Medical Practitioners Bill, 1977: Committee and Final Stages.

Sections 1 to 8, inclusive, agreed to.
SECTION 9.
Question proposed: "That section 9 stand part of the Bill."

I know the Minister has heard a good deal already about the representation on the proposed medical council. There are a couple of points I would like to make on it. I purposely did not put down amendments because I know this matter has been discussed very extensively in the Dáil and I do not want to labour the point too much. I am aware that the Minister is concerned that medical educational establishments and specialists' interests ought to be represented on the medical council. This council, we hope, will be quite different from the existing medical registration council. It will have many functions quite apart from functions concerned with the education and training of doctors.

Any governing body of any profession should be, in so far as it is practical, representative of the overall membership or composition of the profession itself. I do not think the proposed council is that, or anywhere near it. The specialists' interests, and particularly the interests of the medical colleges, and so on, could be properly represented on committees which the council would have power to set up. I wonder whether the Minister would consider some changes in that respect.

I know there will be at least three general medical practitioners. I know the Minister feels that, because the general practitioner composes such a large section of the overall number of medical practitioners in the country, they should have the voting power. The ordinary general practitioner will not be elected to this. The likelihood is that a general practitioner will only be know in his own locality, unlike the specialist who will be known by many general practitioners, and unlike the professor in a medical college who will be known, presumably, by all his past students and, generally speaking, should be known throughout the country. I wonder would the Minister consider any leeway on the question of increased membership for general practitioners.

I also wonder would the Minister indicate whether or to what extent consumer interests are likely to be represented on the council. I see in subsection (1) (g): "four persons appointed by the Minister at least three of whom shall not be registered medical practitioners". What does the Minister have in mind on that? Are they likely to be representative of the nursing profession or has the Minister in mind that they should represent the pure consumer, the patient?

Section 9 is, of course, a very important section. It is, perhaps, the crucial section so far as the legislation is concerned. It deals with the make-up of the council. The council will have 25 members. The make-up of the council has been arrived at after long, hard, careful discussion and negotiation. In fact, at one stage it was increased in order to allow for exactly the sort of representation the Senator has mentioned. As it stands, it represents a fair balance between the different interests, all of whom have a legitimate interest in being represented on the council. I would be very reluctant to change it at this stage. It has met with almost universal approval throughout the profession and in the various institutes and schools. It is as satisfactory as we can make it.

On the specific point about the general practitioner, there must be one person appointed by the Minister specifically as a general practitioner. Of the elected members, two at least must be general practitioners. When it comes to my nominations, I certainly intend to nominate three persons at least who will not be connected with the profession or the practice of medicine in any way. With regard to the fourth, it is just possible that there might be some very important person or institute who would not have succeeded in getting onto the council through the processes set down. It might be necessary for me to appoint a medical person in those circumstances but, prima facie, I will be appointing four civilians, four persons who would not be connected with either the medical profession, as such, or with the nursing profession, or with the para-medical professions.

Is the Minister indicating that none of the para-medical professions will be represented on this council?

That would not be my intention. It is a professional council. It is a body to regulate the doctors' profession. Therefore, it is they who should control their own profession, subject, in response to a fairly universal demand in the Dáil and elsewhere, to having a consumer interest represented.

Is there not some reason to believe that if doctors are represented on the governing body of the nurses' profession——

I do not think anyone objects to that.

In view of the fact that there will be a need for much more emphasis on preparation for family planning and, indeed, control of the type of pill which will be prescribed—I will raise this matter again in relation to the functions of the Medical Council—would the Minister consider appointing a person with special knowledge in this field to ensure that the medical council will consider this as one of their priorities in exercising their functions in relation to education and training? It would seem that particularly in the light of the recent report by the expert committee of the IMA, which was published in yesterday's newspapers, there is a very serious situation indeed in relation to prescription of certain brands of the contraceptive pill which have been withdrawn in most other countries. I believe that this problem stems from a number of factors.

The Minister himself, as quoted in today's newspapers, pointed out that this abuse has been known since 1970. So for the past seven years, there has been a continuation of a toleration of prescribing a pill in this country which can have very dangerous side effects for women who are using this pill. That reflects very badly on the organised medical profession. I believe one of the basic reasons why this is so is the absence of alternative methods of artificial contraception and also—and this is where the importance of the composition of the medical council comes in—the absence of proper training and preparation by practitioners and by doctors generally.

In shaping the Medical Council which will have a very dominant role in regulating the conduct and the orientation of the profession over the next years in Ireland, it is extremely important that the composition of the council should reflect this important priority in itself and that the Minister should use the opportunity to ensure that a person is included in the membership of the Medical Council with a special expertise in this area. I would ask the Minister if he would be prepared to consider using his powers in this way. It is particularly important because of the key role the Medical Council will play in deciding on standards of education and training of the medical profession, both academic training and clinical training. The Minister is in a position to make a very substantial step forward in this area by deciding to include in the membership of the Medical Council, which the Minister himself has said is key to the implementation of this Bill, a person who is known to be expert in the area of family planning, concerned about it, and who would ensure that this was in the forefront of deliberations of the Medical Council in trying to redress an inadequate and narrow training of doctors here in the past which, as I say, has put at risk perhaps thousands of Irish women who down the years have been prescribed pills which have been withdrawn from other markets. The reason, of course, for this is that there is not a choice and there is not proper training of doctors, so that they are not as aware as they should be of the particular hazards. This is a primary responsibility of any medical council, and it relates very much to the type of education and training of our doctors in future. It is a step which I believe is at least as important as making changes in the law which we hope will be done without any further delay.

I do not think any of the matters Senator Robinson spoke about are relevant to this section. This section is not concerned, nor will the council be concerned, with the dispensing of medicine, or prescribing for patients or for the public. This body will be concerned with the conduct and discipline of the profession, with standards. Another body is dealt with later in the Bill which will deal with post-graduate education of members of the medical profession. That will be a medical post-graduate board which is established under a different part of the legislation. This particular council will be really regulating the profession as a profession. Most of the points Senator Robinson made are relevant to teaching in the medical schools and perhaps to the post-graduate education and training of doctors.

In any event, I do not really appoint medical people to the Medical Council. Therefore, I cannot give the undertaking Senator Robinson seeks. In fact, I will appoint four persons only. The others will all come from the processes laid down in the section. The four people I will be nominating are meant to represent the consumer interest, the ordinary simple man or woman in the street. At least three of them will be such. I could not possibly give an undertaking along the lines Senator Robinson seeks, even if I thought it were necessary.

