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Seanad Éireann debate -
Wednesday, 4 Apr 2007

Vol. 186 No. 20

Medical Practitioners Bill 2007: Committee and Remaining Stages.

I welcome the Minister for Health and Children, Deputy Harney, to the House.

Section 1 agreed to.
SECTION 2.

Amendments Nos. 1 and 2 are related and may be discussed together by agreement. Is that agreed? Agreed.

Government amendment No. 1:
In page 12, line 42, to delete ",55(1) or (6)” and substitute “or (6), 55(1)”.

These technical amendments are included to correct typographical errors. Amendment No. 1 relates to a cross-reference to another provision in the Bill. Amendment No. 2 inserts a cross-reference that was submitted in error from the relevant provision.

Amendment agreed to.
Government amendment No. 2:
In page 13, line 1, after "section 52(5)” to insert “, 80 or 81(2)”.
Amendment agreed to.
Section 2, as amended, agreed to.
Sections 3 to 8, inclusive, agreed to.
SECTION 9.
Question proposed: "That section 9 stand part of the Bill."

A considerable amount of fanmail has been sent to all of us about the influence the Minister might have through her appointees over any newly formed Medical Council. It is important to note that this section means the Minister, personally or through appointees, will not give advice on the ethics or professional conduct of registered medical practitioners. I do not know how or why some people got involved in an expensive campaign of e-mails, letters and telephone calls. It was nice that some people were confident Senators would put a stop to what the Minister intended to do.

I welcome the section, but I regret that a considerable amount of distress was caused to Members to whom the letters were sent. The letters sent to me were polite. Given that I am not running for re-election, there was no good in threatening me about what someone might do at the next election.

I echo Senator Henry's comments. I received reams of communications and quite a number of telephone calls from many people with genuine concerns. I have every confidence in the Minister's proposals in this Bill. I am sure that the result of the enactment of the relevant section of this legislation will be consistent with best practice.

Some of the letters I received suggested that the Medical Council was in favour of the sending of such correspondence. I have been informed specifically by the president of the Medical Council, Dr. John Hillery, that this is not the case.

I confirm that, as Senators Henry and Glynn suggested, the Minister cannot give the Medical Council any directions on ethical issues. The council's ethics committee will have a majority of doctors, rather than a majority of lay people. It can be chaired by a lay person, however — it was once chaired by Senator Feeney. Dr. Deirdre Madden, who was recently elected as the chair of the council's ethics committee, is a lawyer and scientist rather than a medical practitioner. While the ethics committee can be chaired by lay people, most of its members are doctors.

Question put and agreed to.
Section 10 agreed to.
SECTION 11.

As amendments Nos. 3 and 11 are related, they may be discussed together by agreement.

Government amendment No. 3:
In page 20, subsection (2)(u), line 14, after “88(3)(a)” to insert “or (4)(a)”.

These technical amendments have been tabled to correct typographical errors in the Bill. Amendment No. 3 inserts a cross-reference that was omitted in error from the relevant section. Amendment No. 11 corrects a cross-reference to another provision of the Bill.

Amendment agreed to.
Section 11, as amended, agreed to.
SECTION 12.
Government amendment No. 4:
In page 21, subsection (1), line 42, to delete "(9)” and substitute “(8)”.

This technical amendment has been included in the Bill to correct a typographical error. It corrects a cross-reference to another provision of the Bill.

Amendment agreed to.
Section 12, as amended, agreed to.
SECTION 13.
Question proposed: "That section 13 stand part of the Bill."

I hope the Medical Council will not have to spend too much time and effort on preparing business plans. If one examines such plans a few years after their publication, when circumstances have changed, one will learn that they were fairly ridiculous in light of what was going on. I hope the council will not have to devote too much of its time to business plans.

I agree with Senator Henry's comments. Provisions relating to business plans are normal in legislation relating to public bodies. While I accept the need for greater governance requirements, I do not want the Medical Council to be tied up with endless bureaucracy. I have not accepted some of the amendments proposed on Committee Stage, such as an amendment that would compel the council to make available information on the latest medical developments, etc., because it would be impossible for the council to complete such a bureaucratic task. We have got the balance right. I do not think the council has a problem with this provision. It has not raised any issues with me in this respect.

Question put and agreed to.
Sections 14 to 16, inclusive, agreed to.
SECTION 17.

I move amendment No. 5:

In page 27, lines 7 to 14, to delete subsection (7).

I am offended by the manner in which this section of the Bill lumps politicians in with convicts, fraudsters and bankrupts. I am sure such people are not too happy about being lumped in with politicians. While I do not suggest that politicians should have to be on boards of this nature, I do not think there should be a blanket ban on their membership. The Minister knows how difficult it is to get people to go into politics. We are trying to encourage people to participate in the democratic process. Provisions of this nature, which require people to choose whether to be involved in politics or in public bodies, deter people from going into, or staying in, politics. While there could be a conflict of interest in some cases, there would be no such conflict in many cases.

I am not sure whether the Minister was involved in the establishment of the Personal Injuries Assessment Board when she was Minister for Enterprise, Trade and Employment. That Senator O'Toole is doing an excellent job as the vice chairperson of the board will neither lead to his election nor cost him his seat in the next Seanad election. Not only is the Senator bringing great experience to the board, but he is also able to update the House on issues relating to the board's operations. Senator Feeney has been a member of the Medical Council and Senator Henry has a wealth of similar experience.

If we were to provide that nobody from the Bills Office, for example, could ever sit on public boards of this nature, we would be accused of discrimination and breaches of equality legislation. We are imposing such a prohibition on ourselves, however. We should remove section 17(7) so that people can be judged on their individual merits. It is unfortunate that convicts, fraudsters, bankrupts and politicians are being lumped in together. Senators can laugh, but public representatives are being put in the same category as those I have mentioned.

The Minister is aware of my views on this matter. I do not think it is right to preclude a person from membership of the Medical Council because he or she is a mandated representative of the public. I reiterate that I am not suggesting that any particular individual should be on the Medical Council. When Senator Feeney and I made a proposal during the debate on the Health Bill 2006 last week, the Minister of State, Deputy Seán Power, explained that the Minister, Deputy Harney, intends to recommend to her Cabinet colleagues that a commission or committee be established to draw up a list of public bodies on which it would be appropriate for members of local authorities and other elected public representatives to sit. I will be satisfied if such a body comes into existence in the near future.

