Seanad Éireann díospóireacht -
Wednesday, 8 Feb 2006

Vol. 182 No. 15

Third Level Education: Statements.

Minister for Education and Science (Ms M. Hanafin)

I thank the House for this invitation to address it on the subject of the Government's commitment to funding for third level education and the reform of medical education. There have been significant recent announcements on these fronts and I am glad of the opportunity to exchange views with Senators on the direction we are taking. I propose to outline these developments in some detail for Members of the House and to set them in the context of broader Government strategy.

As Senators are well aware, higher education in Ireland has come through a period of major expansion. It has transformed from an elite sector of less than 20,000 students in the mid-1960s to a system that now caters for over 130,000 students and a majority of school leavers each year.

More than 30,000 new third level places have been created since this Government took office in 1997. Overall investment in the sector per annum has more than doubled over that period. This now stands at €1.7 billion in 2006.

The major expansion of higher education, through the development of the institutes of technology and the major growth in participation rates, has been an extremely important factor in our economic success over recent years. Indeed, the commitment of successive Governments over many years to invest in education at first, second and third levels has been widely recognised as an extremely far-sighted contribution to our modern economic and social status.

In seeking to develop future competitive strengths in the global knowledge era, similar vision and an even more determined approach to investment in our skills, creativity and innovation capacity are now required. The Government's strategic ambition for Ireland is to continue to develop as a world-leading knowledge economy. To achieve that, and to enjoy the social dividends that flow from it, we need to produce quality skilled graduates at third level and quality researchers at fourth level who can serve the high-value needs of the emerging sectors of the economy.

The independent review of lreland's higher education system conducted by the OECD during 2004 had identified the need for change and development in the sector if it was to contribute effectively to these broad national goals. The Government has endorsed this strategic agenda for change in the sector and the need to align this with policies for investment and funding. Ireland's successful transition from being a technology-importing, low-cost economy to a technology-based, innovation economy depends critically on progress on this front.

In my pursuit of these broader national objectives, investment in higher education has been a major policy priority. When I set out my approach to a programme of development and change in higher education in April 2005, I announced my intention to establish a strategic innovation fund to drive the transformation of the sector by promoting collaboration and change. I am delighted that budget 2006 enabled this multiannual fund to become a reality with an allocation of €300 million over the next five years. Significantly, this was announced as part of a wider additional investment package for higher education of €1.2 billion. This funding will serve to transform higher education in a number of ways. It will allow high priority infrastructural projects to be addressed, drive the reform and change agenda at an institutional level and promote collaboration and change in pursuit of system wide excellence.

Achieving the desired change is a complex and challenging task. I intend to make the strategic innovation fund available to higher education institutions to support the following key objectives: incentivise and reward internal restructuring and rationalisation efforts; provide for improved performance management systems; meet staff training and support requirements associated with the reform of structures and the implementation of new processes; implement improved management information systems; introduce teaching and learning reforms, including enhanced teaching methods, programme restructuring, modularisation and e-learning; support quality improvement initiatives aimed at excellence; and promote access, transfer and progression and incentivise stronger interinstitutional collaboration in the development and delivery of programmes.

A major emphasis of the fund is the promotion of inter-institutional collaboration in building world class strength within the Irish system. The quality of higher education in Ireland must be measured against the highest standards across the world. The emphasis being placed on promoting collaboration through this fund is deliberate. Collectively, our higher education institutions represent a very valuable national resource. The full potential of that resource can only be achieved through a systemwide approach that builds on our strengths.

Awards under the fund will be made on the basis of a competitive call for proposals. The Higher Education Authority has been asked to develop the detailed criteria for the fund with a view to making an early call for proposals. An international panel of experts will be convened to consider the proposals submitted and to make objective recommendations on funding awards. An initial €15 million will be available this year for what is essentially a start-up period. This will grow to €60 million in 2007 and to €75 million per annum in each of 2008, 2009 and 2010.

In framing proposals, there will be a requirement on institutions to contribute funds from their own resources to copper fasten the reform efforts. This is important in ensuring that the fund can leverage fundamental change by promoting new thinking and new priorities in the use of existing resources. The overall objective is to achieve new levels of performance at third level and, building on this, to develop a fourth-level system of research that can be benchmarked against the highest international standards.

In pursuing these objectives, continuing investment in the basic physical facilities on third level campuses around the country is an essential foundation. As part of the budget day announcements, €900 million capital funding was allocated for higher education projects as part of my five year envelope for 2006 to 2010. This will allow me to deal with a number of key projects in universities and institutes of technology identified as part of the needs assessment and prioritisation exercise conducted by the Kelly review group for the Higher Education Authority. I have already announced a series of major projects across the country which will now be progressed either by conventional procurement or under the public private partnership initiative. A total of 53 major capital projects across the system have been earmarked for progression. A remaining balance of some €200 million will be used to deal with emerging priorities in the context of overall national strategy.

The budget announcement of a new multiannual funding package for higher education came on foot of an important 7% increase in core funding for the sector in 2006 and a 17% increase in research and development funding for this year. This Government's record of investment in research and development in higher education has been one of its outstanding achievements. The research landscape has been transformed over recent years with the establishment of the programme for research in third level institutions, PRTLI, and Science Foundation Ireland. Awards totalling more than €605 million have been made under the PRTLI for the development of basic research infrastructure across our higher education institutions. Prior to 1999, there was no dedicated programme of basic research funding in the Irish system.

It is the Government intention to continue building on this and an ambitious new national research plan is to be considered by a Cabinet committee shortly. The Taoiseach and the Minister for Finance have both indicated that investment in our intellectual capital through higher education will be a central objective of the successor national development plan now being prepared. I look forward to returning to these issues in this House as we continue to pursue these fundamentally important objectives for Ireland's future economic and social prosperity.

I want to turn to the more specific issue of reform in medical education and training, which, as members are aware, was the subject of two landmark reports jointly published by the Tánaiste and I last week, namely, the Report of the Working Group on Undergraduate Medical Education and Training, chaired by Professor Pat Fottrell and the Report of the Postgraduate Medical Education and Training group, chaired by Dr. Jane Buttimer. The two reports represent the most significant review of medical education and training ever undertaken in Ireland. They make a series of major recommendations across the continuum of undergraduate and postgraduate medical education and training, spanning the education and health systems in a variety of delivery settings. These are aimed at responding to the needs of a changing health system and ensuring that medical education in Ireland is sufficiently resourced and developed to maintain our reputation for producing quality doctors in the future.

