Medical Practitioners (Amendment) Bill 2014 [Seanad]: Second Stage

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.

The next speaker on the list is Deputy Caoimhghín Ó Caoláin.

How much time do I have?

My goodness. I am sorry I missed the Minister of State's opening remarks. I was attending the briefing on the Traveller accommodation issue in County Louth in the AV room. I have to say it is a very serious matter and most disturbing indeed.

The Medical Practitioners Amendment Bill 2014 had its genesis, as I recall, in a Private Members' Bill in 2009. Some might dispute that, but that would certainly be my view. I actually thought we had spoken on this already. I was checking with the Bills Office today because I thought I had spoken on that already and could not understand how I would get a second bite at Second Stage, but it was almost seven years ago now and I did indeed speak on it. To put the Minister of State at her ease, I will say at the outset that we will, of course, be supporting this Bill. We welcome it. It is regrettable that it has taken so long to get to this point, but we will be supporting it through all Stages and I hope the Minister will have the opportunity, other matters considered, to progress it to finality before the whistle is blown.

It alarmed me then and has continued to alarm me through all the intervening years that the current status in respect of medical practitioners and the legal obligation to acquire medical indemnity insurance had not already been provided for. It is a most disturbing fact. This has been reflected in the Seanad address of the legislation, where this Bill has come from. I concur with those in the Upper House who have expressed surprise and alarm that this "strange situation," as it was described, has been maintained over all these years.

Under this Bill, the medical practitioners themselves will have to ensure they have suitable cover. The Medical Council will be in a position to sanction a medical practitioner engaging in medical practice who does not hold indemnification or the appropriate insurance. I also welcome the fact that there will be an exemption from indemnity for those who are not actively engaged in medical practice, including those who are lecturing, those who may be retired, and those who may have taken time out for whatever reason and who are not actively involved as medical practitioners over a given period. That is absolutely appropriate. We have had instances that were much worse than unintentional adverse outcomes. We have had possibly intentional interference with the bodily function of individual patients over the years, matters that we have addressed in this Chamber on many occasions, including on a number of occasions during the course of this Dáil term. As this is a Bill related to the health service, Second Stage affords me an opportunity to address some of those matters that have been particularly disturbing and that I can only refer to as scandalous. I hope these scandals are confined to the past. I am speaking particularly of the horrors of the Michael Neary scandal and the dreadful experiences of those who were subjected to symphysiotomy at a number of hospital locations over the years. The Government has introduced redress in respect of the Dr. Michael Neary case.

However, there was a significant cohort who were not covered by the redress scheme, some of whom were subsequently brought in under an additional or subsequent tranche of supports. There was also the symphysiotomy situation, which is currently being addressed, however unsatisfactorily in the eyes and minds of many of those who have suffered grievously. Some progress has been recorded on some of these matters, and that must be welcomed.

In relation to a Bill dealing with the requirement for indemnification and medical insurance, I feel obliged to draw attention to the very small number of victims of Dr. Neary who have not been included in the extended redress provision. I have recently spoken to the senior Minister in this regard. I speak quite particularly in relation to four women. There may be other cases, but I am familiar with four who have a commonality, not only of experience but of the expert analysis and assessment of Dr. Richard Porter, who carried out specific reviews of each of their cases. I have a copy of each report. I am, again, bringing them to the Minister of State's attention in a last-ditch - for the want of a better word - appeal in the closing days of this Administration, and I ask that she exercise her position to speak to the senior Minister and that they jointly review the situation that still obtains in relation to these four cases.

I have three of the reports prepared by Dr. Porter here, and I will highlight one of these cases. I will maintain the anonymity of those concerned. I will not refer to them at all by name, but I have met all of them. I know them personally and I must say that the exclusion of their cases from acceptance under the terms of the scheme compounds the hurt and pain that they have suffered over many, many years. No woman should be left in that position. Having the little bit of time, I will demonstrate the type of case that we are talking about here, read into the record the opinion of Dr. Porter and ask of the Members here, particularly the Minister of State, why any woman who has been through what these women have suffered could be refused inclusion under the terms of the Neary redress scheme.

