This meeting has been convened to consider Committee Stage of the Medical Practitioners Bill 2007. I welcome the Minister for Health and Children, Deputy Harney, and her officials. I propose that we meet until 2.45 p.m., breaking from 1 p.m. until 1.30 p.m. Is that agreed? Agreed. If we do not complete our consideration of the Bill today, we will meet tomorrow from 9.30 a.m. until 1 p.m. and from 2.15 p.m. until 6 p.m. Is that agreed? Agreed.
Medical Practitioners Bill 2007: Committee Stage.
Section 1 agreed to.
SECTION 2.
I move amendment No. 1:
In page 10, paragraph (a), line 1, to delete “made in” and substitute “arising out of”.
The purpose of this amendment is to clarify that the specific legal grounds of an allegation do not have to be laid out in a complaint received by the Medical Council, but that the allegation arises out of the complaint received. It would be difficult for a complainant to set out in very specific legal terms the substance of an allegation. Section 107 provides for the council, the preliminary proceedings committee or the fitness to practise committee to have the power to specify the form of documents. This could, for example, allow the preliminary proceedings committee to require a complainant to complete a specific form when outlining a complaint, which could assist in identifying the appropriate allegation arising out of the complaint.
Amendment agreed to.
Amendment No. 2 is consequential on amendment No. 76, amendments Nos. 70 and 71 are consequential on amendment No. 72, amendment No. 73 is consequential on amendment No. 74 and amendments Nos. 69, 75 and 76 are related. Amendments Nos. 2 and 69 to 76, inclusive, will be discussed together. Is that agreed? Agreed.
I move amendment No. 2:
In page 11, line 18, to delete "section 63(1)(b) or (2)” and substitute “section 63”.
Amendment No. 2 is the consequence of the substantial amendments proposed to sections 61 and 63. Section 63 requires the preliminary proceedings committee to refer a matter to the fitness to practise committee for an inquiry if a prima facie case is established.
Amendments Nos. 70, 71 and 73 are technical drafting amendments included as a consequence of moving the reference to a decision on whether a process of mediation is appropriate from section 63 to section 61. Amendment No. 72 inserts a new paragraph (c) in section 61(1), the effect of which is to require the preliminary proceedings committee to notify the council if it considers that a complaint is one that should be resolved by mediation or other informal means. Amendment No. 74 inserts a new paragraph (d) in section 61(2). It goes on, consequentially, to re-number the existing paragraph (d) as paragraph (e). The amendment provides for the council to refer a matter for mediation based on the opinion of the preliminary proceedings committee, given under the new paragraph (c) inserted by amendment No. 72. Amendments Nos. 72 and 74 take account of the provisions which were previously included in section 63(1)(a).
Amendment No. 71 provides for the Medical Council to notify a registered medical practitioner and complainant of the referral of a matter to a process of mediation. The effect of amendment No. 76 is to remove the requirement for a prima facie case to be established before a matter can be referred for mediation. Following a finding of a prima facie case to answer, a complaint should always be referred for an inquiry may not be deemed suitable for mediation. Mediation should be used for less serious matters where an inquiry is not warranted but the medical practitioner and complainant may be able to resolve the matter through discussion in a confidential mediation process.
Were the decision on mediation to be provided for in section 63, an extremely high legal bar would be imposed for a mediation process which could only take place where a prima facie case had been established. It must be clear that a medical practitioner who is the subject of a prima facie finding cannot avoid by engaging in a process of mediation an inquiry which must always be undertaken by the fitness to practise committee in the public interest. It must also be clear that there can be no option whereby pressure or inducement can be brought to bear on a complainant to engage in a mediation process in a very serious case of alleged professional misconduct.
The new drafting of section 63 set out in amendment No. 76 provides that following the establishment of a prima facie case by the preliminary proceedings committee or a direction by the council under section 61(2)(e), a matter should be referred to the fitness to practise committee for inquiry. I hope the changes proposed in the amendments will address the concerns raised by Deputy McManus in amendment No. 69. While amendment No. 69 relates to section 59 of the Bill, the effect of my amendment will be to provide that the preliminary proceedings committee will have to consider whether a complaint can be resolved by mediation without a prima facie decision.
I feel at a slight disadvantage due to the way in which the Bill is being processed. It was very difficult to find adequate time to reflect and consider the provisions set out. The proposed amendment sounds welcome and I take the Minister at her word.
What will constitute a serious matter on preliminary hearing? Will it mean a matter sufficiently serious to require striking off or refer to circumstances in which there has been a serious adverse outcome? Many complaints reach the Medical Council which do not go anywhere and it seems the Minister is not referring to such matters. They do not go to mediation as they tend to be deemed not to have any consequence. What sort of complaints will go to mediation? While they will not be matters requiring full hearing, they will also not result in a statement by the Medical Council that nothing is wrong.
In legal terms, a prima facie case is one in which there is strong evidence to suggest that there has been professional misconduct requiring an inquiry. People may complain for other reasons, however, including communication or personality issues which are minor and resolvable through mediation. The purpose of the provisions is to provide a range of options and to ensure that fitness to practise inquiries are only carried out where serious issues arise and there is a prima facie case to answer and serious allegation requiring investigation.
Many complaints are received by the Medical Council and other regulatory bodies which can be resolved in a much more satisfactory manner through mediation or discussion. The goal is to ensure mediation cannot be abused where there is a serious allegation by allowing a doctor to discourage a complainant by inducement or other means. Clearly, it will be for the preliminary proceedings committee to make a decision one way or the other. Many of the complaints received are often such that they can be resolved through dialogue and mediation.
Would the findings of such mediation be binding and would the person who made the complaint have the option of referring it for further investigation or to a full hearing of the fitness to practise committee and so on if need be?
Mediation is entered into in order to resolve a dispute. I am advised matters such as a doctor not turning up to his or her clinic could be the subject of a complaint. Issues such as rudeness to a patient may arise. A patient may wish to make such a complaint. The purpose of mediation is to reach agreement on an issue.
I do not understand what the Minister is implying in respect of "inducement by doctors". I presume the person against whom the complaint is made has absolutely no say in respect of whether a complaint goes before a full hearing of the fitness to practise committee or to mediation. The Minister stated that a doctor might offer inducements to complainants to go the mediation route.
The point I am making is that the Bill will make it easier for complainants to deal with matters through the mediation process. I am also saying that one does not have to establish a prima facie case in that regard.
I am trying to understand what the Minister meant when she stated that doctors might offer an inducement to a complainant to ensure he or she takes the mediation route rather than putting the case to a full hearing of the fitness to practise committee. I would assume that a doctor would not have absolutely no say in respect of whether a complaint made against him or her goes to a full hearing of the fitness to practise committee or to mediation.
I was making the point that where there is strong reason to believe something serious has happened the matter can be addressed by way of mediation as opposed to inquiry. Where there is a prima facie case that there are serious grounds to believe professional misconduct took place, such a matter must be dealt with by way of inquiry rather than mediation. The mediation process will be used to deal with minor issues which cannot be regarded as professional misconduct. Such matters which may be unsatisfactory and may have caused serious distress, worry and concern to patients should be resolved to the satisfaction of the patient and doctor by way of mediation. That is the purpose of much of what we are doing today.
The Minister stated that a doctor against whom a complaint has been made might offer inducements to a complainant in order to avoid the matter going before a full hearing of the fitness to practise committee. I am trying to understand this. I do not know how a doctor could prevent a case going before a full hearing of the fitness to practise committee. My understanding is that if a complaint is made to the Medical Council and it decides that the matter is not serious enough to warrant a hearing by the fitness to practise committee, it may offer the complainant the option of dealing with the matter through the mediation process if he or she so wishes.
What did the Minister mean when she stated that a doctor might offer inducements to a complainant? I do not understand what role a person, against whom a complaint has been made, would possibly have that could supersede a decision made by the Medical Council.
Both parties must agree that a matter go to mediation. If it were the case that serious issues could be dealt with by way of mediation as opposed to an inquiry——
That is not the decision of the——
That is the point I am making. We are not allowing serious issues to go to mediation. Only minor issues will be dealt with by way of mediation.
What did the Minister mean when she stated that doctors might offer inducements to complainants?
If serious issues can be dealt with through the mediation process rather than by way of a full hearing of the fitness to practise committee——
That decision is made by the Medical Council.
If we were providing in this legislation that one could opt for mediation or to have a matter go to a full hearing of the fitness to practise committee——
The Medical Council makes that decision.
We are making the law and that law must be implemented by the Medical Council. In making the law---
Obviously, the Minister does not understand my difficulty. What I am trying to work out is how a doctor could offer an inducement to the complainant to supersede the decision of the Medical Council?
If a serious complaint could be resolved through mediation, clearly that could happen. The point I am making is that serious issues cannot go to mediation, and that mediation is only for minor issues. We are introducing the concept of mediation in order to ensure that the fitness to practise committee is the process that is used for serious issues only and that it is not used for what could be termed minor matters that can be dealt with through dialogue, discussion or mediation.
I think we all understand that mediation means that the two parties to the dispute or people working on their behalf can resolve the issue to the satisfaction of both parties. That process cannot be used if there is a prima facie case of professional misconduct, which must go before a fitness to practise committee. One cannot mediate a way out of that. I hate to use the most recent example but, it would not be satisfactory if a serious issue could go into a mediation process. Everybody wants to see legislation that is workable, pragmatic, sensible and fair to both patients and doctors. The mediation process which has been widely supported by doctors’ representative bodies and the Medical Council is a good process for resolving minor and less serious complaints. Under no circumstances could one facilitate serious issues being resolved through mediation. That would be neither in the patient’s interests nor the interests of the profession.
The Minister's initial comments seem to have thrown me. I do not know whether——
Deputy Twomey was one of a number of people, including Deputy McManus and the Medical Council, who made the point on Second Stage that we should have a mechanism short of the fitness to practise committee to resolve disputes between both sides.
I am not attacking the legislation but it is very important that the option to enter mediation must be controlled by the Medical Council.
Both parties must agree to enter mediation, but if the issue is serious, there cannot be mediation.
There should be no means by which the complainant and the person against whom a complaint has been made can agree to write to the Medical Council to request that they go through the mediation process.
The import of the amendments is to rule out mediation if there is a prima facie case to answer. Mediation can only be used for minor issues and cannot be used for what would be broadly called serious issues. Even if the complainant were to agree to mediation, that would not be satisfactory. In other words, one cannot mediate one’s way out of a situation that merits an inquiry not just in the interests of a particular complainant but of future patients.
Amendment agreed to.
I move amendment No. 3.
In page 11, line 32, after "a", to insert "significant".
I suspect this amendment is in line with what the Minister has articulated. The issue has been raised by the IMO and the thinking behind it is that the incorporation of poor professional performance, as distinct from professional misconduct, may lead to a significant number of complaints against practitioners in circumstances where there has been no professional misconduct. This appears in part to be linked to the issue of competence assurance and the proposed review of practitioner competence.
The effect of these provisions, particularly the inclusion of poor performance as a separate head of complaint, dramatically increases the pressure on individual medical practitioners. The absence of any de minimis provisions could potentially impose major difficulties where both practitioners and the Medical Council are dealing with a large number of complaints of a minor or trivial nature. The IMO has expressed its concern on this issue and I think it is worthy of consideration. Inherent in the doctor-patient relationship is the idea that doctors are infallible and do not or cannot get things wrong. If something goes wrong it can undermine the patient’s confidence. We must all accept when introducing legislation to deal with misconduct or malpractice that there is no super-human doctor and that the whole idea of competence assurance is to ensure that doctors practise to the highest standards possible. There is legitimate concern that we could end up with an enormous number of complaints, many of which are minor in the sense that deliberate malpractice is not involved.
I accept the Minister's view that mediation is the appropriate provision in such cases and I welcome that approach. However, we need to be quite specific in defining what it is we are dealing with in the legislation. Fitness to practise is a very definitive description. If someone is unfit to practise, that has very significant implications. I understand that traditionally, if a doctor was censured it was regarded as the equivalent of a slap on the wrist. It was not seen as a major event and that is why there is no right of appeal in that situation.
Obviously the whole context within which medical practise is carried out is quite different now and it is much better that patients know they have a right to complain. I have no doubt that the improved culture is improving medical practise. There does not always have to be litigation to improve medical practise and patient expectations can be a very beneficial and benign influence. However, I am concerned about the practicality of what the Medical Council is doing. We have already had a legion of complaints about the lack of medical personnel on the Medical Council to enable it to carry out its duties, which could result from this legislation. That is why this amendment is being proposed. I shall be interested to hear the Minister's views on it.
Before the Minister replies, I should have said that amendments Nos. 4 to 6, inclusive, are related and amendments Nos. 3 to 6, inclusive, will be discussed together.
I do not disagree with much of what the Deputy is saying. My amendment No. 6 proposes to remove the definition of professional misconduct included in the Bill, which will allow for the interpretation of the courts to continue to be used. According to legal advice, and the strong views expressed to me by the Medical Council, which were compelling, it is preferable to accept the established case law interpretation and the definition included in section 2 of the Bill is therefore not required. The accepted interpretation of professional misconduct is that given by Mr. Justice Keane in the case, O'Laoire v. Medical Council on 27 January 1995. In his judgment Mr. Justice Keane stated:
Conduct which could not properly be characterised as "infamous" or "disgraceful" and which does not involve any degree of moral turpitude, fraud or dishonesty may still constitute "professional misconduct" if it is conduct connected with his profession in which the medical practitioner concerned has seriously fallen short, by omission or commission, of the standards of conduct expected amongst medical practitioners.
The purpose of amendment No. 4 is to clarify the definition of poor professional performance. This amendment clarifies the importance of a medical practitioner having the requisite knowledge and skill, but account must also be taken of the ability to apply them. Amendment No. 5 is intended to clarify that this can be applied to a particular circumstance in which the doctor normally practices. For instance, a general practitioner or psychiatrist will not normally be required to be expert in advanced surgical techniques, but will be competent as regards their normal scope of medical practice. Although we are coming at it in a different way, based on legal advice and the views of the Medical Council I have removed the provisions in the Bill and we will rely on case law, which is more appropriate and fair.
I welcome that and withdraw my amendment. Is it just simply taken out and there is a dependence on precedent or is that inserted at some point?
Yes, that is the position.
The legislation is silent on the matter.
Yes.
What if a judge, at some point in the future, has a brainstorm and decides on a different definition?
The legislation does not provide a definition of misconduct.
If a precedent is created——
That would be a matter for the courts. They generally follow precedent but they also create precedent and make law. The current law was laid down by Mr. Justice Keane in 1995, which is 12 years ago. It remains to be seen whether or not that precedent will be superseded in the future. It is appropriate that misconduct be defined in the circumstance of a particular case rather than in legislation. If we introduce words such as "significant" into legislation we will then have to define those words. I am advised that misconduct is virtually impossible to define and that it is better to rely on case law.
What is the significance of the Government amendments? Is the Minister saying they change nothing?
They make it clear that we are relying on case law. Amendment No. 4 inserts the words, "whether in knowledge and skill or the application of knowledge and skill or both". Amendment No. 5 inserts the words, "of the kind practised by the practitioner". Amendment No. 6 deletes lines 42 to 44 in page 11 and lines 1 to 10 in page 12.
The significance of these amendments is that the Bill could establish a precedent, as Deputy McManus has observed. Competence assurance will become the major issue.
That is right.
The Bill will change very little, apart from the legalisation of competence assurance, which will be central to the Medical Practitioners Act. The Bill will not change case law. We will continue to follow precedent as established in 1995. It will, however, allow competence assurance to change precedence. The next court case may concern a doctor who has not completed the necessary competence assurance forms.
They are separate things. Competence assurance means requiring doctors to meet a certain standard on an ongoing basis, as laid down by the Medical Council. Doctors who are competent can still be involved in professional misconduct. Competence does not preclude a doctor from being the subject of a complaint or found to be unfit to practise.
The Bill does not merely deal with negligence. To be declared unfit to practise a doctor must deliberately harm a patient. Incompetence involves an action by a doctor who is not doing deliberate harm or acting fraudulently. The case of Dr. O'Laoire, heard by Mr. Justice Keane, hinged largely on the doctor's competence.
An appropriate competence assurance regime will take some time to become fully operational but it will minimise complaints.
