Seanad Éireann díospóireacht -
Monday, 15 Jul 2013

Vol. 225 No. 1

Adjournment Matters

Medical Indemnity Cover

Senator Colm Burke

I apologise for taking up the Minister of State's time as I realise he has been waiting all evening.

I refer to the issue of compulsory insurance for medical practitioners, an issue on which I published a Private Members' Bill which was debated in the House in January. At the time I was advised by the Department and know it has some other urgent issues on its cards. This matter was raised in 2009 by the Minister for Health, Deputy James Reilly, and at that stage the Department stated it would be dealt with by January 2010.

I have been in contact with people practising in the area of cosmetic surgery who are very concerned about a number of incidents, in respect of which they are not satisfied there was adequate medical insurance cover. I have also come across a case and was advised by a legal colleague involved in the litigation that the medical practitioner in question had admitted he was not covered by insurance. This issue must be resolved. As I noted in the debate referred to, I cannot practise as a solicitor without insurance. The Minister of State cannot drive a car without insurance, yet we have GPs who have no legal obligation to have insurance. Concern is growing that because people currently face many financial pressures, they may start to take short cuts. I am concerned this may happen also with people involved in medical practice; therefore, there is urgency attached to dealing with the matter.

I understand there may be a situation where there is inadequate insurance cover for breast implant surgery, which is also of concern. Having regard to the EU directives on the free movement of people and the provision of services, there is nothing to prevent medical personnel coming here from the United Kingdom. Although they must be registered with and work through the Medical Council, the council has no power to force any such person to have insurance. I know of one centre that closed because of the number of claims it had received, but it has reopened under another name. There is concern about that case, particularly those involved in the area of cosmetic surgery.

What progress has been made? The Bill was debated in this House. We consulted widely with the Medical Council, the IMO and the IHCA in preparing the legislation. We met representatives of the insurance industry who flew in from England to talk to us about it and took on board their amendments. There is the basis of legislation which we must deal with and expedite. Obviously, the Bill we have been debating for the past three or four hours has been given priority within the Department, but I ask that my Bill not be pushed further down the road and that we try to deal with it as soon as possible.

Minister of State at the Department of Health (Deputy Alex White)

I thank the Senator for giving me the opportunity to inform the House of the steps being taken to address this important matter, in which he has very much taken a lead.

Mandatory indemnity cover for medical practitioners is necessary. As the Senator may be aware, in 2009 the Minister, Deputy James Reilly, then in opposition, introduced a Private Members Bill in the Dáil on the issue, but it was not enacted at the time. When he took office, he instructed the Department to commence drafting a Bill to achieve this aim. Last year the Government approved the heads of the Medical Practitioners (Professional Indemnity) (Amendment) Bill 2013, which will provide for what the Senator is proposing by way of medical indemnity insurance requirements. The purpose of the Bill is to amend the Medical Practitioners Act 2007 to make it mandatory for registration purposes that all medical practitioners engaged in the practise of medicine have adequate medical indemnity insurance cover. Drafting of the Bill is at an advanced stage and officials of the Department are in consultation with the relevant stakeholders, including the Medical Council, the State Claims Agency and representatives of indemnity providers, on an ongoing basis.

Under the Bill the Medical Council will be given the power to refuse registration if a practitioner does not have adequate indemnity cover. The council will also have the power to remove a practitioner from the register where indemnity cover is not maintained. The continued maintenance of indemnity cover will be confirmed by the practitioner at the time of his or her annual retention of registration, a practice similar to provisions that obtain in other professions. It will be the responsibility of each medical practitioner to establish that he or she has the required professional indemnity.

The legislation will provide for the State Claims Agency to assist the Medical Council in setting out indicative or minimum levels of cover, having regard to the medical specialty involved and the procedures being undertaken by each medical practitioner. It is the intention that the draft legislation will be at a high or enabling level. The Medical Council will subsequently specify the necessary detail, by the provision of guidance and-or rules, in accordance with the statutory powers given to it in its establishing legislation. A key issue in the drafting process is to ensure this provision will be robust in order that the council will be empowered to ensure all registered medical practitioners will have appropriate and adequate indemnity insurance cover.

The Bill is on the A list of the Government's legislative programme for the summer 2013 parliamentary session. However, following recent meetings between officials of the Department and the Parliamentary Counsel and having regard to the issues raised by the Parliamentary Counsel at these meetings, it is now unlikely that the Bill will be finalised before the Dáil summer recess. However, it is still the intention to have the Bill finalised and published as soon as possible following the recess.

I acknowledge the contribution of the Senator in advancing the objective of having mandatory indemnity cover for practising doctors. The House will be aware that earlier this year the Senator introduced a Private Members Bill on this issue. The objective of that Bill was almost identical to the Bill being progressed and developed by my Department.

However, there were a number of important areas where the Department had some reservations on the approach being taken. Due to the many similarities in both Bills it has been arranged for Parliamentary Counsel to take account of Senator Burke's Bill in finalising the text of the Government's Bill.

I am pleased to have had the opportunity to address the House today and I would like to assure the Senator and the House that the Minister, Deputy James Reilly, is committed to bringing proposals to Government for its consideration of this matter at the earliest possible.

Direct Provision System

Senator Trevor Ó Clochartaigh

Gabhaim míle buíochas leis an Aire Stáit as bheith anseo linn. Coincidentally the Minister of State was present when I raised a similar issue previously on the payments relating to the direct provision system.

I have forwarded, as part of my question, a receipt that a person who is in direct provision accommodation gets from the Department of Social Protection. The question is around the figures. The receipt shows a total payment of €186 per week for the individual. However, there are deductions of €166.90 and the amount payable to the person in direct provision accommodation is €19.10. That is the figure that is commonly used when we hear of payments being made to people in direct provision accommodation. The question is what happens to the €166.90. To whom is it paid? I am curious as to the legal basis for the payment.

