Medical Practitioners (Amendment) Bill 2014: Committee and Remaining Stages

I welcome the Minister, Deputy Varadkar, to the House.

Section 1 agreed to.

Amendments Nos. 1 to 3, inclusive, form a composite proposal and may be discussed together by agreement. Is that agreed? Agreed.

Government amendment No. 1:
In page 3, between lines 14 and 15, to insert the following:
" " 'Agency' means the National Treasury Management Agency;".

This introduces a new definition for the agency, to mean the National Treasury Management Agency.

Amendment agreed to.
Government amendment No. 2:
In page 3, line 21, to delete "Council, pursuant to section 43A" and substitute the following:
"Agency, pursuant to section 8A (inserted by section 12 of the Medical Practitioners (Amendment) Act 2015) of the National Treasury Management Agency (Amendment) Act 2000".
Amendment agreed to.
Section 2, as amended, agreed to.
Section 3 deleted.
Sections 4 to 7, inclusive, agreed to.
Section 8 deleted.
Sections 9 to 11, inclusive, agreed to.
Government amendment No. 3:
In page 7, between lines 19 and 20, to insert the following:
"Amendment of National Treasury Management Agency (Amendment) Act 2000
12. The National Treasury Management Agency (Amendment) Act 2000 is amended by the insertion of the following section after section 8:
"Additional function – specification of minimum levels of indemnity for classes of medical practitioners
8A. (1) The Agency shall, by notice in Iris Oifigiúil, specify, having regard to the criteria set out in subsection (3), and after consultation with the Medical Council and any other person that the Agency considers appropriate, the minimum levels of indemnity applicable to classes of medical practitioners.
(2) The Agency shall, as regards the minimum levels of indemnity specified in a notice referred to in subsection (1), specify, in that notice, a date or the occurrence of an event from which such levels of indemnity are to take effect and different dates or events may be specified for different classes of medical practitioners.
(3) The criteria referred to in subsection (1) in respect of a class of medical practitioners are—
(a) the level of risk generally inherent in the medical specialty practised by the members of that class,
(b) the level of risk, from any act or omission of a member of that class, to the health, safety or welfare of any person to whom a duty of care is owed by the members of that class in their capacity as medical practitioners who fall within that class,
(c) the risks identified by providers of indemnity as particularly associated with the medical specialty practised by members of that class, and
(d) the level of awards or settlements made in proceedings where the cause of action arose out of an alleged breach of duty involving a member of that class in his or her capacity as a medical practitioner who falls within that class.
(4) In this section—
(a) "indemnity", "medical practitioner” and "minimum level of indemnity" have the same meanings as they have in the Medical Practitioners Act 2007,
(b) "medical specialty" means a medical specialty recognised by the Medical Council under section 89(1) of the Medical Practitioners Act 2007 and includes any subset of a medical specialty.".".
Amendment agreed to.
Section 12 agreed to.
Government amendment No. 4:
In page 3, lines 7 to 9, to delete all words from and including "to" where it firstly occurs in line 7 down to and including "healthcare;" in line 9.
Amendment agreed to.
Title, as amended, agreed to.
Bill reported with amendments and received for final consideration.
Question proposed: "That the Bill do now pass."

I thank the Minister for coming to the House. As he is aware, I have been involved in the Bill and the previous Minister, Deputy James Reilly, introduced a Private Members' Bill on this matter back in 2009 or 2010. At the time a commitment was given to him by the Department that this would be brought forward. The Bill concerns the necessity for professional indemnity insurance. In 2012 I introduced a Private Members' Bill. I am delighted to see this Bill is being passed and will come into law. It is extremely important at a time when we have so much movement of medical personnel coming to and leaving the country.

The big area affected is that of cosmetic surgery. People come to this country and provide a service and then, unfortunately, do not have adequate insurance. As a solicitor I cannot practise without professional indemnity insurance and no individual can drive in this country without car insurance, but when I started this process in 2012 a doctor could practise without having professional indemnity insurance. While I know all of the people in the HSE and anyone who contracts with it must produce evidence of insurance, people still provide a service in this country without adequate insurance. From this point of view the Bill is important to ensure medical practitioners are protected and, if something goes wrong, the general public is also protected.

We need clarification for people offering services who are not aware their insurance is inadequate, particularly GPs. I have heard of cases of GPs and others providing scanning services. I know of a GP who intended to offer such a service but found the existing insurance policy did not cover it and the premium required would not make it a viable proposition to provide the service. It is important to have insurance and to ensure it adequately covers people for the work they do.

We need to deal with the cost of professional indemnity insurance. The Department is dealing with it from the point of view of the cost of professional indemnity insurance in hospitals. Recently I heard that a particular private hospital cannot employ an orthopaedic consultant because the premium required is more than €104,000 per annum. As a result the position remains vacant. It would cost €2,000 per week for the person to provide the service.

I suppose we have to look at the whole courts system as well. Are we doing enough? We brought in the Personal Injuries Assessment Board to deal with car accidents and industrial accidents, but we did not make any major fundamental change in the area of medical indemnity that would deal with the claims that arise when mistakes are made. We need to do something to bring down the costs in this area. People are leaving this country because of the cost of insurance. The moneys they are able to earn are not adequate to pay for insurance. It is something we need to look at.

I am delighted with this legislation. The Minister and the officials in his Department have worked to bring it forward. I am pleased that it will be in place in a very short time. I thank the Minister for his assistance on this matter.