In joining the Tánaiste to launch the reports, I was particularly pleased that the Government is already in a position to respond to the reports' complex range of recommendations. The Government has approved a €200 million multiannual programme of investment in medical education that will more than double the number of places, provide an additional access route for entry to medical education, facilitate significant curriculum reform and provide for improvements in the provision of clinical training.

Specifically, it is now intended to increase the annual number of undergraduate places for Irish and EU students from 305 to 485 and to introduce a separate graduate entry stream to medical education which will provide 240 additional places per annum. These increases will be phased in over a four-year period, commencing this autumn when an additional 70 undergraduate places will be provided. A further 40 places will be provided in 2007 and 35 in each of 2008 and 2009. The Higher Education Authority will begin immediate consultations with existing medical schools on the provision of the additional undergraduate places.

The authority will also issue a competitive call for proposals to provide the new graduate entry programme, with a view to the additional places being provided on this programme from 2007. The provision of a graduate entry stream is an important development in reducing pressures on aspiring medical students who until now have effectively had one chance of entry based on their leaving certificate performance. The high points pressures associated with this has had a negative knock-on impact on the senior cycle school experience for many students. Graduate entry, which will be open to graduates of all disciplines, will allow students to make a decision to enter medicine at a more mature age and should result in a more diverse range of entrants into the profession. The Higher Education Authority will now establish an expert group to develop a standardised test that, drawing on best international practice, will evaluate aptitude and suitability for entry to the graduate programme. This selection test will be in place for 2007.

In the interests of alleviating the enormous pressures of high CAO points requirements, the Fottrell report recommended that leaving certificate results should no longer be the sole selection criterion for undergraduate entry. It proposes that all students with 450 leaving certificate points be considered for selection on the basis of a separate aptitude test. I am a keen supporter of the fairness and objectivity of the points system but I recognise that the pressures on students wishing to study medicine in terms of achieving an almost perfect leaving certificate are excessive and unnecessary. For that reason, I am anxious to explore the detailed options with regard to a dual selection process. There is a need, however, to ensure that the revised system will adequately reward strong academic performance, provide an appropriate evaluation of aptitude and suitability for a career in medicine and will retain public confidence in its objectivity and fairness.

I have asked the HEA expert group to bring forward more detailed proposals on the proposed new undergraduate selection system, to devise an appropriate second selection test for use at undergraduate level and to advise on the logistics of its administration. The expert group is to report to me by summer 2006 in order to allow a clear signal of any proposed changes to be given to the cohort of students entering the senior cycle, that is, those going into fifth year in September 2006. To allow adequate notice to students, the new entry procedures for undergraduate medical education will not be introduced any sooner than September 2008.

The Fottrell report lays strong emphasis on the need for curriculum reform, with a greater emphasis on small group interaction, problem-based learning approaches and interdisciplinary contact. It is also critical that clinical placements for students provide a highly-effective learning experience. These are essential elements of the reforms and investment on which we are now embarking. I have allocated an additional €4 million in 2006 to commence investment in curriculum improvements, clinical training and the provision of 70 additional places this year.

Unprecedented investment is now being made in our higher education system in pursuit of the development of the knowledge base on which Ireland's growth strategy, and the economic and social benefits that will flow from that, depends. Supporting our higher education institutions is a major policy priority. The targeted investments that this Government is now making in the higher education infrastructure, in promoting excellence through system wide collaboration and change, in widening access and in creating a vibrant fourth level sector are key long-term investments in Ireland's future. I know that Seanad Éireann endorses the objectives we are pursuing.

Mr. U. Burke

I welcome the Minister for Education and Science, Deputy Mary Hanafin, to the House. Her speech is a very positive indication of her commitment to change. In her address, she emphasised the importance of change, development and investment and has demonstrated that these three principles are foremost in her mind.

It is important that as a relatively new Minister, Deputy Hanafin has undertaken much-needed reform of the third level sector. I do not wish to be political at this point, but in the past year the presidents of all of our colleges and third level institutions found themselves facing a financial crisis as a result of the fact that investment, under successive Ministers, had not kept pace with investment in other sectors, or even within the education system itself. The third level sector had fallen behind. It has been recognised that if our third level institutions cannot produce graduates of the highest quality because of underinvestment, this will have negative implications for the creation of new job opportunities in this country.

The Fottrell report is welcome and timely because it is clear to everyone that there is a shortage of medical practitioners in this country. In rural Ireland in particular, gaining access to a doctor, even during so-called working hours, is difficult and outside those hours, virtually impossible. The consequence of that is the crisis that exists in accident and emergency departments in many hospitals. The Minister, by creating an environment which will allow for the training of additional doctors, has allowed us to hope for a change in that situation. While it may be too late for some, for many people who rely on their general practitioner, this is a welcome step forward.

Some third level institutions have been preparing for this announcement for a number of years and may have the capacity to take in additional students this year. I am referring, in particular, to the University of Limerick, which has additional capacity through its forward-looking development plan. I ask the Minister to consider that option if it is available to her. It would move the reform programme forward and allow for a faster throughput of doctors.

Entry to the GMS scheme is problematic and has been for some time. I hope that any review being undertaken of training and output of medical practitioners will also examine access to the GMS scheme. Such access is a serious problem in rural areas and particularly in the west, where a high proportion of the population is ageing and where the need for access to the scheme will be even greater in the coming years.

I welcome the package announced by the Minister in co-operation with the Tánaiste and Minister for Health and Children, Deputy Harney. If there is an opportunity to accelerate change and move the programme forward, I hope it will not be lost. There is no doubt that we have trained medical practitioners of the highest quality, who can take their rightful place at the top of any medical system. Indeed, many are in the highest positions abroad. Unfortunately, as the Fottrell report makes clear, many of our medical graduates are forced to go abroad for additional specialist training. The Minister did not refer specifically to this issue today but I hope there will be a parallel development of specialist training in Ireland. While such training is available here, its further development must be accelerated, in tandem with the proposed increased output of general medical practitioners.

Most people accept that the requirements for entry into medical faculties that existed until now, through the CAO system, made it almost impossible for students to gain entry without seriously damaging their lifestyles. In many cases, the pressure to gain the enormous number of points required took its toll on gifted students, whose only ambition was to gain access to medical school. I am pleased that the barrier is to be reduced somewhat, but not to the extent that the quality of those who gain access will deteriorate markedly. The fact that the pressure on students will be reduced is very welcome. The proposal for aptitude tests and interviews must be given careful consideration and I welcome the fact that a working group has been established to finalise the terms of the tests. Currently, people joining the Civil Service at any level must do an aptitude test and its content is relevant to the job application. I do not know, however, how an aptitude test could be framed to identify what is required to make a good doctor. I heard an eminent medical practitioner on the radio after the Minister announced her proposals asking how a test could assess the characteristics required. The experts the Minister has drawn together have an unenviable task and I hope they can devise a method whereby that end will be achieved.

