4th April, 2002
Dr. Henry: I welcome the Minister to the House. She gave a really splendid speech, but I wish we had the main Bill before us now rather than having to wait until the autumn. When the Government came to office new medical practitioners legislation was promised and I am extremely disappointed there has been such a delay in introducing it. At least the explanatory memorandum is honest in saying this Bill has to be brought forward as a matter of urgency. While I agree it needs to be introduced as a matter of urgency, I pointed out to the House over three years ago that we would arrive at a point where we would be bereft of non-EU doctors who are the main service providers in our health service because the Medical Council had changed its training regulations.
I know that the Medical Council has reservations about this Bill in regard to those getting permanent registration. More than three years ago the Medical Council decided that people with temporary registration could only be employed in approved training posts. When it examined the facilities for training in hospitals around the country, it decided some of them were inadequate for the proper training of doctors. In this Bill, we are ensuring that people can work in hospitals because they have permanent registration despite the fact that the Medical Council thinks those posts are not adequate for training and that some people in these posts require further training. So, we are giving permanent registration to people without proper training and not assessing their competence. This cannot be regarded as a good thing. Proper training is essential to have a proper health service and we know that many of the rural hospitals which are almost totally staffed by non-EU graduates, many of an excellent calibre, are not approved for training posts.
There are two types of non-EU doctors here. First, there are those who have come here from abroad and are charged extremely high fees from our medical schools to qualify here. Until very recently, when they qualified they were treated very shabbily by the system. There is a shortage of intern posts so non-EU graduates frequently found they had to work in supernumerary posts without payment so that they could obtain full registration here despite the fact that we had taken considerable money from them over the years. One brave non-national recently took a case under the equality legislation and won. All those now employed in these posts must be paid, and rightly so. I hope all those employed in such posts in the past will get the money to which they are entitled for the time they held our health service together.
The second group of non-EU doctors are those who qualified in their own countries. Many who come here are the brightest and the best. They come here for further training to perhaps get membership of the Royal College of Physicians and the Royal College of Surgeons and to study in the various fields so that they can return to their countries and make a contribution. The service they give this country in the meantime is unbelievable, yet they have been outrageously exploited. My profession has played an important role in this.
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The situation regarding temporary registration was very serious for them. For a certain number of years one could be registered temporarily here for only five years at a time when many training programmes were for six years. It meant they could not stay here long enough to fulfil the training programme on which they were trying to complete a postgraduate degree. A couple of years ago the period of years was extended to seven, which was an improvement. However, they were employed in the heaviest of the service jobs so that they frequently had insufficient time left to do the amount of study required to undertake their postgraduate degrees.
The Minister of State said that 98% of all posts in the service area at non-consultant doctor level posts have been filled. While this may be the case it is worrying how little competition there is for these posts. Sometimes there is none. It means that the authorities are very grateful if they can get anybody to take them up. We must remember that quality is important. It is not merely a question of filling the post. Last year there was commotion when it was found that a consultant psychiatrist, Dr. John Harding Price, who had been suspended from the medical register in England, was working in a post in the South Eastern Health Board. He was entitled to do so and I am sure Senators will be pleased to note that he was totally exonerated of the complaint made against him by the Medical Council and has been reinstated. It is important to note that he was the only applicant for that job. We are in a desperate situation in terms of getting people to fill posts in some parts of the country. We must take cognisance of this, especially as we will have to compete more and more with other countries for these people.
The Medical Council's efforts to improve training has been greatly hampered by the fact that there is such a shortage of consultants. At present we have one consultant for every 2,725 people. Sweden has one for every 607 while Norway has one for every 702. In this regard we are one of the worst countries in the EU. Given this, it is easy to see how difficult it is for people to get involved in properly training these trainees. In many hospitals no time is scheduled for consultants to give them proper training.
The Bill has done everything possible to ensure we will not be bereft of these people from 1 July. It is amazing we have managed to stagger so far with having most posts filled. The number of years before a permanent registration can be given has been reduced from four to two, which is a big reduction. While it is good to give credit for training in other areas, such as general practice and public health, there is a need to ensure there is quality assurance in these areas regarding the available training schemes. Public health doctors are up in arms about this. Again, we must be careful we do not give credit for training where people do not consider themselves to be in a proper position to give training. Huge improvement is required in this area. The recent letter from the second secretary in the Department of Finance to the Secretary General of the Department of Health and Children pointing out that we are not necessarily working towards a consultant provided service was a nice blow in the face. Again, it will seriously affect the amount of proper training which can be given to trainees in these posts.