Dr. Porter states:

I have been asked to comment on the appropriateness or otherwise of the surgery performed in June of 1991.

Before doing so I think it is appropriate to comment on the management leading up to that.

Although I do not have the full details of [the management of the patient concerned], there must be a strong suspicion that the management was inappropriate and inadequate.

It appears, to me, inconceivable that in 1991 a couple could be followed for prolonged infertility without semen analysis having been performed. In addition it appears extraordinary to me that at no stage in the management of her infertility had she undergone an ultrasound scan. Both of these omissions raise serious questions about the professionalism and the adequacy of the clinical evaluation.

In February 1991 a laparoscopy was performed which purported to demonstrate endometriosis. No attempt was made to establish the patency of the fallopian tubes, indeed this is actually explicitly mentioned as having not been performed during the laparoscopy.

I should add in passing that the sub-umbilical incision used for this laparoscopy was, without exception, the largest such incision that I have ever seen. I have to say that this raises for me questions concerning the competence with which this procedure was undertaken.

Dr. Neary elected to perform a laparotomy some four months later.

It is not clear to me on what grounds this operation was undertaken.

[The lady concerned] was not complaining of abdominal pain at this time, indeed her only complaint was of a failure to become pregnant.

If the intention of the surgery was to maximise her fertility prospects then it is hard to see how the removal of the left tube and ovary would come under that category. Nor is it easy to understand how it was proposed that removing an endometriotic cyst on an ovary, which would inevitably result in a potential increase in scarring within the pelvis, could be expected to result in enhanced fertility prospects.

These facts were known in 1991.

The operation was performed through a midline sub-umbilical incision. This was a wholly unnecessary approach to the surgical area. This is an uncomfortable and unsightly incision and it was totally unjustified to perform this surgery for benign gynaecological disease through this incision.

Dr. Neary has described the operation as taking 2 1/4 hours.

This is contradicted flatly by the anaesthetic chart, which suggests that the operation only lasted 1 1/4 hours - but there is a possibility that it lasted 1 3/4 hours [...]

Dr. Neary mentions that the pelvis was very fixed.

By definition this was an area that required specialist surgery performed by an expert in the field, if surgery was indicated at all (which remains in my [Dr. Porter's] view highly debatable).

I have no reason to believe that Dr. Neary was an expert in fertility surgery and it is my view that he should not have been undertaking this operation in the first place.

He drained a right ovarian cyst, which he claims was an endometriotic cyst. I believe that this diagnosis remains open to very considerable doubt.

This uncertainty is made all the greater given the histological findings on the left ovary.

Dr. Neary proceeded to remove the left ovarian cyst but he omitted, it would appear, to send this for histological analysis. This was incompetent and unacceptable.

He did, however, declare in his operation note that the left ovary contained several endometriotic cysts and that there was 'no functioning ovary' at the end of the removal of the ovarian cyst. He therefore removed the ovary and sent it for histological analysis.

Histological analysis of this ovary however refutes both the clinical diagnosis of endometriosis and the assertion that the ovary was 'non-functioning' at the end of the operation.

The ovary was in fact of considerable size at the end of the procedure, as shown by the histology report, and far from being a non-functioning ovary it clearly contained the potential for useful endocrine and probably fertility function.

The histopathological analysis makes it very hard to believe that the clinical diagnosis of endometriosis was correct, and it clearly indicates that the surgical removal of the ovary was wholly unjustified.

The subsequent findings at surgery in 1994 suggest, far from surprisingly, that there were an increased number of adhesions around the right adnexal region, probably as a direct result of the surgery that had been undertaken in 1991.