I support Senators Browne and Glynn on this matter in so far as it relates to members of local authorities. I thought there was a conflict of interest when I was a Member of the Oireachtas while I was a member of the Medical Council. On a couple of occasions, I could not be paired to facilitate my absence from the House. I was needed here for votes and also needed for council duties. Members of the Oireachtas and Members of the European Parliament would have to overcome some significant obstacles before they could serve on bodies like the Medical Council. Even though there were times when I was not sure whether I was serving the Oireachtas or the Medical Council, I managed to juggle my two roles during the short period of time in question. While I do not think it would be appropriate to allow Members of the Oireachtas and Members of the European Parliament to sit on the Medical Council, it is undemocratic to prevent members of local authorities from accepting such a role. I was not a member of a local authority when I sat on the Medical Council. My time on the council was one of the best educational experiences I have ever had — it opened my eyes to all sorts of things. I would hate to think that somebody could be prevented from taking up a similar role because he or she is a member of a local authority.

I would like to add my voice to the argument that is being made. If one of the many doctors who are serving on local authorities is nominated to the Medical Council, he or she will be prevented under this Bill from accepting that position. I do not see any reason for this unfair provision, which discriminates against doctors who are members of local authorities. I fail to understand the rationale behind this measure. It is not proposed to prohibit barristers, teachers or members of other professions from serving on the Medical Council. This Bill is changing the procedures which apply when members of the Medical Council are nominated to serve on local authorities. It is not clear whether they will have to resign immediately, or will be allowed to stay on the board of the council until its term comes to an end.

I ask the Minister to review this provision in light of the representations we have made. Has she brought proposals to the Cabinet on the establishment of a select committee to examine the role of members of local authorities who wish to serve on boards? A composite Bill may have to be introduced after the next general election to remove inconsistencies from the legislation that has been passed in recent years. Senator Browne mentioned that when the Minister, Deputy Harney, was the Minister for Enterprise, Trade and Employment, she decided to allow public representatives to serve on the Personal Injuries Assessment Board. Senator O'Toole, who is the vice chairperson of the board, is performing well in that capacity. The Minister does not seem to have an overall philosophy of excluding elected members of local authorities and Members of the Oireachtas from serving on public bodies. This provision is resented, as it is in other Bills. If one is a doctor and a councillor one cannot serve on the Medical Council.

When does the Minister propose the group will meet? We have received a letter from the Minister of State at the Department of Health and Children, Deputy Seán Power, indicating the Minister's agreement to the establishment of a select committee of the Cabinet or composed of Members of the Houses to debate this matter and to make a policy decision.

It might not look good if I did not support this amendment. Local authorities have nothing to do with the election of university Senators. I support this amendment because it is important that local authority members are considered eligible.

I sympathise with the perspective expressed. Last week I had a lengthy discussion with Senators Glynn, Feeney and Leyden on these points. The HSE and the Health Information and Quality Authority, HIQA, were established after health reform analysis of the Prospectus and Brennan reports. They recommended the establishment of a single entity in place of the health boards in the case of the HSE. Valid arguments were proposed in favour of this measure. Regarding the HIQA, the advice was to appoint experts to the board. We now have regulatory bodies. I have sympathy with those who believe councillors, members of the European Parliament and Members of the Oireachtas may have the expertise required. That they are politicians does not mean they cannot have the expertise to be on such bodies.

There is much concern, especially in regard to the Medical Council, that lay majorities would be partisan. Under this legislation the Minister will appoint fewer people than under the regime in 1978. The Minister could appoint six in 1978 and the figure now has been reduced to five. The Minister of State, Deputy Seán Power, gave a commitment here last week. We need to bring clarity across Government in regard to the bodies of which councillors can be members and the bodies from which they are prohibited from being members. I have undertaken to bring proposals to Government. We should have an informed debate, with a small group of people analysing and examining the practice in other countries, consulting with the General Council of County Councillors and other representative bodies and political parties. The group could then make proposals that would have broad support across the House. That would be a worthwhile exercise. I will bring the proposals to the Cabinet within two weeks and we can clarify the issue over the summer months. There is major concern for local authority members, particularly in this House. I have given an undertaking to consult.

The Medical Council, individual members of the board and doctors who spoke to me were concerned that moving to a lay majority should not make the council partisan. Senator Feeney is a member of one of the committees of the council. One is not excluded from doing the job professionally and objectively because one is a politician. I do not want confused signals to the effect that the Minister seeks a lay majority to take political control of the council.

We do not wish to be partisan, we want to look out for the public interest. Whatever one thinks of politicians, they must present themselves before the electorate every five years. The electorate may decide to hire or fire.

During my short time in politics I have seen an erosion of democracy. Members are not allowed to sit on local authorities. County managers are the only people happy with this. They are relieved that people in the Oireachtas, who pass legislation and see the wider picture, are not members of local authorities. In the Seanad I meet colleagues from throughout the country and learn from their experiences. If I were to attend a council meeting in the morning I would have a greater depth of knowledge of the issues than when I was a local councillor.

I am not concerned about the partisan aspect of this. Politicians come and go and they are elected by the people with a mandate. The people adjudicate. I give notice to the civil servants drafting these Bills that, whether I am in the Seanad or in the Dáil after the general election, I will take the same position next time. One does not end a career in other areas because one becomes a politician.

Question put: "That the words proposed to be deleted stand."
The Seanad divided: Tá, 27; Níl, 14.

  • Brady, Cyprian.
  • Brennan, Michael.
  • Callanan, Peter.
  • Daly, Brendan.
  • Dardis, John.
  • Dooley, Timmy.
  • Feeney, Geraldine.
  • Glynn, Camillus.
  • Hanafin, John.
  • Kenneally, Brendan.
  • Kett, Tony.
  • Kitt, Michael P.
  • Leyden, Terry.
  • Lydon, Donal J.
  • MacSharry, Marc.
  • Mansergh, Martin.
  • Minihan, John.
  • Mooney, Paschal C.
  • Moylan, Pat.
  • O’Brien, Francis.
  • O’Rourke, Mary.
  • Ormonde, Ann.
  • Ross, Shane.
  • Scanlon, Eamon.
  • Walsh, Jim.
  • White, Mary M.
  • Wilson, Diarmuid.

Níl

  • Browne, Fergal.
  • Burke, Paddy.
  • Burke, Ulick.
  • Coghlan, Paul.
  • Cummins, Maurice.
  • Feighan, Frank.
  • Hayes, Brian.
  • Henry, Mary.
  • McHugh, Joe.
  • Norris, David.
  • O’Meara, Kathleen.
  • O’Toole, Joe.
  • Phelan, John.
  • Terry, Sheila.
Tellers: Tá, Senators Minihan and Moylan; Níl, Senators Browne and Cummins.
Question declared carried.
Amendment declared lost.
Question proposed: "That section 17 stand part of the Bill."

