The Bill would make it extremely difficult for the Medical Council to be critical of either the HSE or government health policy, writes Catherine Wann.
The medical profession has been damaged by well-publicised and traumatic failures - most notably the Dr Neary affair. While no one can undo the damage done to the individual patients, we can all try to make sure that no such systemic failure again occurs. And that unimpeachable motive is what proponents of the Medical Practitioners Bill 2007 seem to be supporting.
Unfortunately, ushering the Bill through quickly and without proper debate will leave us all with yet another rushed piece of legislation which fails to do what was intended of it.
The role of the Medical Council is to protect patients by assuring educational and professional standards, and by registration and discipline of doctors. The council is independent of political affiliation, but it has a medical majority - and therein lies a problem: doctors are, in effect, self-regulated.
Perhaps rightly, self-regulation is widely regarded with suspicion. All professions are conspiracies against the laity, Bernard Shaw joked. Like all the best jokes, this has a kernel of truth: Groups acting solely in their own interest are - very likely - acting against the public's.
Even a cursory look at Ireland's recent history bears this out: a catalogue of planning scandals, political and bureaucratic corruption, and most terribly, child abuse on a literally industrial scale. The common factor linking them all? A group of insiders, acting without any accountability to a wider public. But to our credit, we have learned from our recent past. One by one, the great institutions of the State have been reined in, and virtually all must now answer for their actions. The medical profession, too, needs to be accountable. It should be answerable to the general public, or their representatives.
Under the proposed Bill, the Minister would have powers to direct the council on matters of education and policy. The minister would also be allowed appoint and direct the majority of the council, and to remove appointees who fail to meet the minister's approval. But a panel of political appointees is not the same thing as a disinterested lay majority on the council. Would the medical profession then be accountable? And if so, to whom?
The Medical Council, as it stands, may be imperfect, but at least it is independent. It is subject to the laws of the State, but not to whatever ideology happens to be the current minister for health's.
The proposed make-up of the Medical Council would not be independent of party politics.
How could it be, filled as it would be by political appointees? Do politicians appoint people because they can think - and more importantly, act - independently of their political masters?
An independent Medical Council can at least disagree with - and criticise - health policy. This Bill points us down a direction towards a dangerous conformity with whatever the current minister is thinking.
The Bill would remove the autonomy of both the Medical Council and the individual doctor (who would have to - as now - answer to the council) and damage their ability to be an advocate for patients where this advocacy is in conflict with the minister's own political agenda.
While it is not suggested that any particular minister for health would use this power to deliberately act against the public good, such a concentration of power in one individual's hands is hardly the best way forward for protection of the public.
Unfortunately, the Bill would make it extremely difficult for the council to be honestly critical of either the HSE or government health policy.
Doctors would be answerable, but no one else in the system would be. Health policy could be devised and constructed by politicians and their advisers, without the nuisance of any serious appraisal by health professional themselves. Would you sail in a ship designed and skippered by engineers who had never spoken to the sailors?
The council has responsibility for training and standards (the two, of course, are inextricably linked). The minister, however, has a far greater range of responsibilities, and there is very real danger of a minister facing dangerous conflicts of interest.
Imagine a scenario where, facing an upcoming election, a minister for health has huge surgical waiting lists.
They might decide that a few more consultants would provide a quick fix - maybe even in time for the election. But consultants' training is very long, and there may be just too few qualified to sufficient standard to fill all the new posts. A slight diminution of the standards might get you over the hump, so to speak, and the new consultants would eventually bring themselves up to speed, and then, who would be any the wiser. And would it matter? Perhaps not, but maybe it wouldn't be a safe course of action.
If you think that a lowering of training standards to meet politically motivated objectives is unlikely, just consider the situation in the UK, where doctors' standards are within the remit of the National Health Service (an arm of the state), rather than with the (independent) General Medical Council.
There are reports of doctors - particularly in surgical specialities - who are unwilling to take consultancy posts when offered, on the grounds that they feel their training is inadequate for patient safety. The Irish Medical Council website (www.medicalcouncil.ie) says: ". . . the Bill as worded may end elements of the Medical Council's independence and as worded will allow future ministers of health to block council activities that might be in the patient's interests, but that might give discomfort to officials at local and national level."
Rushing through legislation which concentrates power in the hands of the already powerful does not make an institution more accountable; it makes it less so.
This Bill is being hustled through as further protection for the public. It is nothing of the sort; it is an unhealthy step, in every sense of the phrase.
Dr Catherine Wann is a GP in Nobber Health Centre.