My conclusion therefore has to be that:

- There was little or no pretext for performing the laparotomy in June 1991

- The diagnosis of endometriosis was in any event highly unlikely to be correct ([Dr. Porter believed] that [the patient] had haemorrhagic follicular cysts in her right ovary)

- The surgery on the right adnexal region worsened, rather than enhanced, her prospects for future fertility

- The removal of the left ovary was totally unnecessary

Overall, therefore, [Dr. Porter believes] that the surgery in June 1991 was unjustified in the first place, and incompetently performed, and that the operation note is probably not a true record of what was found at surgery.

I have taken the time to read this and I appreciate the Members' listening carefully. It is just one of three of the four cases, and it is unnecessary for me to repeat it for each of the others.

The Bill seeks to ensure everyone under the inclusive term "medical practitioners", which covers the Dr. Nearys - God bless us and let us hope there are no more of his ilk - has indemnity insurance. That on the one hand we are seeking to regularise the absolute requirement of indemnification while on the other hand we are ignoring the most learned report of a highly respected practitioner, Dr. Porter, who has presented in so many of the cases concerned, coming from the neighbouring island to be of assistance in these cases, is a sad reflection on all of us in political life.

This woman, whom I have met and whose report and conclusions by Dr. Porter I have just read, is, like all the others, a victim of Dr. Michael Neary. She and those who presented with her have made repeated appeals, time after time, to have their cases respected, included and properly recognised. I appeal to the Minister of State, who would share my wish that no woman would be excluded from due recognition, acknowledgement and compensation. While it is very difficult to put into compensatory or monetary terms anything that would reflect on the extent and depth of the hurt and pain she and others have been put through, if some such recognition took place it would help these women and this woman who was denied the chance of ever becoming a mother, something which she feels grievously to this day.

I appeal to the Minister of State, using the opportunity of this not unconnected legislation. It is very important that the connection is there. I am using my Second Stage address to confirm my support for the passage of the legislation and to appeal to everybody in the House, especially the Minister of State and the Minister, Deputy Varadkar, to use the remaining days of the Dáil term to revisit these cases. I will have the copies of these reports, which have already been presented to the Minister and the Department, in their pigeon holes first thing in the morning, in confidence and in the understanding that they will be treated respectfully. I ask the Minister of State please, in all justice, to use the remaining days to help see that justice is done for all who have suffered so much at the hands of this individual who should never have been allowed to practise as he has. I have adequately reflected my surprise that this has not been enshrined in legislation heretofore and I welcome the fact that, hopefully, before the Dáil rises for the general election, the legislation will be on the Statute Book.

Like the previous speaker, I support the Bill. I would like to ensure a few matters are covered. We all know, from all different walks of life and business, people must have insurance and indemnities. Long ago, when we were young and able to play football, if we got an injury such as a busted eye we could go to the local doctors and they sewed us up quickly. Nowadays, with insurance and indemnities, many medical practitioners are becoming fearful of performing such procedures.

I fully agree with Deputy Ó Caoláin's statement that what happened in Drogheda and all around the country is unacceptable. People should have insurance to cover the wrongs that were done. However, we must also ensure that we do not price ourselves out of the market in insurance. The Minister of State said public doctors were fully covered and indemnified by the State and did not need insurance. Around the country, people would go to a private doctor. While there must be insurance, is there a risk that insurance could be driven up? Insurance costs on all sides of business are increasing. Is it accounted for? Have we ensured we will not make it unreachable for some people?

I refer back to what I said about a youngster having a busted eye sewn up. Those doctors and medical practitioners must have insurance. Will insurance costs increase for doctors who might stitch a wound or remove a wart and make it unworkable for a rural GP in a small area, be it Donegal, Cork or elsewhere? Will it prevent doctors from doing such work and thus put more pressure on accident and emergency services? We must ensure that when we do something, we do it right.

I support the Bill. I have seen the denials that happened over the years and I welcome the fact the Minister of State is bringing this forward. As Deputy Ó Caoláin said, I hope it passes before the day of reckoning comes for us, in the not too distant future.