I want to mention two points on section 17. I am pleased the Minister has stipulated in the section that, "Only registered medical practitioners are eligible for election as the President or Vice-President of the Council in accordance with Schedule 2.” This is important because, while the council has to serve the public interest, it is essential it also has the confidence of the profession.

One area that concerns me as regards lack of representation, however, is the fact that only two people can be nominated from the bodies approved to deliver programmes of basic medical education and training. With the increase in the number of medical schools and the fact the council is taking over much of the work of supervising medical training, those two people will be very overworked. A significant amount of council time will have to be put into this area, given the changes made in this legislation.

As the majority of those currently qualifying in medicine are women, I am pleased the Bill states that the Minister shall, to the extent practicable, endeavour to ensure there is an equitable balance between men and women in the membership of the Council. Women are poorly represented on many regulatory bodies, through no fault of the Minister. In attempting to do this the Minister may end up trying to find five women as the lay representatives. I am confident that when the medical profession is electing people, it will endeavour to ensure this feature is preserved because it is very important in terms of work and training for women. When the graduate medical schools begin to have an intake it will be interesting to note whether the proportion of men to women will be the same. I do not believe it will be. The number of women registering at graduate level will be far higher than the number of men, not that there is anything wrong with that. It will be a fact of life, however, that once women have children, domestic commitments will lean on them to a great extent. It is good the Minister has mentioned this in the Bill.

I want to refer to what Senator Henry said regarding only two people representing both undergraduate and postgraduate training. I could not hear what the Senator said because of the noise at the door. However, I share her view. The five medical schools were represented by the deans of medicine on the last council. In my experience they concerned themselves solely with education and training issues and that was their sole remit on the council. Will the Minister confirm whether the education and training committee of the Medical Council can co-opt expertise, and will the other schools of medicine be represented? We will now have six schools of medicine and if two representatives are on the council will the other four be co-opted to the education and training committee? I would support this.

The council is free to co-opt additional persons onto its committees. The point was made very strongly to me by the president of the Medical Council and the CEO, Mr. John Lamont, that with such a rigid structure it was difficult to get the required complement of people for the various committees, given the requirements under existing legislation. We are giving the council the authority to recruit whatever expertise it requires for its committees, whenever it feels that is desirable. That will deliver the type of flexibility needed and, hopefully, give the council both the expertise and the input from the educational training sector it requires for this as well as other areas.

Question put and agreed to
Sections 18 to 42, inclusive, agreed to.
SECTION 43.

I move amendment No. 6:

In page 41, subsection (1), line 15, to delete "establish and maintain a" and substitute the following:

"establish, maintain and make available to the public a published".

This is about public accountability and availability.

This is already covered in section 56(1), which states the council is required to ensure a register is published "in the prescribed manner", as defined on page 12, as follows:

(a) is published on a relevant Internet website, and

(b) is available for inspection, at the office of the Council and at all reasonable times, by members of the public.

I believe the intent is covered.

Amendment, by leave, withdrawn.
Section 43 agreed to.
SECTION 44.

Amendment No. 7 is a Government amendment. Amendments Nos. 7 and 13 to 18, inclusive, are cognate and may be discussed together, by agreement. Is that agreed? Agreed.

Government amendment No. 7:
In page 44, subsection (4)(i), line 49, to delete “speciality other than the medical speciality” and substitute “specialty other than the medical specialty”.

These are technical amendments to correct minor typographical errors in the word "specialty", which was incorrectly spelt in certain areas. An "i" was put after the "l", where there should not be one.

Amendment agreed to.
Section 44, as amended, agreed to.
Sections 45 and 46 agreed to.
SECTION 47.
Question proposed: "That section 47 stand part of the Bill."

I am pleased this register is being instituted in the council. We did not have a register like this before and it is very important. People without adequate training could describe themselves as specialists in certain areas and this will ensure that cannot happen. One has to have proper qualifications in a particular area before one can say one is a specialist.

Senator Henry is correct that this is the position.

Question put and agreed to.
Section 48 agreed to.
SECTION 49.
Question proposed: "That section 49 stand part of the Bill."

While I agree with section 49, a real problem will emerge regarding internships due to the increased number of medical graduates. We have a responsibility to those doctors trained in Ireland to ensure there are enough internships to fulfil their qualifications necessary before they can be registered with the council. We cannot, as used to happen in the good old days as they were described, have people going to England to complete internships as that avenue is being closed. Has the Minister any thoughts on how we will fulfil these criteria? This year there will be an increase in the number of medical graduates. An awful bottleneck will be created with the reduction in the number of non-consultant hospital doctors and an increase in consultant-provided care.

I have concerns about this. Recently I had meetings with the IMO and final year medical students, half of whom had placements and the other half who were concerned as they did not. Since then, I have met with Professor Drumm and the HSE to make this a priority. With the increased number of medical graduates and the new medical school in Limerick, there will be issues around the accreditation of training. The Department is in discussions with the HSE on this matter. Cost implications must also be considered.

Question put and agreed to.
SECTION 50.
Question proposed: "That section 50 stand part of the Bill."

This important section allows for visiting practitioners to provide services on a temporary and occasional basis. There is no provision in the section, however, that a person providing specialist treatment, particularly cosmetic surgery, must have specialist qualifications. This concern is further heightened by the recent establishment of several cosmetic surgery clinics.

They must have specialist qualifications. Issues surrounding cosmetic surgery cannot be dealt with in their entirety in this legislation. It will be dealt with by a licensing system. I have established a patient safety commission to examine the accreditation and the licensing of health facilities, particularly hospitals. Anyone can own and run a hospital in this State but doctors must be registered to practise in one. I am satisfied that they do have to be specialists.

Section 50 transposes an EU directive but a specialist would have to be qualified in a EU member state.

My concern is the specialist training that these people may or may not have had.

I am advised we cannot go beyond the directive's provisions. It must be implemented.

The Senator used the example of cosmetic surgery and a person not properly qualified in another member state coming to practise in Ireland. The directive specifies that any doctor who has a basic qualification and internship can practise in Ireland on a temporary basis. It is more a European issue than an Irish one.

It is important that this is made plain to the general public. I welcome the fact that people on a specialist register must have specialist qualifications. There are medical people entering the country every several weeks to undertake complicated medical procedures. One must query their qualifications. That they do not have to have specialist qualifications must be made well-known to the general public. If a doctor is on the Irish register, it could be assumed his or her specialist qualifications are similar to those of an Irish doctor. This is an area, where through court cases, we have seen there has been trouble. Some of the people concerned were not resident in the country. I am delighted with the proposed legislation on who is qualified to run a hospital. I am amazed at the number of hospitals that have been started.