Deputy McManus and I raised this matter continually during the debate on Second Stage. The Minister must clarify the competence assurance regime she intends to establish. This legislation will be the basis of any court case heard in the next year but the competence assurance scheme has not been established. We do not know what it will be.
I am not competent to decide if Dr. Twomey is a competent general practitioner or whether another person is a competent surgeon or psychiatrist. The Bill provides that the Medical Council will put a system of competence assurance in place. The process will be co-funded by the Medical Council because it will be extraordinarily expensive. I am reluctant to refer to the particular case which has informed some of our thinking on this Bill.
If a competence assurance regime and system of audit had been in place in the maternity unit at Our Lady of Lourdes Hospital in Drogheda, what happened would not have continued for 25 years. We all know that. Competence assurance will, over time, reduce the incidence of serious complaints. There will always be complainants, of course, even where there are competent doctors.
There is no timeframe for competence assurance.
It has to be introduced in a 12-month timeframe from the enactment of the legislation.
Will that be for everybody?
Yes, but the scheme will be phased in. It will not happen overnight. I sent the Deputy documentation I received from the Medical Council, but there is a considerable amount of work to be done. No competence assurance scheme is set out in the pharmacy legislation, which we will discuss in the House on Friday, as a policy has not been advanced between the Pharmaceutical Society of Ireland and the Department. Our thinking is much more advanced in the context of medical practitioners, which is welcome.
Thanks are due also to the Medical Council.
We have a terrific Medical Council, which I have acknowledged previously. The president, staff and membership of the council are committed to the highest possible standards for the medical profession. It is the council's role to regulate in the public interest and it takes its obligations seriously. Competence assurance operates very successfully in other countries. The doctors who graduated from university with me in 1977 have seen the world of medicine change a great deal in the intervening 30 years. Many of them have 20 years of practice left. Given that a doctor can practise for 50 years from graduation, we must ensure they maintain their skills, which is what competence assurance is about. It is not about trying to do the impossible but about maintaining the highest possible standards of skill, expertise and professionalism.
We all welcome competence assurance. From enactment of the legislation, what will be the timeframe for compulsory competence assurance?
The Medical Council must come forward with a scheme within 12 months. I do not know how long it will take to make the scheme fully operational for all 12,000 doctors in Ireland. We must be realistic and acknowledge that it will take a while.
Will it take five years?
Perhaps. It will take quite a while. I launched a voluntary scheme with the Medical Council which is operating extraordinarily well with 360 general practitioner participants, representing a high percentage. It may well be, therefore, that the scheme can be rolled out more quickly than five years or in one area of practice more quickly than in another. I am not certain or competent to say. Our task here is to provide for a regime that the Medical Council will implement with financial support from central government funds. It will be extraordinarily expensive.
It is an important point. People have raised with me the point that the time commitment for good competence assurance is a number of hours a week. If a hospital doctor is working 40 or 50 hours a week, the time spent on competence assurance will have to be compensated for by extra staff. While it will be expensive, the sooner it is rolled out, the better.
I will move an amendment on the modification of a requirement on the HSE with the phrase "as far as is practicable". The Medical Council made valid points about the matter which is why the phrase will be removed. We wish to ensure that patient safety and competence assurance is a requirement rather than a matter which is addressed after everything else. There will be resource implications, a significant one of which will be time off. Costs will be incurred by the HSE and private providers not just in policing and implementing the scheme, but in releasing people from work. This will result in very significant costs for the Health Service Executive and private providers.
Is provision made in the Bill to ensure doctors against whom significant complaints have been made — they may not be incompetent but may need to have their practise reviewed — are competence assured or are they required to await the introduction of the competence assurance scheme? It will be very difficult to competence assure 9,000 doctors. Would it not be better to include in the Bill a provision to deal with the minority of people who need to be competence assured having had complaints made against them?
We could start with them.
Section 61 makes provision for what will happen when a complaint is made. The Medical Council will also be able to initiate its own inquiries.
The Minister could guarantee complainants that within the next 12 months all doctors needing to be competence assured will be competence assured. The Minister stated earlier that the scheme will be put in place over the next five years but it could take seven years to do it. She could also state her intention to ensure that in future all doctors will be competence assured.
This is not a witch hunt. As a member of the medical profession — I am sure Deputy Devins will agree with this — I know that doctors take complaints made against them to the Medical Council very personally. I am not speaking of the type of complaints made against Dr. Neary, which were significant. The Minister will be aware that the vast majority of complaints made to the Medical Council are deemed to not warrant any type of review. However, the doctors involved take them personally. If we are serious about competence assurance we need to do a little more than tell people everything will be great in five or six years. We should try to guarantee patients that within 12 months any person against whom a significant complaint has been made will be competence assured.
Two separate issues arise. I share the Deputy's view that it is easy to complain. I occasionally receive anonymous letters complaining about various people, including politicians. I am sure people complain about me to other Members.
The Minister should not go there.
All professionals against whom complaints have been made take them seriously. We want to ensure that we provide in this legislation a fair and reasonable system that does not encourage vexatious complaints or take them seriously, and includes a weeding out process.
The Minister should be careful. Not all complaints are vexatious, there are often genuine sentiments behind them. A person may take a complaint made against him or her very personally.
Often a complainant may not like a particular person and may make a vexatious complaint against him or her. I have seen this happen. I am aware of a particular professional against whom nearly everybody in the State made a complaint despite the fact that the matter related to a row in his neighbourhood. The matter was under investigation by several bodies. However, to be fair that is an exceptional case.
We must provide different layers which allow these matters to be screened and sorted out. Less than 10% of complaints received are heard by the fitness to practise committee. I have no doubt this will not change much. Issues relating to the health sector will be addressed by way of the health provisions. As I stated earlier, this legislation is as much about supporting doctors as it is about protecting the public. It is important that we have these supports in place.
On competence assurance, it will be a matter for the Medical Council to decide on what basis this scheme will be commenced and how it will be rolled out. It is appropriate that the council is given the freedom to do this. I am being criticised for seeking to interfere too much in the Medical Council. We will deal later with amendments in that regard.
Will the Minister consider using her new found powers to issue a directive?
I will not be issuing the directive the Deputy accused me of issuing on Second Stage.
Amendment, by leave, withdrawn.
I move amendment No. 4:
In page 11, line 33, after "competence" to insert the following:
"(whether in knowledge and skill or the application of knowledge and skill or both)".
Amendment agreed to.
I move amendment No. 5:
In page 11, line 34, after "medicine" to insert "of the kind practised by the practitioner".
Amendment agreed to.
I move amendment No. 6:
In page 11, to delete lines 42 to 44 and in page 12, to delete lines 1 to 10.
Amendment agreed to.
Section 2, as amended, agreed to.
Sections 3 and 4 agreed to.
SECTION 5.
Amendments Nos. 7, 8, 77, 86 and 95 to 97, inclusive, are related and will be discussed together.
I move amendment No. 7:
In page 15, subsection (1)(b), line 28, to delete “an officer” and substitute “a member of the staff”.
The purpose of this group of amendments is to correct technical drafting matters. In amendment No. 7, the persons employed by the council and provided for under section 25 are referred to as the members of the staff of the council, therefore the term "officer" is replaced with "member of the staff" by this amendment.
Amendments Nos. 8, 77 and 86 correct typographical errors and amendments Nos. 95 to 97, inclusive, correct references to previously enacted legislation. Amendments Nos. 77, 95 and 96 are also proposed by Deputy McManus.
Amendment agreed to.
Section 5, as amended, agreed to.
Section 6 agreed to.
SECTION 7.
I move amendment No. 8:
In page 16, subsection (2)(f), line 16, to delete “paragraph (d)” and substitute ”paragraph (e)”.
Amendment agreed to.
Amendment No. 9 not moved.
Amendments Nos. 10 and 11 are related and will be discussed together.
I move amendment No. 10:
In page 16, subsection (2)(i), line 40, after “on” to insert “all maters related to”.
This amendment arises from concerns expressed by the IMO. Mr. Justice Keane figures in this as well. The Bill provides a definition of professional misconduct, as stated in the footnote to the draft general scheme, to be based upon the test for professional misconduct outlined in the judgment of Mr. Justice Keane in O'Laoire v. Medical Council. In applying these principles, Mr. Justice Keane noted that the Medical Practitioners Act 1978 provided that it shall be the function of the council to give guidance to the medical profession generally on all matters relating to ethical conduct and behaviour. This provision is being replaced in section 7(2)(i) which states that the council shall, “specify standards of practice for registered medical practitioners, including the establishment, publication, maintenance and review of appropriate guidance on professional conduct and ethics for registered medical practitioners”.
Although these provisions are broadly similar, it does appear that the current wording envisaged in the Bill is somewhat more restricted in that it refers to appropriate guidance on professional conduct and ethics for registered medical practitioners, as distinct from guidance to the medical profession generally on all matters related to ethical conduct and behaviour. This seems to envisage circumstances in which other bodies may also seek to provide guidance on ethical conduct.
There appears to be a blurring of the line dividing the responsibilities of the HSE and the Medical Council in this regard. It would appear to be in the interests of all parties that there is a clear demarcation between the HSE and the Medical Council in respect of guidance to be furnished on what constitutes professional misconduct. In these circumstances, the Bill should be amended to confirm the position under the 1978 Act which was that the Medical Council was responsible for all such matters. It may be a slight difference but concern is being expressed.
This is a concern that has been expressed in other areas of the Bill, as to the relationship between the Medical Council and, for example, the HSE. Historically the Medical Council has been a standalone body. While there have been instances such as the Neary case with which we are all familiar, as the Minister confirmed, we are fortunate to have a Medical Council which has applied excellent standards. If it is not broken do not fix it. The provision is allowed for in the existing Act and it seems there are some grounds for concern. I undertook to table this amendment to hear what the Minister had to say about the matter.
Am I to speak on amendment No. 11 as well, because it is quite different? I am rather surprised at the two being taken together.
This was decided by the Bills Office.
I never criticise the Bills Office. I used to and I got hammered for it, so I will not do it now.
The Deputy has the protection of the Chair at all times.
I needed it. I thank the Chairman.
I want to put amendment No. 11 forward for consideration and debate because I have concerns about changes the Minister is proposing. I am all for democratisation and for ensuring there is openness and accountability and that we meet the needs of a changing world. However, I am also conscious that for centuries doctors have applied high ethical standards and it is recognised that ethics determined their work. The ancient Hippocratic oath applies today. The idea that one maintains life still applies.
I am concerned at the notion that non-medical practitioners who have no direct experience of the difficult complex life and death dilemmas doctors face, have a role to play as regards the ethics that apply to medical practice. The Minister is very committed to providing a lay majority and I have been convinced by her in that regard. However, I wonder whether this board will be appointed before the general election.
I do not think so, because of the regulations. It might be appointed with the Deputy as Minister, although I hope not.
The Minister hopes not. That is exactly the problem I am concerned about. She hopes not.
It is not for personal reasons. I look forward to being back as Minister for Health and Children.
This is the whole point. We are now into political judgments and choices. I would not expect the Minister to want to be the person, but that is the point I am making, namely, that there is a political perspective being introduced. Whatever about ensuring that the systems operate in a way that is accountable, when we talk of the ethical practice of doctors we have to look at the situation in general. I have had real arguments with doctors, particularly as regards human reproduction, but I must recognise that there is a tremendous strength in medical practitioners determining how they function in relation to their consciences, and that there is a danger of undermining that. Perhaps neither of us will be Minister for Health and Children. Perhaps some Minister for Health and Children will want to appoint Paddy the plasterer, and I do not even know the man. I mean no disrespect.
He could not take it anyway, because he is too busy.
He will have more time on his hands after the election.
He is certainly making lots of money, that is for sure.
Does the Minister get my drift? We are moving into territory that will not necessarily be of benefit or ensure that we have professional standards into the future. There should be a lay majority to oversee what is being done once the standards are set. If a medical practitioner is not living up to the ethical requirements, the system should then move into action to deal with it. I have concerns about the idea that we should take away the role of doctors being directly involved in determining ethical practices for other doctors. It may be a neo-con view but I do not care because I have concerns about it.
I am happy to take amendment No. 10 on board on Report Stage. There is a typographical error with the word "maters" in the amendment.
I do not agree with amendment No. 11. In the area of professional conduct and ethics, we do not need a narrow focus but the wider perspective of those not in the medical profession. The current chairperson of the ethics committee of the Medical Council, elected by a council with a majority of doctors, is a layperson. Previously, a member of the health committee, Senator Feeney, was chairperson of the committee. I am advised by the Medical Council that she did an extraordinarily good job. I have no doubt the current incumbent will do an excellent job. Neither of them was a doctor but they were elected by a council, the majority of whom are doctors, because they had confidence in their abilities to chair the ethics committee.
I do not agree with amendment No. 11 because a narrow focus of doctors-only is not good. I note Deputy McManus has a further amendment to remove all lay members.
That amendment should have been withdrawn. The Minister must accept that it is difficult to deal with this Bill. I am not competent to deal with this Bill. The Minister can criticise me all she likes.
I am not criticising the Deputy.
Human capacity is not sufficient to deal with the process that the Minister established for this Bill. My apologies.
Is it because of the timeframe?
Yes, it is impossible. We were in the Houses until 9.30 p.m. dealing with complex issues.
Members have been screaming at me about the state of various Bills.
We were screaming at the Minister three years ago and not last week.
I was not Minister for Health and Children three years ago. I will accept amendment No. 10 on Report Stage.
I am not stating that the committee should not have lay people or a lay chairperson in the management of the processes for monitoring misconduct. I have an issue with the drawing up of the original ethical basis for the process. For instance, should lay members be allowed to vote on deciding what constitute medical ethics? This amendment would not stop lay members being involved in determining whether ethics were breached in a particular case. It simply covers lay members being involved in the specification of standards.
What is wrong with the current Medical Council? I do not mind if the Minister takes the ethics or professional conduct aspect of the debate.
First, the Medical Council informed me that there was a significant onus on the four lay members of the existing council which was unsatisfactory. The Bill gives the council the right to recruit people to various committees who do not have to be members of the council. One lay member had to commit 100 days to a fitness to practise committee while holding down another job, which was an unsatisfactory arrangement.
Overall, what did the Minister believe was wrong with the structure of the Medical Council? What guided her when drafting the legislation?
The purpose of the Medical Council is to regulate in the public interest. Confidence, therefore, in the council must be paramount. The onus of proof is on those who maintain it should be a medical majority rather than vice versa. For example, there is not a single banker or insurance representative on the board of the Central Bank or the Irish Financial Services Regulatory Authority. If anyone suggested there should be a majority of such persons in these bodies, it would never get through.
That is a different situation.
No, it is not. No one objected to a lay majority in the health and social care professionals regulatory body. The Bar Council, on a voluntary basis, has a lay majority. All of this is to inspire public confidence and bring a wider perspective to the work of the council. The UK White Paper on the same matter states that doctors should not be in the majority in a self-regulatory body. That is the way international practice is moving. I have attended several conferences and informed myself of developments abroad. It is appropriate when there is self-regulation for a professional body, that the majority does not come from that profession.
On Second Stage I made no reference to the lay majority; therefore, I am not picking an argument. However, the Minister is taking the Medical Council structure down a particular route. Doctors no longer believe the Medical Council is theirs and that they are somehow responsible for it. The council will metamorphose into a HSE-type State organisation.
It is a regulatory body for their profession.
Yet they will see it differently.
It is not a representative body for doctors.
I am saying that as a member of the profession. One sees matters differently when one does not believe one has ownership. The Minister claims her main concern was that the Medical Council was too small.
I am keeping the same number but believe the council was restricted in trying to operate its committees with lay persons. One had to be a member of the council to be on the various committees. That was unsatisfactory and certainly will be changed.
Therefore, the Medical Council can bring in another 15 people to sit on committees.
It can bring in people to serve on committees, which is a good development simply from the sheer time perspective.
That applies to all committees, including the fitness to practise committee.
Yes, particularly the fitness to practise committee.
Will the Medical Council decide this as a body or a majority?
The council will decide. It has the scope to do it. I am advised by the council that it will use the provision because it needs to. In fairness to all concerned, the commitment required to be a committee member in terms of time is incredible.