I do not think that this is the time to deal with the problems Senator Robinson adverted to. On the general question of prescribing of pills, whether they be contraceptive pills or any other sort of pills, that is an area which is governed by the National Drugs Advisory Board. We have that official body whose job is to keep an eye on all medicines, all pills, and to issue directions to the medical profession in regard to them. I am quite satisfied that that body does its job satisfactorily and, as I pointed out in the Press statement which I issued yesterday, it has in fact on two occasions in a general guidance issued to the medical profession adverted to contraceptive pills. If there is any action to be taken in regard to the prescribing of a particular medicine or opposing prescribing a particular medicine by the medical profession, it is through that body that action should be taken.

I do not want to enter into it here but I just want to record the danger from the sort of general sweeping statement Senator Robinson made about the prescribing of harmful pills by the medical profession in recent times. I have no evidence to suggest that any such situation prevails. These are not matters for me to decide. They are left traditionally to the skill and the training and the experience of the medical profession and, helping the medical profession in that regard, we have now available advice and guidance from the National Drugs Advisory Body.

I cannot agree with the Minister that the point I made is not relevant to the section. Indeed, none of his arguments in reply has at all pointed out any irrelevance. Rather he has confirmed my view that it is extremely relevant to try to ensure that there is somebody included in the composition of this very important medical council who would have, as a priority, concern for the need for training and advice and much greater information for general practitioners and doctors generally so that they may be properly equipped to give comprehensive advice in the area of family planning.

This body will not advise doctors.

If I may pursue the argument, the Minister said that the council seem to have no relevant function, but I would point out that the Medical Council have extremely important functions in this area. I will come back to this point when we are talking about those functions under section 35.

The Medical Council, not the post-graduate board, have functions. Under section 35 they have a duty to satisfy themselves "as to the suitability of the medical education and training provided by any body in the State recognised by the Council for such purpose. As to the standards of theoretical and practical knowledge required for primary qualifications, as to the clinical training and experience required for the granting of a certificate of experience, and as to the adequacy and suitability of post-graduate education and training provided by bodies recognised by the council for the purposes of medical specialist training."

These are key areas, both at primary and post-graduate level. The Medical Council can ensure—and have a duty to satisfy themselves—that there is adequate knowledge and adequate provision in the training programme, so that the young doctors coming out of medical school are equipped to provide a comprehensive area of advice and services in family planning. This is an extremely important area. It is sometimes forgotten in this whole debate about the availability of contraceptives, that contraceptives are importable by people. They can be imported for private use without any restriction as to number, or any restriction at all, and yet the women who may choose to import contraceptives because they cannot get them in this country, or people who may import them because they cannot get them here, are unable in many instances to get adequate medical advice and medical help in relation to their use, in relation to the risks involved. It is extremely important that this be a primary consideration of the Medical Council.

The Minister says he can only appoint four persons to the Medical Council and that three of these will be specifically to represent consumer interests. I believe a very important consumer interest at the moment is the approximately 50,000 women who are known to be using the pill each month, and the considerable number of women using other forms of contraceptives who might not be getting the advice they want, and the still other number of men and women who may want access to other methods of family planning and may want advice about it.

It is an absolutely shameful situation that there is still no change in the legislation. I hope the Minister will address himself to this without postponing it in a sort of smokescreen of consultation. Virtually every possible method of changing the law has been tried. There are not very many other methods to try. It is a fairly simple process. It does not require elaborate consultation.

Probably more important at this stage is to ensure when we are bringing in a new Medical Practitioners Bill, and establishing a new medical council, that we build visibly into the composition of that medical council somebody known to be both trained and knowledgeable in the area of family planning, and to have that as a particular priority. This is a genuine consumer interest. I would urge the Minister to reconsider. I hope he still has an open mind about some of these appointments, that there is a possibility that he can reconsider the matter very seriously and use this opportunity. He could do a great deal. By appointing somebody who was knowledgeable and concerned in the area of family planning it could actually be a very positive step forward in ensuring that the Medical Council in their deliberations and the functions they will exercise under section 35 were conscious of the need to redress the failure of the past, to redress the fact that there has not been an adequate training of young doctors and an adequate insurance that any medical graduate is knowledgeable in this area.

The real problem at the moment is over-prescription of the pill generally in Ireland. There are still on the market in Ireland at least seven categories of contraceptive pill which have been withdrawn in other countries. The reason for this is precisely that there is an absence of a guarantee of adequate training for young doctors going through the medical schools in Ireland. This should be a primary concern of the Medical Council. The Minister, far from considering that it is not relevant to the appointment of personnel to the Medical Council, might take the point that, in one fell stroke, by making a highly relevant appointment here, he could perform a very positive service in ensuring that, from now on at least, we are aware of the substantial health risks and of the need generally as a country to provide this very necessary, basic service to the consumers, to the ordinary men and women who want this sort of advice, who are now badly advised, who are in some instances in the case of women placed very substantially at risk.

There are medical reports of the risk. There are studies which show the very substantial risk incurred by women in over-prescription of the pill, in prescription of the pill in circumstances where it should not be prescribed, where they have a heart condition, varicose veins and various types of counter-indicative conditions. This is something that, too often, the general practitioner is not aware of and there is, therefore, a medical responsibility. If the couple want to use artificial means of contraception the pill is prescribed whether or not it is not only the suitable but even the medically indicated type of contraceptive. I would again urge the Minister to reconsider his point on it. He has said that the——

The Senator is generally relevant but the Chair would like her to avoid going into too much detail.

Yes. I appreciate the Chair's concern. The point I was making, and I am concluding on it, is that the Minister tried to suggest in his reply first, that to consider putting somebody on the Medical Council who had a specialist knowledge and interest in family planning generally was not relevant because the Medical Council only deal with the discipline of the profession. This is not the case. The Medical Council have a key role in the whole training and preparation of doctors, both at primary level— which is probably the most important —and also at post-graduate level. They have a much more key role in that regard than the post-graduate board, also established under the Bill.

Secondly, the Minister tried to suggest that he does not really have much function in appointing to the board; he will appoint four people only, three of whom will be specifically catering for consumer interests. Again, that is an argument in my favour. A very important badly-served consumer interest in this country is the need for advice on family planning, the need for comprehensive training in the area of family planning. Therefore, I would urge the Minister to reconsider the matter and to realise that by this appointment he could, in fact, make a very substantial step in the right direction and move towards a situation where we will have comprehensive advice and services in the area of family planning.

I just want to repeat that this council are primarly a council to govern the ethics and standards of behaviour and the professional conduct of the profession.

Have they not functions under section 35?

The general administration of medicine is for other bodies, other organs and other institutions. This body, in so far as they have any function relevant to what the Senator is talking about, simply have a function to satisfy themselves about standards of training and education.

