I move: "That the Bill be now read a Second Time."
I am very pleased to have the opportunity to address the House on Second Stage of the Medical Practitioners (Amendment) Bill, as passed by Seanad Éireann. The purpose of the Bill is to make it mandatory for medical practitioners who are engaged in medical practice to provide evidence of minimum levels of indemnity insurance cover to the Medical Council, on registration with the council and on annual renewal of registration. There is currently no legal obligation on a medical practitioner to have medical indemnity insurance cover. In some cases also, doctors may have cover, but it may be inadequate for the area in which they practise. As a result, some patients and the users of medical practitioners' services may find they are unable to seek redress in the event of a medical mishap or negligent care from a medical practitioner. Given the high cost of litigation and the long-term consequences of some adverse events, this legislation is to be welcomed as patient-focused and progressive.
The main purpose of the original Medical Practitioners Act 2007 is to protect the public and to have a proactive system of robust registration and regulation of the medical profession, in order to minimise the risk to the public and to safeguard the health and well-being of people accessing health services. Under the Medical Practitioners Act, the Medical Council must register every medical practitioner who practises in Ireland. In anticipation of the enactment of this Bill, the council already asks medical practitioners on application for registration and on annual retention of registration whether they have indemnity cover. On the enactment of the legislation, medical practitioners will not be registered to practise unless evidence of adequate indemnity cover is provided to the council. This development can only be to patients' benefit.
The Bill as originally published put an onus on the Medical Council to specify minimum levels of indemnity, on being advised by the State Claims Agency of what these levels should be. However, during its passage through the Seanad, the Bill was amended to make it explicit that it would be the State Claims Agency which would specify minimum levels of indemnity. At present, the State Claims Agency's functions relate to the management of clinical claims under the clinical indemnity scheme and so it has the expertise in this area. It also has close contacts with private medical indemnifiers and other experts in the area of clinical negligence and risk. It is, therefore, very well placed to assess and specify the minimum levels of indemnity which should be required by medical practitioners.
This policy change required that a new function be given to the State Claims Agency under section 8 of the National Treasury Management Act 2000, as amended. On 5 June 2015, the Government approved the drafting of amendments to the Bill. In the Bill, the State Claims Agency will link with relevant bodies in order to assess and specify what the minimum levels of indemnity should be for medical practitioners in different specialties on the Medical Council's register. There are currently 57 specialties on the register, and practising in some specialties has an inherently higher risk of a medical mishap. Even within different specialties, some types of medical practice, by definition, will have a higher risk than others. It is important to point out that all doctors who work in the public health system are provided with medical indemnity insurance under the State's clinical indemnity scheme. Private consultants who practice in public hospitals are also covered by this scheme. However, doctors who are engaged in wholly private practice must purchase private indemnity insurance cover. There is a wide range in the cost of cover for consultants engaged in wholly private practice. For example, a consultant practising dermatology, based on figures from medical indemnifiers, would be considered low-risk, and the annual premium for this practice could be around €16,000. However, a spinal surgeon may have to pay over €100,000 for annual medical indemnity insurance cover, reflecting the much higher risk involved in that practice.
The Joint Committee on Health and Children heard last year how the cost of cover for medical indemnity in private practice had increased significantly in recent years. For example, the increase was around 42% in 2014. The reason given by the medical defence organisation for this increase is that it is mainly due to the high cost of awards for clinical negligence in Ireland. The legislation will not require medical practitioners to pay any more than would be the normal adequate cover for the medical practice in which they are engaged. A medical practitioner who is not engaged in medical practice and does not pose a risk to another person relating to his or her medical practice - for example, a practitioner who is a full-time lecturer - will have no legal obligation to have medical indemnity insurance cover.
The legislation is one element of a package of measures being introduced by Government relating to medical negligence. Other elements include legislation on pre-action protocols for clinical negligence cases. This forms part of the Legal Services Regulation Act just enacted by my colleague the Minister for Justice and Equality. That legislation should help shorten the time it takes for negligence cases to get through the courts. In addition, the heads of a Bill on periodic payment orders and on open disclosure have been agreed by Government and this legislation will be published shortly. Deputies may wish to note that further amendments to the Medical Practitioners Act will be made in a health (miscellaneous provisions) Bill, which is currently being drafted as a matter of priority. This Bill will amend the five health professional regulatory Acts, including the Medical Practitioners Act, to provide for consequential amendments required by the transposition of EU Directive No. 55 of 2013, which relates to the recognition of professional qualifications, appeals against minor sanctions in fitness to practise cases, and a number of other amendments. As the amendments consequential to the transposition of the directive require changes to how medical practitioners will be registered, the Minister, Deputy Varadkar, is taking the opportunity to make amendments to remove the requirement to have the equivalent of a certificate of experience for entry to the trainee specialist division.
I hope Deputies will support this important Bill. Given the trauma faced by patients and their families when things go wrong, there will at least be clarity that medical practitioners have adequate minimum levels of medical indemnity insurance cover. I wish to thank Senators for approving the Bill and for checking on Committee Stage that the legislation was robust and fit for purpose. I commend this Bill to the House and I hope the Deputies will approve it.