I commend to the Seanad the Medical Practitioners (Amendment) Bill, 2002, which addresses important issues relating to the registration of medical practitioners. This Bill represents a first step in the ongoing programme to update and revise the Medical Practitioners Act, 1978.
The public health service is dependent, above all else, on the people who provide the service. Without the health service staff who, week in week out, provide a high quality service it simply could not function. To ensure that the service had access to doctors of the highest quality, and that the interests of patients were treated as paramount, the Medical Practitioners Act, 1978, set out to regulate the practice of medicine in Ireland through the mechanism of the registration of medical practitioners. Under the Act the Medical Council was established as the statutory authority that oversees the registration and regulation of doctors and also evaluates the suitability of the medical education and training provided by any body within the State. The council's constitution and additional functions are set out in detail in the Act.
It has been recognised for some time that the Medical Practitioners Act, 1978, no longer meets the needs of a modern health service but it is intended that a new amendment to that Bill, which is a substantial piece of legislation, will be brought forward in the autumn. New legislation which will provide for the regulation of nursing and midwifery is currently being prepared and the preparation of draft heads of a Bill to govern the regulation of the professions allied to medicine is at an advanced stage. When passed, these Bills, along with the Bill to update the Medical Practitioners Act, 1978, will provide a legislative framework for the regulation of the health professionals that will ensure the highest level of competence among those who provide our health services.
In the national health strategy, Quality and Fairness – a Health System for You, a commitment was given to undertake an independent audit of functions and structures in the health system. The results of the audit of the Medical Council, Comhairle na nOspidéal and the Postgraduate Medical and Dental Board obviously will have to be taken into account in drafting the heads of the new Bill. Last month the Minister launched the national task force on medical staffing. The task force will examine the implementation of the medical manpower forum report and the Hanly report on the working hours of non-consultant hospital doctors. It will also examine the area of medical education and training.
The Medical Council has also brought forward a number of proposals for change. The council wants to improve its efficiency and delivery of services. It has also undertaken an exercise to set out a scheme for competence assurance for doctors. The proposed scheme will encompass continuous medical education, continuous professional development and clinical audit and peer review. The purpose of competence assurance is to ensure that doctors maintain the highest levels of competence and awareness of developments in their field of expertise. The Department of Health and Children will work closely with the Medical Council in further developing this scheme.
The new Act will also address issues surrounding the area of fitness to practice procedures. The streamlining of procedures and the appropriateness of committee structures will be examined. The question of the council's accountability and timely provision of relevant information to the Minister, employers and the public will be provided for.
There are, however, a number of priority issues that cannot wait until a new Act is passed and which must be addressed urgently to avoid any potential disruption to service delivery. It is for this reason that I present the Medical Practitioners (Amendment) Bill, 2002, to the House today. The most important amendment being proposed today is to section 27(2) of the current Act. Approximately 3,600 non-consultant hospital doctors are employed in the health service. Of this number approximately 1,600 are temporary registered doctors who come from outside the European Union. These doctors provide essential services in our hospitals and in some rural areas these doctors constitute over 60% of the NCHD cohort.
As many of these doctors joined the Irish health service before the implementation of the temporary registration assessment scheme, they have not sat the TRAS exam. This has affected their ability to move from the temporary register to the permanent register. Under the 1978 Act, only qualifications and training can be taken into account when considering applications for the permanent register. The current legislation, while recognising the training element, does not permit the Medical Council to give due regard to the relevant experience gained while working in the public health service by doctors applying for full registration, despite the fact that some temporary registered doctors have spent up to seven years working in the Irish public health service. At the same time graduates of Irish medical schools who have completed just one year of postgraduate internship can apply for full registration.