They will not be able to practise as specialists because that will be a designated title. They can practise as doctors but not as specialists. There are two issues involved. First, there is an EU-wide dimension for standards and patient information. Many people are going to doctors who are not medical practitioners such as in alternative medicine. Second, there is an issue with the licensing and the accreditation of facilities and the people who work in them. This is an area in need of major reform because it is a major gap in our regulation of health facilities.

I hope the Medical Council will make it plain that people cannot just call themselves specialists.

The title "specialist" will be designated in this legislation. After the regulations are made, it will be a matter for the council to ensure those that are qualified can call themselves specialists. It will be an offence under the Act to call oneself a specialist when one does not have a specialist qualification. It will require vigilance on the part of the Medical Council.

More people now go abroad for medical treatment advertised in this State. On some occasions the procedures have led to horrific results. Does the legislation cover those without specialist qualifications from abroad who advertise in the State?

There was a well-publicised case of a young woman who died. I am not sure what the outcome of the investigation was in that case. A doctor attended a hotel in Ireland from which he recruited patients for cosmetic surgery. There are many people going abroad for dental work and other treatments. We cannot control the output flow of patients. Sometimes the Irish health system has to pick up the pieces if the person has not gone to an appropriately qualified practitioner.

We are obliged to implement EU directives but the issue of specialists is for the Medical Council after the regulations are made. The main issue is there has to be a licensing and accreditation regime for hospitals. That hospitals will have to reach certain standards will bring greater confidence, assurance and information to patients.

Question put and agreed to.
Sections 51 to 56, inclusive, agreed to.
SECTION 57.
Question proposed: "That section 57 stand part of the Bill."

I praise the Minister for having said the complainant should be given information because not giving information to the complainant was a serious problem in the past.

Question put and agreed to.
Sections 58 and 59 agreed to.
SECTION 60.
Question proposed: "That section 60 stand part of the Bill."

I raised this matter previously so I will not labour the point. It concerns the hearings and stress in respect of whether they will be heard in public. I cannot understand why a person, such as a court reporter, who attends and reports on family law cases in an anonymous fashion could not report such hearings. Whatever criticism some journalists may have had of the work, I believe it appears to have been excellent. I am anxious about this provision because I have known complainants who did not pursue their complaint because the conditions under which the Medical Council's fitness to practise committee operated were secretive. Complainants did not go before it with what I considered genuine complaints because the complaints were of a very personal sexual nature.

I am concerned the same sort of pattern may occur in this context. I am aware the council may decide to hear some or all of an application in private but it might be preferable for a person such as court reporter in the Courts Service to be in attendance and with the agreement of the complainant and, unless the reason for not permitting the proceedings to be heard in public was totally irrational, for the proceedings to be published.

I support Senator Henry on that point. It is difficult to find a balance in such cases because we are moving from a position where this process was surrounded by a cloak of secrecy to one where we are trying to introduce a degree of transparency. I know of cases where the complainant was devastated because he or she was not allowed in to hear the case that was made against him or her or that was put forward on behalf of the practitioner. Some sensitivity must apply in dealing with the parties concerned, the complainant and the practitioner because the practitioner is not found guilty of professional misconduct in all cases. Given the nature of these types of complaints, one must query in respect of the proceedings what is best in the public interest as against the curiosity or news value of the hearing of such proceedings in public. I have no doubt the Minister will work out what is best in the public interest and what is not.

In this respect, we have gone for a position that is a half-way house. Much lobbying, particularly from patient groups, was engaged in for everything to be heard in public. I very much take the point made by both Senators in the case of complainants. Many people want to remain private citizens but want to do their duty by themselves as patients and by other patients by making a complaint and having it investigated. They should be entitled, if they wish, to have their case heard in private. Equally, a doctor should be able to make his or her case. The fitness to practise committee will comprise a lay majority of reasonable men and women who, in the first instance, must be objective and fair-minded and, for the moment, we should leave it to them to decide on this issue.

With all the new committees being established, such as the health committee, the preliminary screening committee, the mediation process and so on compared with there being only the fitness to practise committee and no other option in the past, it is to be hoped that only serious matters where there is a prima facie case will go before the fitness to practise committee and many health related issues can be dealt with elsewhere. The proactive power given to the council to intervene at a much earlier stage will help greatly in ensuring that only serious matters go before the fitness to practise committee. Although it is provided for that the norm will be for cases to be heard in public, the fitness to practise committee has discretion in that respect. On balance, this is a half-way house between a hearing being either fully public or fully closed. The committee has been given the option in that respect.

Question put and agreed to.
Sections 61 to 64, inclusive, agreed to.
SECTION 65.
Government amendment No. 8:
In page 61, subjection (1), line 14, to delete "63(1)(b) or (2)” and substitute “63”.

This technical amendment is included to correct a typographical error in the Bill relating to a cross-reference to section 63. As this section was amended in the Dáil, the reference no longer exists.

Amendment agreed to.
Section 65, as amended, agreed to.
SECTION 66.
Government amendment No. 9:
In page 62, subsection (3), line 8, to delete "section 12” and substitute “section 11”.

This technical amendment is included to correct a typographical error in the Bill relating to a cross-reference to section 11 — rules made under section 11 and not section 12.

Amendment agreed to.
Question proposed: "That section 66, as amended, stand part of the Bill."

I am glad the Minister has included a provision that evidence may be given by video link. It can frequently be difficult to get witnesses who worked in a hospital at one stage but are now based in Toronto, Tierra del Fuego or elsewhere to appear before a committee. Therefore, I am glad this provision has been included.

Section 66(9)(a) provides that the records shall not be made available unless “the patient has consented in writing to the records being made so available”. What is the position if a patient refuses to allow records to be made available but the partitioner considers it essential that they be made available?

I am advised it is a matter for the council and the committee to make a decision in such a case.

This provision could be hard on the practitioner if he or she thought the production of a patient's records were essential.

We are dealing with the complaint being made in writing.

I know that, but this is regarding a patient's records being made available, a patient not allowing his or her medical records to be made available, yet the practitioner may consider they are essential to his or her defence.

I am reading the subsection.

It is section 66(9)(a) and (b).

I do not know how the practitioner can force these to be——

If the patient does not consent, I note that section 66(9) states "or (b) the Committee has directed in writing the practitioner, or any other person who has power over or control of the records, to make the records so available”. The patient might not consent in writing but might consent orally, I presume. Is the Senator saying that if a patient refuses to make his or her records available, it puts the doctor concerned in an impossible position?

I am told this provision exists in the current legislation.

The subsection provides that the committee can direct the practitioner to act, but that could put the practitioner in an awkward position.

I am told this is the law under the 1978 Act and it has not caused any difficulties.