I am concerned about an aptitude test being seen as a step forward. There were also hints that we might go along the English route, where the test would be followed by an interview.

Ms M. Hanafin

Absolutely not.

Mr. U. Burke

If that was the case, and I am glad the Minister has said it is not, we are too small a country to do it. In the past, once there was a family tradition established in the medical profession, it would carry on. Thankfully that has been eliminated by the present system.

If there is a commitment to invest resources in this plan it will succeed and we will get the number and calibre of people we need in the medical profession. It will require investment, particularly if we wish to increase our current intake of Irish and EU students. There will necessarily be a subsequent decrease in the number of non-European students from Asia, Africa and America. We have taken those students from outside Europe for financial reasons, to balance the Exchequer input; that was part of the problem that led to the present crisis. Many of those trained in our medical schools went back to their own countries, leaving a need here. Now there is an opportunity to address that and strike a balance in favour of Irish students. They may have to go abroad for further specialist training but the Minister might rectify that in due course.

The Irish intake is currently made up of students who have just completed their leaving certificate but now there will be a graduate intake, with a ratio of 60:40 in favour of second level entrants. The graduate students who enter training will come in with experience of life in another profession and will add a level of experience greater than that of ordinary entrants.

I welcome the proposals in the report. I would like the Minister to fast-track the process and see if an intake at the University of Limerick is possible. That would greatly improve the situation. Many more students at second level will now be able to aspire to entry to medical school.

Mr. Fitzgerald

I welcome the Minister to the House. Her approach to the funding of third level education was set out in detail in her speech. It is important to remind the House of the Minister's stated objective on third level education and her intention to invest in the enhancement of third level to support national strategic goals. That theme has recurred every time the Minister has discussed her vision of and priorities for third level education.

The OECD report published in 2004 stated that if we want to lead in the information age, we must have a world class third level education system. It is clear that it has been the Minister's intention from the outset to build on the Government's success in achieving that goal. The Minister has outlined the packages that have been provided prior to and since the budget in terms of capital and current spending and the innovation fund.

There are two partners in this scenario — the Government and those who deliver the services. Sometimes it is forgotten when criticising the Government's commitment to putting third level education at the centre of our national strategy that the other partner to the deal was not front-loading either. The Minister's predecessors challenged the bona fides of those agencies, both the universities and the institutes, to be more specific about delivery of objectives.

A submission was made to Government last year on reform of the culture in the institutes and relationships between them. In this regard it is significant to note that the Minister's achievement in securing increased funding for third level education in the budget has silenced some of the Government's loudest critics. I was also heartened to read in recent weeks that some of her most vocal critics have become some of her most vocal champions. This is a matter of public record. For example, one former critic stated the Minister has achieved a seismic shift in Government policy on third level funding, which has become anchored at the heart of our national economic and social strategy. This is a heartening development. While I do not propose to address issues in detail at this point, I will do so in my concluding remarks if the opportunity arises.

I warmly welcome the contemporaneous publication of the Report of the Working Group on Undergraduate Medical Education and Training, known as the Fottrell report, and the joint announcement by the Minister and her colleague, the Tánaiste and Minister for Health and Children, Deputy Harney, of a €200 million package of reforms of medical education, a major initiative which will be of critical importance. I read recently — I am not good at tracing my sources — that the problems facing the health service can be simplified by breaking them into two parts, namely, funding and service delivery. This applies equally to first, second and third level education. The scribe in question pointed out that while health service funding was characterised by serious shortcomings in the past, these have been compensated for in large measure in recent years and it is now up to the other parties, the professionals in the field, to address the issue.

The working group on undergraduate medical education, which was established in 2003, has now reported to the Minister and her colleague, the Minister for Health and Children. The publication of the Fottrell report is timely. Its conclusions and recommendations represent a broad consensus of views and analysis from top professionals and administrators drawn from the full range of stakeholders involved in the delivery of medical education and training and the health service in general. This is important as it ensures the Ministers are given an holistic, rounded picture.

I join the Minister in paying tribute to Professor Patrick Fottrell and his working group. Like her, I believe the report before us is a landmark document which charts our future course in medical education. I also acknowledge the publication of a report on postgraduate specialist training by Dr. Jane Buttimer. Before commenting on several of the many issues addressed in the Fottrell report, including weaknesses in the system and how, based on international best practice and excellence, we should meet the challenges which constantly arise in the health service, I pay tribute to the standards of excellence achieved by our doctors and consultants at national and international level. While I have been an occasional critic of certain aspects of the medical professions' behaviour and have not changed my views in this regard, nevertheless, I commend their excellence over the decades.

When the working group on undergraduate medical education under Professor Fottrell started work on its terms of reference it noted major lacunae in terms of how we will meet future needs and recommended radical changes across the spectrum, particularly in the area of medical education and training, for which it envisaged a critical role in enhancing the quality of health care delivery. In responding to the report, the Minister's initiative facilitates greater access to the medical profession, a point on which all sides agree. It also has the potential to address at least two issues of major significance, namely, the easing of entry to medical training and the provision of greater numbers of doctors to service our medical care needs.

As we are all aware, entry to the medical profession has become extraordinarily competitive in recent years. The leaving certificate requirement for entry to medical training is, I understand, 570 points and the CAO system is the virtually the only entry route to the system. I understand a small number enter the professions via the medical schools but I am not familiar with the procedure or numbers involved. While the CAO system is a fair assessment and yardstick of competitive academic achievement, it has serious shortcomings in its application to training for medical professionals. I am pleased, therefore, that the working group examined this issue and made some far-reaching proposals for reform.

As with most professions, aptitude and suitability are key requirements for qualification as a medical professional. We have all known academically brilliant people who achieved fantastic leaving certificate results and flew through medical school with many accolades but proved unfit for the job. If unfitness for a job is damaging and potentially dangerous in any profession, it is in medicine where lives and the health of individuals are at risk. The approach to aptitude and suitability recommended in the report is critically important. The reforms proposed by the Minister for Education and Science and the Tánaiste and Minister for Health and Children include the introduction of a new graduate entry programme for medicine, the development of new aptitude tests for selection for graduate entry and a new selection mechanism to involve a combination of CAO points and suitability test performance.