My other concern was that legislation was being modernised with a greater knowledge of regulation. Above all else, regulation must inspire confidence. Coming from a consumer perspective in my last portfolio, patient focus is important. Many doctors agree and disagree with me. I have had many heated debates with friends in the past four weeks on the issue. In some instances, it is misunderstood; some doctors feel threatened by it. In the main, doctors are concerned that people who are envious of them will make frivolous complaints and that they will end up before the Medical Council. That is not the intention and I do not want a regime that encourages this. We want to support professionals but where there are legitimate complaints, they must be pursued. Anyone can make a complaint but the issue is whether there is an appropriate mechanism for the council to adjudicate on it. A complaint which is not serious should be dealt with in the informal preliminary hearing mediation process and a health complaint should be dealt with in a health context. The present regime, which only allows for either full-blown inquiry or nothing, is not satisfactory.
The Bill adds the mediation aspect to the process.
Is also adds provision for preliminary hearings and the health committee. They are all new.
The Minister says she has received many representations in recent weeks, as have all Deputies. I ask her to clarify an issue which has been brought to my attention. Paragraph 7(2)(g)(i) states that the Medical Council will “where appropriate, act as the competent authority for the purpose of the mutual recognition of medical qualifications awarded in or recognised by member states”.
This matter was the subject of amendment No. 9 tabled by Deputy Gormley.
Unfortunately, I was out of the room.
I am happy to deal with the matter. The Medical Council has been doing this since the middle of the 1970s. I cannot think of another body more competent to do it than the Medical Council.
What do the words "where appropriate" mean? In what circumstances would it be appropriate and in what circumstances inappropriate?
It would be the duty of the council to implement EU directives, for example.
When would it be inappropriate?
I will have to check that. I am told the word "appropriate" has only drafting implications. I will check if it is legally necessary to include the word "appropriate". The purpose of the measure is that the Medical Council will be the body which approves qualifications, implements directives, deals with mutual recognition and so on. No other body is competent to do that. The Medical Council also approves education and training.
Are there grounds for concerns among doctors that this is a way of bringing foreign doctors, whose qualifications may be inferior and whose language skills may be inadequate, into Ireland? Ought we not be encouraging more people to train in Ireland, as recommended in the Fottrell report? Are those concerns groundless?
Decisions made at European level must be implemented in all member states. The Medical Council would be the competent body to do that. The Medical Council would have to satisfy itself on issues of linguistic competence and qualification. This is not a way of allowing unqualified doctors to practise in Ireland. It could not be.
That is people's concern.
I know there is a concern but that could not be the case.
I thank the Minister.
Amendment, by leave, withdrawn.
Amendment No. 11 not moved.
I move amendment No. 12:
In page 17, subsection (2)(l), line 4, after “including” to insert the following:
"the advances, limitations and risks of current medical knowledge and practice".
This amendment places an onus on the council to inform the public of the advances, limitations and risks of current medical knowledge and practice, thus encouraging the development of equal partnership, trust and understanding between patient and doctor.
I ask the Minister to accept this amendment. It expands the role of the Medical Council. For years, the Medical Council was a shadowy, unknown and mysterious body. Even when people approached it with a complaint they did not find it to be welcoming or open. I welcome the changes being introduced by the Minister to change this situation. There remains a dearth of understanding of the changing nature of medical practice, including its possibilities and limitations. The Bill provides an opportunity to address this situation. The Medical Council is a high level regulatory body and has a unique relationship with medical practitioners. The section makes provision for advising the public on all matters of general interest relating to the funding of the council, its areas of expertise and other matters of interest to the public relating to the practice of medicine and medical practitioners. While reaching out is implicit in the section, I am arguing for a more precise definition to ensure that the new Medical Council sees as part of its role increasing public awareness of medicine.
It is important for people to better understand what health delivery is all about and their relationship to medical practice. I urge the Minister to include such provisions, which would not be especially onerous in the context of the work of the Medical Council. Such provisions would represent a new way to inform and educate the public, many of whom end up being patients sooner or later. Very often, they are completely mystified and ill-informed, even where medical practice applies to them personally. The failure is often one of medical practitioners but it can also be a failure of a system which is very demanding in which people are under a great deal of stress.
While at first sight the amendment sounds sensible, we were not so certain of its practicability on teasing it out. It would be very onerous to place this burden on the Medical Council given the rate of change in medical practice, which is almost daily. If we were to require the Medical Council to inform the public constantly of changes in practices, it would place an enormous burden on it. Involvement in the dissemination of public information would be a new role for the Medical Council. It would perhaps be more appropriate for the training bodies or colleges to play a role in this area. If I thought the matter were as simple as Deputy McManus suggests, I might be more open to the idea.
According to the advice available to me, it would be impossible for the Medical Council to keep up to date with advances in every branch of medicine and inform people of changes on an almost daily basis. It would be an onerous task on any organisation. I am not aware of any body in any other jurisdiction which has a regime of this kind in place. If there is one, I would like to see how it operates as I am always open to new ideas. Informing the public is important as we know from the use of antibiotics and their effect on MRSA. Many patients demand prescriptions from doctors and do not feel satisfied unless one is provided. There is significant work in the area of public information which must be done on the issue. I have just returned from a trip to Denmark, Norway and Sweden where there are impressively low levels of antibiotic prescription, which has a significant impact on the levels of MRSA in particular. It has been like that for generations.
We must do something about it here.
I accept that. It will take perhaps 14 years to inform the public, medical practitioners and pharmacists and change the idea that it is always necessary to obtain a prescription for antibiotics. The frequency with which people with very minor ailments are able to access antibiotics is incredible. I would like to see a public information function established. Obviously, the HSE has a public health role. I will speak to my officials in advance of Report Stage and revert to the Deputy on whether provisions in this area are practicable. It would be a significant and new task.
I do not want to make unrealistic demands. I accept that the way the amendment is drafted would require every advance and limitation to be promoted by the Medical Council, which would be nonsensical. The spirit of the amendment is strong, however, and I am willing to give the Minister time to look at it.
Amendment, by leave, withdrawn.
As I explained earlier to the Chairman I must leave for a short while but the Minister of State, Deputy Tim O'Malley, will take over in my absence.
Is it agreed to break for ten minutes? Agreed.
Sitting suspended at 10.50 a.m. and resumed at 11.05 a.m.
We now come to amendment No. 13 in the name of Deputy Gormley. Amendments Nos. 18 to 26, inclusive, are related. Amendments Nos. 13 and 18 to 26, inclusive, will be discussed together.
I move amendment No. 13:
In page 17, subsection (4), lines 28 to 31, to delete paragraph (d).
I wanted clarification from the Minister as regards paragraph (d) on page 17 which reads, “the policies and objectives of the Government or any Minister of the Government to the extent that those policies and objectives may affect or relate to the functions of the Council”. This is the type of clause one also sees in the context of planning matters. Certainly it has caused problems as regards An Bord Pleanála, for example. The board will often say there is very little it can do about a certain matter and although the best planning reasons have been presented, ultimately it remains Government policy. This is an override clause and causes me concern for that reason. Once a Government sets down in any detail a policy as regards any medical matter, that takes precedence. That is why it causes me concern.
In effect, as regards planning matters, it has meant that planning issues are not as important as Government policy. I ask the Minister for some clarification in this regard.
This group of amendments relates to the requirements outlined in the Bill for the Medical Council to have regard to Government policies and objectives, as they relate to the performance of the council's functions and reflect on a statement of strategy, business plan and annual report. They also propose the deletion of certain provisions which relate to the format and standards applicable to these documents.
The Medical Council is a statutory body, performing its functions in the public interest. No statutory body can possibly be completely independent of public policy. It cannot ignore the normal standards of accountability applicable to statutory bodies. It must work with the Government in performing its functions and, importantly, in accounting for its performance of those functions which are to be undertaken in the public interest.
In the case of the Medical Council there is a particular requirement for it to account for its plans and their implementation because it has such a significant role in public protection. As regards amendment No. 13, as proposed by Deputy Gormley, this relates to section 7(4)(d), which specifically requires the Medical Council to have regard to the policies and objectives of the Government in the performance of its functions. Amendments Nos. 19 and 24 relate to the provisions which apply similar requirements to the council as regards its statement of strategy and business plan. It is entirely reasonable to require the Medical Council to perform its functions having due regard to public policy, given its important public interest role. For this reason I cannot accept amendments Nos. 13, 19 and 24.
Amendments Nos. 18 and 22 remove the provisions requiring the council to prepare its statement, strategy and business plan in a form and manner and in accordance with any directions issued by the Minister. The purpose of these provisions is not to interfere with operational matters, but to ensure that these documents are prepared to the highest standards and in accordance with best practice, as applies to any other body under the aegis of the Department of Health and Children, and indeed in the wider public sector. This is in the interests of effective and accountable governance as recommended in both the Prospectus and Brennan reports.
Amendments Nos. 20 and 21 related to sections 4, 5 and 13. The subsections referred to outline that the Minister may direct the council to amend its statement of strategy in specifically outlined circumstances, where it does not contain information such as the key objectives of the council, the manner in which it may measure its achievements of those objectives and how it proposes to apply its resources. A direction is also provided to amend the strategy, where the required standards are not met in the preparation of the strategy, or where it is without regard to the policies of the Government as they relate to the functions of the council.
Amendment No. 25 relates to section 15(4) which applies similar provisions regarding the council's business plan. These are legitimate matters which should and must be outlined in any statement of strategy. There must be a facility for the responsible Minister to require compliance with these matters. I consider these provisions to be reasonable and necessary and for these reasons I do not propose to accept amendments Nos. 18, 20 to 22, inclusive, and 25.
Amendment No. 23 proposes the deletion of section (15)(2)(d). This paragraph provides that the Minister may specify information to be included in a business plan. Amendment No. 26 proposes the deletion of the paragraph which provides for the Minister to specify information to be included in the council’s annual report. It seems entirely reasonable for the Minister to be able to specify certain information to be included in these documents. These are all related to accountability and should assist the Medical Council in being accountable regarding its statutory public interest functions. These are normal matters regarding accountability which I consider necessary and, therefore, I cannot accept amendments Nos. 23 and 26.
Amendment, by leave, withdrawn.
Section 7, as amended, agreed to.
SECTION 8.
I move amendment No. 14:
In page 18, subsection (1)(a), line 5, before “confer” to insert “with the agreement of the Council”.
There are concerns that the Minister will be able to take potentially sweeping powers in this provision, as drafted. There is a danger that the Medical Council will end up being perceived by medical practitioners as simply an arm of government. While I am not saying that is the Minister's intention, there are concerns about the future. Having the agreement of the Medical Council on decisions and approaches required of it seems to be a sensible idea. We should not lose sight of the issue of partnership.
Section 8(1)(a) provides for the Minister by order to assign additional functions to the council in matters it is concerned with, including the implementation of relevant matters which are European law. If the Minister could openly assign additional functions with the agreement of the council, it would mean the Medical Council could potentially refuse to implement European law. The council is the designated competent authority for the State as regards the recognition of qualifications of those medical practitioners exercising their right to free movement under EU treaties. Therefore, the provisions allowing for the Minister to impose additional functions on the council relating to these matters is required.
Under section 8(2), every order made by the Minister must be laid before the Houses of the Oireachtas which may by resolution annul the order.
I accept that the order must be laid before the Houses but that is a weak provision compared with the powers the Minister will take on. No one is arguing about EU directives. The amendment can be altered to allow for that. One must respect the idea that a body such as the Medical Council has a certain autonomy. If there is an attitude that it is simply a puppet of government, it could end up damaging the structures in place. I ask the Minister of State to consider this amendment. Allowing for EU directives, it would be a simple matter to alter the amendment. If the Minister of State cannot accept the amendment I will withdraw it and I may re-introduce it on Report Stage.
Amendment, by leave, withdrawn.
Section 8 agreed to.
SECTION 9.
Question proposed: "That section 9 stand part of the Bill."
Again I make the argument regarding partnership as opposed to dominance by a Minister. If there must be overriding political direction it should come from the Oireachtas and not from an individual Minister. I oppose the section.
A number of concerns have been expressed by members of the public at the politicisation of the Medical Council and unnecessary political interference. They see its independence being eroded. This section is a further example of that erosion. It gives the Minister the capacity to dictate to the Medical Council and to give it political direction with regard to professional conduct and ethics. That is the major source of concern of the many people who have contacted my office and who, I am sure, have also contacted other Deputies. The Minister may also have been contacted with regard to this matter.
This section provides that the Minister may direct the council on very important matters. The traditional independence of the council is going. I ask the Minister of State to comment on my objections and those of Deputy McManus before we go any further. I will resubmit my opposition to section 9 on Report Stage.
The power given to the Minister under section 9 to issue policy directions to the council explicitly excludes the areas of professional conduct and ethics, complaints, inquiries and sanctions. In addition, subsection 9(2) provides that nothing in policy directions to be given by the Minister "is to be construed to prevent the council from, or to limit the council in, performing its functions". This means that the Minister has no power to issue policy directions on fitness to practise issues, investigations and ethical matters and cannot override the functions conferred on the council by the legislation.
The purpose of such policy directions is to ensure that the work of the Medical Council would take account of public policy regarding, for example, medical education and training, medical workforce planning and compliance with relevant European legislation. These are matters which involve a number of stakeholders and not just the Medical Council.
In 2006, the Department of Health and Children issued a framework for corporate and financial governance to all regulatory and other statutory bodies under its aegis. The document outlined minimum standards expected of all such bodies. The framework is necessary in the context of the Prospectus and Brennan reports, which highlighted the need for strengthened governance across the health system.
The framework complements governance guidelines approved by the Government for all statutory bodies. In terms of the role of the governing body of any statutory body, the framework states that the documented role of the governing body should reflect its role as guardian of strategic direction and policy, including ensuring that these are in line with overall ministerial Government policy. It is not intended that the Minister can or should interfere with operational matters, which are clearly the business of the council, but that the Minister with overall responsibility for the health system must be able to give direction to any statutory body which is part of that health system, in accordance with general public policy matters.
The provision is not unique and can be found in numerous instances in other legislation on regulatory and statutory bodies. Examples can be found in section 7 of the Irish Aviation Authority Act 1993, section 13 of the Communications Regulation Act 2002, section 27 of the Sustainable Energy Act 2002, section 32 of the Transport (Railway Infrastructure) Act 2001, section 5 of the Ordnance Survey Ireland Act 2001, section 4 of the National Development Finance Agency Act 2002, section 8 of the Civil Defence Act 2002, section 6 of the State Authorities (Public Private Partnership Arrangements) Act 2002, section 31 of the Adventure Activities Standards Authority Act 2001, section 15 of the National Treasury Management Agency (Amendment) Act 2000, section 13 of the Education (Welfare) Act 2000, section 9 of the Electricity Regulation Act 1999, section 15 of the Veterinary Practice Act 2005 and section 10 of the Health Act 2004. Clearly, this is a normal provision common to regulatory bodies and I am convinced of the merits of its inclusion in the Bill in its current form.
Question put and agreed to.
Section 10 agreed to.
SECTION 11.
I move amendment No. 15:
In page 19, subsection (1)(b), lines 10 and 11, to delete “and in accordance with the request”.
The amendment seeks to provide for an element of control by requiring the Minister to work with the Medical Council rather than instruct it. The amendment allows the Minister to make a request to which the Medical Council must respond accordingly. The phrase "in accordance with the request" in section 11 seems unnecessarily restrictive.
It is important to understand the nature of the Medical Council, which can be trusted to make an appropriate response to a request by the Minister. It does not need to be nailed down in such a restrictive way. We spend a great deal of time checking on legislation and finding mistakes. The Minister, like any doctor, is not superhuman and could make a mistake in issuing a request. The Medical Council should not be forced to comply with a request it knows is mistaken and erroneous. It would not make sense to so provide.
The provision it is sought to delete is included to ensure compliance with a request by the Minister that the Medical Council make rules to facilitate the improved operation of any provision of the Act. It would not make sense to remove the words proposed to be deleted by the Deputy. Accordingly, I cannot accept the amendment.
I may reintroduce the amendment on Report Stage.
Amendment, by leave, withdrawn.