I welcome the Minister. I apologise for being a little late; I had another engagement. I concur with my colleague Senator Burke in welcoming this legislation. It is something that all general practitioners across the State will welcome because it will give them a certain level of protection. We have to recognise the Trojan work being done by GPs throughout the country, east to west and north to south. They often work in difficult circumstances to deal with emergency situations and so on. The thrust of this bill will give them a certain cushion and allow for medical indemnity insurance to be made available.

Of course, it would be remiss of me not to mention the concerns of GPs, particularly in the north west, with regard to an issue I raised here recently. I refer to the absolute logjam in referrals to hospitals by GPs, particularly Letterkenny General Hospital, where waiting lists are continuing to increase. I am aware that many GPs, some of whom I have met in recent weeks, are more than concerned. I am not having a political shot at the Minister. I know there are management issues. I heard what the Taoiseach had to say in the Dáil today about the management issues in hospitals. This needs to be dealt with at management level within hospitals. Each hospital receives a budget. Perhaps that system needs to be totally overhauled down the road.

I absolutely agree with what was said in the Department of Health's publications in 2012 about the need for a mechanism that ensures the money follows the patient. In other words, hospitals should be paid for their current activity rather than for the work they did last year. I suggest that until that happens, we will not have the performance incentives within hospitals to make them efficient and effective and to improve outcomes for patients. I do not doubt that the Minister is aware of this major issue, which is a source of frustration for many GPs, particularly in the western group area. I am thinking specifically of the north west and of Letterkenny General Hospital, which is geographically isolated from the other hospitals within the group. While there are major issues in that regard, I do not want to take away from the thrust of the Bill.

I welcome the Bill and what has been said about it. I know that GPs appreciate the work that has gone into bringing this Bill to fruition. I acknowledge the work of the Minister, Deputy Varadkar, in that regard. I do not doubt that in light of his background as a GP, he was able to bring expertise to this agenda as he drove it forward. I hope he will show similar initiative in driving the agenda that seeks to achieve a reduction in waiting lists. I do not suggest that the difficulty in that regard lies within the Department of Health. As legislators, we have a responsibility to raise the difficulty that exists and that needs to be addressed regardless of where it lies. It is wrong that politicians often play politics with the health sector. We should not do that. There are major issues and vested interests that need to be dealt with. Many Ministers for Health have tried to face this challenge. All Ministers for Health need to be supported in their efforts. I will support any effort that the Minister makes to try to deal with the issues that are causing the logjam in our public hospitals.

I thank the Seanad for the speed and efficiency with which it has completed Committee, Report and Final Stages of this Bill. I did not think we would get through it so quickly. I recognise that Senator Colm Burke took the lead on this important patient safety legislation some time ago. This Bill, which will require all doctors who are registered in the State to be appropriately insured and will ensure they are so insured, is important because we need to know patients have some recourse when things go wrong and we need to be sure doctors are properly insured for the work they do. I thank my officials, Mary Jackson and Kara Prole, for their work on this Bill. I would also like to thank the Office of the Parliamentary Counsel for its work. The Bill will now go to the Dáil.

I would like to pick up on two points. I will take on board Senator Ó Domhnaill's comments about waiting lists in the north west. I am very aware of this issue. Additional resources have been provided to hospitals across the country to make sure nobody is waiting more than 15 months for an outpatient appointment, or any procedure, by the end of the year. I am getting a few examples of cases in which people have been waiting for that long. When those cases are looked into, it seems those people have not been waiting for that long; however, that is beside the point. It is something we are working on. When we run into difficulties, it is often a question of a specialist not being available, as opposed to a financial issue. It is something I am conscious of. I know the Senator takes a genuine interest in it. I appreciate the bipartisan manner in which he raised it today.

On the wider issue of the high cost of indemnity for doctors in Ireland, a number of reforms are in train. We are working with the Minister, Deputy Fitzgerald, on legislation that will introduce periodic payment orders. This will ensure there will be smaller settlements that can be reviewed over time on the basis of the changing needs of a patient, instead of big lump-sum settlements of €10 million or €12 million. Earlier this week, I received the approval of the Cabinet for the inclusion in that legislation of protection for open disclosure so that hospitals, doctors, midwives and others can give full information and apologise where something has gone wrong without having that used against them in court as an admission of liability. It can often take many months after something has happened to find out what really happened. We want hospitals, doctors, midwives, nurses and others to be enabled to make apologies and to give full information without having it then used against them in court, which is unfortunately what can happen.

Separately, the Minister, Deputy Fitzgerald, is bringing through the Legal Services Regulation Bill, which provides for pre-action protocols that will ensure cases happen more quickly and legal costs are reduced. That has had some success in Great Britain. We envisage that all of this legislation will have been passed by the time the Dáil and Seanad are dissolved. I hope that will happen. If it does not, the legislation can be revisited in 2016. When the State Claims Agency is defending claims on behalf of the HSE, it is more frequently offering mediation. I would like to see more people resolving their cases by mediation. The take-up from the side of the plaintiffs has been pretty low, unfortunately. I imagine their legal advisers are telling them to have their day in court, rather than going for mediation. I think that is regrettable, quite frankly. I would like to see mediation happening a little more often.

I would like to make a final point on the cost of indemnity. Obviously, there are two costs. The cost to the taxpayer of compensation claims, which is very large and is increasing, is my main concern. The secondary cost is the cost of insurance for consultants operating exclusively in private hospitals. I think we should bear in mind that it is an anomaly - and a little bit of a privilege, in fact - that the State covers any of the costs of people who work exclusively in the private sector. I am not aware that the State covers any of the insurance costs of any other group of professionals in society who work exclusively in the private sector. Perhaps that is a debate for another day. I thank the Senators for their support for this important Bill.

Question put and agreed to.
Sitting suspended at 3.20 p.m. and resumed at 5 p.m.