The Minister consistently emphasises that all new criteria must be objective, transparent and fair and must be seen to be so. The competitive selection measures must adhere to these fundamental principles. The reforms will have considerable benefits in opening up access routes to those who aspire to a medical vocation but could not realise their aspiration as a result of failing to obtain the required points in the leaving certificate examination. As a result of the variety of routes to be introduced under the proposed reform programme, many adults who still cling to their childhood dream of working in medicine — we all know some of them — will have an opportunity to realise their dreams because they will be given a second chance. It is wonderful to introduce a second chance for all professions based on fundamental criteria.

I am pleased the Minister has selected a basic points threshold of 450. This is a wise, fair and reasonable decision as the figure reflects an appropriate level of ability for those who aspire to practise medicine, a discipline which requires them to constantly increase their scientific and technical knowledge.

As regards the aptitude test, I will address some of the issues raised by Senator Ulick Burke. I am an advocate of the aptitude test. The Minister is determined about fairness, objectivity and transparency. Who will devise the aptitude tests? What is the appropriate aptitude test for a person going into medicine? What constitutes, as near as we can achieve, the ideal test for such a person? The same question applies to teaching and other professions but medicine is more critical. What input will doctors have into designing the test? What score will be given to familiarity with the medical profession? Will it be seen to favour a candidate who socialises in a medical household? It must not.

The Minister will be anxious to ensure the new system does not facilitate a privileged entry corridor for the sons and daughters of doctors. It is vital that from the outset the integrity of the system be seen to exist and be safeguarded. I suggest the oversight committee, to which the Minister referred, be employed to monitor the formulation, introduction and implementation of the aptitude test system. This may be inappropriate but it is a suggestion. If it is not appropriate, another body should be considered for the role.

I welcome the doubling of places for Irish and EU students. Like Senator Ulick Burke, most of us were never happy with the fact that previously up to 60% of the student intake has been of non-EU students. It is inappropriate for a progressive country such as ours. It is unacceptable that we should then have to recruit doctors from abroad, often from countries where they are needed, instead of training more of our own. The Minister has grasped that nettle and is implementing reforms on a phased basis. We must be realistic about it.

We would all love to aspire to Senator Ulick Burke's suggestions but this can be done only on a phased basis. There are significant implications for costs, curriculum change, group sizes and interaction between professionals. Developments are also required which medical students will need to see in place, which they have never had before and which the Fottrell report found to be serious lacunae without which we could not aspire to compete with international best practice. I accept that the Minister for Education and Science, the Tánaiste and Minister for Health and Children and the Government can approach this only on a phased basis but it is heartening that they are starting now and I welcome it.

I welcome the path on which the Minister has started. Although there are commendable elements to it, there is no such thing as a perfect system and there will always be slight questions. I have one or two, one on the repeat leaving certificate. Although we are all idealists, pragmatism must play a role. If I had more time I would explore it further but I will not dwell on that now.

This programme of reforms of medical education and training is not a quick fix. Such a solution does not exist. It is a vital element of the programme of reform of the health services and of medical education and training. It is critical we do it now. The programme outlined by the Minister has unquestionable merit as a solution. It is not a fond hope but a well-founded, prudent plan to address the inadequacies of our deficient medical service and I commend it.

Dr. Henry

I welcome the Minister to the House. Despite being one of the university Senators I hope she will forgive me if I do not concentrate on the funding for third level education. I appreciate it greatly and welcome everything the Minister said in her speech. As I have been involved for many years in medical education I will concentrate on the Fottrell report.

Although it has been said that the report is timely, it is long overdue. For years we have known we were in a dire situation regarding the production of our own graduates. For almost 30 years there has been a cap of 305 and we have known it was far too small, even for replacement numbers. We had a policy of taking people from the third world to perform much of the service commitment in our hospitals. That was wrong and I am delighted to see that this report has come forward now.

I am cheered by the Minister's response to the report. I am sure her decision before the report was published to provide an extra 70 places for EU students this year was due to the motion I placed before the Seanad last year encouraging this to happen and which was supported by the Independent Senators. It is nice to see one's advice taken occasionally.

I will quote from the report:

In this new model of medical education there will be more students, more diverse delivery settings, more small-group work and interaction, including mentoring procedures and more inter-disciplinary contact. This therefore involves considerable logistical support on a scale not seen to date. The gain will be graduates more fitted to the complex, increasingly multi-cultural society Ireland has become.

Judging by the Minister's speech today and by what she has said outside this House her approach to the report has been wise. The recommendations cannot be brought in on what may be termed a "big bang" basis with everything implemented at once. I have examined the various scenarios as to how undergraduates and graduates would be phased in to the system over a certain number of years from years one to 11 and how the non-EU graduates, who, it has been said by everyone, have been supporting the system financially, will be phased out. It is extraordinarily optimistic and the Minister's approach is wise.

As the situation regarding admission requirements has concentrated most people and will concentrate the public, I will deal with it first. The Minister is wise to focus on undergraduate students. Everybody agrees that doing interviews in such a small country is not a good idea. The Minister should be careful with aptitude tests. Other university subjects have high demand and high points. Why are veterinary medicine, pharmacy and physiotherapy not also singled out? A wide range of people are needed in medicine. A pathologist is not the same kind of person as a general practitioner. No survey has yet concluded that very intelligent people are less compassionate or less able to communicate than people with lesser intellectual abilities. I was delighted to see the chairman of the Irish College of General Practitioners, a discipline in which communication and compassion are most needed, saying that.

The Minister should be careful with aptitude tests, particularly given that the US Commission on Civil Rights has complained about them in 2002 saying they are biased against socially disadvantaged people, ethnic groups and even women. Some 300 universities have abandoned them or said they must be taken in conjunction with a school-based assessment. This is from the 2003 report on the website of the National Centre for Education Statistics. Professor Kathleen Lynch, professor of equality studies in UCD and senior lecturer in education, has frequently pointed this out. In the United Kingdom the biomedical admissions test, BMAT, is said to considerably favour those who are taking higher mathematics and physics as subjects. There was a House of Commons debate on this recently and we must be careful we do not get involved in a pseudo-science that favours the best-off who can afford grinds in aptitude tests, as happened in America. This is the reason they have made such a mountain of them.

We urgently need to address curriculum changes. The pre-clinical changes have taken place, to a certain extent, because people are entering with higher qualifications in sciences in general than was true when I entered medicine 40 years ago, which means the problems are not great. Some of the medical schools have reduced their courses from six years to five. Five years is recommended for those who enter as undergraduates in this situation. However, before we can introduce all the Fottrell recommendations, we need to bring all colleges around to this idea, as it cannot be implemented on a piecemeal basis. A great deal of consultation will be required even at the pre-clinical stage to ascertain how colleges can shorten some of their courses, in which people have greater expertise than they had in the past.