Amendments Nos. 16, 48, 49, 52 and 53 are related. Amendments Nos. 50 and 51 are consequential on amendment No. 52. Amendments Nos. 16 and 48 to 53, inclusive, may be discussed together by agreement.
I move amendment No. 16:
In page 19, subsection (2)(c), line 20, after “register” to insert “or their certificates of registration or both”.
Amendment No. 16 is included to ensure that the Medical Council can include all necessary particulars relating to a medical practitioner's registration on the certificate of registration issued to each registrant. The amendment is related to amendments Nos. 50 to 52, inclusive, proposed for section 54(5) which provides for the certificate of registration. It is possible that the council may wish to include other identifying matters such as a photograph. These amendments allow for additional details to be included.
Section 43(3) states, "The register may be established and maintained in a form that is not legible if it is capable of being converted into a legible form". Will the Minister of State explain this?
Amendments Nos. 48, 49 and 53 relate to the register, the details it contains and how it is maintained and published.
Amendment No. 48 relates to the publication of the register. Amendment No. 53 proposes home addresses should not be published. In my view, section 56 adequately provides for the publication of the register and for the protection of home addresses and other matters which should not be published in the interests of the security of medical practitioners.
Amendment No. 49 proposes the deletion of the provision which allows for the maintenance of the register in an electronic format, which is the most efficient manner for maintaining it. I propose not to accept the amendments.
Will the Minister of State explain section 43(3)?
My understanding is that it is the legal terminology used to explain that it can be maintained in computer form.
The legal terminology for computers is that if it is not legible it can be converted into legible form?
This is the advice from the Parliamentary Counsel.
Does it make sense to other members?
I must say it does not make sense to me. I do not understand it.
My understanding is there is precedent in other legislation for using this terminology.
When it comes to better English usage, it is not the best example.
I understand.
We will be voting on this Bill and no member understands the provision. Will the Minister of State agree that there is a problem with the terminology?
Having spent most of my life reading doctors' prescriptions, there are many problems regarding legibility.
Is this one not legible or has it been converted into a legible form?
We will examine the wording and return to it on Report Stage.
Section 43(4)(b)(ii) states, “the registration of a medical practitioner named in the certificate was subject to the relevant conditions specified in the certificate”. What are those conditions and are they listed?
The relevant conditions regarding a medical practitioner are spelled out in line 30, page 12 of the Bill. Any conditions applicable to the registration of a doctor must be included on the certificate.
Amendment agreed to.
We now come to amendment No. 17. Amendment No. 61 is related. Amendments Nos. 17 and 61 may be discussed together.
I move amendment No. 17:
In page 19, subsection (2), between lines 33 and 34, to insert the following:
"(i) the specification of examinations for the purposes of subparagraph (i) of section 46(b),
(j) the specification of grounds for the purposes of subparagraph (ii) of section 46(b),
(k) the grounds on which subparagraph (iv) of section 46(b) shall not apply to a medical practitioner due to the unfeasibility of a document referred to in that subparagraph being produced in respect of that practitioner,”.
This amendment makes changes to section 11 which gives the council its power to make rules. It is related to amendment No. 61 which applies certain conditions to entry into the general division of the register under section 46. The conditions for entry are intended to ensure that doctors have adequate training and experience to obtain registration in this division similar to provisions which exist for other divisions of the register.
Subsection (a) outlines that persons who are not able to be registered as specialists or trainee specialists may be registered in the general division. Subsection (b) outlines the standards or conditions by which such persons may be registered and this paragraph is the substantial amendment proposed to section 46. Paragraphs (i), (ii) and (iv) require the council to make rules governing such standards and conditions, and amendment No. 17 is consequential on that requirement to make rules.
Given the necessity to ensure that the standards for entry into the general division of the register should be at a sufficient level, I would ask Deputies to support amendments Nos. 17 and 61 as proposed.
Amendment agreed to.
Question proposed: "That section 11, as amended, stand part of the Bill."
Section 11(7) provides: "The Council shall not make rules under this section relating to a professional competence scheme except with the consent of the Minister and the Minister for Finance". Does that mean that the council cannot promote a competence assurance scheme until the Minister for Health and Children and the Minister for Finance have signed off on it?
Yes. It cannot do so.
The competence assurance scheme will not, therefore, be the responsibility of the Medical Council but of the Minister for Finance.
The section provides: "The Council shall not make rules under this section relating to a professional competence scheme except with the consent of the Minister and the Minister for Finance". I understand the matter was discussed this morning. The Minister referred to it in the context of financial implications.
I did not realise that the Minister for Finance would be the competence assurance authority for medical practitioners.
This is standard procedure.
It is not standard procedure. The Minister of State is saying that if the competence assurance scheme as put forward by the Medical Council is too expensive, the Minister for Finance can veto it. That is what the legislation provides.
The scheme must be provided within the resources allocated.
That is not what the Minister of State said on the plinth. He said the Government was going to do everything it can to protect patients. He did not say that the Minister for Finance would have the power to veto a proper competence assurance scheme.
Am I correct in saying that if the Minister for Finance vetoes it, medical practitioners will have to pay for it?
All health expenditure is based on the availability of resources.
Terms and conditions apply to the Government's commitment to competence assurance.
This is extraordinary. I thank Deputy Twomey for raising this issue. I am not aware of any other area in which the Minister for Health and Children shares responsibility with the Minister for Finance in respect of matters relating to health care and medical practise. Are we to have the right to table parliamentary questions to the Minister for Finance in respect of his or her role in the competence assurance scheme?
As I understand it, the Department of Health and Children and the Health Service Executive receive their allocations through the Estimates process and the Minister for Finance does not determine how that money is spent. Why is this being applied? Will we be able to interrogate the Minister for Finance if he or she vetoes a competence assurance scheme? I do not believe we will be allowed to do so. We will be ruled out of order before we can draw a breath. The Minister for Finance will have the power to block one of the most important schemes provided for in this legislation and nobody will be able to question this.
Why not give responsibility for the Department of Health and Children to the Minister for Finance?
Deputies will realise that no scheme can have unlimited financial implications. Section 5 of the Health Act 2004 provides that expenses incurred by the Minister in administering the Act are, to such an extent as may be sanctioned by the Minister for Finance, payable out of money provided by the Oireachtas. This applies in all areas. I do not see where the problem arises.
This does not apply in all areas. The HSE does not seek funds from the Minister for Finance. Is it that the Government does not trust the Minister for Health and Children? Is this what is going on in Government?
There is no question of the Government not trusting the Minister for Health and Children. Perhaps the Deputy does not trust the Minister.
I do not, but that is my job.
Not necessarily.
One of the outcomes of this legislation is competence assurance. The Minister of State may be good at talking about it but I suspect he does not quite understand it. Competence assurance in respect of 9,000 doctors, every three years, will result in significant costs for all involved. Perhaps the Minister of State can tell us what type of scheme will be introduced and who will pay for it?
Under self-regulation of the Medical Council, doctors paid their own registration fees. The council is, to some degree, no longer self-regulating. Therefore, doctors will not be keen to pay significant sums for competence assurance. The Minister of State said that the Minister for Finance will not be keen to pay significant amounts in that respect either.
This is the problem with rushed legislation and a failure by the Department to know what it is doing. The Department has no idea what the cost implications are. It must show a clear commitment that whatever competence assurance scheme is brought forward by the Medical Council will have as its aim the protection of patients. The Department must also show a clear commitment to funding the competence assurance scheme, otherwise we will end up with a "tick the boxes" scheme which will fall apart very quickly. We will revert to the sort of circumstances in which problems developed at Leas Cross where inspections were carried out but nothing was done to protect patients.
The Government has to tell us how it intends to fund competence assurance. It is clear that the Minister for Finance could simply veto the scheme and tell the Department of Health and Children to find funding somewhere else. While there is no problem finding €1 million to look after Professor Drumm's advisers before they move on to the private sector, there may be significant problems in getting €5 million to ensure patients are protected.
The Minister has already said there will be cost implications which will be addressed in the design of the competence assurance schemes in consultation with the Medical Council.
The Minister of State is not very sure.
Is Deputy Twomey sure?
I am not the Minister.
This is not unique to the medical profession but will happen in other areas also.
Of course, it is not unique.
That is why the pharmacy Bill is being introduced. Doctors are not unique.
The Minister of State should not demonstrate his ignorance.
It is not my ignorance but my competence.
There is no competence assurance scheme in the pharmacy Bill. It does not apply to pharmacists.
I understand that. It is coming in the second Bill. That is why the Minister is introducing in the pharmacy (No. 2) Bill.
We will wait and see. The point is that when a Government brings forward legislation, it must show how it will implement it. The committee is not soundbite territory, it is the place where the Government should indicate what it intends to do with its legislation.
We have been trying all morning to tease out what is so special about the legislation and what difference it will make. While some of the provisions on fitness to practise are very progressive, I have not been reassured about competence assurance to which I see no clear commitment. Having asked a number of parliamentary questions on the matter, I have concluded that the Government is not sure what it wants from competence assurance. While I acknowledge the complexity of the issue, the Government cannot bring forward legislation without the foggiest notion of what it wants to do in 12 months.
Deputy Harney said this morning that the competence assurance scheme would be phased in on a progressive basis. That will happen.
That is very reassuring.
I am delighted the Deputy is reassured.
I think she said it would be implemented within a five-year period.
We have no idea what she wants. She mentioned a five-year period but we have been given no information on the structures to be put in place. We do not know if competence assurance will simply entail filling out a form or taking a test every three years. There is a significant difference between the two.
It will be more than just filling out a form.
Does Deputy Devins know that for sure?
That is not how the Medical Council's current competence assurance scheme operates.
The scheme is voluntary.
Yes, but it is quite detailed. I presume the Deputy has applied.
I would like to apply. I will see what happens first.
The matter has been clarified. We will try to move on.
Question put and agreed to.
Section 12 agreed to.
SECTION 13.
I move amendment No. 18:
In page 22, subsection (2), lines 23 and 24, to delete all words from and including "in" in line 23 down to and including "Minister" in line 24.
The role the Minister will have in giving directions to the Medical Council represents another significant departure in the legislation.
We have already discussed amendment No. 18. Deputy Twomey, do you wish to speak on these points?
I wish to speak on these points as I did not get back from the coffee break in time.
I have dealt with this issue.
I was not back from the coffee break in time to deal with this matter. It is a core issue regarding ministerial direction to the Medical Council. How does this Bill differ substantially from the existing Medical Practitioners Acts with regard to ministerial responsibility?
I will go through all this again; it is quite complex.
Can the Minister of State explain the difference between the Bill and the existing legislation, as regards ministerial responsibility? Why is the Minister seeking to have such a say with the Medical Council?
Amendments Nos. 13 and 18 to 26, inclusive, relate to the requirements outlined in the Bill for the Medical Council to have regard to Government policies and objectives, as they relate to the performance of the council's functions, and be reflected in its statement of strategy, business plan and annual report. They also propose the deletion of certain provisions which relate to the format and standards applicable to these documents.
The Medical Council is a statutory body, performing its functions in the public interest. No statutory body can possibly be completely independent of public policy. It cannot ignore the normal standards of accountability applicable to statutory bodies. It must work with the Government in performing its functions and, importantly, in accounting for its performance of those functions which are to be undertaken in the public interest.
In the case of the Medical Council there is a particular requirement for it to account for its plans and their implementation because it has such a significant role in public protection. Amendment No. 13, proposed by Deputy Gormley, relates to section 7(4)(d), which specifically requires the Medical Council to have regard to the policies and objectives of the Government in the performance of its functions. Amendments Nos. 19 and 24, proposed by Deputy Twomey, relate to the provisions which apply similar requirements to the council as regards its statement of strategy and business plan. It is entirely reasonable to require the Medical Council to perform its functions having due regard to public policy, given its important public interest role. For this reason I cannot accept amendments Nos. 13, 19 and 24.
Sitting suspended at 11.53 a.m. and resumed at 12.18 p.m.
Deputy Devins took the Chair.
The Chairman has asked me to apologise to the select committee, as he has been unavoidably delayed. I will chair the remainder of the session. We resume on amendment No. 18 to section 13. The Minister of State had replied to Deputy Twomey's query.
The Minister of State has stated the Medical Council cannot be independent of public policy and must account for its functions. He also mentioned other aspects of the legislation. Ministerial function is strengthened dramatically by the Bill. Will the Minister of State indicate where ministerial functions have been increased in this legislation and the Medical Practitioners Act and why? I agree the council cannot be independent of public policy. It must account for its functions and have a business plan.
First, we are talking about a modern governance framework. It is proposed to remove the provisions requiring the council to prepare its statement of strategy and business plan in a formal manner and in accordance with directions issued by the Minister. The purpose of these provisions is not to interfere with operational matters but to ensure that the documents are prepared to the highest standards and in accordance with best practice for the production of such documents, as applies to any other body under the aegis of the Department of Health and Children and in the wider public sector. This is in the interests of effective and accountable governance, as recommended in the Prospectus and Brennan reports and the framework for corporate and financial governance adopted by the Department of Health and Children in April 2006.
The provisions are peppered with statements such as "the council shall in preparing its strategy have regard to the policies of the Government" or the Minister may indicate changes in policy and make a direction to the council. Is the Minister of State claiming these were also included in the Medical Practitioners Act?
No, I am saying this is an improvement on the old legislation. This is a modern governance framework. It is not in line with the Government's policy; it is included in the Department's guidelines.
Some of these provisions mean the council cannot be independent of public policy.
They are strengthening transparency and accountability. This is not unique to the Medical Council.
Although it is new.
It is an improvement on what was in place.
The Minister can dictate the council's policy.
I did not say that.
That is what I am asking.
It improves the governance framework. Other bodies which will be similarly affected.
Governance is fine, although it took the HSE nearly two years to set up its governance framework. Governance in this case means the Medical Council must show transparency in its operations. This must be laid before the Houses of the Oireachtas. How much influence has the Minister over the council? How much power would a Minister have to change policy?
To change the policy of the Medical Council?
Yes, or to give a direction. I raised this matter on Second Stage through the example of stem cell research. For example, if end of life directives are to be introduced, how much power does the Minister have to instruct the council on the matter?
Under this Bill, it is improving the framework for corporate and financial governance. Under the old Act, there was no provision for the Minister to influence policy or directives.
If we take the issue of ethics, how much influence can a Minister exert? Stem cell research and an end of life directive involve two important ethical issues. One could say those are two ethical issues at the beginning and end of life. If, for instance, the Medical Council disagreed with the Minister on either of those issues, can she issue a directive to the council specifying that it has to follow her policy?
One cannot issue any policy directive as regards ethical or operational issues.
That is ethics for today, but the position can change.
The provisions of this legislation are exactly the same as those in other legislation. I do not know whether these were read out to the Deputy. The provisions in this Bill apply to all regulatory bodies as regards public policy directives. In the area of education, perhaps the Government might want to fast-track training or upskilling, manpower or planning issues. Perhaps we might want to bring in foreign doctors because of a particular shortage and we would want the Medical Council to deal with that. It is in the area of education, training and broad policy issues. It applies in the health and social care professions — and no issue was raised here about that — as well as in many other ways. There is no question as regards operational issues, fitness to practise inquiries, ethical issues around abortion or end of life, stem cell research, etc. It does not apply in such cases and is specifically ruled out in section 9 of the Bill, which specifies:
The Minister may give general policy directions in writing to the Council in relation to the performance by the Council of its functions except any such functions---
(a) relating to the professional conduct and ethics of registered medical practitioners, or
(b) under any of Parts 7, 8 and 9.
That includes all the regulatory functions of the Council. I know that some tend to want to misunderstand this issue in order to confuse people, but it could not be clearer. There is no question of any ethical directives being given by the Minister to the Medical Council or interference in operational matters. We shall deal later with the form of the report and so on which is in line with the corporate governance guidelines the Government issues for regulatory and other bodies. What is included in this Bill is in line with all of that. Whether it is in the area of finance services or health and social care professionals, the accounting profession, etc., across the board these are policy provisions that have come to exist in an entire host of legislation enacted over the past couple of years.
Let us get these two points clear as regards this area because while I believe stem cell research and end of life directives are not very controversial, they give a good indication as regards where we might be going. To some degree stem cell research is---
The Deputy is talking about embryonic research. This is clearly an ethical issue. There are people who have serious issues of conscience in this regard. There is no question of giving directions as regards that issue.
