I move: "That the Bill be now read a Second Time."
I commend to the House the Medical Practitioners (Amendment) Bill, 2002, which addresses important issues relating to the registration of medical practitioners. It represents a first step in the ongoing programme of updating and revising the Medical Practitioners Act, 1978. The public health service is dependent, above all else, on the staff who provide a high quality service week in week out. The 1978 Act regulated the practice of medicine in Ireland through the registration of medical practitioners, to ensure that the service had access to doctors of the highest quality and that the interests of patients were paramount. The Medical Council, which was established under the Act, is the statutory authority that oversees the registration and regulation of doctors and evaluates the suitability of medical education and training provided by bodies in the State. The council's constitution and additional functions are outlined in detail in the Act.
Almost 25 years have passed since the Medical Practitioners Act, 1978, was enacted. The provision of health services in Ireland and throughout the world has moved on considerably in the intervening period. The need for doctors to keep abreast of new developments, the rights of patients to be informed about their treatment and public expectations have greatly increased since 1978. It has been recognised for some time that the Act no longer meets the needs of a modern health service and, in this context, the need for a comprehensive review, aimed at developing legislation to meet current and future requirements, was acknowledged. The Department of Health and Children has undertaken a thorough review of the Act in the past year, involving widespread consultation with the key stakeholders in the health service: patients, doctors, the Medical Council and health service agencies. The message from those consulted is that the 1978 Act needs to be updated. My Department has used the information in the submissions to prepare a structure for the development of the draft heads of a new medical practitioners Bill, to be published in the autumn.
In this regard, I wish to inform the House that new legislation to provide for the regulation of nursing and midwifery is under preparation and the draft heads of a Bill to govern the regulation of the professions allied to medicine is at an advanced stage. When passed, these Bills and the Bill to update the Medical Practitioners Act, 1978, will provide a legislative framework for the regulation of the health professionals and will ensure the highest level of competence among those who provide our health services. The national health strategy, Quality and Fairness – a Health System for You, launched by the Minister for Health and Children in November 2001, contained a commitment to undertake an independent audit of functions and structures in the health system.
The results of the audit of the Medical Council, Comhairle na nOspidéal and the Postgraduate Medical and Dental Board will have to be taken into account in drafting the heads of the new Bill. The Minister launched the national task force on medical staffing last year to examine the implementation of the medical manpower forum report and the Hanley report on the working hours of non-consultant hospital doctors and provide an overview of medical education and training. The work of the task force will have significant implications across the public health service. Any recommended changes will affect hospital doctors, general practitioners, nurses, hospital and health board managers, the training bodies, the Medical Council and, in the final analysis, the patient. It is for the purpose of delivering better, safer and higher quality health services for the patient that the Government has adopted this integrated approach.
The Medical Council has also brought forward a number of proposals for change. The council wants to improve its efficiency and delivery of services. It has also undertaken an exercise to set out a scheme of competence assurance for doctors. The proposed scheme will encompass continuous medical education, continuous professional development and clinical audit and peer review. The purpose of competence assurance is to ensure that doctors maintain the highest levels of competence and awareness of developments in their field of expertise.
The new Act will also address issues surrounding the area of fitness to practise procedures. The streamlining of procedures and the appropriateness of the committee structures will be examined. The provision of relevant information to the Minister, employers and the public will be provided for.
There are a number of priority issues that cannot wait until a new Act is passed and which must be addressed urgently to avoid any potential disruption to service delivery. It is for this reason that I present this Medical Practitioners (Amendment) Bill, 2002, to the House today.
The most important of the amendments being proposed today is the amendment of section 27(2) of the current Act. We have, at present. approximately 3,600 non-consultant hospital doctors employed in the health service. Of this number approximately 1,600 are temporary registered doctors who come from outside the European Union. These doctors provide essential services in our hospitals and in some rural areas these doctors constitute more than 60% of the non-consultant hospital doctors cohort. They may have lived and worked here for extended periods and may, in some cases, have taken out Irish citizenship. I wish to publicly acknowledge the quality and quantity of their contribution to the Irish public health service. We owe these doctors our gratitude and should value their expertise and experience.
As many of these doctors joined the Irish health service before the implementation of the temporary registration assessment scheme they have not sat the temporary registration assessment scheme exam. This has affected their ability to move from the temporary register to the permanent register. Under the 1978 Act, only qualifications and training can be taken into account when considering applications for the permanent register. The current legislation, whilst recognising the training element, does not permit the Medical Council to give due regard to the relevant experience gained while working in the public health service by doctors applying for permanent registration despite the fact that some temporary registered doctors can have spent up to seven years working in the Irish public health service. At the same time, graduates of Irish medical schools who have completed just one year of postgraduate internship can apply for permanent registration.
It should be noted that employers and regulatory bodies in other jurisdictions are only too happy to recruit and permanently register these doctors based on the experience they have gained while employed in the Irish health service. At a time when the Irish public hospital system is undertaking extensive recruitment initiatives to ensure that all medical posts are filled we must ensure that every effort is made to retain the complement of doctors currently within our hospital service. Many of these temporary registered doctors are reaching the end of the period of temporary registration and may be lost to the Irish health service if we do not take action.
In addition, changes in European Union law and a recent ruling of the European Court of Justice require us to take account of relevant experience gained within the EU when assessing applications from EU citizens for permanent registration.
The resultant benefits will mean that fewer recruitment and retention difficulties will be experienced by hospitals in relation to non-consultant hospital doctors. The temporary registration period for some doctors, especially those from non-EU countries, which lasts a maximum of seven years, will begin to expire from next June onwards thus requiring the doctors concerned to leave the Irish public health service system and potentially causing some hospitals to experience difficulties in securing their required number of junior doctors. This Medical Practitioners (Amendment) Bill, 2002, will ensure that doctors who may otherwise have had to leave the country will be able to remain here and to apply for permanent registration. This will result in continuity of staffing and the maintenance of service delivery in the public health service, while at the same time tackling certain inequities with regard to access to permanent registration on the register of medical practitioners.
We must also look to address anomalies within the current Act which prevent EU citizens who have graduated from European medical schools from completing their internships in Ireland. In 1978 it was not envisaged that there would be any interest from amongst EU citizens for internships in Ireland. The 1978 Act, therefore, restricted internship, or as it was called at the time "provisional registration", to graduates of Irish medical schools.
Nowadays more and more Irish students have decided to study medicine abroad within the EU. Many of these students would wish to return to Ireland for the purpose of completing their internship in an Irish hospital. In order to facilitate these and other EU citizens we propose to take the necessary steps to amend the current legislation.
The Minister for Health and Children has also been requested to address how the current Act might be amended to provide for both internship and temporary training to be carried out in a variety of health care settings. At present such training is restricted to training in the acute hospital setting. This requirement has the impact of restricting both the location and nature of training which can be undertaken and reduces the ability of the doctor in training to gain the widest possible experience. It is now accepted that there are a number of health care settings, such as community-based services and general practice, in which a doctor in training could and should gain very valuable experience.
It has also been brought to the Minister's attention that there is a requirement, in certain circumstances, for an appropriate form of temporary registration to be available where a doctor is in this country on a short-term basis, for example to demonstrate his or her skills to medical colleagues or to provide professional support at a sporting event.
The Minister, Deputy Martin, is concerned to ensure that appropriate safeguards are in place in certain areas of health care, such as cosmetic surgery for example, where doctors may be entering the jurisdiction for short periods in order to carry out such procedures.