There have been problems with the allowances for rural GPs here and there around the country. I urge the Minister of State, the HSE and the Minister to ensure people have access to local GPs around the country. They are being refused the rural GP allowance here and there, and it is causing problems. It must be addressed. If these things happen, people will leave areas and there will be no doctors in areas. I welcome the Bill. I ask the Minister of State to address the issues I raised and give us the comfort of ensuring she has balanced it as well as possible. We all agree there must be proper insurance in place.

The other side of it is that we need to start looking at what is and is not reasonable with regard to insurance in the whole medical spectrum and in many other areas. I know from being in business that if one draws down the insurance, it will get more and more expensive. If claims are going higher and higher, someone has got to pay because it all comes out of one big bag of money. It is all right to talk, but if claims keep going through the roof as some of them are at present, someone somewhere will have to pay and insurance costs will continue to rise. Everyone has to be looked after properly. I am not saying that people do not need to be looked after properly. I fully believe that everyone should be compensated properly for the wrongs that are done, but there comes a stage between what is covered properly and what goes beyond that. We need to make sure we look at that because if we fail to do so, at the end of the day the people will end up paying for the medical practitioner, the surgeon or the State. We need to make sure we cover that as well.

Ba mhaith liom mo chuid ama a roinnt leis an Teachta Seán Kenny.

Before I get into the specific remarks I want to make about this legislation, I want to record my complete support for the words of my colleague, Deputy Ó Caoláin, regarding the four women who are not yet included in the scheme of compensation for the Dr. Neary scandal. I ask the Minister of State, Deputy Kathleen Lynch, and her colleague, the Minister, Deputy Varadkar, to look at the material that will be brought forward. I know a couple of the women reasonably well. I know one of them very well. I met one of them with Deputy Ó Caoláin some months ago. Neither of us wants to put their names on the record. While I do not wish to repeat the sound case Deputy Ó Caoláin has made, I want to ensure I leave no ambiguity by making it clear that I support him on this important matter and I congratulate him on his lucid presentation of this complex case.

I welcome the opportunity to speak on this Bill, which seeks to ensure it is mandatory for all medical practitioners to have an adequate level of medical indemnity insurance. This is a very important protection for all patients. It goes without saying that this vital protection has to be accompanied by continuing regulation and scrutiny of the insurance sector and of the cost of insurance. Nevertheless, the purpose of this legislation should be unambiguously supported. It is startling enough that medical practitioners are not required to have professional indemnity cover in order to be registered with the Medical Council. Under current legislation, any medical doctor - Irish or otherwise - can carry out cosmetic surgery without needing to have any specialist training or qualification or the requisite insurance. I find this very alarming because it is common practice for surgeons from other countries to spend short periods of time in Ireland carrying out procedures before leaving again. Many of these surgeons are not covered with indemnity. This poses a real threat to unsuspecting patients who may suffer damage if work is carried out by a non-specialist surgeon. Dr. Peter Meagher of the Irish Association of Plastic Surgeons has raised concerns about the level of aftercare service offered at some plastic surgery clinics that have limited opening hours and lack of availability of surgeons. It is clear that a great deal of regulation is needed in this area. I am glad to see that this Bill addresses many of these issues and protects the patients.

It is interesting to make the point, as the Minister of State did in her speech, that there are 57 specialties on the medical registers. Section 6 of this Bill places a duty on registered medical practitioners to have an adequate level of indemnity in place to cover his or her class of practice. This must be in place at the time of his or her registration. Section 9 includes a provision that would make the Medical Council unable to register somebody unless he or she has adequate insurance. Section 11 provides for the power to remove somebody who does not have such insurance. Obviously, insurance is otherwise provided in the cases of lecturers and others working in the State system. All of that is provided for in this legislation.

The work of any medical professional within the health service is both challenging and rewarding. It is important that provisions are in place to protect the safety of every patient and to support our medical professionals. The vast majority of our surgeons, doctors and general practitioners operate in a very safe and responsible way. Sadly, there are exceptions for which we have to legislate. This country has a team of excellent medical personnel who are very highly qualified. There is no implicit suggestion that anything other than this is the case. The Government has acknowledged this by making a great investment in the health service. Some €13.19 billion will be invested in the health service in 2013. This represents an increase of €900 million on last year's figure. That is a very important vote of confidence in our health professionals and is a reflection of the importance of health care.