I qualified 40 years ago last year and the clinical training and how it is delivered have not changed much over the years. What is suggested in the report will be incredibly expensive. The expense will arise in numerous areas. It is not widely recognised that most clinical training is done by people who are not paid to do it. Only 40 academic whole-time equivalents are being paid to give clinical medical training. When students complain about frequent no-shows of those who are to give clinical training — the report states this can be as high as 30% — it is important to remember that those people are not being paid to do it. It has an enormous impact on service work. That will take considerable retraining and re-skilling of those who are involved in the clinical training.

One group has not been mentioned. There will be considerable change for patients. Patients could be described as the raw material for teaching these students in clinical training. I was rather disappointed that the report laid no emphasis on them. It has been suggested that patients be seen in different settings. Most students see patients either in acute hospitals or within primary care practices. It would be good if they could see patients in their own homes or in community care settings. However, the logistics would be significant. A very significant level of support staff would be required in this regard.

Students are frequently taught in clinical sites that were never designed for teaching. I never allowed more than three students into a cubicle with me. However, the students must wait outside in order that the patient's consent can be sought to allow them be present for the consultation and examination. It is necessary to seek consent for students to be present even if the patient is to be anaesthetised. All this takes some time. I have had cases where, for example, a patient has agreed to give consent provided their daughter can be present. The daughter had a child in a buggy. The cubicle contained me, the nurse, the patient, the daughter, the child and the buggy. When the three students came in the cubicle became very congested, which would be made worse if we were forced to increase the number of students to four, five or six.

A doctor must try to treat a patient and teach at the same time. I always enjoyed teaching, so that was not a problem. Most places have few or no tutorial rooms and small lecture theatres, which are the types of issues mentioned in the report. It will cost a considerable amount to put these facilities in place before we can, with any dignity for patients, introduce much of what is suggested in the report. I regret that such reference to patients was left out of the report.

I like the phased approach of the Minister for Education and Science and while her partner is the Minister for Health and Children, both of them will have trouble with their superior, the Minister for Finance, who will need to give far more than the €4 million he has given this year. That will be very little given that a sum of €100 million is mentioned in the report. Enormous sums of money will be needed for all the small units in the hospitals in this city where doctors will be trying to teach increased numbers of students while still giving the patients the dignity and privacy all of us would want them to have. This area needs to be addressed with the greatest of care.

Non-EU students provide approximately 60% of the funds to run the medical schools, which is enormous. Owing to the approach the Minister for Education and Science is taking, she will need to ensure that the Minister for Finance understands that he cannot turn off the tap in four years' time and suggest increasing the numbers of non-EU students to increase the money coming in. We cannot have a turn-on and turn off- approach. It has taken 20 years to get many of those students to take up places here, given the tremendous competition from universities in the United Kingdom. This type of scheme is so popular that Italy now has medical courses in English. We need to commit to a long-term approach.

It is a very good idea to bring in more graduates, as is done by most medical schools by giving places to approximately 20 such students each year. While they do well, it is much more difficult for those who graduated from arts disciplines than for those with science backgrounds. They have frequently told me they never realised they would need to work so hard. In general they are extremely committed, work very hard and do very well. However, now many of them will also have a significant financial commitment and they will start their medical careers either with huge loans, which they will need to repay or with obligations relating to grants given to them. This is what happens in America resulting in increased medical charges, as the doctors must repay their huge loans. Most medical graduates in America now finish with a loan of approximately $120,000, or €100,000, which is very big.

While we are enthusiastic about getting more graduates — one of my colleagues said they are much less trouble as it is not necessary to spend half as much time minding them, etc. — we must remember that they will also have their own problems, for example, having families to deal with. As pointed out in Dr. Buttimer's report, flexi-training becomes far more important.

Hospitals will need more facilities to allow for clinical training with clinicians and will also need more facilities for students, which will cost more money. I would suggest that sufficient account has not been taken of this matter either. It is disappointing that we have been considered to be falling behind in development both nationally and internationally, which is one of the most important matters for the Minister to tackle. She should try to encourage those involved in teaching to raise whatever standards are needed.

I come to the issue of the intern year. Much medical care is still provided by non-consultant hospital doctors. The Tánaiste and Minister for Health and Children is working towards consultant-provided health care but we still have many non-consultant doctors whose numbers we are trying to cut down. In view of the increase in the number of medical students we will have to increase the number of intern posts by approximately 300, but what are interns looking for? They seek junior house officer posts and, subsequently, they will seek senior house officer posts. We know from the Buttimer report the number of them who go abroad for training but, unfortunately — I can speak from family experience — unless consultants' posts in those disciplines in which the person is training abroad are available here when they finish training, they will take up places in the United Kingdom, America, Australia and elsewhere and are then lost to us.

In addition to the situation regarding the intern posts, which will cost the Minister for Finance a fortune, we also must address the question of improved training programmes in this country. We should get rid of the non-consultant hospital doctor posts for which there is little training and concentrate on those with good training because we have to improve the position as outlined in the Buttimer report whereby many people go abroad. After all the Minister's fine efforts in helping them get through medical school, they end up running the large hospitals in New York, Washington, London, Newcastle and elsewhere and do not come back here to treat the Irish public as many Senators want.

I congratulate the Minister on her approach and implore her not to be pushed into taking measures too rapidly. We had to wait a very long time for this report, and I compliment the former Minister for Education and Science, Deputy Martin, on commissioning it. Now is the time to consider it carefully; there is no need for a big bang approach. What the Minister is doing to date is extremely good.

Mr. Minihan

I welcome the Minister to the House and thank her for her statement. The last time I spoke on this topic, the context was the position of the Irish education system in the top rank of the OECD in terms of both quality and level of participation. The motion before the House on that occasion expressed the view of the House that we were anxious to maintain quality, responsiveness and competitiveness as a priority in higher education.

Today's contributions follow directly on from this in terms of ensuring that the quality and level of participation in education is maintained through funding and other measures and how we can make responsiveness and competitiveness features of our education system. In my contribution I want to focus on two particular developments of importance to third level funding, namely, the most recent budget and the publication of the Report of the Working Group on Undergraduate Medical Education and Training, chaired by Professor Fottrell.

The budget gave a useful indication of the Government's view of the country's priorities as being infrastructure development, welfare, pensions, child care, fair taxation and helping the consumer. It is noticeable, first, that investment in third level education is also a specific priority and, second, that it features under the heading of supporting our economic success. In the 1980s the challenge was to turn economic stagnation and social despair into a situation where we could prioritise the areas where massive investment was to be targeted. We must be able to create an environment in which the economy thrives, jobs are created, revenue is generated, better public services are provided and the vulnerable are assisted.