Yet to some degree the courts in this country are saying there is no legal protection——
Even if the courts decide, which I do not believe will happen, that in certain circumstances——
The courts have decided.
Not on embryonic stem cell research. One cannot force any medical practitioner, whether a nurse, doctor or anybody else to do something he or she ethically does not wish to do. There is no question of that happening.
If we gave legal status to end of life directives, would that not have consequences?
I do not envisage a Government in the foreseeable future introducing abortion, for example. If that were to happen, one could still not——
I am sticking to those two issues because they are simpler.
——give directions to the Medical Council or medical practitioners. Irish law and the law in many other countries always supports people having conscientious objections on particular issues. There is no question of policy as regards ethical issues being foisted upon the Medical Council or any other group for that matter by way of this legislation. The policy directives we are talking about are those that apply to public bodies. We expect public bodies to adhere to policy matters that are the agenda of a particular Government in areas such as education, training and so on. These are the only situations in which we can envisage directives being given or, for example where there might be a shortage in a particular specialty and we wanted to fast-track the registration of people from foreign countries. We have had long discussions on this issue, but we might give a direction to the Medical Council to fast-track such a process.
If, for example, there was a pandemic, we would want all groups and stakeholders to co-operate. If there was a role for the Medical Council and for some reason it was reluctant to co-operate, that is the kind of situation envisaged. I emphasise that there is no question of any direction being given by me or any other Minister in regard to ethical matters. It would be highly improper to do so. It is precluded under the legislation. I must accept the bona fides of many people who have spoken to me. They have been convinced by others. However, the idea is bizarre. Anyone who has read the Bill can see it specifically excludes ethical, operational and fitness to practise issues.
The reason I raised this on Second Stage was to ask what direction a Minister can give in regard to, for example, the end of life issue, given the discussion at a recent conference on the issue of people making what are called living wills specifying what sort of treatment they would like to receive if they are incapacitated at the end of their days.
Under Irish law, a family can seek the court's approval in such cases. I have come across one or two cases. There is one well-known case in which the patient was in the rehabilitation hospital in Dún Laoghaire for 15 years and the family sought the court's approval because the medical profession or the hospital could not participate in a decision to bring somebody's life to an end. There was another case in recent months. I am not sure whether it has yet gone to court. However, there is no question of a Minister interfering in these issues or giving a direction. Nor can he or she do so under the provisions of this Bill.
I am looking at this issue from both sides. Having to go through the courts and fight the issue for a long time results in a certain amount of trauma for families.
I accept that, but that is the law. It is not anticipated that it will be changed in the foreseeable future. I have no plans to introduce laws in this area. It is an extremely sensitive and complex area and must be a matter for families and the courts, not for public policy in terms of a Minister laying down the law. I shudder to think how one would go about framing legislation, even if one wished to do so.
Amendment, by leave, withdrawn.
Amendments Nos. 19 to 21, inclusive, not moved.
Section 13 agreed to.
Section 14 agreed to.
SECTION 15.
Amendment No. 22 not moved.
I move amendment No. 23:
"In page 24, subsection (2), line 12, to delete paragraph (d).
I will withdraw this amendment and reintroduce it on Report Stage if I get new information in regard to it.
Amendment, by leave, withdrawn.
Amendments Nos. 24 and 25 not moved.
Section 15 agreed to.
Amendment No. 26 not moved.
Section 16 agreed to.
SECTION 17.
Acting Chairman
Amendment No. 27 is in the name of Deputy Twomey. Amendments Nos. 27 to 29, inclusive, are technical alternatives to the same part of the Bill. Amendments Nos. 33 to 36, inclusive, are related. Amendments Nos. 27 to 29, inclusive, and 33 to 36, inclusive, may be discussed together.
I move amendment No. 27:
In page 25, subsection (1), lines 21 and 22, to delete all words from and including the where it firstly occurs in line 21 down to and including Minister in line 22 and substitute the following:
"a proportion of the members of the Council shall be appointed by the Minister, a proportion shall be appointed through election by the bodies regulated by the Medical Council".
The Medical Council will be appointed by the Minister. The Minister, therefore, has a veto in regard to the make-up of the Medical Council. This is a significant change in the status of the Medical Council. I do not believe the Minister had a veto in respect of the make-up of the Medical Council prior to this.
This is the law regarding every other regulatory body to which members are appointed by the Minister. It is a formality that everybody be formally appointed by the Minister. There is no question of the Minister not accepting those nominated. It is a technical issue. This is the case in respect of every regulatory body appointed in the State including the Central Bank which is governed by the European Central Bank. The Minister appoints the governor on the advice of the Government and members of the Central Bank. This also applies in respect of the Financial Regulator and many other bodies. I can assure members that the intention is not that the Minister may not accept the nominees put forward by the different bodies. The process is consistent with other legislation and ensures everyone is on an equal footing by way of their having been appointed by the Minister.
I will be happy to clarify that those nominated will be accepted by the Minister. I can assure the Deputy it is not intended that the Minister will overrule those nominated by the bodies referred to in the Bill.
I have received a number of representations in respect of this part of the Bill. There appears to be much public concern in respect of the make-up of the Medical Council. The belief is that it will be dominated by lay people.
I am also concerned about some of the nominating bodies, for example, the Royal Irish Academy of which 300 people are members. I do not know whether one needs to be a member of Mensa or part of a learned society to be nominated to the academy.
The Royal Irish Academy nominates its own members and allows 20 new members each year. In addition, a person must be nominated by people from within that body. Election of members takes place on 16 March each year. I am concerned about this type of control being given to that type of closed shop. The Minister will have the power to appoint six people to the council. This provides for a great deal of Government intervention.
The Bill provides that appointees will have such qualifications, expertise, interest or experience as in the opinion of the Minister would enable them to make a contribution to the performance of the council's functions. However, it does not specify what type of qualifications, expertise, interest or experience is required. The provision is vague in terms of what type of people can be appointed.
The Independent Hospitals Association is also mentioned in the Bill. I am not familiar with how it was established or by whom. In addition, I have never heard of the Irish Psychiatric Training Committee. I am concerned about the inclusion of such organisations in the Bill.
We have all received representations in respect of section 17 and other sections which appear to empower the Minister to direct the council in certain matters. However, it is the make-up of the council which has caused concern, particularly among medical practitioners who believe this is a conspiracy of the laity against the professionals. This is not often the case; it is usually the other way around.
I am informed that some of my amendments have been disallowed. Amendment No. 28, which is in order, states:
In page 25, subsection (1), line 22, after "Minister" to insert the following:
", following consultation and approval by the Joint Oireachtas Committee on Health and Children".
It seeks to ensure that we are consulted in respect of the make-up of the council. That would answer some of the concerns raised by Deputy Connolly. We could act as a vetting agency in respect of the relevant qualifications and experience. The Minister may not have time for us.
I come before the committee more than most.
We have a role to play in this matter. To involve us in the process would be a way to ensure maximum consultation. While the Government has a majority on the committee, the views of members ought to be taken into consideration. My proposal represents a small way of addressing the concerns which have been raised by so many people.
I question section 17(e). I have not heard of the Irish Psychiatric Training Committee.
It is the recognised training body.
Given the inclusion of the Royal College of Physicians, the Royal College of Surgeons in Ireland and the Irish College of General Practitioners, why has there been a failure to recognise the Irish College of Psychiatry, the main body representing the psychiatric community in Ireland, and provide it with a nominee? Similar professional bodies have been provided with a role. A great deal of concern has been expressed to members on the composition of the council. While the amendments which were tabled could have addressed those concerns, they have, disappointingly, been disallowed. We register the concern among interested parties on the balance on the proposed council.
Some of the consultancy bodies have also expressed concerns, which it is only fair to record. They do not believe the proposed composition of the council strikes the correct balance with the Minister. They highlight the ministerial powers to enforce health policy directives on the council, appoint all members and remove some or all members where their behaviour prevents the council from "performing its functions in an effective manner". It is their view that the Medical Council will, de facto, become an extension of the Minister, the Department of Health and Children and the HSE. This could lead to the downgrading or altering of services without reference to national or regional concerns, the curtailment of services for financial expediency or the introduction of ethically contentious legislation without due process.
They are also of the opinion that the proposed role for the HSE on the council is inappropriate as it creates numerous conflicts of interest. The HSE would become both the employer of doctors and the purchaser of services while functioning concurrently as part of the body charged with the independent regulation of doctors and the standards of service.
While difficulties have arisen in respect of the control of the medical profession, to write it off in this way is not the proper approach to adopt. The current structures are also the ones in place throughout Europe and North America. The GMC in the UK is comprised of 40% non-medical members, which is one of the highest rates in Europe. Is the Minister's approach not throwing the baby out with the bath water? Serious concerns have been expressed by many people at the balance on the board. These cannot be addressed by way of the amendments proposed but I wish to record our concerns regarding this matter.
Concerns have been raised with me regarding the composition of the Medical Council. In responding to an earlier amendment, the Minister explained her thinking on the matter. What is the practice in the rest of Europe? Will Ireland be the first country to have a lay majority on its medical council? Why does the Minister want this to be the case? All Deputies have received representation from various groups, particularly regarding the adoption of ethical guidelines under the Medical Council. Can the Minister expand on this matter and explain why she thinks a lay majority is a good idea?
Acting Chairman
Why do paragraphs 17(1)(g) and 17(1)(h) state that the council shall include “one person nominated by the Royal Irish Academy who is not and never has been a medical practitioner in the State or in another jurisdiction” and “2 persons nominated by the Health Service Executive who are representative of the management of the public health sector”? This could mean that a complaint against an employee of the HSE would be adjudicated by a board including his or her employer.
Why does the Minister not simply accept nominations by nominating bodies? A thread of suspicion and control runs through the Bill and is hard to fathom. The nominating bodies are reputable and are recognised as having an important contribution to make. Why, then, are their nominations not good enough?
All members have been subject to pressure from various quarters and I do not refer to that. However, there is a danger of disaffection among medical practitioners. Without the goodwill of medical practitioners this legislation will not work. I wonder at the extent of the control being applied and whether or not it is absolutely necessary.
Acting Chairman
I must apologise to the committee. I did not realise that as Chairman I was not allowed to raise an issue.
The members of every regulatory body appointed in the State are appointed by the Minister, even when they are nominated by various bodies. This gives consistency and uniformity. All members are appointed by the Minister even when they have been nominated by others. However, I am happy to clarify, if possible by way of a Report Stage amendment, that nominations will, of course, be accepted. There may be an assumption that the nominations will not be accepted. I am happy to clarify that point.
Will the Minister amend the Bill?
The members of every regulatory body, even when nominated by various interests, are appointed by the Minister. It is not the intention to refuse to accept the nominees of the bodies named in the Bill.
For the information of Deputy Neville, the Irish Psychiatric Training Committee is the recognised training body. I understand that discussions are taking place regarding a possible merger between the training committee and the college. Amendment No. 33 will deal with that merger, if it arises. The college does not have a training remit and is not the recognised training body. I want to be sure the legislation covers the possibility of the two bodies merging.
Who appoints the training body?
The Medical Council. It is the recognised training body for psychiatrists.
The other bodies are representative of psychiatrists.
No, they are not. They are all training bodies. All the bodies referred to are training bodies. One of the main functions of the Medical Council is in the area of training and education and it decides on quality and so forth.
While geriatricians comprise 50 practitioners, they will have one representative. There are 2,500 practising general practitioners, but they also have one representative. The Medical Council has suggested re-jigging their representation. I want to have the scope on Report Stage to re-jig the medical practitioners' element.
The Royal Irish Academy is the recognised body in Ireland for excellence in the sciences and humanities. It is an appropriate body to participate in the council with its wider focus and perspective based on excellence. It is a good idea for the academy to participate on the Medical Council.
The nominees of the HSE and other providers will not act in a representative capacity. If a conflict of interest arises for a member of the council, the member would have to exclude himself or herself from participating in the matter. When it comes to Medical Council matters, those nominated by the HSE will not report to or represent the HSE. They come to the Medical Council with the wider perspective of having being involved in the management of health services.
I have discussed this with my Scandinavian ministerial colleagues. Many countries are examining the issue of regulation afresh. Some have a separation between registration and regulation and some have statutory regulatory bodies rather than self-regulation. The UK is moving to a situation, as advocated in a White Paper it recently published, where there will not be a majority of doctors on the body. That is the way the world is going. I attended a meeting recently where Gro Harlem Brundtland, a former Prime Minister of Norway and Director General of the WHO, said the days of self-regulation in the medical profession were quickly coming to an end.
What informs my view is my experience in other areas of regulation. When I introduced the IASA Bill to establish the supervisory body over the accounting profession, there was much unease among accountants that only four out of the 15 members of the body were accountants. One will not meet an accountant now who is not happy and does not believe the body has inspired public confidence in the profession. I would be amazed if any member could cite an accountant that will say it was a bad idea.
Many doctors who belong to representative bodies but do not attend their meetings have said that, on balance, this structure for the Medical Council is the right formula for their profession. Next Monday, we will launch the health and social care professionals council. The ministerial appointees are reputable people, not political hacks. We went to significant trouble to get people of substance and who have a contribution to make. I do not believe there will be a single criticism levelled against any member of that council. It depends on our imminent rendezvous with reality and it may well be another Minister who will make the nominations. I would have every confidence that he or she would appoint patients' representatives to that council. I hope it will go in our favour and that is my ambition, but it may well be that some other Minister will make these nominations. I should like to find as patients' representatives people who have been involved in some of the causes and have been fantastic champions for patients, yet have not been anti-doctor in the process. Such people will have been balanced and fair, in my opinion, in the manner——
The Irish Patients Association would have fitted that bill, if it had been delegated as one of the nominating bodies.
That might well be the case. However, the Irish Patients Association is a very small organisation. There are quite a number of patients' groups and we need to be careful. However, if I am the Minister making the nominations, I intend to have some patients' representatives among the six members I will have to nominate as people with the competence, skill and confidence to be able to participate at this level of medical regulation.
That may be very laudable, but this Minister will not always be making the appointments in the future.
I will have confidence in my successor. After all, we live in a democracy.
I would not have much confidence in the event of Fianna Fáil being in power on its own.
I do not accept that.
The Minister has mentioned that the world is moving towards having a lay majority, but where has this been introduced? Is there any country where——
The UK has just produced a White Paper. I am not aware of legislation going through any other parliament at the moment in this regard. Many jurisdictions have more modern legislation than Ireland. Ours dates back to 1978. However, it is not necessarily bad to be first. We have done it with the health and social care professionals, we are doing it with the Pharmaceutical Society of Ireland——
It is a matter of recognising that we are first. The World Medical Association, for example, has expressed its concern. It is concerned about the removal of democratic and very efficient self-regulation of the profession. It is a clear deviation from the traditional norm of self-regulation. What has the Minister to say to that?
That is a trade union. I do not like to use the term "trade union" because it often offends professions, but it is a representative body for doctors, of which the IMO is a member. Naturally some of its members may think along those lines. That is not unusual.
It is a worldwide organisation.
It is a world body, but it is equivalent to a congress of trade unions.
If the world is moving in the direction the Minister is suggesting, the trade union worldwide medical organisations is setting out its position.
Naturally, it would say that. I know professionals do not like it. My husband worked for IBEC and I used to tell him he was a trade unionist and he did not like to hear that, but he was. This is also a trade union in that sense.
I know people do not like to consider themselves as part of a trade union, but representative bodies are obviously going to articulate their concerns. However, we must think of wider interests. I have been very encouraged. All of the non-representative groups I have spoken to, such as patients' representative bodies, have been very supportive of these provisions. Obviously the Medical Council has not got involved in this issue.
Is the Medical Council a statutory organisation?
It has always been a statutory body. Any council established by statute——
It is no longer self-regulated.
It is self-regulated, but it is a statutory body.
It has a lay majority.
That is correct, but it is still governed by self-regulation.
What about other boards such as the Health and Social Care Professionals Council?
That has a lay majority as well.
It is a statutory body, is it not?
That is correct. The Medical Council is a statutory body, funded by the profession. For the first time, because of competence assurance we shall give money to the Medical Council. Heretofore, all its financing came from the registration fees of its members, and that will continue.