My understanding is that direct provision, as a system, does not have a legislative basis as no legislation has been enacted in that area. I have mentioned on a number of occasions that it is an appalling system and needs to be reformed. Notwithstanding that, I do not believe there is a legal basis for it as a system. Therefore, what is the legal basis for the payment? To whom is the payment made? Is it to private individuals, third parties, or another Department and how is it divided up?

We have had some serious discussions on the whole area of direct provision. I attended a launch last week by Ms Emily O'Reilly of another scathing review of the direct provision system. I note the Ombudsman for Children, Ms Emily Logan, has spoken out and aired her concerns about the whole system as has the Minister for Children, when we had a debate on the children's referendum. The Minister for Children said she had serious concerns about some of the conditions and what was going on, as did the Minister of State, Deputy Kathleen Lynch, who is in the same Department as the Minister of State, Deputy Alex White. I am sure the Minister of Sate has his own opinions as has Mrs. Justice Catherine McGuinness.

It has been stated by me and Senator Jillian van Turnhout that direct provision is another State-supported scandal. It will require some Taoiseach in the future making an apology similar to the way the Taoiseach has had to apologise for scandals in institutions. We need much more transparency around the system. There is no HIQA oversight. The Ombudsman has no oversight. There is a sense that it is very much a closed shop, a very secretive system. That payments of €186 are made to an individual from which €166.90 is deducted means that the person is paid €19.10 into the hand. This is another area where we are seeking transparency.

I ask the Minister of State to clarify where the money goes, the third parties to whom the deductions are paid and the legal basis for those payments.

Deputy Alex White

I thank the Senator for raising the matter. I am responding to the matter on behalf of my colleague, the Minister for Justice and Equality, Deputy Alan Shatter, who regrettably cannot be here to address the matter.

I assume this motion refers to the weekly payment of the direct provision allowance of €19.10 per adult per week and €9.60 per child per week payable in respect of any personal requisites required to the 4,571 asylum seekers in 34 accommodation centres throughout the State under contract to the Reception and Integration Agency of the Department of Justice and Equality. These payments are made on an administrative basis for the Department of Justice and Equality by the Department of Social Protection.

The phrasing of this motion for debate pre-supposes that this direct payment allowance is a residual sum after a larger sum has been disbursed to some other entity. This is not the case and is a misapprehension of how the State meets its international obligations to asylum seekers. There is, perhaps, some confusion in that in order to make these payments, the Department of Social Protection uses the same system that makes supplementary welfare allowance, SWA, payments - normally €186. To make the €19.10 payment the system is configured to make a manual insertion of means amounting to €166.90. This is a technical adjustment done to facilitate payment - there is no question of a resident in direct provision having an entitlement to the €166.90.

Since April 2000 the needs of asylum seekers are catered for under the direct provision system operated by the RIA. The system is essentially a cashless one, under which asylum seekers are provided with food and other services on a full board basis. Residents do not have to pay for rent, electricity, heating, food, maintenance or other costs. Health and education services from mainstream hospitals-clinics and schools are provided in the same way as for all Irish citizens. To take account of the services provided, the direct provision allowance of €19.10 per adult per week and €9.60 is paid.

It continues to be open to any asylum seeker to seek assistance for a particular once-off need by way of an exceptional needs payment under the supplementary welfare allowance scheme as contained in section 201 of the Social Welfare (Consolidation) Act 2005. There is no automatic entitlement to an exceptional needs payment as each application is determined based on the particular circumstances of the case.

This administrative system of direct provision needs to be seen in the context of legislative provisions which would otherwise specifically prohibit asylum seekers from being able to be provided with the basic necessities of life. For example, asylum seekers cannot work under section 9(4)(b) of the Refugee Act 1996, cannot access rent allowance under section 13 of the Social Welfare (Miscellaneous Provisions) Act 2003 and are not entitled to a range of benefits, including child benefit, as they are deemed to be not habitually resident under section 246(7) of the Social Welfare (Consolidation) Act 2005.

There is, therefore, no direct link as between the entitlements of asylum seekers and non-asylum seekers, as inferred in this motion. As to the administrative nature of the direct provision scheme, including the direct provision allowance payments of €19.10 and €9.60, the Minister for Justice and Equality is aware of the argument, cited most recently by the Senator's colleague, Senator Jillian van Turnhout, that there ought to be a specific legislative underpinning of the provision of State services for persons who otherwise would not be entitled to such services. However, interaction of legislation and administration depends on the particular context involved and the Minister is satisfied there is no necessity to change either the direct provision policy itself, including the associated welfare provisions, or their administrative and legal basis.

The Minister acknowledges that the direct provision system is not ideal but it is a system which facilitates the State providing a roof over the head of those seeking asylum or seeking other grounds to be allowed, on humanitarian grounds, to stay in the State. It allows the State to do it in a manner that facilitates resources being used economically in circumstances where the State is in financial difficulty.

Senator Trevor Ó Clochartaigh

I gather that the figure of €186 is a factious amount and that €166.90 is not handed over to any third party. The basic social welfare allowance of €186 is the mechanism used to pay a person in direct provision accommodation and that a technical deduction is made of €166.90 which does not go anywhere. I take it that is the issue. I am not sure if we can get the Minister of State on the record on his own opinion on the direct provision system. If that is appropriate, it would be welcome.

Deputy Alex White

I have nothing to add to what the Minister for Justice and Equality has aid in his response.

The Seanad adjourned at 8.20 p.m. until 10.30 a.m. on Tuesday, 16 July 2013.