I am aware from experience that if no records were made available, the committee would find itself in a awkward, vulnerable position. It would either make a direction to obtain the records and, if the patient was agreeable, the committee's position would be outlined to the complainant. Not many such circumstances have arisen, but in one case consent was given to have the records made available.

By the doctor?

No, by the patient; the patient gave consent. We did not have the patient's consent initially.

My concern is if the patient will not give such consent.

It is provided under the current Act. It provides that if the patient does not give consent, the committee can direct the doctor to make them available.

That is what happens.

That is what it states in the current Act. It states the committee can specifically direct the registered medical practitioner concerned to produce such records. If the patient is the complainant, I do not understand why he or she would not make his or her records available. This may be covering a case where somebody else is the complainant and a patient's specific records are required.

I am not totally happy about this provision but there is not much I can do about it.

I do not understand why if a patient is the complainant, he or she would not make his or her records available.

Sometimes they make a complaint and then realise, as has happened and as I have seen in court cases, information will be revealed from past medical records, they having thought only information concerning the subject of the current complaint would be produced. However, they suddenly realise that medical records will be produced and they do not like that.

Apparently this provision is part of the current law and it has not caused a problem. The committee can give a direction to the doctor concerned. It is probably being done so patients' records are not made available on too liberal a basis.

Question put and agreed to.
Sections 67 to 69, inclusive, agreed to.
SECTION 70.
Question proposed: "That section 70 stand part of the Bill."

I like to praise the Minister when I can because people are giving out about her. It is good complainants will be told what will happen because they were not told in the past and it was a problem.

Mr. Browne

Lately the Minister for Justice, Equality and Law Reform has been quick to announce on radio the number of people arrested for drink driving. However, I have discovered only half of them are convicted. I understand that if one is arrested on suspicion of drink driving, one's name is put on the database, or on the PULSE system, as having been arrested. However, there is an issue about one's name being removed from the system if one is subsequently proved not to have been over the legal limit. If a medical practitioner is found innocent, will his or her name still appear on a database indicating her or she was under investigation or will it be wiped off? This issue relates to the Data Protection Act more than anything else.

Obviously, we cannot supersede the Data Protection Act. Is the Senator talking about a doctor who has been cleared?

Mr. Browne

I am talking about a medical practitioner who has been cleared.

If he or she has been cleared, his or her name will still be on the register as he or she has not been struck off. Does the Senator mean in the newspapers?

Mr. Browne

No. In the case of drink driving, one is recorded as having been arrested for drink driving but there seems to be a gap between when one is found innocent and one's name being removed from the system. Will the same happen in this case? If a medical practitioner is accused of something but is found innocent, his or name should not appear——

It would not appear anywhere but if there is a fitness to practise inquiry in respect of him or her, obviously, there would be records of that. The inquiry might be held in public or in private but if he or she is not struck off, his or her name remains on the register.

Mr. Browne

I am not focusing on the register.

Is the Senator talking about a vexatious complaint?

Mr. Browne

Not necessarily, but a vexatious complaint is an issue. If a person is found innocent, he or she is entitled to have his or her good name fully restored. There should not be a question mark over him or her.

His or her good name cannot be taken away without a fitness to practise inquiry taking place. Under this Bill, people will have the right to go to the courts if they believe they were not given fair play. They will have the right to appeal to the courts where these matters are ultimately determined. When the Senator talks about a person's innocence, a fitness to practise inquiry can recommend that a person is struck off, censured or whatever. That would be a matter of public record. If there is no censure and the inquiry finds the doctor has no case to answer, there is no record anywhere of a negative against the doctor.

The only time a doctor's name is ever recorded is where a fitness to practise inquiry finds against him or her. His or her name would go out to the medical media around the world and to the High Court. Where no professional misconduct has been found and where the doctor has proved he or she has no case to answer, his or her name is not mentioned, the papers are destroyed and the matter is kept in-house. Other medics would know the doctor was before a fitness to practise inquiry but that is another issue. There is nothing we can to do to stop people talking. Where a case against a doctor falls, he or she does not come up for mention anywhere. There would be no mention of his or her name on any file.

Mr. Browne

The difficulty has been identified by Senator Feeney. If a teacher is accused of sexual abuse, his or her career is basically ruined whether he or she is found guilty or innocent. All it takes is a picture of a teacher going into a courthouse to face a court case. It does not matter if he or she is found completely innocent as people do not read the story. They just read the headline and see the photograph. That is the point I am trying to make.

The difference here is that we have a preliminary screening committee and mediation. If a patient makes a complaint about a doctor, it is to be hoped mediation could be used to resolve it. The doctor might have been rude or turned up late. That will not go to a fitness to practise inquiry. If there was a health issue and somebody believed the doctor was drinking too much or whatever, it could be dealt with through a different channel. It is not a question of there being a fitness to practise inquiry and a huge question mark over the doctor as a result of a minor complaint.

I have much sympathy with the point of view Senator Browne expressed. I know somebody against whom an allegation of sexual abuse was made. The man, who was a priest, was totally innocent. He and his family, whom I have known for many years, were devastated for two years. As the matter got close to being investigated, the complainant withdrew the complaint and apologised privately. That man is still a destroyed person. We want to avoid that happening under this legislation and that is the reason we have preliminary hearings.

The Medical Council will be made up of good, decent, honourable and objective women and men who will not be out for anything except to serve the public interest and to support doctors which is the whole purpose of the Medical Council. It is as much about supporting doctors, particularly in the type of situation Senator Browne mentioned, as it is about protecting the public interest and investigating complaints.

Question put and agreed to.
Sections 71 to 74, inclusive, agreed to.
SECTION 75.
Question proposed: "That section 75 stand part of the Bill."

Previously I raised the fact section 71(a) may not be appealed, either on the facts or the censure. This is where a person can be given advice, an admonishment or a censure in writing. I gather this is because of the legal advice the Minister has been given in view of the case before the courts at present. People will feel very aggrieved if they cannot appeal an admonishment if they believe they were in the right. When this court case is resolved, does the Minister propose to amend this legislation? It could be quite serious. People take their professional names quite seriously, and rightly so. How will this issue be addressed after the court case?

I took legal advice and consulted the Medical Council. The view was that this is an area of uncertainty. It is being challenged before the courts and rather than try to put legislation around it, it was decided to await the determination of the courts. Depending on the outcome in the courts, which could take some time, we may need to amend the legislation. The strong legal advice was not to start to amend until we know what we need to amend.

Question put and agreed to.
Sections 76 to 83, inclusive, agreed to.
SECTION 84.
Question proposed: "That section 84 stand part of the Bill."

