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Dáil Éireann díospóireacht -
Wednesday, 15 Dec 1954

Vol. 147 No. 11

Supplementary and Additional Estimate, 1954-55. - Medical Practitioners Bill, 1954— Final Stages.

I move amendment No. 1:—

In pages 4 and 5 to delete Section 6.

This is an amendment to deal with an amendment which was tabled on Committee Stage relating to Section 6 of the Bill. I have accepted the principle and it is proposed to delete Section 6 which proposed that the accounts of the council would be audited and that the result of the audit would be placed here in the House.

Are you taking amendments Nos. 1 and 6 together?

No. Amendment No. 6 is different, Sir.

It is the same matter, I think. One is to delete and the other is to insert in its place.

Amendment No. 1 is to delete Section 6 of the Bill.

This has relation to the difference of opinion that existed on the Government Benches. Is this in connection with the fixing of fees by the Registration Council?

No. Section 6 of the Bill provided that the accounts of the council should be audited in a specific way. Objection was raised on the Committee Stage. I have accepted the principle.

Amendment put and agreed to.

I move amendment No. 2:—

In page 5, to delete Section 7 (3), lines 13 to 15, and substitute the following sub-section:—

(3) Section 19 of the Principal Act is hereby amended—

(a) by the deletion in paragraph (c) of "with the approval of the Minister";

(b) by the insertion after "Act" in paragraph (f) of "and with the approval of the Minister"; and

(c) by the deletion in paragraph (g) of "with the approval of the Minister".

Amendment No. 2 relates to objections that were raised here.

I take it that relates to amendments Nos. 3 and 4 also.

Yes. They all follow.

We should discuss amendments Nos. 2, 3 and 4 together, I think.

Yes. Deputies who took part in the Committee Stage debate will recollect that objection was raised by Deputy de Valera, Deputy Sheldon and Deputy McGilligan to the retention by the Minister of any powers in relation to the council itself. A code of control is set out in the Act of 1927 and, as I stated on Second Reading and Committee Stage, it was my view that the council should be completely removed from any form of ministerial control except in relation to the fees for registration which they might impose and also in relation to the length of time they might prescribe for different courses. It is in order to meet that objection that these different amendments are tabled and, in effect, they remove certain controls set out in Section 19 of the Act which provided that the form of the register, for instance, should be subject to approval by the Minister and a variety of matters of that kind. They are now being removed by these amendments.

Amendment put and agreed to.

I move amendment No. 3:—

In page 5, Section 7, before sub-section (4), line 16, to insert the following sub-section:—

( ) Sub-section (5) of section 21 of the Principal Act is hereby amended by the deletion of "with the approval of the Minister".

Amendment put and agreed to.

I move amendment No. 4:—

In page 5, Section 7, before sub-section (6), line 27, to insert the following sub-section:—

( ) Section 31 of the Principal Act is hereby amended—

(a) by the deletion in sub-section (1) of "with the approval of the Minister"; and

(b) by the deletion in sub-section (3) of "with the approval of the Minister" and "with the like approval".

Amendment put and agreed to.

I move amendment No. 5:—

In page 5, Section 8, to add a new sub-section as fellows:—

( ) Section 10 of the Act of 1951 is hereby amended—

(a) by the deletion of "with the consent of the Minister"; and

(b) by the addition at the end thereof "with, as respects the prescribing of a period under sub-section (1) of Section 3 or the prescribing of a fee under sub-section (2) of Section 7, the approval of the Minister".

That is a somewhat different type of amendment.

Is this the amendment that covers the fixing of the fee of the Registration Council?

It is inserting a new sub-section.

Amendment No. 5 will preserve this position only, that approval of the Minister will be still required for the registration fees, whatever fees the council may propose, and also with regard to the period of internship which the council may prescribe for different purposes. These are the only two purposes for which approval will still be retained.

This Bill, of course, is designed for the purpose of removing controls. I appreciate the fact that the Minister has gone a long way to erase any objection that may have been felt on that point and to remove as many controls as possible but, in effect, as the Bill stands at the moment there are two controls. One is that the Minister still has power to fix the registration fee. I think I am right in that.

To approve of the fee.