Will it remain self-regulating when it does not have a lay majority?
That is not the issue of self-regulation, which is where a body funds its own registration and regulation. In some of the Scandinavian countries the regulation side is funded by the state and not by the profession. The president and vice president will obviously be members of the profession.
Does the Minister plan to leave the registration to be funded by the members and the competence assurance to be funded by the State?
No. Obviously the State will be contributing to the competence assurance element because this will be extraordinarily expensive. I believe that we have a duty in that regard. It is fair and right to do that and not leave all the onus on the medical profession to fund competence assurance, which could be very unfair on some individuals. It is right to keep regulation and registration together. However, it is not done like that in some other countries.
Is there a member of the Royal Irish Academy on the board of HIQA?
No.
Is there a member of the Health Service Executive on the board of HIQA?
No.
Is there a member of An Bord Altranais on the board of HIQA?
No.
Are any other regulatory bodies represented on the board of HIQA?
There are members of other bodies. The board of HIQA is, at the moment, an interim board because we have not yet passed the legislation.
Is there any cross-pollenation across the professions?
In other bodies, yes.
How well does it work?
I am advised that there are doctors on An Bord Altranais. Having a representative on An Bord Altranais was suggested by doctors as a good idea.
I ask because there is a certain sense that there is not really a medical council, given that there is such a variety of members. I am not saying doctors should be treated differently, but one does not see the same variation of representation in respect of the boards of the regulatory bodies of other health care professionals.
The nurses and midwifery regime has to be reformed, although I am advised there are doctor representatives on the current board. A Bill is being prepared in my Department.
There may be doctors on the board of An Bord Altranais. Is there a representative of the Department of the Minister for Health and Children on An Bord Altranais?
The Medical Council has a significant role in the provision of education and training. The Government yesterday accepted the expert report on the new medical school in Limerick.
Nursing is just as important.
The Minister for Health and Children has a role in these matters, and in regard to nursing the Minister for Health and Children pays.
Has the Minister for Education and Science a nominee on An Bord Altranais?
Probably not on the current board. I do not know the answer to that question.
Acting Chairman
It is just after 1 p.m. It was agreed to adjourn until 1.30 p.m.
Sitting suspended at 1.05 p.m. and resumed at 1.35 p.m.
Acting Chairman
We resume our discussion on section 17, amendment No. 27.
It was stated before the suspension that the reason the HSE or other bodies are not represented on An Bord Altranais is that the organisation is 20 years old. HIQA is not even 24 hours old and it does not include members of either organisation.
It must set the standards for the provider and, as such, a conflict would arise.
A conflict would arise in respect of employers being on the Medical Council but no conflict arises in respect of their setting standards.
The role of HIQA is to set standards and to monitor how the provider, the HSE, does its job. There is no conflict between the HSE and the regulation of the medical profession. As I stated, the nominees when appointed will not represent the HSE. Their first duty is to the council and not the HSE. They do not report back to it and must observe confidentiality.
No conflict arises when two members of the employers are appointed to the Medical Council.
No.
Issues of collegiality arose in respect of the Neary hearing. I have major difficulties with this. People cannot be members of the HSE one day and be appointed to the Medical Council the next and forget about the HSE. It does not work that way. The Medical Council will be made up of powerful and influential people.
I have made my point. As I understand it, the Deputy wants the majority of appointees to the Medical Council to be doctors. It is not unreasonable that the organisation with responsibility for employing the vast majority of doctors who work in this country should be in a position to nominate people in order to bring a wider management perspective to the work of the council. This will be good for the Medical Council and the individuals nominated to participate. On a personal level, it will provide them with important insights. Clearly, they or any other member cannot be in any conflict situation. This situation pertains to other boards, given that we are a small country. Where conflict arises it will be dealt with by the code of governance. People exclude themselves from situations in which they believe a conflict of interest might arise.
Would we have been better off providing for a larger Medical Council? The Medical Council is perceived as representing doctors though it is broadened quite dramatically in this Bill. Five medical organisations and six organisations allied to the medical profession are represented on the council. This is before any medical doctors or the Minister's appointees are elected. I have nothing against some of these representatives being involved, particularly those from An Bord Altranais and the Health and Social Care Professionals Council. However, I do not know who will be the representative from the Independent Hospice Association of Ireland — it could be Jimmy Sheehan for all I know.
The council will also be made up of members of the HSE and HIQA. This is a strange set-up for a medical council. It takes a certain amount of focus from what the Medical Council does in terms of setting standards for doctors in Ireland. As I stated on Second Stage, the Medical Council has been broadened into a type of quasi-patient safety authority though that is not what it is. Would it not have been better to revise the provision and enlarge the Medical Council? It might function better.
When I set out to draft the legislation, my aim was to make the council substantially smaller. From a logistical perspective, large organisations are difficult to chair and manage. I accept that 25 members represents a large council. To make it larger still would make it very cumbersome and unwieldy. It would be more like an assembly.
Flexibility is important for the council to allow it recruit the necessary expertise for its various committees. By virtue of the prescriptive nature of law, one cannot specify in legislation the complete range of expertise one would want in any given scenario. Providing the council with the freedom and flexibility to recruit to committees from time to time is, therefore, a better approach.
I spoke this morning about the burden on individuals, but there may also be a need to obtain expertise in areas we have not envisaged and which are not catered for on the council. Such flexibility will be a good thing. Not everybody would wish to be a full member of the council, given the responsibilities and time commitments involved.
If I could have reduced the membership to 12 or 15, I would have liked to have done so. With the need to provide training bodies with a reasonable number of representatives and other requirements, it became extraordinarily difficult to achieve my original goal. Whatever may be the case in the future, it was not possible at this time
Deputy Twomey wishes to ensure that those nominated by the bodies are appointed by the Minister. I am happy to consider an amendment on Report Stage to make such a provision, which is in keeping with our legislative intent.
Amendment, by leave, withdrawn.
Amendments Nos. 28 to 32, inclusive, not moved.
I move amendment No. 33:
In page 25, subsection (1), lines 36 and 37, to delete paragraph (e) and substitute the following:
"(e) one registered medical practitioner nominated by—
(i) subject to subparagraph (ii), the Irish Psychiatric Training Committee in relation to psychiatry,
(ii) if a body other than that Committee is approved under section 89(3)(a)(ii) to grant evidence of the satisfactory completion of specialist training in relation to psychiatry, that body;".
Amendment agreed to.
Amendment No. 34 not moved.
I move amendment No. 35:
In page 26, subsection (1), lines 11 to 14, to delete paragraph (k) and substitute the following:
"(k) one person nominated by the Health and Social Care Professionals Council—
(i) subject to subparagraph (ii), who is a registrant within the meaning of section 3 of the Health and Social Care Professionals Act 2005,
(ii) in the absence of any such registrant, a person who is a member of a designated profession within the meaning of that section;".
Amendment agreed to.
Amendment No. 36 not moved.
Section 17, as amended, agreed to.
Sections 18 and 19 agreed to.
SECTION 20.
I move amendment No. 37:
In page 28, subsection (3), line 29, after "Part 10” to insert “or section 106”.
Amendment No. 37 is intended to allow the Medical Council to assign to its education and training committee such of its functions as it considers appropriate under section 196 which relate to the Anatomy Act. Given that the functions include the inspection of schools of anatomy which are attached to the medical schools, it would be appropriate to allow the council to assign them to the education and training committee if it so wishes. The amendment provides the council with the flexibility to make practical arrangements.
Amendment agreed to.
Acting Chairman
Amendments Nos. 38 and 49 are related and may be discussed together, by agreement.
I move amendment No. 38:
In page 29, subsection (10), line 5, to delete "not".
The Minister has made up her mind on the issue of a lay majority on the council. We are trying to establish a system which the medical profession and the Minister can understand and in which people can have confidence. The Minister is convinced that the public are in favour of having a lay majority on the Medical Council. The Medical Council has been damaged by the handling of the Dr. Neary affair. This has led to the public's slanted view of how the council operates. Many people are of the impression that the three obstetricians who examined the case were appointed by the Medical Council and that they exonerated Dr. Neary. That is not the case. The Medical Council acted appropriately when it was made aware of what was happening in Our Lady of Lourdes Hospital. I can understand how a difficulty might arise. I have even heard speakers in the Dáil Chamber confusing the names of the Medical Council, Comhairle na nOspidéal, the Royal College of Surgeons in Ireland and the Royal College of Physicians of Ireland. It is easy, therefore, for the general public to be confused as to the role of various organisations in the Dr. Neary affair.
This confusion is clouding the judgment of the public regarding this Bill. The Minister is exploiting this confusion. She tags a reference to Dr. Neary to many of her public utterances regarding the appointment of a lay majority to the Medical Council. This reinforces in the public mind the idea that the Medical Council is associated with Dr. Neary and is a bad thing. The Minister has her own reasons for ensuring a lay majority on the Medical Council but in order to sell the idea to the public she has linked it with the Neary affair.
The Minister accepts that the Medical Council operates relatively effectively under existing legislation. Unfortunately, it does not have the capacity to bring in outside help to sit on some of its committees. The council is forced into an all or nothing situation of either sanctioning a doctor or letting him or her off completely. The new mediation process will deal with that difficulty. The Medical Council has been very effective, considering the resources it has been given. The new Medical Council will have a very significant workload in dealing with competence assurance but will not be given the necessary resources and will face the same problems as the old one.
Amendment No. 38 will require a majority of the members of the fitness to practise committee to be members of the medical profession. Amendment No. 39 will impose the same requirement on all other committees. In the interest of the future of the Medical Council we must reach a decision on this matter. The Medical Council acted appropriately in the Dr. Neary affair. The three obstetricians concerned were sanctioned, to some degree, by the fitness to practise committee but not by the full committee. It is unfortunate that the Medical Council was seen to have allowed the three obstetricians to proceed with no sanction.
Given that the full council will have a lay majority, will the Minister accept my amendments and allow the fitness to practise committee to have a majority of medical practitioners? In such a case, the full council and the fitness to practise committee could be seen to represent both sides.
Medical majorities tend not to support the doctor in fitness to practise cases. International evidence supports the claim that fitness to practise committees with a majority of medical practitioners tend to be harder in censuring doctors. The overall council seems to have taken on increased responsibilities. It will not just be concerned with doctors but will be the patient safety authority for the health services. When the dust settles and Dr. Neary is no longer in the headlines and HIQA is properly established, if there is an overall lay majority on the Medical Council, then there should be an overall medical practitioner majority on the fitness to practise committee.
I do not agree. I accept the Deputy's claim about international evidence on fitness to practise committees and doctor majorities. The Irish Hospital Consultants Association suggested not having a doctor majority on the fitness to practise committee but that was in the context of not having a lay majority on the council.
The fitness to practise committee will have the power to decide whether a hearing will be in private. In order to maintain public confidence in that decision, a lay majority is important. It is provided for in the Bill that, as a matter of course, hearings will be in public except when there is a good reason they should not be. It is the fitness to practise committee, composed of a lay majority, that makes that decision. For this reason, I am not in favour of accepting the Deputy's amendment.
In courts every day of the week, juries of ordinary women and men listen to expert witnesses across a range of subjects, assess the evidence and come to a decision as to whether a person is guilty of a serious office. No one has ever suggested ordinary women and men are not capable of doing this. There will be legal representatives for the doctor in question and rights and natural justice will have to be protected.
The preliminary hearings committee and the mediation and other processes, including the health committee, will ensure issues not relevant to fitness to practise will be dealt with elsewhere. Serious issues will go to the fitness to practise committee. It is not a question of its being the only forum. I envisage the matters that will come before the committee will concern serious matters of alleged professional misconduct. The public and patients would have greater confidence in a fitness to practise committee structured along these lines.
The council will be obliged, as it is now, to accept the findings of the fitness to practise committee and the sanctions are a matter for it. This was the case in its most recent publicised inquiry.
It is not the case that I constantly refer to Dr. Neary. When the Harding Clark report was published, I went out of my way to say it was not all black and bad, that Dr. Neary had done some good things and we had to be fair and balanced. I trust that I am fair and balanced in the manner in which I address these issues. However, I have to be informed by Judge Harding Clark's report and this Bill is informed by the recommendations she makes. Having presided over an inquiry for a considerable length of time, it would be foolish not to be mindful of the recommendations she has made, along with others which we shall deal with later. When other experts were asked to examine various aspects of the health service, they made recommendations and we are informing ourselves in this legislation about these as well. We are taking on board the recommendations made by those who have had a specific task in looking at issues. We need to learn from this and it would be foolish of me not to do so.
I have praised the Medical Council on the manner in which it handled the most recent matter. Many people have criticised me for praising the council and said there should have been sanctions imposed, etc. However, the council, in initiating the investigations in the first instance, took the appropriate course of action. I do not believe there was an alternative course of action it could have taken. It was right to do that, despite all the consequences. I am not going to say any more because these matters will be adjudicated on in the courts, certainly as regards two of the three individuals. I am not aware of the status of the third.
In any event, these issues are before the courts and I do not wish to say anything that might prejudice the outcome of those hearings in any way. It is has been difficult for everybody involved, including the three doctors in question. They are eminent professionals, their own practices were not the grounds for complaint, but rather the inquiry, the manner in which it was done and what was and was not said, the conclusion they came to which was not included in the report and so on. Doctors have said to me, "There but for the grace of God go I", and everybody will learn from this experience. The manner in which that has been handled will fundamentally change the culture and that is good for the profession and patient safety.
I am not in any way suggesting that bodies with a lay majority are unable to adjudicate on the complexities of such cases. As the Minister says, in any court of law lay people are well able to adjudicate once they are given direction and assistance. That is not the point I am making.
There is a difficulty when talking about this issue in light of the Neary case. Although I was pretty annoyed with those three people who went to Our Lady of Lourdes Hospital, I never questioned the fact that they were good obstetricians. We know they were good, in fact they were fantastic obstetricians. The problem was they went to Our Lady of Lourdes Hospital as experts, to exonerate someone, or to look at his practice, one or the other. In the way matters were structured they went there as experts and another outcome would have been quite possible if subsequent events had not occurred at Our Lady of Lourdes Hospital.
However, if we are trying to be dispassionate about this, and even if someone decides that what we are doing today is wrong, as the Minister clearly pointed out, the last Medical Practitioners Act was passed in 1978. Neither she nor I will be here in 30 years if any mistakes are made with this legislation. It is possible now to arrive at a position where there is a lay majority, while at the same time having a medical majority on the fitness to practise committee with the inference, almost, that the two structures will hold each other to account.
I also received correspondence on this issue. The Minister says people reported that the fitness to practise committee had sanctioned the three obstetricians in question, but when matters went to a full council hearing no sanction was applied to them. When one talks about public confidence in the Medical Council, people read that in the newspapers but they did not go to the Internet and read the transcripts which showed why they were sanctioned by the fitness to practise committee and no sanction was applied by the full council. People assumed that this was just doctors looking after their own.
Given a Medical Council with a lay majority, people will assume that it is just the Government of the day protecting its own interests. There is a possibility that the profession and the council may be seen to be watching over each other. If the Minister does not want to accept the amendments, I shall just withdraw them.
Amendment, by leave, withdrawn.
Amendment No. 39 not moved.
Section 20, as amended, agreed to.
Sections 21 and 22 agreed to.
SECTION 23.
Acting Chairman
Amendments Nos. 40 to 43, inclusive, are related and may be discussed together.
I move amendment No. 40:
In page 30, subsection (1)(c), line 2, after “satisfied” to insert the following:
"on the recommendation of the President of the Council".
When I initially raised the point that the Minister had the power to abolish the Medical Council, the Minister denied it. However, it is clear that under this legislation the Minister has the power to remove the Medical Council. That is not the way to deal with a situation, which is unlikely but could arise, where a Medical Council has to be removed owing to unforeseen circumstances.
The first amendment refers only to a member. I would have thought the Minister would have no difficulty in accepting it given that I suggest there be a recommendation from the president of the council before a Minister moves in regard to a council member. That is a very good and simple safeguard to ensure, first, that justice is done and, second, that the public interest is safeguarded.
In regard to amendments Nos. 41 and 42, I suspect the Minister will not accept them because she seems to be of the opinion that the Minister must always be in the driving seat and that nobody else has the authority of a Minister. There is a higher authority and that is the Oireachtas.
