Regulatory Reform: Motion
Dr. Henry: I thank Senator Ryan for his kind words. As a member of the medical profession and a consultant, I appreciate them.
Mr. Ryan: The Senator knows I am married to a doctor.
Dr. Henry: I welcome the Minister of State. I will talk about the last part of the motion:
[that Seanad Éireann] supports the Competition Authority and the Director of Consumer Affairs being given additional priorities and tasks to boost this counter-inflationary policy, including:
(i) more aggressive implementation of competition policy, including dealing with sheltered sectors where unnecessary barriers to entry exist,
and
(ii) accelerating the studies of professional services, which were initiated by the Competition Authority at the request of the Government on foot of the OECD review of Ireland's regulatory regime.
I will try to stick to my last remark and discuss the medical profession. It is very odd to hear the word "competition" used so much in dealing with the medical profession because most of us involved in it feel that if only we could have a bit more competition, life might be a bit more bearable. Far too many doctors are far too busy and many, unfortunately, are now taking early retirement. I do not think this has been taken into account, nor has it been taken into account by those who would address the problem.
Thirty per cent of all doctors are general practitioners and work, on average, a 79 hour week, of which 46 hours is on calls. I note that this all comes from the report we are discussing. A total of 39% of general practitioners said it was extremely difficult to get help. Another 33% said it was very difficult. In other words, 52% were having terrible trouble in getting help to run their practices. We must take into account that there really is a shortage of supply rather than a need for competition. This has not been dealt with in the report. Certainly, the price of a visit to a general practitioner seems to be about €35 but is more expensive in town than in the country. The increase in the price of a consultation with a general practitioner is larger than inflation but one thing on which the Minister for Health and Children and I agree all the time is that medical inflation has been much larger than general inflation, of which, unfortunately, our old bugbear, insurance, is a very important part.
Deputy Glennon could be asked about the increases Medisec have had to bring forward. He initiated a very economic scheme but after a certain number of years the fees are now about twice what they used to be. That is a big problem. On questioning patients, the authors of the report did not find that price was a major factor in whom one chose as a doctor. Geographical proximity, reputation, quality of service and customer trust, as it was described - I would prefer to have seen it being described as patient trust, but what harm - were more important factors.
I have found that one of the greatest difficulties experienced by general practitioners in starting up lies in getting planning permission. Senators might remember that in the good old days people could start in their front rooms or perhaps have a garage converted but that is no longer allowed. Obtaining planning permission in one of the new shopping centres is a difficulty but there is also the problem of cost. These outlets, which are competing with retail outlets, are very expensive. This is certainly putting up the cost of seeing general practitioners.
Quite rightly, patients would like more information on fees. Perhaps the Medical Council's stipulations have been too harsh - certainly, one cannot advertise one's fees in the Yellow Pages - but one can put up a schedule of charges in one's surgery. The vast majority of doctors do this. It is nearly a form of advertising because it does tell people about one's specialist services. I do not think doctors would have a problem with this.
The report did discuss the issue of doctors' being disallowed from forming limited liability companies with other medical or paramedical practitioners. It seems a good idea from the point of view of economics. We all see how well the new co-operatives are working. However, there is one problem. The report stated if doctors set up a limited liability company, there could be specialists within the company but there is a problem with this. If the company had a specialist in toenails, we could see everybody being referred for treatment for their toenails for the good of the company - not that any of my colleagues would ever think of doing something like this. That is something we have to take into account just in case in the distant future some medical practitioners are like that. It could end up making things more rather than less expensive for the patient.
Over the years there have been clinics that have occasionally developed very bad reputations for continually referring patients from one person to another. That adds hugely to the cost of health care services and was at one stage tackled by the Voluntary Health Insurance Board.
It is a pity general practitioners are so dependent on the pharmaceutical companies for promotional literature encouraging people to have vaccinations, even though the Department of Health and Children produces some very good literature. Patients who have colostomies have a stoma with a bag attached and they have to learn how to deal with it. A patient recently pointed out to me that all the stoma care nurses are employed by the pharmaceutical companies. Naturally they will push their own product and encourage frequent use and frequent changing. It would be far better if the Department of Health and Children employed stoma care nurses. In areas like this more competition would be extremely useful.
The report says there should be easier entry for all general practitioners into the General Medical Service. I could not but support this. Nowadays the IMO must be consulted to see if setting up another GMS list in an area where there are plenty of other doctors with GMS lists would be resisted by people in those areas. This very rarely happens now and the most serious problem is getting people to take up GMS lists in some parts of the country. It is not a question of trying to get competition for these lists; it is a question of getting anyone to take them at all. Not all of this was taken into account by the people who wrote the review.
Some 25% of doctors in the country are consultants, but we have a terrible shortage of consultants. The report points out that we are ranked 13th out of 14 European countries in the number of inhabitants per doctor. The health boards and hospitals apply for the doctors they want and are far more likely to apply for cardiac surgeons than neurologists. There is a desperate shortage of neurologists, but people with Parkinsonism or degenerative myelomas do not get the same sort of attention that people with bad hearts do.
There is a serious delay in appointing consultants. This is not just the fault of Comhairle na nOspidéal or the Department. A doctor who is appointed in December might not agree to start until September due to existing commitments. These sorts of considerations have not been taken into account. They have taken no notice of these important delays.
We must be careful about assessing the non-EU medical schools through which people from outside the European Union have qualified. Not enough consideration is given to that. The Medical Practitioners Act, which we brought in with great haste last June to allow service as well as examinations to be taken into account, still has not been enforced. We have been promised for years a medical practitioners Act but still do not have one.
There are plenty of people who are skilled enough to come forward for medical posts. However, they have to be given intern jobs in order to be registered. The Department will not allow for an increase in the number of intern jobs when there are already too many.
Question put and agreed to.
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