I hope I will be both snappy and unchallenged on a personal basis or otherwise. On behalf of the Medical Council, we are delighted to have the invitation to give a presentation to the committee and to bring our concerns to its attention. We are happy to take away from today any questions, comments or advice members want to give us or to follow up on any aspects of the issues we have raised. I have circulated a presentation which I hope to work through quickly and perhaps then take questions and comments.
The first slide in the presentation summarises the document we brought to the committee's attention and with which members are probably familiar at this stage, namely, the proposed EU directive on professional qualifications. It is and has been progressing for about a year through the various elements of the EU legislative process. Our understanding at the moment is that it has most recently been debated in the European Parliament and is being considered by the European Commission for progression during this year or, at the latest, during Ireland's Presidency of the EU in a year's time.
The proposed directive is intended to amalgamate into a simplified directive the 15 current directives which regulate the various professions within the EU. That simplification process is to be welcomed. However, the descriptor of the proposed directive states that its intention is to cover almost all the regulated professions, from engineers, including all the other specified professions, to hairdressers, but does not include lawyers who are apparently given a bye on the basis of their personalised arrangements, something which we would be interested in pursuing further.
I will tell the committee a little about the Medical Council to establish why this arcane subject should be of interest to us as doctors and people involved in the provision of health services to members of the public in this country. The Medical Council was established on the basis of the Medical Practitioners Act 1978. It has 25 members, ten of whom are elected by the profession, six appointed by the Minister for Health and Children and nine appointed by the various universities and postgraduate training bodies within the State. The business of the Medical Council is detailed and comprehensive but is best summarised in a simple phrase. Our business is to protect the public interest and the interests of members of the public when they deal with registered medical practitioners.
What I have spelt out in slide four is the main themes we use to complete or address that mission. We maintain general registers of all doctors who have completed their undergraduate training and specialist registers of doctors who are trained to a point where they can practise independently. We set and maintain by scrutiny the educational standards at all levels within medicine. We provide ethical guidance to the profession and, probably most infamously, we are associated with a disciplinary process for the profession. It is obviously a very important part of our functions but is not the only one.
How do we fulfil all these roles? I want to hit on a few points that are perhaps relevant to the main tasks. The rigour of our scrutiny is something we are perhaps famous for, but the rigour with which the registration process, for example, is applied is unimpeachable. The standard setting and scrutiny of education is an issue on which we have focused a great deal of time and effort in recent years and which has become thoroughly professionalised. The ethical guidelines are revised on the basis of submissions from the profession and public on a five-yearly basis. Competence assurance is a hugely important initiative which the Medical Council has undertaken in the past five years, again with the intention of offering real assurance to the public of the continuing competence throughout the professional lives of independent practitioners.
Fitness is perhaps the most familiar aspect of what we do. The health committee is a good example of something which is much less familiar. It is a vehicle through which those doctors who have not yet harmed patients, and who bring themselves to our attention, can receive support in achieving safe practice.
I now move to the current medical mobility situation in the EU and slide No. 6 summarises a number of the provisions that apply to the movement of doctors around the EU at the moment. This is covered by an EU directive of 1993 under the sectoral directive provisions of the EU. It provides for graduates of EU medical schools to obtain full registration in Ireland on the basis of administrative procedures. They need not go through any additional clinical or language scrutiny before coming here. That process has been in place successfully for many years. It is based on a process of harmonisation of standards for education and training across Europe which was carried out under the aegis of the advisory committee on medical training, an advisory unit established by the EU Commission. Each of the disciplines, such as nursing, dentistry and so on, has had its own advisory committee providing technical advice and guidance to the Commission.
These provisions apply to general and specialist registration. A doctor on the specialist register in another member state for a particular medical discipline can bring that specialist registration and right of independent practice to Ireland. There are approximately 200 such registrations in this country each year and many of those arise in the United Kingdom. However, there are an increasing number of applications and registrations.
The Medical Council welcomes the general thrust of the proposals but has serious concerns about many of the detailed specifications. First, the move is from the sectoral to the general systems directives. That is a very complex issue but, in general, it means that rather than the professions being treated on an individualised basis, there will now be a global set of rules applied to all professions within a package arrangement. Second, the dissolution of the advisory committees and their replacement by an EU Commission appointed group which will provide advice on a comitology basis directly to the EU Commission and will be appointed by it.
There are specific concerns. One of the highlights of the proposed legislation is the ability of doctors registered in another EU member state to practice in Ireland without registration here. The aim of clearer and simpler administration is to be welcomed but the several highlights I have touched on are the Medical Council's principal concerns and the main reasons for putting this issue before the committee. There are other concerns, for example, the collapse of medical specialities across Europe from the current 50 or more recognised specialities into a core group of approximately 16. If a speciality is recognised in all member states it will be entered into the core group, which raises concerns I will return to shortly.