That is the key.

This council will not conduct any education or training courses or involve themselves in that area. They will satisfy themselves about standards only.

If they are satisfied that there is not adequate family planning——

I did not interrupt the Senator. Let us try to have a bit of dignity about this. The Senator is, perhaps, overlooking section 9 as it stands:

two persons appointed by the Royal College of Physicians of Ireland, of whom one shall be appointed to represent the medical specialties, and the other shall be appointed to represent jointly the specialties of pathology, obstetrics and gynaecology.

I would expect that these people representing the specialties of obstetrics and gynaecology at least would know something about family planning and contraception and the areas which seem to be of particular concern to the Senator. This council are expected to represent the entire medical profession. They cannot and should not be overloaded with any one particular aspect of the medical profession, whether that be family planning, mental handicap or any other branch of the medical profession. This council are broadly based and are carefully constructed to represent the medical profession as a whole. Their primary function will be to control the behaviour of the medical profession as professional people, to make sure that they adhere to the proper standards of behaviour in exercising their profession. They also have an important function of satisfying themselves about the standards obtaining in the medical schools and teaching institutions.

I do not want to delay the House unnecessarily on this subject, but the Minister is still failing to understand the point I am making. I am well aware that the College of Physicians will be making two nominations and that one of these will represent jointly the specialties of pathology, obstetrics and gynaecology. That is from the medical perspective. and rightly so, but what the Minister has accepted—I am glad he has accepted it—is that a Medical Council should represent consumer interests. The situation in Ireland reveals all too sharply that it is not enough to leave it purely to the, perhaps very highly qualified, medical representatives. What is also needed is a highly articulate and insistant consumer voice, the voice of somebody who is able to speak for the needs of the 50,000 women who are being prescribed the pill in Ireland at the moment and the unknown number of other women who are either availing of other methods of artificial contraception or would choose to do so if they had adequate advice and services in family planning. It is precisely to serve this consumer need, not because I doubt that the medical expertise will, in its professional sense, be represented on the Medical Council, that I try to urge the Minister to reconsider. I have had an opportunity of putting this point to the Minister and I do not want to labour it at this sage.

Is this debate going to develop into an elucidation of our own interests in the field of medicine or is it going to stick to the business of the Bill? I have particular interests in the medical field and I have a feeling that some of them are of a lot more social consequence than what we have been listening to here tonight. Senator Robinson seems to think that every time she gets up on any Bill she can jump on her hobby horse. Is she going to be allowed to jump on her hobbyhorse? If that is to happen we should get this Bill into an open area and talk about our own interests within any sphere of the medical profession.

It is the Chair that decides whether any matter is relevant or not.

I beg the indulgence of the Chair but I felt that what Senator Robinson was saying had no relevance in this Bill. If it has we should be able to get into the other areas where concern can be expressed.

When she "opes her mouth, let no dog bark".

Question put and agreed to.
SECTION 10.
Question proposed: "That section 10 stand part of the Bill."

When does the Minister feel he will be in a position to make the appointments? In other words, when is the new medical council likely to be in operation?

As soon as this gets through the Oireachtas, I will get on with the elections and the whole process as quickly as I can. There will be no delay.

Could the Minister give some indication as to how long he thinks it will take to establish the new medical council in terms of weeks or months?

I would hope it will be within a matter of months, but a limited number of months. It certainly could not be done within weeks. We have to have elections and nominations by the different organisations. They will have to meet, submit their nominations and we have to have elections for the ten elected members. It will certainly be some months but I assure the Seanad there will be no delay. Everybody is anxious to get the new council into operation.

Question put and agreed to.
Sections 11 and 12 agreed to.
SECTION 13.
Government amendment No. 1:
In subsection (4), page 9, line 10, after "Council" to insert "provided that in the case of the committee referred to in subsection (2) (b) of this section the chairman shall be a member of the Council other than the President or the Vice-President of the Council".

The Medical Council are obliged by section 13 (2) to establish a Fitness to Practise Committee and membership of that committee is restricted to members of the council. That is desirable. Under section 45 of the Bill the Fitness to Practise Committee is the body which will inquire into the conduct of doctors and will report to the Medical Council as a whole. Then the council will decide. It is considered desirable that in no circumstances should either the president or the vice-president of the council be chairman of the Fitness to Practise Committee. This amendment is designed to ensure that. The Senators will appreciate that, if the Fitness to Practise Committee is reporting on a disciplinary matter to the council as a whole, it is well that the president or vice-president of the council as a whole should not have been unduly involved in the first step in the fitness to practise examination. In other words, they should be in a reserve position.

Amendment agreed to.
Section 13, as amended, agreed to.
Sections 14 and 15 agreed to.
SECTION 16.
Question proposed: "That section 16 stand part of the Bill."

In subsection (2), I see the registrar is to be appointed by the council. Will he, or she, be in fact appointed by the Local Appointments Commission and the appointment finalised by the council or will he, or she, be appointed by the members of the council? What are the likely qualifications to be for the post?

They will be appointed by the council and the procedure will have to be left to the council.

Why has this method of appointment of the registrar been decided upon rather than a more objective method of appointment, using the Local Appointments Commission?

The officer in question will be an officer of the council. He will not be a civil servant or a member of the public service. Members of the public service are recruited either through the Civil Service Commission or through the Local Appointments Commission but this person will be the servant of the council and, therefore, it is only fitting that they should have the right to select the man they want and appoint him. This is the procedure which is followed in all cases such as this. He will, incidentally, be paid by the council out of their own funds. He will not be paid from public funds.

Question put and agreed to.
Sections 17 to 24, inclusive, agreed to.
SECTION 25.
Question proposed: "That section 25 stand part of the Bill."

On the question of fees, the council will have the possibility of charging an annual fee which can be increased each year. Is that the intention?

A retention fee, yes.

And is it possible that this may increase each year?

Yes, it could be increased.

Is there any possibility that this may, in fact, be prejudicial to younger practitioners? I understand this is a new provision for a retention fee and that it might cause hardship. I know that it can be a very real burden on young practitioners to have a very high retention fee. Is it intended that it will be graded, for example, to allow more practitioners to pay a larger retention fee?

That is a good point. There are a couple of safeguards. First of all, the idea of the retention fee could be regarded as being in aid of the young doctors because the initial fee need not be so high and there is a retention fee. At present there is only one fee, the initial fee and, therefore, that has to be sufficient to keep the council going. The fact that the new council will have retention fees to pay its annual expenditure, its annual outgoings, will mean that the initial fee need not be all that high. To some extent that will be in easement of the position of the young doctor. Furthermore, the fees have to have my consent, and I hope that I would have due regard for the interests of the younger members of the profession struggling to make their way. Of course, any increase in fees would be subject to the National Prices Commission—I am sure I am right in that. If the council wanted to increase the fees they would have to get the consent of the National Prices Commission.