I would like to make a point about primary care, which is germane to this legislation in so far as it relates to doctors, surgeons and specifically general practitioners. Although immense things are being done in this area of health delivery, there is room for more development and more supports here. I am very proud of the new primary health care centres in my constituency. I refer, for example, to the refurbished facility in Kingscourt and to the centres in Bailieborough, Cootehill, Drumalee and Townhall Street in Cavan town and Virginia. This Government has a good record of providing a number of health care centres throughout counties Cavan and Monaghan in the worst of times. While I am happy about that fact, I think we need more. I would like to see a primary health centre in Ballyjamesduff because there is a vital need in that part of my constituency.

GPs are of central importance in our primary health centres. We should be very supportive of our GPs in that role. It was great that we reached agreement with the GPs on the progressive reforming legislation that provides GP cards to people under the age of six and over the age of 70. We should work with our GPs in a co-operative manner. We should be sensitive to their needs and fully respectful of their traditions and their work. They provided our primary health centres for generations. Indeed, their services were often provided intergenerationally in families. We should support our GPs practically and proactively in the development of primary care centres. I think we need more public health nurses. As the country starts to be in a position to afford it, we should begin to augment the numbers of such nurses to get better cover there. We need home care assistants. The home care packages are vital as a cost-effective way of keeping people out of institutional care at a low level of cost. They provide meaningful, good and fulfilling jobs for people. They allow people to stay in their own homes and they allow the primary care centres to function. It is very important for this service to be augmented. We need to put more money directly into care assistance and home care packages.

The people on carer's allowance who provide care in their own homes should be feted and very highly valued in our community. The means-testing system that applies to them is relatively benign. We provide a half-rate of carer's allowance to people who are getting a second payment. There are many good aspects to it as it is. We have restored the respite care grants. While all of that is in place, I think more needs to be done. I think all possible secondary benefits, including those that relate particularly to older people, should be applied to carers to make it a very attractive option to be a carer. I think we should increase the rate of carer's allowance constantly, incrementally and annually as the country can afford it.

It is a no-brainer in two regards. One is because institutional care is so expensive, and in cold, clinical economics it makes sense to support our carers. Second, it is good for the carer and for the person being cared for, so there is a huge amount at stake and very practical and real supports are needed. I suggest to the Minister that more needs to be done in the area of the primary carer at home with carer's allowance, secondary benefits and a gradual further relaxation of the means test. It should be attractive for somebody who wants to care for a relative and practical for them to leave employment and get an income which replaces their employment. They are freeing up a job for somebody else and doing a very important job in the home, allowing people to stay there where they want to be. That is very important and this Bill provides an opportunity to address it. I hope and intend that this speech to the Chamber is not my last. In one of my latter speeches I am delighted to get the chance to speak on the carer's allowance because I feel very strongly about it.

I also think this Bill protects patients and can only be supportive of our GPs. Proper practitioners have no difficulty in being compliant in these areas and this stops the wrong people coming into the market. A point was well made earlier about insurance, about people needing regulation and the cost of insurance regulation, as well as the need not to have exploitative rates of insurance. There is a need to stress test the insurance industry when it seeks increases in insurance costs, and this idea merits support. The legislation is excellent, it is very reassuring for patients and is a further reform of our health system that is to be welcomed and commended.

