I thank the Minister for attending the House. Last week the Minister for Health delivered the Doolin lecture to the Irish Medical Organisation in which he stressed the need for the medical profession to learn to communicate better. I made this point myself when speaking at the inaugural meeting of the Trinity Biological Association last month. The Minister is correct when he says that most complaints about doctors to his Department, to hospitals and to the Medical Council are about lack of communication. Indeed, the medical insurance companies say that this is also the initiating problem with patients in many of these cases.
While this lack of communication is regrettable, even if it arises in a small number of cases only and given that a huge volume of work goes through the hospitals, through general practices and so on, it is much more serious if any obstacles are put in the way of doctors expressing concerns on behalf of their patients, which is one of our primary ethical duties. Recent directives by some health boards, if taken at face value, will mean that doctors, especially those who work for health boards, will not be able to speak out on behalf of their patients. For example, page seven of the handbook from the Southern Health Board handbook entitled "Caring for People", in many ways a laudable document, states:
Publications — Publication of any matter relating to the affairs of the Health Board, or use of information drawn from official sources in publications by staff members or for publication by others, should have the prior approval of the Chief Executive Officer.
Media — The giving of interviews, statements or any other information connected with the services provided by the Health Board should not be undertaken without the prior approval of the Chief Executive Officer or the delegated official spokesperson for the Board.
Information — Public statements by Board staff may be taken as reflecting Board policy or illustrative of Board attitudes. Therefore information should be issued only through authorised spokespersons (leaking of such information to any source, including making it available to colleagues in professional/staff associations in this or other Boards, is not permitted).
These are extraordinarily serious matters, and these directives are in direct conflict with the consultant's common contract and associated legislation on clinical independence of the consultant which, under paragraph 6.4.6, states:
...the employing authority will provide a forum, in the first instance, for the consultant's advocacy role. Neither does it preclude the profession as a body advocating more or better services for patients.
Even worse, these directives are in direct conflict with our obligations to our patients. It is our patients and not health boards, or even the Minister, to whom we owe our first loyalty. Article 25 of the principles of medical ethics in Europe, which is supported by the Medical Council states:
It is the duty of a doctor, whether acting alone or in conjunction with professional organisations, to draw the attention of society to any deficiencies in the quality of health care or in the professional independence of doctors.
Similar directives to those issued by the Southern Health Board were issued some time ago by the Western Health Board, but according to a report in the Irish Medical Times of 10 November, these have been modified, because the chief executive officer of this health board said of his board: “...[it] was an open shop and [he] was not in the business of stifling comment”. He was responding in this instance to complaints by County Mayo GP, Dr. Noel Rice, a member of the board, who urged that employees should be allowed to speak without fear of reprisals by the board or its agents.
A complaint about doctors could be made that we do not speak out enough on behalf of our patients regarding the inadequacies we see. Lack of medical facilities are among the criticisms made in the report by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment published today. I know that complaints by doctors working within the prisons have been made privately and publicly, but how much notice does the Department of Justice take of them? Who is responsible for the fact that so many prisoners have been treated, or inadequately treated, for psychiatric diseases within the prisons? It is important to mention that, in the early 1970s, if it were not for the complaints in Northern Ireland, we do not know how many of the inadequacies regarding the treatment of those in holding centres may not have been brought forward.
This is an extraordinarily serious issue for doctors. I was at a meeting of the International Medical Parliamentarians Organisation in London last week and we talked about these kinds of problems, and that our ethical obligations are to our patients and not to Governments. I hope the Minister will explain to health board why instructions, such as those set out by the Southern Health Board, are in conflict with doctors' ethical obligations.