There are those safeguards. Of course, there is the ultimate safeguard, and to some extent that is what this new council is to a large extent about in so far as fees are concerned, the election procedure. If young doctors are not satisfied with the level of fees being charged by the existing council they can elect different people when the time of election comes around. In fact, there was a great deal of discussion about this in the United Kingdom and the idea of election is very closely related both in the United Kingdom and here to this idea of retention fees. If there are going to be retention fees payable annually then the profession has a right to elect members to the bodies taxing them in this way.

Question put and agreed to.
SECTION 26.
Question proposed: "That section 26 stand part of the Bill."

On section 26 (4), the display of the certificate, could this be construed as the main or one place where the practitioner is engaged in the practice of medicine?

There was a lot of discussion in the Dáil, and I raised it on the Second Stage debate here, on the whole question of registration and on how tight the situation is so far as potential employers and the general public are concerned. I suggested that the Minister might consider issuing annually practising certificates to doctors. This is done in the legal profession and I do not see any reason why it ought not be done for the medical profession. The cost involved would be very slight. In the Dáil it was suggested that doctors would probably equip themselves with the register every five years and get the annual supplement, but this is something that the medical council could make a very definite arrangement about whereby doctors would have a current practising certificate. There is provision there for retention fees. The amount of cost involved in this would be very very slight. There would only be changes in respect of doctors who had died, or in respect of new doctors or those whose names had been erased from the register. It would help considerably and health boards then could look to a potential employee for his current medical practising certificate. It would assist a great deal. A very simple amendment would make this possible, and I would ask the Minister to consider that.

I recall the Senator making this point on Second Stage and I have thought about it since but I am not sure that it would be worthwhile or worth the administrative inconvenience involved. One would hesitate to suggest that there is greater stability in the medical profession than in the legal profession, but one would like to think that the certificate which a doctor is issued with at the start of his career remains on his wall, achieving venerability, dignity and age as he proceeds through his professional career. That is a much more desirable professional situation than having a fresh one issued every year. Generally speaking, I do not think the administrative inconvenience involved in issuing fresh certificates every year would be justified. There is also possibly a danger that if we have too many of these certificates knocking around every doctor would be getting a new one every year—there would be a lot of them in existence after a while.

They would go out of date.

If a patient goes into a surgery he is not going to go over to scrutinise the certificate to see if it is an up-to-date one. If he sees the certificate on the wall that will be enough for him in normal circumstances.

The Minister slightly misunderstands the idea I have in relation to the certificate. I am not concerned with what the patient thinks. I agree that the age old parchment that an established practitioner would hang on his wall——

Going yellow at the edges.

I certainly agree that that should remain and not be issued each year. I am talking simply about a certificate to the effect that he is currently on the register, not to be displayed in his surgery but to be available to him to show to a health board if he was presenting his qualifications.

We have a provision that every health board will have to have a register and keep that register on display in its central office.

I come from a small country town where we had the experience a few years ago of a doctor arriving into town, setting up in a hotel, living extremely well and working extremely well, as far as we thought, but he disappeared out of town a short while later with a new Mercedes sports car and a colour television set which he had hired a short time before. He left some other bills knocking around the place. It seems to me that if the person who brought him into the town had seen his current practitioner's certificate which, of course, he did not have, it would not have happened that way. I understand that that man did, in fact, appear on a register but that his name had been erased because of malpractice somewhere else.

I am not concerned with what the patient thinks. I realise there would be some administrative inconvenience but it is very slight in relation to the problem we are dealing with. I am particularly concerned about it because of the free movement of doctors within the European community territory. That is something that solicitors do not have to concern themselves with too much. A simple change in the Bill at this stage could bring about a good and definite tightening up of what is a very important matter. I had experience of this in my town and a number of instances were quoted in the Dáil of health boards and doctors who were not registered putting themselves out as registered practitioners. It is something that needs to be looked at very carefully.

The only thing I can say is that at least the idea of a certificate displayed in his principal place of business is a step forward. There is nothing at the moment. The real protection that will exist from now on is the fact that we are going to have an up to date register which will be in every health board central office. Furthermore, I have given an undertaking in the Dáil that we are going to ensure that all those employing people at any level throughout the profession will check that the person is duly registered. That is the real protection.

I am not going to push the point any further. I am sorry the Minister will not take the point. We have had problems up to now because health boards and existing practitioners who take on additional employees do not go to the trouble of checking. I am suggesting a way that I think would copperfasten the situation and ensure that this would never happen again. There is no point in my pushing it further.

Question put and agreed to.
Sections 27 and 28 agreed to.
SECTION 29.
Government amendment No. 2:
In page 14, lines 20 to 23, to delete subsection (3).

An Leas-Chathaoirleach

Amendments Nos. 2 and 3 are related.

Senator Robinson and myself are agreed on this and I think that the Seanad will agree with both of us. Subsection (3) of this section is concerned with the imposition of linguistic tests for people who are seeking provisional registration. One can see the desirability of a linguistic test, in the interests of the patient particularly. An objection was raised in the Dáil to this provision on the basis that it would amount to racial discrimination. Any member of the medical profession who is from an EEC country would not have to undergo this linguistic test while somebody from outside the EEC would. I listened carefully to that argument and I was not totally persuaded by it but, nevertheless, if there was any element of racial discrimination it is better to do away with it rather than have anything of that sort suggested.

We are proposing, Senator Robinson and I, to delete subsection (3) which provides for this linguistic test. The situation will then prevail whereby the matter will be left to the individual employing agencies to satisfy themselves that the respective employee has the appropriate qualifications for the job, including language, rather than have this statutory provision of a linguistic test which would, in practice, only apply to persons outside the EEC.

I am glad the Minister tabled a Government amendment after I had put in an amendment to delete this subsection requiring a test of linguistic ability for doctors other than EEC nationals. The Minister has outlined a number of reasons why this is desirable. It is very important that we do not fall into a kind of trap in creating a privileged status for EEC nationals here and, consequently, begin, however indirectly and unintentionally, to discriminate against people from developing countries such as Africa and India who have traditionally come here and gained valuable training and experience as doctors. I am sure that was not intended, but that kind of statutory linguistic test applied to other aliens, non-EEC nationals who wished to be put on the register here, could have given rise to a discrimination, in particular if there was to be any pressure about jobs being available and doctors coming from outside the country seeking jobs in our hospitals and elsewhere.