The Government has pursued economic policies with social objectives that have made that investment possible, and we are not inclined to stop now. Ireland's education system was the basis for the rapid economic progress we have made in recent decades. In his Budget Statement the Minister for Finance stated that a disproportionate amount of emphasis is placed on taxation policy as a key element in our economic success. While this has been extremely important, I agree that the single biggest contributor to our success has been the availability to both indigenous and foreign investors of an exceptionally well-educated workforce. In this regard, prudent financial management, which is a core policy of the Progressive Democrats, demands that we continue to position ourselves at the very front of the world's knowledge-based economies. Prudent financial management means not just managing the present but also preparing for the future.

When I spoke on this issue in the previous debate in the House, I said it is imperative that we ensure our education system is kept relevant to our wider social and economic needs. In a changing society and a rapidly evolving economy, higher education must be continually challenged to remain relevant and responsive. Education skills, research and innovation are the by-words for success in the new economic era. That means that there must be a strong and constant connection between higher education policy and our national development needs. A natural economy was once based upon natural resources — coal, gas, oil, agriculture and so on — but if knowledge is the new basis of a national economy, then the rules have changed.

The budget is a key part of making that happen. It acknowledges the connection I referred to and the changing of the rules. It also acknowledges the need for substantial change and improvement in quality in our universities and centres of higher learning. It is an acceptance that we must pursue the so-called system wide collaboration, maximising potential by applying the collective strengths of our third level institutions. The budget allows for a multi-annual strategic innovation fund for higher education and the establishment of a new PhD level of education at fourth level.

I commend the Minister for the allocation of €300 million to the strategic innovation fund for higher education over the next five years. It is entirely appropriate that we provide for competition for these new funds to stimulate excellence through collaboration and change. The Government is also committing €900 million to the third level sector over the next five years as part of the Department of Education and Science capital envelope. Some €630 million of that investment will be from Exchequer funds; the balance will come via public-private partnership initiatives.

Before I move on to discuss the working report group, I wish to stress one point. I said at the outset that the Progressive Democrats have pursued economic policies not for its own sake but as a vehicle to deliver the best services for society. Over the next four years, planned capital investment and the strategic innovation fund for third level will total €1.2 billion, an incredible sum of money. That investment will be targeted. The people of Ireland have worked hard to make this type of funding possible. We employ the right policies to maximise the benefits of that work and the budget provisions for third level education are testament to the rectitude of our approach.

The second element of my contribution concerns the Fottrell report and it is closely linked to the issues I explored earlier in that education and research are critical to the quality of service delivered in our health system by those persons educated in Ireland to train and work in Ireland. In my previous contribution on this topic, I expressed my concern about the entrance requirements and access, especially in the health sciences areas. The Higher Education Authority report of 2003 proposed reform of graduate entry to medicine and a range of other health professional disciplines. The goal was to relieve some of the pressure associated with entry to these programmes.

In framing the programme for Government, the Progressive Democrats and our partners in Government committed to addressing that specific issue. This was in recognition of the point I raised earlier regarding the negative impact such high-pressure competition has on the second level education system. In this regard I commend the Minister for Education and Science and the Tánaiste for jointly establishing the working group on undergraduate medical education and training. More significantly, I acknowledge and commend the work of the group that recommended the number of EU places in undergraduate education, a course curriculum in the medical schools, graduate entry programmes, accreditation and increases in the number of academic clinicians as well as the many other complex issues that shape the delivery of undergraduate medical education.

On foot of this great work, the Minister together with the Tánaiste jointly announced a €200 million initiative for major reform of medical education and training, which correctly encompasses the system from undergraduate level through to postgraduate training. In general terms, the doubling of numbers for Irish and EU students has received most comment. This is due, most likely, to the pressures of entry I mentioned earlier and is not surprising.

However, there is a wider significance to the reforms announced by the Minister. We must guarantee a significant number of highly-trained doctors for our growing population, but this will also allow for a wider programme of health reform. It will mean a shift from a consultant-led to a consultant-provided service, increased emphasis on doctors, nurses and other health professionals working in multidisciplinary teams. It will also lead to a more co-ordinated approach to medical education and training.

The two reports produced by the groups chaired by Dr. Jane Buttimer and Professor Fottrell inform important steps towards the development and reform of medical education. A great debt is owed to these groups. They will facilitate an integrated implementation strategy, as the Tánaiste has stated, to enhance and modernise medical education and training across the continuum from the undergraduate stage through to specialised training.

I said at the outset that we must be in a position to provide targeted investment in third level education. We must also have the correct strategy to ensure that investment delivers the excellence associated with the Irish education system. While this becomes increasingly complex as we move from a more conventional to a knowledge-based economy, the measures outlined in the budget and the developments on foot of the Fottrell report demonstrate that the Government is committed to maintaining that standard of excellence. I compliment the Minister on the leadership and initiatives she has taken in this regard, which will not only benefit Irish citizens, but also the economy.

Ms Tuffy

I have 15 minutes and wish to give five of them to my colleague, Senator Ryan.

An Leas-Chathaoirleach

Is that agreed? Agreed.

Ms Tuffy

I intend to speak on some general points as regards funding which I have raised before with the Minister. She has attended many debates in this House, in contrast to her predecessor as Minister for Education and Science. I looked at the monitor one evening and noticed she was attending Adjournment matters in the House. She is one of the few Ministers to have attended the House on such matters, which indicates the degree of interest she has in education. I welcome her here again.

Funding for universities and colleges of technology should encourage these institutions to offer courses in a more flexible way. A related point is that the difference between full-time and part-time participation should be blurred. I have made that point before and it is important that the Minister starts to direct third level education in the direction of the model, as I have outlined it, as this will help in efforts to increase access to third level education from different sectors of society.

Access to third level should not merely be determined by the leaving certificate and the points system, rather there should be a system based essentially on the lifelong learning model. This would encourage people to get third level qualifications according to their needs. It would allow a person to go, for example, from certificate level to a diploma, to a PhD, if necessary, as sometimes happens. They should be able to go from part-time to full-time education and back, from the institute of technology sector to university and back again. Our education system needs to be modelled more along these lines if it is to meet the requirements of modern society Some people cannot afford to enter full-time education on finishing school or they may not have the expectations of third level at that point. They may need a second or third chance to return to education to get a third level qualification.

This type of approach is also very important for the economy because it ensures that people upskill, particularly those working in vulnerable manufacturing areas, for example, whose job opportunities might be lessened by industrial developments. There is also a need to get more mature people involved in the education system, which is very much the concept for Irish education advocated in various reports including that of the OECD.

