Tuesday, 27 January 2004

Questions (36)

Emmet Stagg


149 Mr. Stagg asked the Minister for Health and Children the position regarding the introduction of a new system of medical insurance for hospital consultants; the steps he is taking to ensure sufficient capacity in our maternity hospitals, in view of the threat of the closure of the Mount Carmel maternity unit arising from the problems regarding insurance; and if he will make a statement on the matter. [1913/04]

View answer

Written answers (Question to Minister for Health and Children)

From 1 February personal injury claims against hospital consultants arising from the delivery of clinical care will be covered by the clinical indemnity scheme, CIS. This move will bring consultants into line with other health service staff and their employers who have been covered by the scheme since its inception on 1 July 2002. In the intervening months extensive negotiations have taken place with the organisations representing consultants in an effort to have them covered by the scheme with their agreement. Virtually all of their concerns about the scheme have been dealt with to their satisfaction. Two issues have remained unresolved. These are the likely cost of purchasing professional indemnity cover for private practice not covered by the clinical indemnity scheme and the question of who should cover claims arising from past events.

The new scheme delivers significant benefits to the vast majority of consultants. For those employed in public hospitals it means that all of their practice in the public hospital, including their private practice, is covered by the CIS at no cost to them. This is a benefit not conferred on consultants in the UK under similar schemes put in place there. Private practice conducted outside of public hospitals is not covered by the scheme. However, the Government, in recognition of the complementary roles of the public and private health care sectors in Ireland, has indicated that the State will bear the cost of individual claims against consultants in private practice to the extent that they exceed €1 million in respect of any single claim. In the case of obstetric claims the limit of indemnity which consultants will need to purchase will be €500,000. The effect of these measures is to reduce the cost of indemnity cover for consultants' private practice by between 25% and 30% of what it would otherwise be. This benefit is available to consultants working in the public system who have some off-site private practice as well as to those who work full-time in private practice. From indicative rates circulated by one of the two medical defence bodies operating in Ireland it is clear that the vast majority of consultants, including those in the private sector, will pay lower rates for their indemnity cover after 1 February.

When the Government decided in December 1999 to introduce the CIS, based on the principle of enterprise liability, it also decided that the new scheme would not have any retrospective effect. The reason for that decision was that hospitals and doctors had already paid insurance premiums and subscriptions for claims arising from events which had occurred before the scheme's inception. Either directly or indirectly, the Exchequer had paid for this cover. The Government saw no reason the State should take over liabilities for which it had already paid. This position has been accepted by all of the commercial insurance companies which had insured health boards and hospitals up to 1 July 2002. It has also been accepted by the Medical Protection Society. The only indemnifier disputing the correctness of the Government's position is the Medical Defence Union, MDU. The MDU believes that the State has some responsibility for liabilities which arise from past events. The Government rejects this position and is insisting that the MDU meets it obligations to its Irish members. The threat by the MDU to leave some of its members without assistance in meeting the cost of claims has put many doctors under great stress. The Government has given a commitment to its representatives that it is prepared, if the need arises, to fund the cost of legal action against the MDU to ensure that it meets its obligations to its Irish members. I believe that it is in the interests of Irish doctors and Irish taxpayers that the MDU is persuaded to take responsibility for its own liabilities like everybody else.

Particular concern has been expressed about the ability of consultant obstetricians who work in the private sector to buy professional indemnity cover at reasonable cost. I have to point out that the cost of this cover has nothing to do with the establishment of the CIS. The particular difficulties of this specialty have been recognised for some time. In response the Government established a group in 2002 to examine the feasibility of introducing "no fault" compensation for infants who suffer cerebral damage at birth. The group is expected to produce its report in the middle of this year. In the meantime the Government has put measures in place which, in effect, subsidise the cost of insurance cover for the two hospitals which deliver obstetric services and for the consultants who practice in them. As a result of the Government's initiative, consultant obstetricians in private practice will pay €100,000 or less for cover rather than the full economic cost of €350,000. These measures ensure that Mount Carmel Hospital in Dublin and the Bon Secour Hospital in Cork can continue to provide these services.