With our own tradition and background and our own links with the developing world we need to be careful not to create a different standard in this way and not to introduce tests for aliens from developing countries who want to come here to gain valuable post-graduate experience and training. I welcome the attitude the Minister has taken following the discussion on this point and the views put forward by Dr. John O'Connell and his plea to the Minister to remove what could be racial discrimination and what, in any case, would not be necessary to achieve the desired objective. It is still possible to ensure that a particular applicant for a job has a sufficient command of the language to be able to communicate with people who he would be treating medically.

The danger of the subsection as it was phrased in the statute was that it could be a bar to a person being registered at all and, in the way in which it was administered, there was no guarantee that it would not, in fact, operate in a discriminatory way. As legislators would be rightly concerned not to approve a provision of that sort where it is still possible, as it will also be with EEC nationals, with French, German and Italian applicants for posts in Ireland, if they are totally unable to communicate in English that they would not be suitable.

Or Irish.

They would not be suitable for posts here where they would have to communicate with Irish patients and treat Irish people medically. This is the appropriate way to approach the problem and I welcome the flexibility and the attitude of the Minister in the matter.

With respect to Senator Robinson, in practice the difficulties have not arisen with people from developing countries. Medical practitioners from developing countries who come here for further training do their undergraduate training through English and the problems in practice usually do not arise. The problems tend to arise with nationals of other European countries who do not have English as their first language and do not go through medical school using English. I agree that the subsection should be deleted to avoid even any impression that perhaps there might be discrimination. Now that we are accepting other EEC nationals it would be irrational to exclude other Europeans but the problem has not been from the developing countries.

Amendment agreed to.
Amendment No. 3 not moved.
Section 29, as amended, agreed to.
SECTION 30.
Question proposed: "That section 30 stand part of the Bill."

I beg the indulgence of the Leas-Chathaoirleach because I want to raise a point which I meant to raise on Second Stage last week. Unfortunately, I omitted to mention it. Section 30 deals with the register of medical specialists and I would like to ask the Minister whether he might consider the setting up of a register for some para-medical group. I realise I am not within the scope of section 30 but I ask the House to raise the point because representations have been made to me from the physiotherapists group. The view has been canvassed within the members of that profession that they ought to have a register because as matters stand one can set up as a physiotherapist without obtaining any qualifications.

An Leas-Chathaoirleach

I must interrupt the Senator to say that the Chair has not discretion to allow discussion on something that is completely irrelevant under this section.

Question put and agreed to.
Sections 31 to 34, inclusive, agreed to.
SECTION 35.
Question proposed: "That section 35 stand part of the Bill."

On paragraph (d) which states that it shall be the duty of the council from time to time to satisfy itself as to the adequacy and suitability of post-graduate education and training, I should like to know if this refers solely to formal postgraduate training or does the Minister imagine that it might include the keeping of doctors up to date on current developments as a result of research and new drugs coming on the market?

Yes, very much. It will have an important function in that area, one which I would regard as important. One of the things the Irish Medical Association, in particular, emphasised to me was the absolute necessity there is to help general practitioners keep in touch.

I wish to return to a point I was making earlier about the important functions in this matter performed by the Medical Council. I was trying to persuade the Minister to pay attention to the composition of the council and now I want to turn to the functions. I want to emphasise the necessity for specific insurance that the medical education and training of our future doctors will stress the need for training in the area of comprehensive family planning. The Minister when talking about the matter which I raised—the fact that there is an expert report of the IMA drawing attention to certain brands of the pill which have been withdrawn in other countries and which could be dangerous if prescribed to women seeking to use the contraceptive pill—said that it was all right, that there is a body, the Drugs Advisory Committee, and it issues directives. That is really a totally inadequate response, and it has even been proved so by the facts of the particular situation. In 1970 there was such a drawing of attention by the Drugs Advisory Committee and it has not had a proper impact. It has not, in fact, ensured the withdrawal of potentially dangerous contraceptive pills from the market. What is needed is not so much a kind of remedial board when the damage has been done to redress the situation afterwards but a guarantee of adequate education and training of our young doctors. That is an area where there is room for grave concern.

I do not believe that in all the medical schools there is an assurance of adequate education and training in the various methods of family planning and, as I emphasised earlier, this is essential because Irish citizens can now import for private use any type of contraceptive with absolutely no control over the situation and, particularly in rural areas where they do not have a very wide choice of doctor, they may not be able to get proper advice on the matter. The Medical Council in exercising their function under section 35 have a key role to play in this area and I would have preferred if, indeed, it had been possible to insert a specific reference to the need for education and training in providing advice and services relating to family planning. Again, we are trying to redress a neglect of the past. We are trying to provide a service which is most inadequately provided generally, and we are trying to do it just at a time when literature about family planning has been banned by the Censorship Board and is now the subject of High Court proceedings on an appeal to the Supreme Court. Doctors are further handicapped by possibly having extreme difficulty at times in having the necessary explanatory literature.

If Senator Lanigan is particularly concerned or disturbed when I raise this point he is perfectly free to adjourn to the library or the bar or somewhere else. I am not hung up on this point. I do not have any particular fixation about family planning. I just consider that it is a very important part of a general health service. I believe that far too many married women in this country are at risk, risk to their lives, to their families and to their children because they cannot get adequate comprehensive advice on methods of family planning. I believe that the Medical Council in satisfying itself as to standards should in doing so regard any education and training for the primary degree in medicine as inadequate unless it covers a full course in methods of family planning and advice and instruction in these family planning methods.

I should like, therefore, to ask the Minister specifically whether he would agree that a primary course in medicine which did not include a comprehensive education on the various methods of family planning should not satisfy the Medical Council as being an adequate training for a primary degree in medicine, and that should be one of the concerns of the Medical Council in the reality of the Irish circumstances.

I do not think it is any part of my duty to indicate what standards the Medical Council should lay down in any particular area. The whole purpose of this Bill is to set up a Medical Council to which we entrust this task of ensuring that medical education and training is adequate. I believe that the sort of council which this legislation provides for will ensure that. I direct the attention of the Senate to the duties which we are imposing on the council. We are obliging it to satisfy itself as to the suitability of the medical education and training provided by any body in the State recognised by the council for that purpose. It must satisfy itself as to the standards of theoretical and practical knowledge required for primary qualifications. It must satisfy itself as to the clinical training and experience required for the granting of a certificate of experience and as to the adequacy and suitability of postgraduate education. I think the terms of those duties imposed on the new council are sufficiently broad to cover the entire spectrum of medical education, including family planning, or any other particular branch of medicine in which any particular Senator may have an interest.