I always give praise when I possibly can. It is very good the council is looking at the situation of people in other jurisdictions. This has caused problems, even in the immediate past. It is most important relevant information is exchanged between jurisdictions.

I agree with the Senator.

Question put and agreed to.
Section 85 agreed to.
SECTION 86.

Acting Chairman

Amendment No. 10 in the name of Senator Henry is out of order because it involves a potential charge on the Exchequer.

Amendment No. 10 not moved.
Government amendment No. 11:
In page 72, subsection (3)(c), line 38, to delete “(4)(b)” and substitute “(4)(a)”.
Amendment agreed to.
Government amendment No. 12:
In page 72, subsection (3)(e), line 46, to delete “of” and substitute “on”.

This amendment is to correct a minor spelling error.

Amendment agreed to.
Question proposed: "That section 86, as amended, stand part of the Bill."

Mr. Browne

A friend of mine involved in the health service often says we should call the Department of Health and Children the department of disease in so far as there is a need for constant forward planning. A census is carried out every five years and the figures for the latest census will be published on 26 April 2007, which will give an indication of population growth. We seem to be playing catch-up, with which the Minister will be familiar because of the current nurses' dispute. Is there a planning unit in the Department which studies population trends? People are living longer now and while this is good news it means the health service is under more pressure. People are surviving illnesses that would have killed them in the past. A heart attack years ago would have killed whereas now the treatment is regarded as a piece of plumbing, according to Dr. Neligan. I do not think he is a friend of the Minister's——

He is a wonderful friend of mine and a great supporter of the Senator's party. I heard he told half the audience at a Fine Gael meeting they had MRSA. I presume this was not because they were members of Fine Gael.

Was he at the Ard-Fheis?

Mr. Browne

Not yet. There have been great advances in cardiology and oncology, but in some respects the health service is a victim of its own success. As soon as one illness is cured, another illness arrives or more is expected of the service. Whatever Government is in charge after the next general election will need to be proactive and forward thinking. I am pleased the Minister has increased the number of medical school and dental school places. Orthodontics is a growing area and we need to be constantly looking ahead rather than simply reacting. Section 86 gives scope to the Department of Health and Children and the Health Service Executive to plan ahead and avoid problems in the future.

On this section I wish to raise the difficult situation in the mid-west and Limerick area where there has been a difference of opinion within the orthodontic service about the training of personnel. I ask whether it is possible within this section of the Bill to find a resolution to a problem which seems to be delaying orthodontic treatment for hundreds of young people who are on waiting lists and who are very put out because they have been delayed for years because of an internal difference of opinion between some of the orthodontic people about the training of orthodontists. I am not sure if the Minister is aware of the situation but with regard to this section she might make a note to have some examination undertaken of the situation in the mid-west and Limerick where children are in need of orthodontic treatment——

Mr. Browne

We have no orthodontists in County Carlow.

——and internal disputes about training are delaying the development of the service.

I am very concerned about the lack of specific details regarding funding for education and training. The only reference in the section states that the HSE should give advice to the Minister on medical and dental education and on all other matters, including financial matters with regard to the development and co-ordination of specialist medical and dental education and training.

I refer to the example of England where there have been significant cutbacks in the national health service because finance has been given priority instead of training and education. However, money is needed to maintain what we hope is the high level of training in this country. It would have been better if ring-fenced moneys had been referred to in this legislation. I can foresee cuts again in the area of study leave and training courses because they all cost money.

In answer to Senator Browne, there is constant planning in the Department. The priority in health care at the moment is to reform the way business is done so that the allocated resources can be better used. We are very fortunate that alone of the countries in the developed world we have been able to increase funding fourfold in one decade. We have greatly enhanced and increased the number of people in training in therapies, medical education and nursing. There has been a significant increase in the number of front-line workers in the health care system. The Senator made a valid point about disease as opposed to health.

One of the issues being examined is the reform of health insurance. The Barrington group has recently reported and I will consider the report over the Easter recess. One of the issues to be considered regarding health insurance is that non-smokers are not given a bonus. Best health advice would be to offer incentives for good behaviour and the Senator has made some valid points about health promotion.

The Dental Council and the Medical Council are the bodies that must approve the location and quality of training and the HSE arranges the facilities. The original Bill as drafted provided that the HSE, in so far as was practicable, should provide competence assurance. This begged the question whether the HSE could say it did not have the resources. This provision has been removed so that competence assurance is a priority and cannot be regarded as being behind everything else. We must ensure that doctors are competent to do the job. We are significantly increasing the amount of money being spent on training and education. We have committed to give money to the Medical Council for competence assurance. The original intention was that this would be completely funded by the profession but I believed this would be an unfair and unreasonable burden on the profession and it would take a considerable time to get to where we need to be if this was the case. The State, therefore, will be involved as a co-funder. We are greatly increasing investment in medical education and training. The funding must be provided to support any increase in the number of places, and the same applies for internships.

I am familiar with the dental issues in Limerick where training was being accredited by an overseas body. The bodies certified to train orthodontists in Ireland are the domestic bodies. A report has been completed on behalf of the Joint Committee on Health and Children. It contains some strong views and I am due to meet a particular person soon to hear a different perspective.

Orthodontic treatment is a priority. It is extraordinarily expensive in this country and we must ramp up the number of orthodontists available to treat younger patients. The need for orthodontic treatment also has a significant cosmetic impact on many young children if they cannot receive the appropriate treatment. I know of a large number of people in the Dublin area who travel to Northern Ireland for orthodontic treatment. It seems to be available there much more cost-effectively than here and I am not quite certain why that is the case. I do not believe the orthodontists in Northern Ireland are of an inferior standard or quality to the orthodontists here. Availability and cost are major issues.

We will reform the Dental Council and introduce legislation. After the pharmacists and doctors, the next two areas needing regulation in a modern context will be nurses-midwives and dentists because the legislation is out of date. Many of these issues will need to be thrashed out in that context.

Acting Chairman

Dr. Henry made a point about the HSE and financing.

I think I dealt with that matter.

Mr. Browne

I raised this issue at the Joint Committee on Health and Children. When I was teaching, I was obliged to give three months' notice if I wished to leave my job and I could only leave my job when somebody else was appointed in my place. It appears that one month's notice is sufficient in the health service and this can cause havoc. If an occupational therapist leaves his or her job, there is no replacement.

I refer to a patient whose family contacted me. I am embarrassed to admit that I was contacted by the family of a patient in October and that I received a reply only in March to queries I made on her behalf. The reply in question indicated that there were no occupational therapy services for Carlow and that it was not possible to provide a definite date for an appointment. I ask the Minister to give consideration to this issue.

