtaí eile Ollscoile.

Le scéal gearr a dhéanamh de, is é an rud adeirim leis an Aire—agus deirim arís leis gur uaim féin atá an moladh ag teacht—go bhfuil an t-am tagaithe go ndéanfaí fiosrú faoi leith ar scéal an leighis, ar scéal tréanála dochtúirí agus ar scéal airgeadais na scoltacha leighis. Ní hé mar adéarfá go bhfuil mí-shásamh orm faoi na dochtúirí, nó leis an chaighdeán, ach tá na ceisteanna seo ag éirí chomh tábhachtach san agus an oiread san spéise ag an bpobal iontu agus arís, go speisialta, mar gheall ar chomh mór agus atá tionchar ag na scoltacha leighis ar airgead as na gcoláistí éagsúla, go measaim go bhfuil an t-am tagaithe go ndéanfaí fiosrú poiblí i dtaobh an scéil ar fad. Tá mé cinnte go mba mhaith leis na dochtúirí féin go ndéanfaí a leithéid sin d'fhiosrú.

Thairis sin, níl aon rud le rá agam, ach go bhfeicim go bhfuil an Bille seo riachtanach agus go mba chóir dúinn é rith.

As one who is registered on the Irish Registration Council, I would like to support the general principles of this Bill. I think it is very gratifying, at a time when State control is besetting us on all sides, to find a Minister coming forward and introducing a measure which is designed to lessen State control on an extremely important professional body. I think the powers retained by the Minister are such as any reasonable body might be content with, in the Bill as it stands.

The Bill has also been discussed in another place, but there is still one point on which I would like some advice from the Minister. We have got now this principle of temporary registration. When the term "temporary" is used it means "for a certain time", but I would like to get an idea of the time it will be. Section 3 says that persons in hospitals or other institutions are temporarily registered. That is all right, as they are only likely to be temporarily in the hospitals. But when you come to Section 5, the registration of visiting post-graduate medical students, they are registered temporarily until they have obtained the qualification. It seems to me that that might be an indefinite period. I myself have known medical students to take ten years to obtain qualification and some of them never obtain it at all. Supposing we have a post-graduate medical student over here who avails himself of this and who takes time about qualifying, it seems to me that he can go on indefinitely. I wonder would the Minister consider introducing a time restrictive clause, that he would be a temporarily registered student for a period of 12 months and then make it renewable, instead of giving him a completely blank cheque. A person may say that the Irish examiner is much harder than anyone he has encountered on the continent, and for all sorts of reasons he may take a long time to qualify.

There is a qualifying phrase in sub-section (3)—until such date "as may be determined by the council at its discretion". I find it hard to believe that the council at its discretion would urge a man to get qualified. I think it would be much better if there were a time limit, if he had to be qualified by that time limit, or have it come up then for renewal.

Another thing arises out of the Minister's remark, that these temporary people cannot practise in the ordinary way. I have always had trouble about that. There are plenty of people not on the register who practise and who advertise and carry on all sorts of activities. Of course, they run the risk that if one of the patients should be "cured dead", to use an old phrase, there might be some trouble about the certification; but I do not see what is to prevent a post-graduate student, who avails himself of registration, receiving patients here and therefore to a certain extent entering into competition with some of our own perhaps hard-pressed graduates. I know that many of our visiting post-graduate students are excellent people, excellent in their own way. It would be hard if we had one or two who might avail of what might be a loophole in the legislation. Apart from that, I support the Bill.

I should like, on the occasion of my first visit to the House, to express my appreciation of the manner in which this Bill has been received, and I am glad that it has appealed to the two Senators who have spoken on the measure. I do not want to open up a broad discussion on the broader questions of medical education and of the future for medical practitioners, because it is too early now to be quite certain as to the trend or what the picture may be in the future; but, as Senator Ó Buachalla has referred to the matter generally, I would just like to make the comment that the whole question of medical education is, primarily, the concern, not of the Minister for Health, but of the Minister for Education. Nevertheless, as Minister for Health I, of course, or any other Minister for Health, must be concerned to see that we have in Ireland what we have always had, the best possible practitioners in medicine, and to that extent I am concerned with the standing in future of our medical schools in this country.

There was a visit here some time ago by people who, as Senator Ó Buachalla has said, came to inspect and have a look at the medical schools which provide medical practitioners here at home, and also in England and in some of Britain's colonies. I do not know what the outcome of that visit has been, and I do not know what view these people may have formed, but I do hope that those in charge of our medical schools here themselves, and themselves alone, will recognise any difficulties now arising, or likely to arise, as a challenge to themselves, and that they will be able to meet these difficulties themselves as they have been met in the past.

We have in this city, for instance, ten teaching hospitals. I regret that, in the past, those ten teaching hospitals were inclined to be ten competing hospitals. Surely, if there are criticisms to be levelled now at our medical schools in this city, and elsewhere, there should be a coming together of those interested in the different schools to supply in three or four general hospitals what elsewhere may be supplied by one large teaching hospital. In any event, while I do not want to discuss the matter in detail, I have no doubt that any difficulties that are now arising in relation to the whole problem of medical education, the number of doctors and all the rest of it, are passing difficulties, and are best met and overcome by those in charge of our medical schools. I know that, in fact, there is a move taking place at the moment in the right direction.

It is, of course, true that if it does transpire that, in England, or elsewhere abroad, there is not the opening for our medical graduates in the future which there has been in the past, then, of course, there would have to be a very drastic reduction in the numbers taken into the different medical schools, and if the numbers attending the medical schools are reduced, that inevitably raises the question as to whether we have too many medical schools. These, however, are questions that I am not going to enter into now. They are part of the problem and of the events that are now taking place, and I have no doubt that our people will recognise the problem and will be able to deal with it.

Senator Fearon raised one or two questions with regard to temporary registration. Under Section 5 of the Bill, persons registered in accordance with that section are prohibited from practising here. It may be that a foreign student desiring to take out a post-graduate qualification here may become a chronic. I suppose that does happen. Well, the council has the power to determine his registration, but in any event he is not a person entitled to practise here by reason of his temporary registration. Needless to say, of course, if any abuse arose, and it was discovered that a person temporarily registered here as a student was endeavouring to practise then, apart from whatever other offence would have been committed, I have no doubt that the Medical Registration Council would immediately take steps to determine his registration and would send him back to wherever he had come from.

I do not think there is anything else which arose from the observations of the Senators who have spoken on the Bill. I am glad that the Bill has been accepted in this spirit by the House, and that the House shares with me the view that it is a step in the right direction.

Question put and agreed to.

I should be glad if I could have all stages of the Bill now.

Is it agreed to take the remaining stages of the Bill now?

Agreed.

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