Question put and agreed to.
Sections 36 to 39, inclusive, agreed to.
SECTION 40.
Government amendment No. 4:
In page 18, line 26, after "concede sultation" to insert "with the bodies specified in sections 9 (1) (a), 9 (1) (b), 9 (1) (c), 9 (1) (d) and 9 (1) (e) of this Act, and".

Senators will realise that this part of the Bill—Part IV— deals with a new body which we are setting up—the postgraduate medical and dental board. At the moment we have a postgraduate medical and dental body which exists on an informal basis and we propose to give it statutory status. One of the functions of the board will be to advise the Minister on all matters, including financial matters relating to the development and co-ordination of postgraduate medical and dental training. That function is enshrined in paragraph (b) of section 40, and, having discussed the provisions of this entire Part IV with different bodies, medical organisations and medical schools and institutions, I have decided on a number of amendments which I want to recommend to the Senate. This is the first of them. Senators will see that I propose to insert in paragraph (b) in the first line after "consultation" the words "with the bodies specified in sections 9 (1) (a), 9 (1) (b), 9 (1) (c), 9 (1) (d) and 9 (1) (e) of this Act." I want to ensure that this new postgraduate education and training board before it advises me will consult with those bodies as set out in section 9. They are the medical schools and the medical colleges. It is an important improvement to this section as it is at present in the Bill.

Amendment agreed.
Government amendment No. 5:
In page 18, line 30, after "denial" to insert "education and".

An Leas-Chathaoirleach

There is a printing error in amendment No. 5 where "denial" should read "dental".

Amendment 5 is a drafting amendment. We seem to be improving the draft and improving the spelling of the improvement of the draft at the same time. As you can see, it is just to insert the words "education and". The section as it was originally drafted spoke about dental training, but of course what is really meant is dental education and training, and the amendment achieves that.

Amendment agreed to.
Government amendment No. 6:
In page 18, lines 31 to 33, to delete paragraph (c).

This proposes to delete paragraph (c). Section 40, as originally drafted, included as a function of the new board that whenever appropriate it would organise post-graduate education and training for registered medical practitioners and registered dentists. In fact that was a mistaken concept. The new board will not actually organise any courses or anything of that sort. It will promote and develop post-graduate medical and dental education, but the function of organising post-graduate education is, of course, a matter for the schools and the different colleges and institutes.

I was somewhat puzzled by this amendment and I am not quite sure if I fully understood the Minister's explanation of it. It proposes to delete from the functions of the board "whenever appropriate to organise post-graduate education and training for registered medical practitioners and registered dentists". It would seem that this would be a function of the board which would be of the same kind as to provide career guidance and that is an active function that would involve organisation of career guidance courses or actually getting actively involved in providing and organising courses for registered medical practitioners and registered dentists.

I am not quite clear why the board are no longer going to be actively involved in the function of organising post-graduate education and training. I say this particularly because it may be that it is something that should be left to the individual schools. But it would, perhaps, be possible for this board to have a sort of neutural collective umbrella under which to provide post-graduate courses which could be available then to graduates of the different medical schools. This does not occur to the same extent in the area of dental medicine but nevertheless it might be suitable to have a neutral forum organising post-graduate courses and in this way to ensure that relatively limited resources were being used to the maximum. Therefore I would welcome further clarification from the Minister of the purpose of this amendment and why he is depriving the board of this particular function.

We are not actually depriving the board of this function because they do not want this function.

Why is the Minister not forcing them to do it?

We have a committee there at the moment who are operating in this area of post-graduate education and training very satisfactorily and, in fact, all I am doing here is giving a statutory status stamp to that ad hoc committee. That committee do not at present attempt to organise as such. Organising education and training is a matter for the medical schools and colleges, this College of Physicians and College of Surgeons or whatever. The function of the post-graduate board is and should be confined to promoting, developing and co-ordinating the provision of post-graduate education by these bodies. But the actual organising of the courses for the training and the education will be a matter for the schools and colleges themselves and not for the board. The board will not themselves provide in that sense education or training, but will promote it, develop it and coordinate it. Perhaps the wording might cause a bit of confusion but if you look at the section, as it will be when this particular section is deleted, I think the meaning will be quite clear, that the board will not be involved in the actual business of organising courses in training and education; they will be developing and promoting training and education as such.

Surely paragraph (c) does provide active involvement "to promote career guidance for registered medical practitioners and registered dentists." Would that not involve active courses in career guidance?

We are deleting paragraph (c).

Paragraph (d).

Career guidance is a different matter from the actual provision. Medical education is properly a role and the responsibility of medical schools and medical colleges; medical education and post-graduate training is their business and we propose to leave it with them. The role of the board, as far as education and training is concerned, will be confined to promoting, developing and encouraging these schools to provide it in particular areas and particular disciplines. Career guidance is a different matter from actual medical training and education as such.

Amendment agreed to.
Question proposed: "That section 40, as amended, stand part of the Bill".

Now that it is clear, a Leas-Chathaoirleach, that the functions of the board in relation to the question of education and training will be more functions of promoting, in a sort of passive way rather than being actively involved, I think it might be appropriate to draw attention to the very serious situation particularly in the dental college and to the very serious need for far better resources and facilities. I have been aware of the grave problems suffered by students at present in the pipeline and they have been forced to strike. They have been——

The students and their educational institutions are the responsibility of my colleague, the Minister for Education.

I know but the Minister is establishing a board which will have active functions to promote dental education and indeed post-graduate dental education.

I agree it is a grey area.

It is a grave, grey area and I was wondering whether the Minister could give us some indication of what kind of resources the board would have to more actively promote. I appreciate that, strictly speaking, the operation of the dental college is under the jurisdiction of the Minister for Education but here we have a post-graduate board which will be promoting post-graduate dental education and training and I would very much like to know what kind of resources the board would have at their disposal in order to try to improve on the extremely serious situation, particularly, as I say, for students at the moment in the pipeline for they have neither the resources nor the technicians to give them proper training.

Some of them risk a prolongation of six months on their present training and the place itself is grim beyond belief as a place to try to study in. I do appreciate that this is not directly under the jurisdiction of the Minister but there is no good in us looking at a section which looks good on paper, saying that there is going to be a board to promote something unless we have some idea effectively of how this promotion can take place. I was much happier before the Minister's last amendment was approved when I felt that this board might have the possibility of organising post-graduate education particularly for registered dentists because I thought this might be a step in the right direction, to try to improve the existing situation.