Perhaps when health professionals working in this sector first qualify, they should be obliged to remain in the service for a certain period. In addition, the one-month rule should be changed in order that the HSE will have time to advertise for and recruit replacement staff. This would mean that patients would not suffer.

A friend of mine visited the Royal College of Surgeons recently and informed me that many people from outside the State, particularly from countries in the Middle East, are training there. I have no difficulty with the latter and I understand that, from a financial point of view, it is attractive to colleges to take these people on because of the huge fees they can be charged. The problem is that when these people qualify, they immediately return to their home countries. This is unsatisfactory and we must reconsider the position. We must either fund the colleges properly in order that they will not be dependent on fees paid by foreign students or oblige those who come from abroad to train to remain here longer and give the State the benefit of their expertise and skills. I know of a Chinese student who had to repeat exams at Carlow IT recently and who was obliged to pay €1,500 for the privilege of doing so. Taking on foreign students is obviously lucrative for the colleges but there is a downside to this.

I support Senator Browne's comments regarding the amount of notice medical personnel should provide. When I chaired the ethics committee of the Medical Council, I received many complaints in respect of trainee doctors. The latter change jobs on 1 January and 1 July. The nature of the complaints would have been, for example, that a trainee doctor had accepted a job in Donegal but had later received an offer of one in Dublin, which would be a better location in which to work. He or she would have given no notice of his or her intention to accept the job in Dublin and would not contact the hospital in Donegal to indicate that he or she would not be turning up. The authorities at the latter would be under the impression that the young doctor in question was coming to the facility to spend six months working there but he or she would never appear.

The Medical Council could do nothing about the type of behaviour to which I refer. Perhaps trainee doctors should be informed that such behaviour is not professionally or ethically correct and that they have a responsibility to prospective employers and patients. The latter would, after all, be expecting that someone would be present to care for them while in hospital. It might be of assistance if junior hospital doctors were made aware of what is expected of them in this regard.

The Senators made some valid points. Many of the foreign students educated in our medical schools wish to return to their own countries to practise medicine. Moving the intern year to a postgraduate year may mean that many of them will complete their clinical placement or internship abroad and this could help ease some of the pressure for places in Ireland. I am of the view that our substituting foreign students with EEA and EU students — we cannot discriminate between Irish students and their counterparts from other European countries — and increasing the numbers from 325 to 745 over a period of years will be of assistance.

Senator Browne made a particularly valid point regarding the month's notice. It seems to take a long time for consultants to disengage from health systems and commitments to patients in other countries before they come here to take up positions they have been offered. I will discuss this matter with the HSE in the context of new contracts of employment. It would clearly not be possible to set aside existing contracts.

Mr. Browne

The period relating to teachers is three months.

A period of three months would not be unreasonable.

Two issues arise in respect of the six-month period. For all sorts of reasons, 1 January is the worst possible day of the year on which to start a new job. The position is similar as regards 1 July. It was suggested to me that the commencement dates should be moved to March and October. I have forgotten what reasons were offered in respect of not doing so. I have not succeeded in convincing people that the timeframe should be changed. Perhaps it relates to an overlap period. People go on holidays in July and it is difficult for a new person to commence work on 1 January in a hospital because many people are on leave and it is a bank holiday. We may need to consider the position in this regard.

A longer timeframe is required in respect of contracts of employment. Issues arise in this regard in circumstances where one member of a small team is obliged to take maternity leave. That is why we needed to increase the number of therapists available and put in place the primary care initiatives in order that there would not be an over-reliance on particular individuals because one person could be sick and another might have family commitments. There are provisions in law under which, for example, people can take time off to care for relatives without their employment being affected. If a service for a region is totally dependent on one or two people, patients will lose out if either individual is not available. That is why it is important to strengthen teams so that they will not be dependent on one or two people.

The start date in July, which predicated the changeover on 1 January, relates to the fact that medical examinations traditionally take place in late May and early June.

Question put and agreed to.
Sections 87 and 88 agreed to.
SECTION 89.
Government amendment No. 13:
In page 77, subsection (2), line 31, to delete "speciality" and substitute "specialty".
Amendment agreed to.
Government amendment No. 14:
In page 77, subsection (3)(b), line 46, to delete “speciality” and substitute “specialty”.
Amendment agreed to.
Government amendment No. 15:
In page 78, subsection (5), line 1, to delete "specialities" and substitute "specialties".
Amendment agreed to.
Government amendment No. 16:
In page 78, subsection (5), line 2, to delete "specialities" and substitute "specialties".
Amendment agreed to.
Government amendment No. 17:
In page 78, subsection (7)(a), line 15, to delete “speciality” and substitute “specialty”.
Amendment agreed to.
Government amendment No. 18:
In page 78, subsection (7)(a)(ii), line 15, to delete “speciality” and substitute “specialty”.
Amendment agreed to.
Question proposed: "That section 89, as amended, stand part of the Bill."

From what the Minister stated earlier — Senator Feeney also raised the matter — I am of the view that she understands the position regarding the heads of the various training bodies and how important it is that they should be involved with whatever committees the council establishes.

I completely agree with the Senator in that regard.

Question put and agreed to.
Section 90 agreed to.
SECTION 91.
Question proposed: "That section 91 stand part of the Bill."

I am glad the Minister informed the HSE that funds will have to be put in place in respect of competence assurance. The latter is terribly important. Even if one is working within a hospital, one can become very isolated in one's field. Making provision in this area will involve giving people time off to attend courses. This, in turn, will lead to questions as to whether locum cover will be provided or whether clinics will be cancelled. The HSE is taking on onerous responsibilities in respect of this matter. I am certain that it will take a great deal of money and organisation to ensure that the new arrangements will operate efficiently.

That is the case and that is why it must be given priority. However, I am of the view that a great deal of money will be saved in the medium to long term because if doctors are competent, up to speed and possess the requisite skills, patients do better. Such patients are obviously less of a burden on the health system than those who were treated inappropriately by doctors who did not possess the necessary skills and who required follow-up treatment. Although it will be costly in the initial period, it will prove very cost effective in the medium term.

Question put and agreed to.
Section 92 agreed to.
Amendment No. 19 not moved.
Section 93 agreed to.
SECTION 94.

Mr. Browne

I move amendment No. 20:

In page 81, lines 20 to 22, to delete subsection (1) and substitute the following:

"94.—(1) The Health Service Executive and the registered medical practitioner shall ensure that practitioner's professional competence is maintained on an ongoing basis.".

The amendment suggests that the HSE has a role in ensuring that practitioners' professional competence is maintained and that responsibility in this regard should not fall solely on practitioners.

I agree. That is why we did not use the phrase "as far as is practicable".