The final specific issue is that this is based not on harmonisation of standards across Europe at undergraduate or postgraduate training levels but on the individual assessment of applicants. This process of movement from sectoral to general systems directives is founded on the understanding that individual applicants rather than systems based structures will be put in place.
The Medical Council welcomes many of these issues, including the target of simplification. We want to see mobility and are delighted to see doctors bringing their experience and breadth of thought from other countries to Ireland. This country will benefit greatly from that as do other countries where Irish graduates work. We also welcome the introduction of a language assessment for the first time and the principle of some type of clinical assessment may be possible under this legislation.
However, there are concerns. The first block of concerns is in regard to the issue of 16 weeks unregistered practice. We fundamentally object to that provision on the basis that it exposes the public to significant risk. The risk arises because those doctors are subject to the ethical and qualitative standards of their own regulatory body, not to those which are relevant or agreed on for this country. There are real concerns about the standards of practice and familiarity with Irish expectations. The council is also concerned that should a complaint arise against one of those doctors, it must be pursued in the country of origin of that doctor by a member of the public here. The Medical Council will have no awareness of the fact of practice of many of these doctors in this country and will have no say in their regulation, discipline or registration.
A single comitology committee cannot serve everything from hairdressing to engineering as that is nonsense. The dissolution of the advisory committees de facto occurred three years ago. The advisory committee on medical training has not convened for more than three years and has been allowed to fall into disrepute because of its lack of activity. There is no question that it has been a cumbersome and less than efficient body but those deficiencies could be fixed.
The council fundamentally believes that each of the professions has an important consultative role to play with the Commission. If all specialities are reduced to a core group of 16, there are serious implications for the competence assurance structures which the Medical Council has put in place. Those structures relate to systems which came into operation on 1 January last by which all doctors on the register of medical specialists - which reflects those doctors who have completed training and are capable of independent practice - have signed themselves up for cycles of five year continuing professional development programmes which will determine their future re-entry on the register.
Competence assurance is based on disciplines and the existing groups of disciplines are the framework around which we have built competence assurance. Administratively, we can consider what options there are under this legislative provision but one clear implication is that there will be a move from the current peer based system of specialists reviewing each other's works to more generic groups centred around these 16 specialities.
The Medical Council has difficulty with the issue of a single advisory committee established by the EU Commission to advise it because the proposed legislation devolves powers to the comitology committee to do a number of things. First, it allows that committee to advise the Commission on making decisions about automatic recognition of experience for future registration of doctors - not recognition of their training but of their experience. Second, it allows the comitology committee and Commission to make decisions about the content of training at all levels. Finally, it allows those bodies powers of establishment of new specialities.
The council has public interest concerns about all of those issues because they may be driven by motives other than the protection of the best service delivery to members of the public. The practice by doctors who are not registered in this country on patients who are under the illusion that those doctors may be subject to scrutiny in this country is unacceptable. We do not believe that doctors should practice outside some umbrella of guidance and supervision within this State.
At a technical level, third country qualifications for EU nationals have begun to become a feature of medical mobility around Europe. That means that if an EU national qualifies as a doctor, perhaps in South America or in another state outside the EU, and then returns to an EU state, he or she may then become fully registered in that EU state and gain all the privileges of medical mobility and registration throughout Europe without any say in how that doctor is being trained. How will doctors be handled if they fall outside the specialist core groups? We may be able to make administrative re-arrangements, but we have some concerns about the impact on what is a delicate flower at the moment - the system of competence assurance that we are building up. An enormous bureaucracy is being established, which undermines the purpose of this legislation. The individualised assessment of every applicant who wishes to come to this country without any systems-wide structures in place will cause serious difficulties.
We welcome increased medical mobility. The current proposals favour the interests of migrant professionals over the interests of the public, which is unacceptable. Unregistered and unaccountable practice in this State is unacceptable. We share these concerns with colleagues in An Bord Altranais, the Dental Council and the Pharmaceutical Society. All of these professions and regulatory bodies have similar concerns and problems with this proposed legislation. We welcome this opportunity to bring our concerns to the attention of the public, the parliamentary process and political agents. We have had intense contact with many individual legislators, and I welcome the support of the Minister for Health and Children in advancing our concerns and bringing them to a range of fora.
Other Ministers with involvement in this process at EU level should also share the concerns of the Minister for Health and Children about the implications of this legislation. Members of the Oireachtas and the European Parliament have an important role to play in bringing the concerns of the Irish public to the attention of their colleagues.