It should be noted that employers and regulatory bodies in other jurisdictions are only too happy to recruit and permanently register these doctors based on the experience they have gained while employed in the Irish health service. At a time when the Irish public hospital system is undertaking extensive recruitment initiatives to ensure that all medical posts are filled, we must ensure that every effort is made to retain the complement of doctors currently within our hospital service. Many of these temporary registered doctors are reaching the end of the period of temporary registration and may be lost to the Irish health service if we do not take action. In addition, changes in European Union law and a recent ruling of the European Court of Justice require us to take account of relevant experience gained within the EU when assessing applications from EU citizens for full registration.
The amending Bill also proposes a number of health care settings, such as community-based services and general practice, in which a doctor in training could and should gain very valuable experience and which, at present, are not approved for training purposes.
The Minister, Deputy Martin, is concerned to ensure that appropriate safeguards are in place in certain areas of health care, such as cosmetic surgery for example, where doctors may be entering the jurisdiction for short periods to carry out such procedures. This is a matter of some concern to the Minister and it is our intention to deal with it in some detail in the comprehensive Bill to be brought forward later this year. It is accepted, however, that some urgent steps must be taken at this time and these are addressed in the amending Bill.
The main proposal contained in the Medical Practitioners (Amendment) Bill, 2002, is to allow validated professional experience to be taken into account in the assessment of applications for full registration on the Register of Medical Practitioners. Under current legislation, only training and qualifications can be acknowledged when considering such applications. This Bill will enable the Medical Council to make rules regarding applications for full registration in which relevant, validated experience will be taken into account as well as, or instead of, prescribed courses of training.
The amending Bill will allow doctors in training under intern registration and temporary registration to work in a variety of health care settings, to be specified by the Medical Council, whereas the current legislation confines these doctors to the acute hospital sector. The council will be enabled to make rules to regulate the type of health care setting where such training can be carried out. The Bill makes provision for any EU citizen who has obtained their primary medical degree within the EU to be granted internship registration in Ireland. At present, only graduates of Irish universities can undertake their internship registration in Ireland.
The Bill makes provision for the indefinite extension of temporary registration for a doctor who has made application for full registration. The period of temporary registration in this instance is extended until such time as a final decision is made with regard to the doctor's application for full registration. The Bill also makes provision for the Medical Council to make rules regarding temporary registration for doctors entering the jurisdiction to work for short periods. The council will also be enabled to make rules regarding those who employ or contract the services of such doctors.
Staffing requirements of hospitals and the deployment of staff within hospitals are primarily a matter for local management having regard to the services which hospitals are expected to provide. Particular staffing difficulties have been faced by the health services in recent years across a wide range of areas, particularly in the medical, paramedical and nursing areas. The Department of Health and Children, in conjunction with the health service employers agency, assists at national level with the development of a policy framework that will enable employers to identify vacancies, to locate, recruit and train suitable candidates for the vacant posts and to retain the staff in whom they have invested significant time and resources.
In the health strategy, under the action plan for people management, the Government set out its plan for the health service to become an employer of choice. In this regard the strategy commits the Government to investment in training and education for health sector staff; implementation of best practices in employment policies and procedures; building and enhancing the management function; improving the quality of working life for our health service staff; developing performance management; promoting improved industrial relations in the health sector; and developing the partnership approach further. Work on the action plan is already underway and is being undertaken in the context of partnership and consultation.
This amendment to the Medical Practitioners Act represents yet another measure to improve the working arrangements for non-consultant hospital doctors. On a broader front, the issues relating to the medical staffing of hospitals were addressed by the medical manpower forum. With particular regard to non-consultant hospital doctors, the forum sought to redress the imbalance between career posts and training posts, the need to improve postgraduate medical training to keep more Irish medical graduates in the country and the need to look at the position of women in medicine in Ireland with a view to reducing the number who leave medicine.
Furthermore, the national task force on medical staffing was established by the Minister, Deputy Martin, to prepare and cost an implementation plan for a new approach to hospital services, based on appropriately trained doctors providing patients with the highest quality service. The task force will prepare detailed implementation programmes based on the two key reports already mentioned which were published last year – the Hanly report and the report of the medical manpower forum. The implementation programme will be addressed in the context of the new health strategy, Quality and Fairness – A Health System for You, which was published last November.
