14 December 2004
Dr. Henry: Senator O'Meara's amendment is important, as is her comment that the Dáil is rising on Thursday and we are dealing with Report Stage then. Are we just involved in a rubber-stamping exercise today and tomorrow? This is particularly important as there is industrial action in progress in the health boards because of what is regarded as the speed with which the Bill is going through the Houses. The amendment asks whether the health of the individual or of the public is being considered. Public health is very important but I thought the philosophy behind this Bill was the health of the individual and that is why there is a complaints section and redress for individuals who complain. The rights of the patient are not mentioned anywhere in the Bill.
Senator O'Meara's amendment centres on this and we should know the Government's views on the rights of individual patients in this Bill, apart from the complaints mechanism. There is no point in having such a mechanism if one has no rights. It is an exercise on paper. The Minister of State should tell us if there is any point in looking at these amendments.
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Dr. Henry: I agree with people in the street who say they prefer to see what is proposed rather than the health boards which currently exist. The Minister of State was not here on Second Stage, but I voted in favour of the Bill.
I do not want a total denigration of the health boards, because some of them have been responsible for huge initiatives. Senator Feeney said we must get everybody registered with general practitioners as it would remove much chaos from accident and emergency departments. I know from Senator O'Toole that a superior type of person comes from Dingle and Anascaul. The Southern Health Board has registered seriously ill people with chronic conditions with one of seven general practitioners in its area. The board then encouraged the families to do the same. I am sure this could happen around the country. Certain people within the various health boards have started up initiatives to improve the situation. However, I do not think they were given sufficient encouragement by the Department of Health and Children.
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Dr. Henry: I am also interested to hear it. The Minister may be aware of the considerable concern among the postgraduate training bodies as to what exactly this means. The board could have significant power over what facilities will be available for training. Professional competence is increasingly important in all parts of the health service, and I am not just talking about medical or nursing students at undergraduate level but also at postgraduate level where we want professional competence maintained. This section seems to allow the board significant power over the training bodies, which have done a good job and worked extraordinarily hard in recent years to make sure that medical professionals received proper training within, for example, hospitals, general practices and the public health service. It appears they will all be subordinate to this board, which has caused considerable concern.
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Dr. Henry: There is a serious problem in regard to continuing medical education. Will the board provide funding and will the other postgraduate bodies have to look to the board for funding?
Mr. B. Lenihan: As the Senator is aware, a significant amount has been invested by the Minister and the Department in the development of higher education in recent years, especially on the nursing side. However, funding is always a matter of individual negotiation in the appropriate context. For example, with regard to in-service training, the question of remuneration and funding becomes a matter between the health service executive and its appropriate corporate pup, which manages this particular activity, and the body with which they are dealing.
Dr. Henry: Therefore, it will be in charge of the funding for postgraduate education.
Mr. B. Lenihan: No, we are at cross purposes. If in-service training is taking place, questions of funding may arise.
Dr. Henry: The Minister is not clear on this.
Mr. Daly: In a recent debate on other legislation, the shortages of speech therapists, occupational therapists, psychologists and a range of specialists were highlighted and it was obvious that something needed to be urgently done. Will the new executive have some role in this? For example, despite a recent advertisement in the national media for a radiologist, nobody applied for the position.
Dr. Henry: It is happening everywhere.
Mr. Daly: It is. I understand there are only approximately 100 radiologists in the country, with some having come from abroad. The situation is unsatisfactory. In the view of many, it is a necessity to deal urgently with this. They look to the executive to make some inroads into the shortages of speech therapists, occupational therapists, radiologists and other specialists that cause difficulties and annoyance for many.
If we are going to put a new health service executive in place, we must have some indication that it will be in a position to deal with that most unsatisfactory situation.
An Leas-Chathaoirleach: I think we have given this matter a good airing. I call Senator Feeney.
Ms Feeney: Will the facility we are discussing deal with protected time for junior doctors and consultants, or teaching hours? Will it cover protected study time for junior doctors? Many of the problems arise because young doctors do not have protected time for study purposes. When they are meant to be studying they are equipped with a bleeper which could go off at any time summoning young doctors back to their posts. Will the provision cover that type of matter because it is very important?
Dr. Henry: I am glad Senator Feeney raised the issue of protected time. Given that the Department of Health and Children will now be solely in charge of policy, it seems that this service board will have extensive control over postgraduate training, with regard both to finance and time.
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Dr. Henry: This would solve the Minister for Education and Science's problem about points, if more people could get in. In addition, while more women opt to study medicine we do not know if any men are applying. I have been trying everywhere to find that out but I do not think male students are applying to study medicine in the same numbers as women students are. I would be most grateful if the Minister of State could find out that information and let me know.
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Dr. Henry: I am sure voluntary and community groups have been in contact with the Minister of State to communicate their disappointment at not being involved in a more formal way in the formulation of the Bill. Senator O'Meara put it well when she observed that workers in this sector are not just service providers. In particular, they are advocates for the various groups with which they deal. There is a perception that they will not be at the table and in a position to continue the advocacy they have undertaken so effectively in the past.
People in the sector were greatly cheered by the praise they were given by the Minister for Finance, Deputy Cowen, at the end of his Budget Statement. This indicated that their worth was recognised. However, they have been disappointed in their hope to make their voices heard through having an input to amendments to the Bill in regard to the important functions of the board and its various sub-committees.
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Dr. Henry: These are important amendments. I assume Adjournment debates in the Seanad are equated with parliamentary questions. It is extraordinarily difficult to get information. Almost a year ago, I asked the Minister for Health and Children in an Adjournment debate if he could tell me how many people with mental illness or intellectual incapacity for which there was no suitable treatment or institution here were being sent outside the country for treatment. The Minister said he could not tell me but he would ask the health boards to get in touch with me. Despite having sent a reminder after six months, I have had replies from only three of the health boards to date, almost a year later.
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Dr. Henry: It is essential to have something which informs us and the general public of the suitability and expertise of those appointed to the board. The medical profession is disappointed there is no specific provision to appoint one or more members of the profession, particularly since the Department of Health and Children made such an issue of getting consultants involved in clinical and general management. The Irish Nurses Organisation is also disappointed because there were specific seats reserved for it on the boards and this is a big change.
Senator O'Meara's amendment regarding gender balance is preferable to everybody doing the best they can. Considering how things are progressing with regard to the HSE, a few people with expertise in human resources might be the most important requirement.
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Dr. Henry: I must support the amendment. If the complaint was in the public interest, it would be essential that a medical practitioner under his or her code of ethics would have to object. The subsection strikes me as vaguely ridiculous.
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Dr. Henry: Are the superannuation contracts of consultants appointed under Comhairle na n-Ospidéal preserved under this section? Section 63 makes it seem that way but I wish to make sure.
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