If we are changing the nature of the Medical Council so profoundly, it is important to have democratic oversight. Giving such powers to a Minister does not provide the kind of democratic oversight that engenders full public confidence among the people working within the profession who are directly affected or the people on the outside receiving services from that profession. I hope the Minister will accept these amendments. It would be a new departure but it would ensure full democratic accountability.
When we look at the health service now we see less democratic accountability than we have ever had. Decisions are made daily that are unfathomable and people feel very alienated from the structures put in place by this Minister. Those are the kinds of conditions in which things can go badly wrong and scandals can be created because there is no accountability.
The Minister is being fairly forthright in saying she wants to expand the boundaries of the Medical Council. She has convinced me in regard to measures she has proposed. I would like to see her go a bit further and prove her mettle.
I am smiling because this power exists in the 1978 Act and it has never been used.
That is an indication that the Medical Council has been doing a good job.
The reason we cannot do it on the advice of the president the council is that one might want to remove the president of the council. However, I am happy to agree to the Deputy's proposal in regard to the Oireachtas. Clearly, this would happen only in an extraordinary situation. I will have to table an amendment, but I will be happy to do that. I will not be removing the Labour Party members, if there are any. The Deputy need not worry about that.
It is not the Labour Party people I would worry about.
Amendment, by leave, withdrawn.
Amendments Nos. 41 to 43, inclusive, not moved.
Section 23 agreed to.
Sections 24 to 29, inclusive, agreed to.
I move amendment No. 44:
In page 34, between lines 41 and 42, to insert the following subsection:
"(8) A disclosure under this section or section 31 shall be recorded in a register together with particulars of any interest of members of the Council or committee or persons to whom section 31 applies, and the register shall be available to public inspection during office hours.”.
I raised the issue of declaration of interests during the debate on the Health Bill. There needs to be a register which records the interests of members of the council. I am concerned that this legislation makes no such provision.
We are faced with an enormous task to ensure that conflict of interest issues are dealt with in a robust manner that copperfastens protection of the public good. This task has been left unfinished by the Government as it goes out of office. There are many predators seizing parts of the health service in order to make profits. They are doing this in a manner that is generally unregulated. Hospitals are not regulated. People can set up private hospitals with no more than planning permission and a fire certificate. They can also act as advisers to the CEO of the HSE, leave prematurely and accept nomination to a board of directors of a private company promoting primary care. Many of these loopholes need to be closed off. The amendment seeks to ensure protection of the common interest.
A person in private business could not, as did the adviser to Professor Drumm, move from his or her position to a related position. The term "gardening time" is often used in this regard. However, that is a matter for another day. We must deal by way of legislation with the conflict of interest which arises in this instance.
The Medical Council is subject to the provisions of the Ethics in Public Office Act. This matter is covered by that legislation and applies to all regulatory bodies of this kind. I do not see the necessity to amend this section.
Is the Minister satisfied the matter is dealt with by way of existing legislation?
Yes.
Amendment, by leave, withdrawn.
Section 30 agreed to.
Sections 31 and 32 agreed to.
SECTION 33.
I move amendment No. 45:
In page 36, subsection (1), line 13, after "may" to insert "with the consent of the Minister for Finance and".
This amendment concerns good governance which applies to all types of bodies. The Medical Council has power to borrow for capital or current purposes. The amendment seeks to ensure good financial governance.
Amendment agreed to.
Section 33, as amended, agreed to.
Sections 34 to 38, inclusive, agreed to.
SECTION 39.
Acting Chairman
Amendments Nos. 46 and 47 are related and will be taken together by agreement.
I move amendment No. 46:
In page 38, subsection (1), line 27, to delete "after consulting" and substitute "on the recommendation of".
The issue of excessive ministerial control also arises in this section. Surely the council can do as it wishes in respect of designation of titles. In addition, there should be some acknowledgement of the right of a person using the title. These are two basic proposals which the Minister could accept comfortably.
I will discuss the matter with the Parliamentary Counsel. As I understand it, the Minister is required to consult the council. I will return to the matter on Report Stage.
Amendment, by leave, withdrawn.
Amendment No. 47 not moved.
Section 39 agreed to.
Sections 40 to 42, inclusive, agreed to.
SECTION 43.
I move amendment No. 48:
In page 40, subsection (1), line 32, to delete "and maintain a" and substitute the following:
", maintain and make available to the public a published".
I will withdraw the amendment until Report Stage on the basis of the Minister's earlier response.
Amendment, by leave, withdrawn.
Amendment No. 49 not moved.
I move amendment No. 50:
In page 41, subsection (5)(b), line 40, to delete “and”.
Amendment agreed to.
I move amendment No. 51:
In page 41, subsection (5)(c), line 42, to delete “included.” and substitute “included, and”.
Amendment agreed to.
I move amendment No. 52:
In page 41, subsection (5), between lines 42 and 43, to insert the following:
"(d) such other identifying particulars of the practitioner as the Council considers appropriate.”.
Amendment agreed to.
Amendment No. 53 not moved.
Section 43, as amended, agreed to.
SECTION 44.
Acting Chairman
Amendment No. 54 is consequential to amendment No. 55. The amendments may be discussed together by agreement.
I move amendment No. 54:
In page 42, subsection (1)(a), line 20, after “shall” to insert “, subject to subsection (2),”.
Amendment No. 54 is technical and required as a consequence of amendment No. 55 which proposes to insert a new subsection in section 44, which provides for the period of transition between the repeal of the 1978 Act and its amendment and the establishment of the new register. Under section 28 of the Medical Practitioners Act, persons with internship registration are subject to certain conditions which limit their practice. Similarly, section 29 of the Act requires those with temporary registration to practise only in specific, recognised training posts. During the transitional period between the repeal of the existing Acts and the establishment of the new register with its appropriate divisions, the amendments will ensure that such persons continue to be subject to the conditions which apply to their existing registration.
Amendment agreed to.
I move amendment No. 55:
In page 42, between lines 33 and 34, to insert the following subsection:
"(2) Without prejudice to the operation of subsection (3), a medical practitioner whose name is entered in the General Register of Medical Practitioners pursuant to—
(a) section 28 (as substituted by section 6 of the Act of 2002) of the Act of 1978, or
(b) section 29 (as amended by section 7 of the Act of 2002) of the Act of 1978, may, for so long as the practitioner’s name is so entered, only practise medicine pursuant to that registration subject to the same conditions that were applicable to the practise of medicine by that practitioner immediately before the commencement of section 3.”.
Amendment agreed to.
Acting Chairman
Amendments Nos. 56 to 59, inclusive, 98, 100 to 107, inclusive, and 109 to 111, inclusive, are related and may be discussed together, by agreement.
I move amendment No. 56:
In page 43, subsection (3)(d), lines 5 and 6, to delete “of the Act of 1978”.
These technical amendments have been suggested by the Parliamentary Counsel to correct technical drafting errors and faults of style. They address certain wording and incorrect citations of Acts such as the reference to the Anatomy Act 1832.
Amendment agreed to.
I move amendment No. 57:
In page 43, subsection (3)(d), line 6, after “2002)” to insert “of the Act of 1978”.
Amendment agreed to.
I move amendment No. 58:
In page 43, subsection (3)(f), lines 19 and 20, to delete “of the Act of 1978”.
Amendment agreed to.
I move amendment No. 59:
In page 43, subsection (3)(f), line 20, after “2002)” to insert “of the Act of 1978”.
Amendment agreed to.
Section 44, as amended, agreed to.
SECTION 45.
I move amendment No. 60:
In page 44, between lines 41 and 42, to insert the following subsection:
"(7) For the avoidance of doubt, it is declared that the Council shall not register a medical practitioner pursuant to section 46, 47, 48 or 49 unless the practitioner has made an application under subsection (1).”.
The amendment clarifies that before a medical practitioner's name may be registered as a specialist, trainee specialist, intern or in the general division of the register, he or she must have made an application for registration under section 45(1). The provision is intended to ensure that no doubt exists as to how the procedure for registration should be undertaken by a medical practitioner and the council.
Amendment agreed to.
Section 45, as amended, agreed to.
NEW SECTION.
I move amendment No. 61:
In page 44, before section 46, to insert the following new section:
46- The Council shall register in the General Division a medical practitioner (other than a visiting EEA practitioner)—
(a) who is not able to be registered—
(i) in the Specialist Division pursuant to section 47, or
(ii) in the Trainee Specialist Division pursuant to section 48 or 49,
and
(b) who--
(i) has passed an examination, specified in rules made under section 11 for the purposes of this subparagraph, for the purposes of registration in the General Division,
(ii) is exempted from subparagraph (i) by virtue of falling within a ground, specified in rules made under section 11 for the purposes of this subparagraph, for such exemption,
(iii)is a national of a Member State who has been awarded a qualification in medicine or a certificate of acquired rights by a competent body or authority designated for that purpose by a Member State, pursuant to Directive 2005/36/EC, or
(iv)subject to rules made under section 11 which apply to this subparagraph, has been granted a document which, in the opinion of the Council, is at least the equivalent of a certificate of experience.”.
Amendment agreed to.
Section 46 deleted.
Section 47 agreed to.
SECTION 48.
I move amendment No. 62:
In page 46, subsection (3), line 18, to delete "third country" and substitute the following:
"Member State who does not fall within subsection (1) or (2), or who is a national of a third country,”.
The purpose of the amendment is to correct an omission in the drafting of section 48. The amendment will allow nationals of EU or EEA member states who have a medical qualification from a third country to gain entry to the trainee specialist division of the register.
Amendment agreed to.
Acting Chairman
Amendments No. 63 and 64 are related and will be discussed together.
I move amendment No. 63:
In page 47, subsection (5), line 10, after "medicine" to insert the following:
"but, in any case, not later than 14 days after so ceasing to practise medicine".
The intention of these amendments is to prevent situations where registration for a specific training post could be effectively blocked because the council could not remove the registration of an individual who does not notify the council that he or she no longer works in a training post. Amendment No. 63 provides that a medical practitioner who has been employed in a training post must notify the Medical Council when he or she leaves that post within 14 days of vacating the post.
The effect of amendment No. 64 is that the council cannot register the medical practitioner in more than one division of the register and that on leaving the training post, the medical practitioner's name may then be registered in the general division.
Amendment agreed to.
I move amendment No. 64:
In page 47, lines 12 to 14, to delete subsection (6) and substitute the following:
"(6) Where--
(a) the Council receives a notice under subsection (5) from a medical practitioner, or
(b) a medical practitioner fails to comply with subsection (5),
sections 45(3) and 46 shall apply to and in relation to the Council and the practitioner.".
Amendment agreed to.
Section 48, as amended, agreed to.
Section 49 agreed to.
Amendment No. 65 not moved.
Section 50 agreed to.
Sections 51 to 56, inclusive, agreed to.
SECTION 57.
I move amendment No. 66:
In page 53, subsection (1)(g), line 6, after “offence” to insert the following:
"(being an offence which does or could potentially reflect on the registered medical practitioner's fitness to practice medicine)".
The category of offences triable on indictment is extremely wide as, apart from road traffic offences, everything else can be tried on indictment. Many such offences could have nothing to do with practising medicine, for example, a technical breach of the Planning Act or the Companies Act. There should be some limit to what offences can result in a person being struck off.
This point is covered in section 57(6).
Is it because the offences triable on indictment are so broad?
It has to be a matter that affects a doctor's ability to practise medicine. Section 57(6)(i) states, “the nature of the offence that is the subject of the complaint or the circumstances in which the offence was committed render the practitioner permanently unfit to continue to practise medicine”. That excludes the issues raised by the Deputy.
One can make a complaint but it will not be considered.
It has to be an offence that would render the person unfit to practise medicine. It cannot be a driving offence.
What if an individual informed a doctor that a complaint would be made to the Medical Council because he or she did not get planning permission for a garage?
An individual cannot do that.
It can be done but the Medical Council cannot investigate it.
It would go to the preliminary proceedings committee and be thrown out.
It would be more sensible not to have that situation arise at all.
If it could be avoided, I do not know how everything would be spelled out.
As it will be included in a later section, why not include it in this section to ensure no nonsensical complaints come forward that take up the council's time in determining that it does not have to deal with them?
In the example given by the Deputy, that is clearly not a matter for the Medical Council.
Under this Bill it is.
It is not if it does not affect the practice of medicine.
Then why not accept my amendment?
Let me take advice in regard to the amendment.
I will withdraw it and resubmit it on Report Stage.
We cannot stop somebody phoning or writing to the Medical Council.
I am not saying we should stop anybody doing anything. What I am saying is that it can be extremely stressful for a practising medical doctor to be told he or she is being reported to the Medical Council for an infringement of the planning laws. If it is clear from the beginning that this is not an issue for the Medical Council, there is no question of it happening. However, currently there is a process whereby if somebody has a nark with or does not like his or her neighbour he or she can complain to the Medical Council. The complaint is on record and the Medical Council must consider it and then eliminate it.
Section 57(1) provides that a person, including the council, may make a complaint to the preliminary proceedings committee concerning a registered medical practitioner on one or more of the grounds of professional misconduct, poor professional performance, a relevant medical disability, failure to comply with a relevant condition and so on. I do not disagree with the Deputy. We do not want the Medical Council dealing with every whinge somebody has against a doctor.
That is my point.
I will take advice on whether there is a way of tightening this up. I appreciate the Deputy's point. Clearly such complaints would be thrown out.
Amendment, by leave, withdrawn.
Acting Chairman
We now come to amendment No. 67 in the name of Deputy McManus. Amendment No. 68 is related. Amendments Nos. 67 and 68 will be discussed together.
I move amendment No. 67:
In page 53, between lines 9 and 10, to insert the following subsection:
"(2) A complaint shall be made on a form prescribed by the Council and shall contain sufficient particulars to enable the registered medical practitioner to which the complaint relates to respond to the complaint.".
I have tabled this amendment on legal advice, so I am taking it seriously. Greatly increased grounds for complaint in this Bill would give rise to very significant pressures. These would go even further if there were not some degree of formality.
Clearly it is important that there should be some formality in terms of the contents of the complaint, in fairness to the doctor complained against. If there is a complaint it should contain sufficient particulars to enable the doctor to respond. It sounds obvious. However, it is a very good idea to set out the parameters so that a complaint can be understood and the doctor given the opportunity of responding.
I would have thought that was covered under the current legislation.
We will not have the current legislation. We are introducing new legislation.
It is covered under this Bill.
Where?
In section 107. We spoke this morning about the forms giving the council the power. I am advised that subsection (5) deals with that but I will check it.
On that basis I will withdraw my amendment and resubmit it on Report Stage.
The Deputy wants to ensure that the nature of the complaint is clear to the person against whom the complaint is made. That is not unreasonable.
Yes. It must be remembered that we are talking about a person's livelihood.
I accept that.
Amendment, by leave, withdrawn.
Section 57 agreed to.
SECTION 58.
Question proposed: "That section 58 stand part of the Bill."
In light of the whistleblowing provisions introduced yesterday, we will have to introduce an amendment because it impacts on this legislation.
Does that mean we will have a debate on it?
It is not the same. It is a technicality to refer to what has already been done in other legislation.
It is not inconsistent with the Bill.
No.
I thought when we dealt with whistleblowing yesterday we covered everybody who was working in the HSE and——
An amendment has to be made to this Bill to deal with that, as it is not a substantive issue.
Does that apply to other areas and does it mean what we passed yesterday does not cover everybody else?
We are repealing the 1978 Act with this Bill, so we must ensure that it is consistent with what was passed yesterday. That is all. It is only a technical issue.
Question put and agreed to.
Amendments Nos. 68 and 69 not moved.
Section 59 agreed to.
Section 60 agreed to.
SECTION 61.
I move amendment No. 70:
In page 57, subsection (1)(a), line 4, to delete “or”.
Amendment agreed to.
I move amendment No. 71:
In page 57, subsection (1)(b), line 6, after “scheme,” to insert “or”.
Amendment agreed to.
I move amendment No. 72:
In page 57, subsection (1), between lines 6 and 7, to insert the following:
"(c) the complaint is one that could be resolved by mediation or other informal means pursuant to guidelines prepared under section 62(1),”.
Amendment agreed to.
