16 December 2004
Dr. Henry: I second the amendment. Like Senator O'Meara I am alarmed at the way the Bill is being rushed through the House. Ultimately, it will be of no help to the Government. If mistakes are found after a Bill is taken properly with every section considered, we can all be blamed for not spotting mistakes. In this case less than a quarter of the Bill has been considered.
I am very disappointed with many parts of the Bill that we have been unable to address because of the lack of time. Representatives of the medical profession have made representations to me regarding, for example, the lack of clarity over the functions of the medical officer of health. The Bill does not take cognisance of the fact that this will not be a 24-hours-a-day job, which is very basic.
Considerable concern has been expressed over the complaints system regarding matters that are not solely for the exercise of clinical judgment. It is felt that it would be better to exclude anything that involved clinical judgment from the general complaints system. The systems proposed in the Bill could conflict with the way the Medical Council deals with complaints against the profession. They could also conflict with the advice given by Comhairle in its recently published guide regarding where to complain. It suggests complaints regarding mental health should be made to the mental health commission and complaints about health services should be made to the health boards, which of course, will be transferred to the health service executive. So many of the matters about which people are told to complain will be covered under the Health Bill that it causes me to wonder if they were given any consideration.
The complaints procedure will give rise to a great deal of confusion. It has been suggested that the fact that carers will be able to complain may cause problems. Carers may change or they may not be looking after someone for a long period and may make a complaint. Cohabitees may also make complaints. I have no difficulty with this but how will it tie in with the fact that cohabitees cannot be considered as next of kin by hospitals? Dreadful confusion could arise. This is a common and serious problem. We could have dealt with the confusion that might arise if we had given the Bill proper consideration.
I understand the basis on which the amendment was put forward because eligibility criteria can be changed at any time. For example, the eligibility criteria for medical cards were changed recently. That is fine, except that no one knows how many additional people this change will involve. When eligibility was extended to those over 70 years of age it was estimated that this would affect between 30,000 to 35,000 people. As it turned out, almost 70,000 people were affected.
We are increasing the number of people eligible for medical cards, for visits to their doctors only, in the Bill but we do not know how many this will involve. We do not know, therefore, if adequate primary care facilities will be available for these individuals. They will not have a right to treatment so I presume they will have to join the queue and wait. That is entirely unsatisfactory.
That we did not consider the Bill properly to ensure that we knew what we were talking about in terms of each section and schedule will come back to haunt us. I have great pleasure in seconding the amendment.
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Dr. Henry: On a point of clarification, I am familiar with Schedule 5.4 but the provision therein is not very clear. The Bill states that complaints, if they solely relate to clinical judgment, will be excluded. However, there is a feeling abroad that matters relating in any way to the exercise of clinical judgment should be excluded.
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Dr. Henry: I support the amendment. The executive will have a staggering budget of €11 billion. Although Senators know there are many developments taking place in the health sector, they constantly ask where the money is going. When I looked at the details we received to date on the mental health services, for example, I could not fully work out where the money allocated to that sector was going. It seems that some of it will be allocated to the national hospitals office and more to the primary, community and continuing care section. There seem to be very few references in the legislation to the person who will be in charge of all the moneys. Some is to be spent here and more is to be spent there. The more accountability we have, the better, because management in some systems is very fragmented. In the mental health services, in which I have been involved for years, nobody seems to be identifying who will be in charge of the various parts of the system.
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Dr. Henry: The amendment is very important. It would be advisable to provide that the Minister must state why advisers are engaged. Frequently, one considers the advice given by external advisers and wonders whether an official in the Department could not have done the job just as well.
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Dr. Henry: If an employee of the executive is a member of the medical profession and is not in a position to disclose confidential information if it is to the benefit of patient care he or she is in a very serious position regarding medical ethics. I am pleased that Senator Feeney, who is a distinguished former member of the Medical Council, is present. The Minister of State will recall that the clinical autonomy of consultants is recognised within the common contract and that the Medical Council's guide to ethical conduct and behaviour in the sixth edition, 2004, recognises in paragraph 4.12 that"Doctors have an obligation to point out deficiencies to the appropriate authorities and should not yield to pressures for cost savings if it means acting against the interests of patients". The guide also states in paragraph 1.3 that"Medical care must not be used as a tool of the State, to be granted or withheld or altered in character under political pressure. Doctors require independence from such pressures in order to carry out their duties." Doctors would be duty bound to disclose any deficiencies or problems that existed even if they had come across them in their capacity as employees of the executive. This has been mentioned to me as a very serious problem. I hope that Senator Browne's modest amendment could be accepted.
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Dr. Henry: I second the amendment.
It is a good idea that the Minister accepts these amendments, since it is always better to rely on the facts rather than rumours, which are always far worse. I accept the reasoning behind Senator O'Meara's amendment. It is not necessary to go through all the stages of each plan, but generally it is preferable to have people discussing the facts rather than rumours.
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