Before I speak on the Bill, as I am not standing in the upcoming general election, I would like to say a few words of farewell to the House. I thank the Cheann Comhairle and the Leas-Cheann Comhairle and all Members of the House of all parties for the courtesy they have extended to me during debates in the House. I thank the electorate of Dublin North-East who elected me to the House and whom I have had the honour of serving in this Dáil. They previously elected me to the 27th Dáil, from 1992 to 1997. I had a break in between and I was glad of the opportunity to come back here again. I believe I represented my constituents in both of those terms to the best of my ability. I thank my Labour Party colleagues, both inside and outside this House, for their support and friendship. I believe the Labour Party in this Dáil has made a valuable contribution to restoring the economy and ensuring people are now back at work. The improving economy is bearing fruit and we need to thank the electorate for their forbearance in the measures that had to be taken to restore the economy. I look forward to restoring the things we had to take away. I accept it was painful for many people during that period. I also thank my staff, my parliamentary assistant, Tom Cosgrave, and my secretarial assistant, Cáit Nic Amhlaoibh, for the work they have done. I wish them every success as well.

The purpose of this legislation is to require medical practitioners engaged in practice to provide evidence that they hold an adequate level of insurance. The reason for this is that there is currently no legal obligation on a medical practitioner to have adequate medical indemnity insurance cover. I find it hard to believe that this is still the case and the question needs to be asked how it has been overlooked for so long. I am pleased that the matter is now being dealt with finally as some patients may be unable to seek redress in the event of negligent care from a medical practitioner, which we referred to earlier in this debate. Medical negligence is, thankfully, not commonplace but it does happen and there is an obligation on us, as legislators, to ensure people are protected.

Under the legislation a minimum level of indemnity will be set for various classes of medical practitioners by the Medical Council, which will consult the State Claims Agency and other relevant parties to set these minimum levels. A medical practitioner will only require indemnity if he or she falls within a class of medical practitioners specified as requiring that indemnity. The Bill should not require medical practitioners to pay more than what would be the normal adequate indemnity cover for their medical practice. If a medical practitioner is not engaged in medical practice and poses no possible risk to others relating to that practice, there is no legal obligation on him or her to have medical indemnity cover. An example of this would be a medical practitioner who is working full-time as an academic.

There are no additional costs to the Exchequer resulting from this Bill, although there will be costs incurred by the Medical Council which must implement the requirements under the legislation. This is because the Medical Council is the regulator. Estimated additional costs to the council are in the region of €200,000, and I understand this will be spent to a large degree on updates to its IT system which will be needed as a result of this legislation.

I commend the legislation to the House. It is well overdue that such medical indemnity is in place and I am pleased that patients will be protected in the event of medical negligence occurring in the future.

We wish the Deputy all the best.

I also wish the best to the Deputy and to all the other retirees, as well as those going on the hustings.

There will be a few of them.

I am interested to see this Bill. It is an important measure because it is vital that people have insurance, especially medical practitioners. I am surprised the Medical Council has not put its house in order before now. If doctors are practising without insurance, it is a very serious situation. I have a small plant hire business and I cannot go out on the road without insurance, without public liability and employer's liability insurance. I am appalled but why would I be surprised? It is 40 years since the GPs contracts were renegotiated.

The level of claims in this country has gone off the Richter scale completely and the advertising of legal eagles on a no win, no fee basis must be tackled. When will we have a Government that will tackle the racket that is going on and the enormous fees that are charged in this and other areas? I spoke to a chap recently whose house had never flooded and will never flood, because if it did so the whole village would flood, but whose bill went from €350 to €1,800. This is a hijacking of the situation in the country with people being flooded.

This Bill is a bit of a veneer being put on in the dying days of the Government. We have rural GPs and we have two standing in the general election, but the plight of rural GPs is perilous. I salute the work done by all GPs and their practice nurses and other staff in health centres. They are the front-line services and more and more people are abandoning emergency departments. They are getting their own blankets because none is provided by the hospital and they are going back to their GPs because they cannot get to be seen in hospitals. That is the legacy of the Government. The GP in my area has retired and I wish her well, but the HSE tells us we have a locum when we do not have a locum. They will not work if we do not pay them. The rural practice allowance is not being paid to 32 GPs in rural Ireland.

It is 7.30 p.m. so I will have to interrupt the Deputy.

I was just getting going.

Debate adjourned.