We must not be too restrictive in the interpretation of the word "organised". So far we have been able to give the ad hoc committee all the funds they have asked for. Literally, they were not of fabulous dimensions but nevertheless what they asked for, they got and I hope we will be able to continue that. The dental service is one of the aspects of the administration of the health services which will be receiving a great deal of attention during the coming year. As the Senator probably knows, we have now arranged for the appointment of a chief dental officer in the Department of Health, a post which has not been filled for a long time, and with that appointment we hope to proceed with a very comprehensive reorganisation and development of the dental services generally. That, of course, will be in a way related to the post-graduates' dental training and education. In fact, we will have a new dental Bill and we will have this new chief dental officer in the Department of Health and we have resources available to, I hope, fairly satisfactorily improve the entire dental services and an important part of that process will be giving increased attention to post-graduate dental education and training.

That is the only assurance I can give the Senator at the moment. As far as the legislation is concerned the position is that this new board will have this responsibility of promoting, developing, encouraging and co-ordinating post-graduate dental education and training. I am sure that they will get on with that job and provide the courses and so on which are necessary to arrange for their provision.

Question put and agreed to.
SECTION 41.
Government amendment No. 7:
In page 18, line 38, after "Minister" to insert "following consultation with the Board".

This is a simple amendment: it speaks for itself. Again, it was suggested to me by the medical bodies. Section 41 enables me to assign to the board additional functions from time to time. This amendment provides that before I assign any additional function to the board I should consult the board. This is just eminent common sense.

Amendment agreed to.
Question proposed: "That section 41, as amended, stand part of the Bill."

Since the section is referring in a very general way to functions other than those currently assigned to the board, would the Minister indicate what particular functions he might have in mind that might be assigned? It is a very general, unrevealing phrase.

It is meant to give me an omnibus, general power. I have nothing particular in mind.

Could I suggest a particular subject matter that might be a matter for concentration?

I think we can take it as fair and reasonable.

Question put and agreed to.
SECTION 42.
Government amendment No. 8:
In page 18, lines 40 and 41, to delete subsection (1) and to substitute the following subsection:
"(1) The Board shall consist of twenty-five members, appointed by the Minister, of whom—
(a) each shall be a person having practical experience or special knowledge of the matters relating to the functions of the Board, and
(b) not less than twenty shall either be registered medical practitioners or registered dentists."

This is an amendment of some importance. This board will consist of 25 members appointed by me. For a number of reasons I had to take the power to appoint the members of this new board. I do not want to convey the impression that I would just abritrarily appoint anybody I wanted to appoint. I want to ensure that this board is representative of the profession. The first part of the amendment prescribes that each member shall be a person having practical experience or special knowledge of the matters relating to the functions of the board. That, again, is a very sensible proviso. I will not be permitted to appoint to this very important board people who have no knowledge whatsoever of the subject matter with which the board will be dealing, that is, the provision of post-graduate education and training.

I also want to ensure that the board will be immediately and directly related to the profession and aware of its needs and so on. I am providing that of the 25 people I must appoint, not less than 20 of them shall be either registered medical practitioners or registered dentists. That is to ensure that it will be a practical board, very closely in touch with the needs of the profession in so far as post-graduate education and training are concerned.

I have also given an undertaking to the Irish Medical Association who are concerned about this situation that I will select for appointment to the board doctors who will represent the practising profession, namely two consultants, three general practitioners, two junior hospital doctors and one community physician. The medical profession were concerned that the practising profession would be fully involved and have a say in post-graduate training and education. That is perfectly legitimate. Most professions, Senator Molony's profession and others, might be totally and fully in control of the post-graduation training in those professions.

Some of them even want to impose quotas now.

That may well be so. This amendment is in pursuance of some undertakings which I have given to the medical profession and to the medical institutes and the schools. It is designed to ensure that it will be a body representative of and closely integrated with the medical profession, the practising profession in particular.

The Minister is really pointing out what in practice would happen.

Amendment agreed to.
Section 42, as amended, agreed to.
Section 43 agreed to.
SECTION 44.
Government amendment No. 9:
In page 19, line 27, after "sections" to insert "and Rules".

This is a drafting amendment. The words "and rules" were left out of the draft inadvertently.

Amendment agreed to.
Section 44, as amended, agreed to.
SECTION 45.
Question proposed: "That section 45 stand part of the Bill."

The Minister in replying to the Second Stage debate here last week indicated that there were certain matters which he might not have touched on directly and said that he would cover these on Committee Stage. Before I make the substantial points I want to make in relation to this section I would like to recall to the Minister one point which I made and which I am concerned about. I was not altogether happy with the reply he gave because it is a matter of very serious concern. It is widely accepted, and particularly by medical practioners themselves, that the existing Medical Registration Council, partly because of the powers that were given it under the 1927 Act and partly because of constitutional difficulties, was unable to function effectively in the area of disciplinary control among the very few members of some profession which presented difficulties to them. I raised the point about the reports of doctors who were misprescribing narcotic drugs to drug abusers. It is something that had been published on a couple of occasions in the national newspapers. I would hope that the powers which will be given to the new council will be of a more practical nature. In passing, I would like to know if the Minister is aware of the case I mentioned and whether he would give consideration to it.

Earlier he mentioned, in relation to the establishment of the new Medical Council, that it would take some months. That would obviously be so. I would not like to think that we should have to wait for the establishment of the new council and the effective operation of the Fitness to Practise Committee under it to solve the particular problem I have made reference to. Perhaps the Minister might like to comment on that.

The point I want to make in relation to that is a legal one. It may be difficult for me to convey but I will do the best I can. The Fitness to Practise Committee will appoint somebody in the holding of an inquiry to, as it were, prosecute the case or make the complaint, to produce the evidence. That position exists on other disciplinary committees of other professional councils. I know from one case in which I was involved a few years ago that the person who was appointed by the committee to lay the prosecution before the disciplinary committee was in fact a member of the council of that profession. When the disciplinary committee reported afterwards to the council the prosecutor was on the council and sat in judgment on the case that was put before the council. It meant that the prosecutor was judge and jury ultimately.

I think that the problem could be overcome in relation to the Fitness to Practise Committee if section 45 were amended. In section 45 (3) (b) it is at present provided that the registrar, or any other person, with the leave of the Fitness to Practise Committee, shall present to the committee the evidence, and so on. I would suggest an amendment, if the Minister would consider it, to provide that it shall be the registrar or any other person, provided that such other person is not a member of the council.