To approve. In other words the council cannot fix a registration fee except with the consent of the Minister. I think the Minister will accept that that is still a control. The other control is that under the 1951 Act introduced by the Minister's predecessor, this country was brought into alignment with conditions that exist in Britain whereby on the conclusion of the ordinary curriculum it is necessary for a practitioner, before he is accepted for registration, to serve an internship in a recognised hospital for a period of 12 months or a period to be agreed upon by the examining bodies or the Registration Council itself. The position as it stands now is that the Minister has still the controlling influence in that. I would like to try to bring home to the Minister this point of view: In the first instance, with regard to the control of the medical registration fee it seems to me that it is unnecessary to have ministerial control there.

It might be that these controls would be necessary in other associations such as those of the Veterinary Surgeons and Dentists but there does not seem sufficient reason for them in matters of health. The position as at present obtaining is that the Medical Registration Council is financially independent of the State. They are receiving no finances at all from the State as they were when these rules and regulations were laid down in the Act. If we come to study the set-up of the present council we will see that it consists of a representative of all the examining bodies—those who are qualified to give a degree to anyone practising—Dublin University and the University Colleges in Dublin, Cork and Galway, the Royal College of Surgeons and the Royal College of Physicians. Added to that you have two members of the medical profession and two members appointed by the Government. It seems to me that the two members appointed by the Government should be an adequate safeguard.

Apart from that altogether it seems to me that it would be in the interests of this body to charge a reasonable fee, because if they do not do so they will be cutting off their nose to spite their face, since they themselves are the examining body and since it is in their interests to have as many people as possible competing for medical registration. If there were higher fees there would be fewer people competing. As long as you have controls you must have the Civil Service personnel to deal with them.

I think we will all agree that in this country as in the world as a whole the greatest difficulty is that when any establishment is set up there is immediately the necessity for an increase in the Civil Service personnel. I feel sure you will want to avoid that as far as possible. There must be a considerable file dealing with these matters in the Department of Health. I think that the time has come when the Minister can say: "Carry on; I do not want any more to do with you." He has two representatives on the council. This council have all the facilities necessary at their disposal; they have all the knowledge appertaining to medical education and so forth, so that does not seem necessary for the Minister to come along now with this. One would think that he would say: "You are free from all control. Carry on." This Bill was originally introduced for the purpose of freeing the Medical Registration Council from State control.

The position with regard to the amendment and to the matters referred to by Deputy Dr. Esmonde are as follows. Under the Medical Practitioners Act, 1951, the council is given power to make regulations dealing with specific matters. First of all they could make regulations regarding internship before final registration. That provision was contained in Section 3 of the 1951 Act, which also makes provision for the distinction between medical service and midwifery. Section 3, sub-section (6), deals with a person claiming registration by virtue of a diploma granted on passing a qualifying examination held by two or more bodies jointly; Section 7 makes provision for provisional registration; Section 8, sub-section (10), states that the form and mode of application for provisional registration and the evidence to be given by an applicant of his title to be so registered shall be such as may be prescribed; so that all the regulations made by the council under the 1951 Act require the consent of the Minister.

The amendment that I am now proposing removes the necessity for ministerial consent in every case except in the two cases with regard to the prescribing of a period under sub-section (1) of Section 3 or the prescribing of a fee under sub-section (2) of Section 7. With regard to both of those matters, Deputies will appreciate that there is a matter of public interest involved and that in order that the public interest may be served it is necessary that the person who is charged on behalf of the public with dealing with these matters should have these very minimum powers. For instance, it might be quite wrong to have the situation here where, according to our laws, somebody could hold himself out as a medical practitioner who is not registered as such. There is to that extent a very proper monopoly given in the practice of medicine. Registration cannot be effected unless the fee for registration is paid by the person applying, nor can it be effected unless the person seeking registration does the period of internship prescribed by the council. In those circumstances, since registration is necessary to practise, it does appear to me to be reasonable that the Minister's approval should be sought to the scale of fees and to the period of internship. It is not very much power to retain and I feel sure Deputy Dr. Esmonde will be very glad to know that when this Bill is passed the file in my Department will be closed.

Amendment agreed to.

I move amendment No. 6:—

In page 5, before Section 11, to insert a new section as follows:—

Section 16 of the Principal Act is hereby repealed.

This follows the previous amendment.

Amendment agreed to.
Question—"That the Bill, as amended, be received for final consideration"—put and agreed to.
Question—"That the Bill do now pass"—put and agreed to.
Ordered: That the Bill, as amended, be returned to the Seanad.
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