I am not sure of the importance of the debate in the European Commission regarding the proposal for the simplification of rules to facilitate the free movement of qualified people, including doctors in the European Union. Apparently a directive is being worked on which would give automatic rights for doctors from all over Europe to work here. The Medical Council is concerned about this. As a self-regulating body, it has naturally been very proud of maintaining standards at the highest possible level. We want to be sure that consultation on the directive will involve not only the Minister but also the council.
Section 9 allows for other non-EU doctors who have completed their studies in medical schools abroad to do their internship here. Is this part of, or separate from, the directive and will the United Kingdom reciprocate in this area? A problem arose a few years ago when I met the Medical Council in London. Up to approximately four or five years ago it used to allow Irish graduates undertake their internship in the United Kingdom. It then changed its position and we were on weak ground to argue against the change because, as the Minister of State pointed out, the 1978 Act made it obligatory for a person who did an internship here to be a graduate of one of our medical schools. Has the United Kingdom now decided to reciprocate? This is a very important matter from a logistics point of view. If we are to allow outside graduates to come here it is only fair that our graduates should be allowed to work abroad. It may also mean that we could have a sudden and severe drain of people electing to do their internships in Great Britain or Northern Ireland. If the provisions of this legislation are enacted it is important we again contact the Medical Council in the United Kingdom to ensure, if possible, that there is reciprocation.
Non-EU graduates have been treated appallingly in this country. The head of the non-EU doctors committee of the Irish Medical Organisation recently wrote an article in which he stated:
The training system is fragmented and apartheid ridden. There are different fast-track pathways for the chosen few but a long and arduous road for others, with a career block at the end if those doctors choose to stay in the system. It is an open secret that some of the training programmes being offered to non-EU doctors are not for the same duration of training and do not lead to the same certification as their EU counterparts.
This is very serious because some of these training programmes, in which these people may now become involved because they are permanently registered, may not be suitable for certification under the Royal College of Physicians or the Royal College of Surgeons. This must be clearly pointed out before they join them. It means that although they may have permanent certification they may still be loathe to take up these posts, which are holding our service together, because they will not have certification towards higher examination.
I wish I could give the Bill a bigger welcome. We are doing this for ourselves rather than for non-EU doctors, who have had an appalling time. The Minister of State's speech gives me some hope for the autumn but I wish the legislation had not been so delayed because we face constant problems due to the need to update the 1978 Act. Perhaps the Minister of State will be promoted if her side of the House is returned to Government, in which case we may further debate the legislation. I hope its provisions will be implemented but it is unacceptable that we should have to bend over backwards to ensure that the health service can be maintained by keeping these people in the service, no matter how good or bad it may be to their training or their future.
Question proposed: "That section 7 stand part of the Bill."
Dr. Henry: This is a particularly useful section. It will not just serve to keep an eye on doctors who come into the State to perform cosmetic surgery on an ad hoc basis, but it will also allow for the entry to the State of specialist doctors who come here to demonstrate intricate surgical procedures to our registered doctors. I commend the Minister and her officials for including this important section in the Bill.
Question put and agreed to.
Section 8 agreed to.
SECTION 9.
Question proposed: "That section 9 stand part of the Bill."
Dr. Henry: Does the Minister know whether the UK will reciprocate regarding internships?
Ms Hanafin: Not at this stage. That is an issue that I would like to have addressed at EU level. We will follow up on that bilaterally.
Dr. Henry: It would be a good idea to follow this up bilaterally. It was a terrible blow when the UK decided to withdraw the facility where Irish interns could train in its hospitals. That action was one of the reasons which led to the establishment of supernumeraries whereby non-EU doctors ended up working for nothing. That was our solution to that problem and it was not a good one. However, it has been stopped but we need to keep after them about it.
Dr. M. Hayes: I encourage the Minister to follow Senator Henry's advice in relation to bilaterals with the United Kingdom, particularly in the context of North-South links.
Dr. Henry: We have established schemes on a cross-Border basis, admittedly at SHO level, but one never knows when an intern might be involved. It is, therefore, very important to get them organised on this issue.
Question put and agreed to.
Section 10 agreed to.
SECTION 11.
Question proposed: "That section 11 stand part of the Bill."
Mr. Manning: How soon does the Minister of State think the Bill will commence?
Dr. Henry: It better be quick because these people are needed at once.
Ms Hanafin: As soon as possible, although there is not, as yet, an early commencement order.
Question put and agreed to.
Section 12 agreed to.
Bill reported without amendment and received for final consideration.
Question proposed: "That the Bill do now pass."
Dr. Henry: I thank the Minister for always being so co-operative in the House. However, it is vital the Department of Health and Children receives the message to push on with this Bill. Regarding the registration of other health professionals, for the past two years no chiropodists have been appointed because there are no people to register them in this country. This is having a serious practical effect on people involved in general medical services. It is most important that the Minister's aspirational speech materialises into a Bill before the House as soon as possible.
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