Incentives are needed to encourage the take-up of engineering and computerised technology places. The Government and the colleges have ignored and tended to cover up the lack of demand last September as regards the significant number of vacant places for engineering courses across the board. Many universities were advertising class vacancies, for the first time, when the CAO places were being offered.

A related issue is the need to implement the recommendations of the task force on lifelong learning. There have also been calls by Aontas and the Labour Party that the free fees initiative should be extended to part-time students. This has been costed by Aontas, which puts the required figure at approximately €40 a year. It could be more, but some of the costs could be absorbed by introducing a more flexible model where there is less of a distinction between part-time and full-time education and colleges are funded on a credit basis. This would take into account a larger student body, reflecting changes in the country's demographic profile.

The Government must support colleges towards engaging with the existing workforce and it must urgently address the skills deficit of that workforce. It must also address the recommendations of the NESF report, published last Monday. I represent the Clondalkin area which still has unemployment blackspots relative to other parts of the country. Institutes of technology should be entitled to funding to carry out special training projects for school-leavers and the unemployed in such areas. Take, for example, the IC manufacturing plant in Grange Castle. People in Clondalkin need to be upskilled so that they can apply for jobs there as well.

I welcome the announcement that the number of student places in undergraduate medical education is to be increased. The route into medicine by way of a primary degree and non-medical subjects is a good idea. At the same time significant recognition must be given to science and technology courses. The new entry mechanism can provide a greater opportunity to make the doctor profile more representative of the population in general. More doctors are needed from places such as Clondalkin, Tallaght and so on. The key to this is to provide transfers into these postgraduate courses from institutes of technology. Various reports, including the Clancy report on access to higher education, have found that lower socio-economic groups are much more widely represented in the institutes of technology than the universities.

The Minister said she would invite proposals on the graduate entry scheme from colleges. It is vital that the guidelines and criteria for such proposals should not discriminate against students in institutes of technology. The fact that graduates in all disciplines will be eligible for the graduate entry scheme will automatically favour universities over institutes of technologies, which tend to have a narrower spread of courses concentrated mainly in science, engineering and business. If we want different types of groups in our society to have access to medicine courses, we need to take that into account.

I welcome the Minister's encouragement for collaboration among colleges to allow institutes of technology to be linked with individual medical schools and colleges. For example, the Institute of Technology Tallaght could be linked with Trinity College Dublin in view of TCD's connection with Tallaght Hospital.

I share the concerns that Senators Fitzgerald and Henry expressed about the aptitude tests. Without going into the issues that have already been raised, we need to consider whether a system that is calculated on the number of leaving certificate points is not more transparent than one based on a leaving certificate together with an aptitude test. If an aptitude test is to be introduced for medicine courses just because they require students to have high points, why should such tests not be introduced for other courses that require high points or even medium or low points? For example, why should aptitude tests not apply to candidates for engineering or science courses? The introduction of aptitude tests alongside points would simply complicate the system. Why will aptitude tests apply only to one career when so many courses require high points?

At some point down the line we should instead consider broadening the number of postgraduate places, as happens in many others professions for which access to courses is restricted only by the standards set. As the Law Society is not allowed to restrict places on law courses, many people study law but the market determines whether they get jobs as solicitors. We should allow for the fact that some people will study medicine and then enter other careers. As long as that did not constitute a huge trend, that would probably be a good thing. Just as people who study law may then go into business instead, people who study medicine might go into research or management or something else altogether. That happens in other subjects and it is not necessarily a bad thing. Many other countries produce too many doctors, but it is better to produce too many than too few. Obviously, checks and balances would still be required, but our approach should be to open up the system. If we were to do that, we would get rid of the pressure on the points system and make medicine a much more accessible career to many people from different sectors of society who have an aptitude for it.

Mr. Ryan

As my colleague, Senator Tuffy, obviously has a lot more to say on this subject than me, I am now embarrassed that I am the cause of her having to finish her speech somewhat earlier. I apologise to her, but I had not known she would finish on such an interesting issue. However, I want to highlight a few issues, which I will do in almost bullet point fashion due to the limited time.

Without a doubt third level education is expensive and will become more so — medical education is perhaps at the pinnacle of that expense — but the real question for the Minister is who will pay for that and, in particular, who will pay for postgraduate education. Will we see the gradual return of fees, given the developments that are taking place, to which I will revert in a moment? I advise the Minister to be very wary of the universities' propaganda. I say that without equivocation, as an advocate of the other side of the dual system in third level education. The universities' conversion to issues such as relevance was forced on them by the success of the institutes of technology. The universities did not believe they were entangled in that world until the ITs began to generate a whole new vision of what constitutes third level education. Now that the universities have got their act together, I advise the Minister not to be seduced by their flowery language.

In engineering education — which I will talk about a bit, as it is important for the country's future — there is now a tendency, which began in the United Kingdom, for the masters degree to be considered the acceptable level of qualification. I have the good fortune to be a member of the profession of chemical engineering, which is accredited by both the Institute of Engineers of Ireland and the IChemE. Two third level institutions in Ireland — UCD and Cork Institute of Technology — have received accreditation that recognises their BEng qualification as equivalent to an MEng in Britain, but the two other universities that teach chemical engineering have not received that accreditation. The issue is complex and difficult, but my personal belief is that a strong case exists for rationalisation in third level education. The idea that two small chemical engineering departments should be located down the road from each other, as we have in Cork, is ridiculous. The funding agent, which is the Government, should knock heads together and require a rationalisation. My understanding and experience of the Department of Education and Science — I have no idea what are the views of the current Minister — is that rationalisation usually means that the university grabs everything that is attractive and leaves other institutions to do the other bits, but that is not what I mean by rationalisation. Rather, we need a putting into practice of the rhetoric about ITs being equal but different. Unless that happens, we will have serious problems.

On the issue of how third level education should be paid for, the Minister should not believe too much of the universities' propaganda about their wonderful fundraising capacity. They are very good at talking about the large amounts of private funding they have raised, but the vast majority of that funding came from one foundation. That foundation's first rule is that it must take the initiative, so I do not know how the universities can claim the credit for obtaining €600 million from Atlantic Philanthropies. The universities had nothing to do with that because Atlantic Philanthropies specifically forbids institutions from approaching it. If universities approach the foundation directly, Atlantic Philanthropies will not have anything more to do with them.

The only way to fund third level education is through general taxation. Introducing fees would immediately create a huge gap between the rich and the not so rich. Introducing significant fees into medicine would immediately prohibit large sections of society from accessing that education. Any sort of universal fees-based system for masters degrees, which I believe will become the standard qualification within the next ten years, will also exclude people. Given the evidence that the abolition of fees in the institutes of technology has produced significantly increased levels of participation, it would be a pity if either ideology or a shortsighted view of where money should be spent resulted in us reintroducing a dual system under which people first gained a basic and valueless first degree and were then unable to continue further because of the level of fees that had been introduced for later stages.