I move amendment No. 73:
In page 57, subsection (2)(c), to delete line 15.
Amendment agreed to.
I move amendment No. 74:
In page 57, subsection (2), lines 16 and 17, to delete paragraph (d) and substitute the following:
"(d) refer the complaint for resolution by mediation or other informal means, or
(e) if it considers it necessary to do so, direct that further action be taken under section 63.”.
Amendment agreed to.
I move amendment No. 75:
In page 57, subsection (3), line 20, after "subsection (2)(b)” to insert “or (d)”.
Amendment agreed to.
Section 61, as amended, agreed to.
Section 62 agreed to.
NEW SECTION.
I move amendment No. 76:
In page 58, before section 63, to insert the following new section:
63.—Where—
(a) the Preliminary Proceedings Committee is of the opinion that there is a prima facie case to warrant further action being taken in relation to a complaint, or
(b) the Council directs under section 61(2)(e) that further action be taken under this section in relation to a complaint,
the Preliminary Proceedings committee shall refer the complaint to the Fitness to Practise Committee.".
Amendment agreed to.
Section 63 deleted.
Section 64 agreed to.
SECTION 65.
I move amendment No. 77:
In page 59, subsection (1), line 31, to delete "Practice" and substitute "Practise".
Amendment agreed to.
I move amendment No. 78:
In page 59, lines 34 to 44, to delete subsection (2) and substitute the following:
"(2) A record shall be kept by the Fitness to Practise Committee of the proceedings before that committee, and the record shall be made available to the public by the Committee in the event of there being a finding adverse to the registered medical practitioner concerned, with the exception of any part of the record which the Committee decides to omit because it contains personal matters about any person which the Committee considers should not be published, or because the Committee decides it would otherwise be appropriate to do so. The hearings of the Committee shall otherwise be held in private unless the Committee otherwise decides for substantial reasons".
The only reason I tabled this amendment was to hear the Minister's view. Obviously, the IMO had great concerns about this and made a submission at length, which the Minister will have received. I tabled the amendment not out of any great conviction, but because I wanted to hear what the Minister's view of the IMO submission was as regards this whole issue of privacy.
Generally, the submissions were to the effect that hearings should be in private. We have decided hearings should be in public unless the fitness to practise committee, which has a lay majority, decides they should be held in private for whatever reasons. The doctor against whom a complaint is made and the complainant can each express their views when the committee comes to decide. We should leave it to the committee to determine whether to have the hearing in public.
As I understand it, the Deputy is talking about publishing the record, where there is a finding against the medical practitioner. I believe Deputy McManus means in lieu of a public hearing. Is that correct?
What I am saying is that where the committee decides otherwise, its hearings should be heard in private.
That is correct. In other words she is reversing what the Bill says.
I am not necessarily going to press this amendment. However, I am interested to know what the Minister's decision to adopt this particular approach is based on. Is it based on best practice elsewhere, because there seems to be very little reference to what happens in other jurisdictions? Has the Minister seen this approach in practice?
When I published the heads of the Bill, the position was the reverse. My decision was mainly based on the response I received from what I broadly refer to as patient groups, many of which said everything should be in public. To be fair, the fitness to practise committee should have the discretion to have hearings in private and I would leave that to its judgment. If it transpires that the complaint does not stand up, I accept it can be extraordinarily damaging. However, the fitness to practise inquiry only clicks in when there is a prima facie case. It will not deal with every complaint made.
There are other processes, preliminary hearings, mediation and so on. Only serious issues would go before a fitness to practise inquiry. The committee, which has a lay majority, should have the capability of making a decision to hold the hearing in private. If that is already the law, I presume it has been re-enacted in this Bill. I presumed that if the committee decided to hold the hearing in private, the transcript could be made public. I am advised, however, that we are not re-instating in this Bill the publication of the transcript. There may be an issue to deal with there. I will reflect on it.
If it is held in private, it is closed off and there is no record.
If it is held in private and if the doctor was struck off or there was a finding against the doctor, the committee could decide to make the transcript available.
There is no provision for that.
Apparently there is no provision. I will look at it. I am advised that the council has discretion. I am happy with that. We should not be too prescriptive.
Amendment, by leave, withdrawn.
Section 65, as amended, agreed to.
SECTION 66.
I move amendment No. 79:
In page 60, subsection (1)(c), line 16, after “production” to insert “(including discovery)”.
This amendment clarifies the power of the fitness to practise committee to compel the production of records, including the power to compel the discovery of records. This is intended to ensure that records are produced in a timely manner through a formal process of discovery, if required, to allow for their proper and detailed consideration.
Amendment agreed to.
Section 66, as amended, agreed to.
Sections 67 to 70, inclusive, agreed to.
SECTION 71.
Acting Chairman
Amendment No. 80 is in the name of the Minister. Amendment No. 81 is consequential on amendment No. 80. Amendments Nos. 80 and 81 may be discussed together.
I move amendment No. 80:
In page 62, line 41, to delete paragraph (a) and substitute the following:
"(a) an advice or admonishment, or a censure, in writing;”.
The intention of amendment No. 80 is to take account of situations where a sliding scale of minor sanctions may be useful to the Medical Council. In particular, the provision of advice has been found to be effective in the past. Such advice or admonishment will be provided, as with a censure, formally in writing. This amendment will change the provisions of section 71(a). Deputy McManus’s proposed amendment No. 81 to section 75 is in regard to the right to appeal a censure imposed under that section. The change proposed to section 71(a) would also be affected by amendment No. 81.
The High Court is due in the coming months to consider a judicial review in regard to appeals against a finding of the fitness to practise committee under the provisions of the Medical Practitioners Act 1978. It is possible that the decision of the court in regard to that matter could have some effect or provide some insight into the matter proposed by Deputy McManus. I consider it preferable to await the decision of the court before making any change in this regard.
Amendment agreed to.
Section 71, as amended, agreed to.
Section 72 to 74, inclusive, agreed to.
SECTION 75.
I move amendment No. 81:
In page 64, subsection (1), lines 13 and 14, to delete all words from and including "(other" in line 13 down to and including “71(a))” in line 14.
Acting Chairman
How stands the amendment?
I need to think about it. I will withdraw my amendment and resubmit in on Report stage.
Amendment, by leave, withdrawn.
Section 75 agreed to.
SECTION 76.
I move amendment No. 82:
In page 64, lines 43 and 44, to delete subsection (2).
It is inappropriate that a person's registration can be removed by the High Court without it giving notice to that person. Notice ought to be a requirement of the court application.
The section as drafted continues the arrangement which exists under Part V of the Medical Practitioners Act in which an ex parte application is made to the courts to confirm the decision to impose a sanction. The provisions of section 76(1) ensure that an ex parte application can openly take place where a medical practitioner has not availed of his or her right of appeal of that decision to the court under section 75. An ex parte application is appropriate and efficient in terms of the processing of such matters given that the medical practitioner has already chosen not to exercise his or her right of appeal.
I am a bit bewildered by this.
Amendment, by leave, withdrawn.
Section 76 agreed to.
Sections 77 to 84, inclusive, agreed to.
SECTION 85.
I move amendment No. 83:
In page 70, line 8, after "public" to insert "or any section of the public".
This amendment seeks to give more flexibility to the council.
Will Deputy McManus elaborate on this amendment? Maybe we will reflect on it for Report Stage?
I think we had better do so.
I am told we do not understand what the Deputy is talking about. I assume the Deputy's amendment seeks to provide that if a sanction is imposed, the council should inform the public. If I accepted the amendment, the section would read, "It would be in the public interest to inform a section of the public". It may be a typographical error and I suggest we examine it before Report Stage.
Amendment, by leave, withdrawn.
Section 85 agreed to.
SECTION 86.
Question proposed: "That section 86 stand part of the Bill."
There is a problem about HSE control over medical education and the council not being consulted. It is an issue I would have been much happier dealing with on Second Stage. On Second Stage, there is a more general debate on a Bill's provisions which allows for reflection before Committee Stage. There was none of that with this Bill. The only way I can get an understanding of the Minister's intentions and express the concerns of the IMO is by opposing a section. Will the Minister comment on the concerns about the relationship between the HSE and the Medical Council as defined in the Bill?
The expert reports in this area, the Fottrell and Buttimer reports, highlighted the need for greater co-ordination in medical education and training. That is why a new division has been established in the HSE and the postgraduate medical and dental board is being dissolved. The HSE must secure places for internships, deal with numbers and so forth. The Medical Council has the quality approval function and the roles are completely separate. The Medical Council must approve the training bodies and positions. The HSE deals with the numbers, places and so on. Its duty is to co-ordinate and organise all that. The quality issues which concern the Deputy and others are the sole remit of the Medical Council and the HSE has no powers in that regard. It has been well flagged that what has informed our thinking in this regard are the two reports on medical education and training.
Question put and agreed to.
Section 87 agreed to.
Amendments Nos. 84 and 85 not moved.
Section 88 agreed to.
Section 89 agreed to.
SECTION 90.
I move amendment No. 86:
In page 77, subsection (1), line 7, after "(II)” to insert “or ”(ii)”.
Amendment agreed to.
Section 90, as amended, agreed to.
SECTION 91.
Acting Chairman
Amendment No. 87 is in the name of the Minister. Amendments Nos. 88 and 93 are related, so we will discuss amendments Nos. 87, 88 and 93 together.
I move amendment No. 87:
In page 78, subsection (7), line 32, after "Division" to insert "or the Trainee Specialist Division".
There may be situations where the professional competence of a doctor practising in a trainee specialist division is found to be below the required standard for the person undertaking specialist training. The first two amendments in this group propose extending the provisions of section 91(7) to the trainee specialist division.
Amendments Nos. 87 and 88 provide that the council must give every reasonable opportunity to a medical practitioner registered in the training specialist division to improve his or her professional performance and that the council will make a complaint about such a person in circumstances where his or her competence is found to be below that which can reasonably be required for continued registration in the trainee specialist division.
Amendment No. 93 is related to these matters and clarifies that the rules made by the council under section 11 about the maintenance of professional competence also apply to persons registered in the trainee specialist division.
Amendment agreed to.
I move amendment No. 88:
In page 78, subsection (7), line 32, after "Division" to insert the following:
"or the Trainee Specialist Division, as the case may be".
Amendment agreed to.
Section 91, as amended, agreed to.
Section 92 agreed to.
Acting Chairman
We had agreed to adjourn at 2.45 p.m. but I am told that the meeting which was scheduled for this room for 3 p.m. will now not take place. So is it agreed to proceed? Agreed.
SECTION 93.
Amendment No. 89 not moved.
Acting Chairman
Amendments Nos. 90 to 92, inclusive, are related and will be discussed together.
I move amendment No. 90:
In page 79, subsection (1), lines 18 and 19, to delete all words from and including ", to" in line 18 down to and including "functions," in line 19.
I referred to this earlier and Deputy Twomey's amendments referred to this as well. After discussions with the Medical Council, we propose to delete the words, "to the extent practicable and necessary to enable the Executive to perform its functions". I believe that is desirable.
Amendment agreed to.
I move amendment No. 91:
In page 79, subsection (2), line 23, to delete ", to the extent practicable,".
Amendment agreed to.
I will be introducing on Report Stage a technical amendment to link sections 91 and 93. It is to put an onus on the HSE and employers to facilitate competence assurance.
Section 93, as amended, agreed to.
SECTION 94.
Amendment No. 92 not moved.
I move amendment No. 93:
In page 79, subsection (2), lines 28 and 29, to delete all words from and including "medical" in line 28 down to and including "Division" in line 29 and substitute "registered medical practitioner".
Amendment agreed to.
Section 94, as amended, agreed to.
SECTION 95.
I move amendment No. 94:
In page 80, between lines 20 and 21, to insert the following subsection:
"(3) The Freedom of Information Acts 1997 and 2003 shall not apply to a record (within the meaning of those Acts) relating to any professional competence scheme.".
The amendment takes account of matters raised by Deputies on Second Stage, suggesting that it might be appropriate in order to ensure full and frank participation by all medical practitioners to ensure that records relating to competence assurance are not subject to release under freedom of information legislation. This amendment takes account of the recommendation of Judge Harding Clark in the Our Lady of Lourdes Hospital inquiry.
Amendment agreed to.
Section 95, as amended, agreed to.
Sections 96 to 98, inclusive, agreed to.
SECTION 99.
I move amendment No. 95:
In page 81, subsection (3)(d), line 26, to delete “2001” and substitute “2005”.
Amendment agreed to.
I move amendment No. 96:
In page 81, subsection (3)(e), line 27, to delete “2001” and substitute “2005”.
Amendment agreed to.
I move amendment No. 97:
In page 81, subsection (3)(g), line 29, to delete “Act 1998” and substitute “Acts 1998 and 2006”.
Amendment agreed to.
Section 99, as amended, agreed to.
Sections 100 to 105, inclusive, agreed to.
SECTION 106.
I move amendment No. 98:
In page 84, paragraph (a), lines 39 and 40, to delete “[2 & 3 Will. IV c. 75]”.
Amendment agreed to.
Section 106, as amended, agreed to.
Sections 107 and 108 agreed to.
SECTION 109.
I move amendment No. 99:
In page 86, between lines 26 and 27, to insert the following subsection:
"(3) In this section, "certificate" includes a prescription.".
This technical amendment is to provide that medical certificates referred to in the section include medical prescriptions.
Amendment agreed to.
Section 109, as amended, agreed to.
SCHEDULE 1.
I move amendment No. 100:
In page 86, paragraph 1, line 38, after "(S.I." to insert "No.".
Amendment agreed to.
I move amendment No. 101:
In page 87, paragraph 2, line 2, after "(S.I." to insert "No.".
Amendment agreed to.
I move amendment No. 102:
In page 87, paragraph 3, line 4, after "(S.I." to insert "No.".
Amendment agreed to.
I move amendment No. 103:
In page 87, paragraph 4, line 6, after "(S.I." to insert "No.".
Amendment agreed to.
I move amendment No. 104:
In page 87, paragraph 5, line 8, after "(S.I." to insert "No.".
Amendment agreed to.
I move amendment No. 105:
In page 87, paragraph 6, line 10, after "(S.I." to insert "No.".
Amendment agreed to.
I move amendment No. 106:
In page 87, paragraph 7, line 11, after "(S.I." to insert "No.".
Amendment agreed to.
I move amendment No. 107:
In page 87, paragraph 8, line 14, after "(S.I." to insert "No.".
Amendment agreed to.
I move amendment No. 108:
In page 87, between lines 14 and 15, to insert the following:
"9. Medical Practitioners (Termination of Agreement) Order 1979 (S.I. No. 158 of 1979).".
This amendment provides for the revocation of a statutory instrument made under the Medical Practitioners Act 1978. This was omitted in error from the published Bill.
Amendment agreed to.
I move amendment No. 109:
In page 87, paragraph 9, line 17, after "(S.I." to insert "No.".
Amendment agreed to.
I move amendment No. 110:
In page 87, paragraph 10, line 20, after "(S.I." to insert "No.".
Amendment agreed to.
I move amendment No. 111:
In page 87, paragraph 11, line 23, after "(S.I." to insert "No.".
Amendment agreed to.
Schedule 1, as amended, agreed to.
SCHEDULE 2.
I move amendment No. 112:
In page 87, paragraph 2, line 33, after "years" to insert the following:
"(for which purpose membership of the Council which occurred before the commencement of this Article shall be taken into account)".
This amendment is for clarification purposes to clarify that the term of office of an individual who serves as a member under the 1978 Act shall be taken into account regarding the requirement that members may only serve two consecutive terms of five years.
Amendment agreed to.
Schedule 2, as amended, agreed to.
TITLE.
I move amendment No. 113:
In page 9, line 17, after "COUNCIL;" to insert the following:
"TO GIVE FURTHER EFFECT TO COUNCIL DIRECTIVE 2005/36/EC;".
There is a standard practice of referring to directives in the Long Title where they are being implemented.
We were advised differently.
Amendment agreed to.
Title, as amended, agreed to.
Acting Chairman
I thank the Minister and her officials for attending today's meeting. I also thank the members of the committee for their constructive contributions to the Bill and for facilitating its consideration in such a timely fashion.
Does the Minister know when Report Stage is being taken?
Next Wednesday, 28 March 2007.
Bill reported with amendments.