Amendment, by leave, withdrawn.
Section 94 agreed to.
Sections 95 and 96 agreed to.
SECTION 97.
Question proposed: "That section 97 stand part of the Bill."

The Postgraduate Medical and Dental Board has done incredible work and has been a most useful and hardworking body. As a former member of the board, it is great to be able to praise it. I hope it will be left in situ until the new procedures to be put in place by the council are up and running. The Postgraduate Medical and Dental Board is the one body about which one never hears complaints. It even tackled the problem to which Senator Browne referred, namely, of people not giving sufficient notice, some years ago. Admittedly, it did not manage to get very far, but I recall it said 20 years ago that a situation in which people accepted jobs only to let the hospital down could not be tolerated. That was very forward looking.

Our specialist qualifications are regarded as among the best in the world. Irish qualifications need only be produced and one never hears of them being questioned. We should ensure those high standards are maintained and that is why I hope the present system remains in place until the conditions are ready for a smooth changeover.

It will be kept in place. The inclusion of the Postgraduate Dental and Medical Board in this legislation came on foot of the recommendations of the Fotrell and Buttimer reports.

Question put and agreed to.
Sections 98 to 102, inclusive, agreed to.
SECTION 103.
Government amendment No. 21:
In page 84, subsection (2), line 46, to delete "this".

This is a technical amendment which corrects a minor typographical error. The word "this" is not required in this context.

Amendment agreed to.
Section 103, as amended, agreed to.
Sections 104 to 109, inclusive, agreed to.
Schedule 1 agreed to.
SCHEDULE 2.

Acting Chairman

Amendments Nos. 22 to 30, inclusive, and 32 to 34, inclusive, are related and may be discussed together by agreement. Is that agreed? Agreed.

Government amendment No. 22:
In page 89, paragraph 2, line 33, to delete "Article" and substitute "paragraph".

These technical amendments correct various references to articles, paragraphs and subparagraphs in Schedule 2. They merely ensure consistency with the normal drafting style of Irish legislation, in which references are generally to paragraphs, subparagraphs and clauses of Schedules to Bills.

Amendment agreed to.
Government amendment No. 23:
In page 89, paragraph 3, line 35, to delete "Article 4” and substitute “paragraph 4”.
Amendment agreed to.
Government amendment No. 24:
In page 89, paragraph 3, line 38, to delete "Article 12” and substitute “paragraph 12”.
Amendment agreed to.
Government amendment No. 25:
In page 89, paragraph 4, line 41, to delete "Article 3” and substitute “paragraph 3”.
Amendment agreed to.
Government amendment No. 26:
In page 90, paragraph 4(a)(i), line 4, to delete “Article 12” and substitute “paragraph 12”.
Amendment agreed to.
Government amendment No. 27:
In page 90, paragraph 4(b)(i), line 13, to delete “Article 12” and substitute “paragraph 12”.
Amendment agreed to.
Government amendment No. 28:
In page 90, paragraph 4(b)(iii), line 20, to delete “Article 12” and substitute “paragraph 12”.
Amendment agreed to.
Government amendment No. 29:
In page 90, paragraph 4(c), line 22, to delete “paragraph (b)” and substitute “subparagraph (b)”.
Amendment agreed to.
Government amendment No. 30:
In page 90, paragraph 4(c), lines 23 and 24, to delete “subparagraph (iii) of that paragraph” and substitute “clause (iii) of that subparagraph”.
Amendment agreed to.
Government amendment No. 31:
In page 90, paragraph 7(1), line 38, to delete "Minster" and substitute "Minister".

This technical amendment corrects a minor typographical error whereby the word "Minister" was incorrectly spelled.

Amendment agreed to.
Government amendment No. 32:
In page 91, paragraph 12, line 23, to delete "Article 10” and substitute “paragraph 10”.

Mr. Browne

I have been always puzzled by typographical errors, which can merely comprise a full stop. Has a Bill ever been challenged in court on the basis of a typographical error?

I have no idea but it is clearly good practice to address these errors once they are discovered.

Amendment agreed to.
Government amendment No. 33:
In page 91, paragraph 13(2)(b), line 38, to delete “Article” and substitute “paragraph”.
Amendment agreed to.
Government amendment No. 34:
In page 93, paragraph 21, line 8, to delete "Articles 8” and substitute “paragraphs 8”.
Amendment agreed to.
Schedule 2, as amended, agreed to.
Title agreed to.
Bill reported with amendments and received for final consideration.
Question proposed: "That the Bill do now pass."

I thank Senators for an informed and insightful debate. I always derive great pleasure from attending the Seanad for debates. I am delighted the Bill has seen a speedy passage because everybody recognises it is long overdue. I thank the Leader and the staff of the House for facilitating today's debate.

I thank the Minister for taking this Bill and commend her officials on the hard work they have done. Of all the recent legislation on medical issues, this Bill is probably the most sensitive.

Two areas of the Bill are worth mentioning. The certificate of good standing means people from outside the EU will no longer experience lengthy delays in having certificates sent from their countries of origin. It was wrong of us to require the certificates and it made matters difficult for the people who had to wait for them.

I am delighted the council has been given powers to prevent a person from practising in this country until he or she registers, which is in the interest in public safety. I look forward to the implementation of the Bill.

I congratulate the Minister on her tour de force and thank her officials for the work they put into this much needed legislation. I realise my profession has not been always welcoming of the Bill but I think it will work well in practice.

Senator Feeney wisely raised the issue of non-EU graduates, who we sometimes ask to obtain letters of good standing from countries which they had to flee. It is ridiculous to ask a person to approach a hospital in Baghdad or elsewhere for a letter of good standing after he or she having fled the country dressed in a burka.

I hope the Bill works but money will be needed for its implementation. The fees of the medical profession would have to be incredibly high to fund all the Bill's provisions. Training and education at specialist level and competence assurance will be particularly important and the Department of Health and Children will have to put its hands deep into its pockets because a considerable amount of money will be needed to make the Bill work as well as the Minister would wish.

Mr. Browne

I thank the Minister and her officials for the work they have done on this Bill. While I am glad we are approaching the Easter recess, I am much better educated, although maybe not wiser, than I was one month ago, thanks to this Bill, the Pharmacy Bill 2007 and the Health Bill 2006. I now understand the differences between the IMO, the Medical Council and the medical practitioners association, and the Pharmaceutical Society of Ireland and the Irish Pharmaceutical Union.

This Bill is ultimately intended to ensure patient safety and achieve a balance between medical practitioners defending their good names and patients correcting wrongs. I hope we have played our part in passing this Bill.

Question put and agreed to.
Sitting suspended at 1.20 p.m. and resumed at 2.30 p.m.
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