Every analysis to date comes back to the same key point – we are overdependent on junior doctors who, while still in training, are required to provide 24 hour, seven day medical care under the formal supervision of individual consultants. A number of factors affect consultants' ability to be present on site at weekends, evenings and during the night. Patients in turn may have limited access to appropriate levels of senior clinical decision making, with implications for safety of diagnosis and treatment on the one hand and efficiency and cost-effectiveness on the other. As an independent entity, the task force is in a good position to develop a suitable cost-effective model which best meets patient safety and quality concerns, as well as contributing centrally to the two fundamental principles reflected in the title of the new health strategy, Quality and Fairness – A Health System for You. It also addresses some of the key national goals of the strategy, which relate to responsive and appropriate care and high performance.
Public health systems, demographics and lifestyles, technology and expectations are exhibiting an international pattern of unprecedented change and challenge, which urgently demand new methods. In preparing the new strategy, it was necessary to look critically and constructively at service issues such as the length of the working day and how we provide cover over this longer period; the redrawing of professional boundaries; organising care and service delivery around the patient rather than vice versa; and a much more dynamic and committed approach to managing quality. The health service will continue to make the case for additional investment, provided we can work collaboratively in making the necessary reforms to yield improved results.
The message from the medical profession expressing its willingness to be more flexible, while maintaining admirably high standards under pressure, is very much welcomed by the Government. Where there is a clear willingness to jointly reassess in a fundamental way some of the assumptions attached to the inadequate status quo, the Government's response can also be flexible. By adopting an open approach together to face change and modernisation, implementation of the strategy will ensure the best use of resources, the sharing of best practice across all disciplines and the provision of significant additional funding.
In addition to the steps already outlined, the Department of Health and Children has been working closely with the Departments of Enterprise, Trade and Employment, Justice, Equality and Law Reform and Foreign Affairs in exploring how the processing of visas and work permits can be streamlined to assist health service employers with their recruiting drives. In this regard the possibility of extending the working visa-work authorisation scheme, which already applies to nurses, to other health service staff has been examined by the departmental group. The scheme would provide a more flexible mechanism for regulating the entry of non-EU and non-EEA citizens into Ireland for the purpose of working in the health service. It is hoped to progress this initiative in the very short term.
Health service providers and members of the public would like to have the best quality and range of services available. This is a worthy aspiration since service demands are triggered largely by issues such as demographic change – an increasing population that is living for longer and the continual and rapid developments in health technology. It is part of the role of the Minister for Health and Children to, in the first instance, measure the real need for additional services, taking account of public expectations as well as the expert view. A second and subsequent demand of that role is to bridge the gap between current provision and what is needed as speedily and efficiently as possible.
There has been a dramatic and well-documented increase in the provision of funding to the health service over the life of the Government. Gross non-capital expenditure has risen by 129% from 1997 to 2002. The Government is committed to maintaining sufficient support to empower professionals to continually improve the services in our hospitals and in the community in general. On the capital side, the high level of investment by the Government will continue over the period of the national development plan, demonstrating a considerable increase in capital investment relative to any previous historic period. Again, examining the level of capital funding provided over the life of the Government, 2002 boasts a capital funding allocation to the health sector that equals a 260% increase on the 1997 figure.
I am seeking the co-operation of the House in amending the Medical Practitioners Act, 1978, to allow for further revised registration arrangements for doctors. Whether originating in Ireland, Europe or beyond, there is no doubt that medical personnel are a major and key resource to the Irish health services, deserving of acknowledgement and support. This amending Bill, in conjunction with the main Bill later this year, will be key factors in ensuring that, in five years, there should no longer be shortages in those crucial disciplines which are currently holding back the development of much needed services. Molaim an Bille seo don Seanad, the Medical Practitioners (Amendment) Bill, 2002.
