Dáil Éireann Debate, Tuesday - 5 February 2019
42. Deputy Stephen S. Donnelly asked the Minister for Health if he will direct the HSE to mandate that patients are informed when their treating consultants are not on the specialist register, including the reason they are not on the specialist register; and if he will make a statement on the matter. [5519/19]
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We were told last May that 149 doctors working in the HSE in consultant posts were not on the specialist consultant register, unbeknownst to patients. We were also told that while some of this was due to legacy administrative issues, some of it was because the doctors had not finished their consultant training. This represents a serious patient safety issue. Will the Minister issue an instruction to the HSE to the effect that any patient seeing a consultant who is not on the specialist register is informed of that and the reason for same?
I thank the Deputy for raising this important matter. In March 2008, the HSE amended the qualifications specified for consultant posts to require membership of the specialist division of the register of medical practitioners. The register is maintained by the Medical Council. Notwithstanding that policy position, the HSE has been obliged in certain circumstances to appoint doctors who are not on the specialist division to consultant posts to ensure service delivery. There are also limited circumstances where an experienced senior doctor not on the specialist register may cover for an absent consultant to ensure the provision of care.
Importantly, any doctor who occupies a consultant post, even if he or she is not on the specialist register, would still hold a medical licence and be on a division of the Medical Council's register. The doctor would, therefore, be fully qualified to practice medicine. A total of 161 consultants have been identified working in the public health services who are not on the specialist register. Nearly a third of these were appointed prior to the change in the HSE's requirements.
The HSE has established a group to examine posts that are filled by doctors who are not on the specialist register as well as the issues of recruitment and retention challenges. It is undertaking site visits and engaging with senior management at sites and with those not on the specialist division register who occupy consultant posts. Its report and recommendations are to be finalised and will be provided to my Department next month. Once received, officials in my Department will consider the HSE's findings and recommendations, in conjunction with legal advices on the matter.
One of the areas for consideration may be, as suggested by the Deputy, mandating that patients be informed when their "treating consultant" is not on the specialist register. However, this would have to be considered having regard to the legal position and the current guidance of the Medical Council on some of these matters. Once I receive the report next month, I will be happy to brief the Deputy on its contents. His suggestion on informing patients is an issue that will be considered at that point.
I thank the Minister for his reply. I am concerned by the lack of transparency for patients. Last May, our committee was told that the number of doctors working in consultant posts but not on the specialist register was 149. We were given assurances that the HSE would look into reducing that number. However, I received information in recent days saying that the number had increased to 161. Shockingly, my figures show that, in the midlands mental health service, 44% of doctors working in consultant posts are not on the specialist register. In South Tipperary General Hospital, that figure is 31%.
I am glad that a report is on the way to the Minister and I appreciate that some of the recommendations can wait for it, but does he agree that, regardless of what the report says, patients and their families have a right to know if the doctors they are seeing and who they have been told are consultants actually are consultants?
Instinctively I do, but I want to allow the HSE to complete this work. Given that it is imminent - it is due to be completed next month - I want to be guided by it. The HSE is pursuing a range of initiatives to improve the recruitment process and support those who are not on the specialist register to pursue registration. As the Deputy was good enough to acknowledge in his opening contribution, there may be people involved who are well entitled and have the qualifications to be on the register but have not applied to be so. For example, those appointed properly prior to 2008 could be dealt with by deeming provision to be part of the definition of "consultant". We can reduce the number and address some of these cases through that.
I do not want to be lost in the debate the fact that, notwithstanding recruitment and retention challenges, the number of consultants working in the health service increased by 125 in the 12 months to the end of December 2018 and by 540 in the past five years.
I am happy to revert to the Deputy when I receive the report.
I would like the Minister to issue an instruction on three matters. First, it should be mandated that, if a patient is meeting a doctor whom he or she believes is a consultant and is in a consultant's post but who is not on the specialist register, he or she is told so and why. Second, every patient who believes that he or she has been seen, assessed or treated by such a doctor should be informed that the person is not a consultant. Third, I would like the Minister to instruct the HSE to conduct an analysis of this cohort to determine whether there is an unusual level of issues relating to patient safety, negligence and so forth. There may be serious patient safety issues concerning people being treated by doctors who are not consultants but whom they believe are consultants. I would like the Minister to take these suggestions under consideration.
I take seriously the Deputy's suggestions and I will reflect on them. However, the Medical Council is the regulator of our doctors. It is important for our citizens and patients to know that there is no suggestion - the Deputy Donnelly has not suggested it - that these doctors who are not on the specialist register are not fully qualified in medicine. This important point has been highlighted by the Medical Council.
I will make a decision on the issue of mandating the HSE to inform patients based on the report that I will receive on the project being undertaken, which is due to conclude next month.
At that time, I will also take an opportunity to engage with the Medical Council. The Joint Committee on Health might wish to engage with the HSE and the Medical Council as well to see how best we can square this circle.