That is very important because, as matters stand, a person could be appointed to act as prosecutor who, although not on the Fitness to Practise Committee itself, would be a member of the council. The Fitness to Practise Committee would hear the evidence and would then report to the council and the council would make a decision. The person who actually presented the evidence before the Fitness to Practise Committee would be sitting in judgment or in consideration of the report which the Fitness to Practise Committee would make. This problem has arisen before. Fortunately enough, in the case I am referring to, we got the right decision from the council, so it did not arise. At the time the matter was investigated thoroughly from the point of view of the practitioner. There was no doubt, and we were satisfied that if the decision had gone against us then the High Court would have had no option but to declare the composition of the council unconstitutional in relation to this particular case.

Provision has been made that the High Court will have to confirm the decision of the fitness of the council, but that could be deait with very easily at this stage and would avoid the possibility of a case going wrong and the costs involved because of this point.

An Leas-Chathaoirleach

It has now reached the time at which it is customary for the Seanad to adjourn. What does the House propose to do?

The option before the House is either to adjourn until 10.30 a.m. tomorrow or if the House thinks it is feasible to sit for an extra quarter of an hour or so and try to finish the Bill.

I would be agreeable to that latter proposal. That is the only point I want to make. I am sorry I did not table an amendment. I did not get a chance to do so as I have been very busy over the past few days. This is something I would have found easier to follow through had I an amendment down, but I think it is an important point; in other words it is a most legal point. It could solve any difficulty that might arise in the future.

I do not wish in this Bill to control completely the procedures of the Fitness to Practise Committee. That is not desirable. We have to leave a lot of matters to themselves to decide, to work out their own procedures and settle their own methods of dealing with things. What is intended here is that the other person referred to in subsection (3) (b) would be a legal person. It is most unlikely that the committee would agree to one of their own members presenting the case and then having that member sitting in judgment on it. That would be so unusual that it is not likely to happen.

The person who can present the case other than the registrar must do so with the leave of the Fitness to Practise Committee. We have to leave an awful lot to the judgment and discretion of this committee. It is a very important committee. They will have very important decisions to take, very important investigations to carry out and very delicate and often sensitive decisions to take. We have to entrust a great deal to them and I think we are safe in entrusting that matter. I do not think we need contemplate their being foolish enough to have the sort of situation which Senator Molony envisages.

I fear there is some slight misunderstanding here. I do not envisage that the person referred to in paragraph (b) would conduct the examination and cross-examination of witnesses or that type of thing. Certainly in another profession it is the practice that a member of the council would act as complainant and the prosecution would be brought in the name of that person. I am not thinking of a legal person who would be the person conducting the case. Maybe I am misreading the Bill, but I understand that some person would be appointed who would present the evidence. I thought that what was intended by that was that would be the person in whose name the complaint would be brought.

Or a legal representative or another of the committee.

For example, the procedure at the Veterinary Council of Ireland, unless it has changed in the past couple of years, is that a member of the council who is not a member of their disciplinary committee presents the case in the sense that the case is brought in his name. It is so-and-so versus the practitioner whose case is being considered, but that person is represented by a barrister or solicitor who conducts the mechanics of the case before the committee. If the intention is simply to allow a legal person to conduct the case then I have no difficulty at all, but if it is intended that the person referred to in this paragraph is the person in whose name the case is brought or is the complainant, then I could see a difficulty. It can be read either way as it stands.

It is not intended that a member of the committee should present the evidence.

Question put and agreed to.
SECTION 46.
Question proposed: "That section 46 stand part of the Bill."

I refer the Minister to the application to the High Court under this section. Will he clarify the point that if a decision has been taken by the Fitness to Practise Committee that decision would not be implemented until the High Court proceedings have been concluded? Is that the intention?

That is right.

How is it intended that the person will apply to the High Court? I notice that the Fitness to Practise Committee, if the person has not moved within a period of 21 days, can apply ex parte. How exactly is it envisaged that the medical practitioner who has been the subject of an inquiry as deemed unfit to practise would apply?

The Senator is better versed about how one applies to the High Court than I am. The normal procedures for applying to the High Court would hold in these sort of matters.

One of the problems of applying in this way would be that it could be a very considerable time before the matter would come before the High Court, and if a person has made a complaint before the Fitness to Practise Committee and that committee have gone through fairly elaborate procedure, held their inquiry and perhaps called witnesses, sought documents and so on, then presumably one can envisage a year, 18 months or two years before that committee have completed their findings.

There are emergency procedures in the Bill.

I am wondering whether, by just giving the person a possibility of applying to the High Court within 21 days, unless care is taken this might be a further way of causing a very substantial delay before the matter is heard before the High Court and the High Court decision either ratifying or striking down the decision of the Fitness to Practise Committee.

We have no option but to give them the right.

This is a provision which is much more elaborate than the equivalent provisions in other sections. I can understand the constitutional problem that has arisen in certain other cases, but I am interested that the Minister has chosen the new and more elaborate method of getting round this constitutional problem.

I refer the Senator to section 46 (3) (b):

if at any time the Council satisfies the High Court that such person has delayed unduly in proceeding with the application, ...

The person might well in a formal sense activate his or her application within 21 days, but then there could be very considerable delay—not necessarily the fault of the person who is, in a sense, appealing against the decision of the Fitness to Practise Committee. It can take eight or nine months to get in to the High Court.

Question put and agreed to.
Sections 47 to 69, inclusive, agreed to.
First and Second Schedules agreed to.
THIRD SCHEDULE.
Government amendment No. 10:
In Article 6 (1), page 31, line 40, to delete "Minister" and substitute "Board".

With your permission, a Chathaoirligh, I propose to take amendments Nos. 10 to 13 together.

As the Bill stands I would appoint the chairman and vice-chairman and I think, being the confirmed dedicated democrat that I am, it is better to let the body elect their own chairman and vice-chairman.

Having appointed the lot of them.

Amendment agreed to.
Government amendment No. 11:
In Article 6 (2), page 31, line 45, to delete "Minister" and substitute "Board".
Amendment agreed to.
Government amendment No. 12:
In Article 6 (3), page 32, line 3, to delete "Minister" and substitute "Board".
Amendment agreed to.
Government amendment No. 13:
In Article 6 (3), page 32, line 4, to delete "the Minister" and substitute "it".
Amendment agreed to.
Third Schedule, as amended, agreed to.
Fourth Schedule agreed to.
Title agreed to.
Agreed to take remaining Stages today.
Bill reported with amendments, received for final consideration and passed.

I am very grateful to the Seanad for their kind attention to the provisions of the Bill and for the expeditious manner in which they dealt with it. I know the Senators are very rightly concerned that both the new council and new board should come into operation as quickly as possible, and by the expeditious manner in which they have dealt with the legislation here this evening they have helped to ensure that that will be so.

The Seanad adjourned at 8.40 p.m. until 10.30 a.m. on Thursday, 23 February 1978.