Ms Ormonde

I welcome the Minister to the House and I commend her on introducing the new funding arrangement. Although the thinking on that started back in 1997, the Minister grasped the nettle by introducing a strategic innovation fund with the sole objective of promoting change and transformation in third level education.

Today's debate is about both third level education funding and the reform of our medical schools. The first issue needs a full debate for itself so I think it a pity that the two issues were combined for today's debate. It is important that we are able to make points about where we go from here with funding, but we also need to discuss the reform of our medical schools so the Minister must forgive me if I do not say too much about the funding issue. We will no doubt return to that at another time when the Higher Education Authority makes proposals on the criteria for how funding should be allocated to third level and fourth level education and on how we should allocate the huge amounts of investment being made in research and grant schemes. Returning to a pet subject of mine, I think we will also need to consider promoting some of our institutes into universities. We certainly need a university in the south east to tackle what went wrong with the distribution of universities in the past. Waterford should not be penalised because of that situation and we now have an opportunity to deal with that. We will return to this when there is more time to debate the subject seriously.

Today, I prefer to discuss the Fottrell report. The report is well put together. Unfortunately, I only have time to deal with the recommendations but I intend to return to this report and discuss it in greater detail. The recommendations relate to how we reform our medical schools and examine the gaps that have existed for the past number of years. In 1978 a cap was put on the intake of students into medical school and it has not changed since then. Medical education was financed by increasing the number of non-EU students. Something had to give when the gap between supply and demand became huge. There was great demand for doctors and consultants but most of our doctors left the country when they qualified. They distinguished themselves well because of the quality of our medical education.

How can we lure these people back and open up the system? I congratulate the Minister on opening the discussion on the recommendations in the Fottrell report. The recommendations relate to student intake, curriculum reform, funding and the assessment of students who enter by different paths. It is great that the numbers will be increased from 305 to 725 over a four-year period in steps of 70, 40, 35 and 35. It is nice to see such clarity about the increase in numbers.

The points will also be reduced to 450. That will remove the stress from the second level sector. Of late, some second level schools have tended to become grind schools, particularly at senior cycle, whose purpose is to maximise the achievement of points. That has had a significant impact on the education of young people. That is not how education should be but the points system and the CAO process have dictated it. I am glad the Minister intends to move forward from that. How to devise a system that will work will be a major problem. I do not know if we will get it right.

There is also the issue of curriculum reform. If we increase the intake of students, it will be necessary to increase the number of academic clinicians and the number of teaching hospitals. At mid-stream the students' medical education moves into the hospitals. This was always on an ad hoc basis but it must be tightened up and structured. This is also true of the funding. Until now, I understood that most of the money was allocated from the Department of Education and Science and that a certain amount came from the Department of Health and Children. The same amount of money should come from both Departments given that half of the education takes place in the medical school while the other half is conducted in the hospitals. The funding has not been tidied up over the years so perhaps the Minister will examine this issue.

My pet subject is the assessment of applicants. I often think of the students who wanted to do medicine and who repeated the leaving certificate time and again. Maybe they got between 490 and 520 points and found, for the third time, that they were unable to get through. It was awful, to say the least. I am glad there is an effort to tackle it but the jury is out on how to do so. What methods should be used?

Aptitude tests were mentioned during the debate. They can be the fairest way of making a determination; there is no influence. However, aptitude tests are like crosswords in that if one practises them enough, one will become good at them. I have administered aptitude tests and one often finds there are 5% who never get them right but who are very good students. How to evaluate suitability for entry into any course is a big issue and I do not know if we can get it right in this case.

Senator Henry mentioned that 570 points are required for veterinary medicine. Prospective radiography students must secure 510 points. They must be the cream of the country to do radiography. I do not deny that it is a good course but it does not warrant those points, no more than veterinary medicine or medicine warrants 570 points. In the past, some members of my family studied medicine. They were just about able to get into college but became very good general practitioners. Now, some general practitioners are bored with their lives because they are too bright for what they are doing and would prefer to be doing something else. This is a serious issue that must be addressed.

What is wrong with an interview? I see nothing wrong with it. Of course, it must be fair and transparent. If one comes from a medical background, knows what is involved from a young age, is not terribly bright but would be a very good doctor, why not accept such applicants? We should not rule out the option of an interview. The same is true of any other profession. Take, for example, politicians who come from a political background. They have to be good when they get into politics but they know what they are facing when they enter politics. Other professionals whose children are anxious to get into the same profession can also find it difficult. However, I hope there would not be another type of elitist discrimination whereby somebody who comes from a medical background must get into medicine. That is not the way it should be considered.

I could discuss this subject for a long time but I cannot. Funding is an important issue with regard to the entry of graduates. It is a great move forward but how can we fund them if they have already gone through a third level primary degree course? How can they get through the system? The stakeholders must become involved and the roles and responsibilities of stakeholders such as the Department of Education and Science, the Department of Health and Children, the Higher Education Authority, the Health Service Executive and the expert group must be defined in detail. There must also be an outline of how the part-time graduates will get through the course.

There is a great deal of work to be done. The Minister should not fast-track it but take it slowly. We have lived with the points system for the past 20 years. Now is the time for a change. If we get one aspect of it right, it must be the entry issue. I must conclude but I could talk for another half hour on this subject.

Mr. Cummins

I welcome Senator Ormonde's comments about a university for the south east. The Fottrell report analysing medical education in Ireland is welcome. This is the first time an inclusive review of this nature has been undertaken and it has been a worthwhile exercise. The report provides a platform for differently structured access to a professional education that equips young professionals and disposes them towards continual professional development when they enter employment.

Given the needs of society and the ever-changing patterns evident in other professions, it is clear that a fresh approach to medical education is needed. Similar changes are required in medical research and extending the knowledge base, which will call for ongoing reform in syllabi and curricula. It will call for change in other areas too.

It will also call for a more diverse range of skills and understanding and a different sense of mission. We know that health issues are complex. The health service is struggling and costs are spiralling. However, we should not lose sight of the care of the individual patients, which should be at the centre of all our thinking about health services. Good medical education and quality health care are inextricably linked, a fact which we perhaps have not always recognised in the past.

We must change the structure of medical education. The current model of medical education for undergraduates has served a purpose and may do so in the future in a more limited fashion.

An Cathaoirleach

In accordance with the Order of Business, I ask Senator Cummins to report progress.

Mr. Cummins

I so do.