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Putting the right touch on medical regulation

04 Oct 2013

Lloyd Mudiwa

Lloyd Mudiwa reflects on the need for a range of urgent and comprehensive amendments of the Medical Practitioners Act 2007, which provides for a system of regulation of the medical profession in Ireland.

The HSE’s National Service Plan for the year was based on €60 million in additional funding being generated from new legislation promised by Minister for Health Dr James Reilly to charge all private patients in public hospitals.

The HSE’s financial report for the first half of 2013, published on September 18, acknowledged that this target could not now be met as the Government had deferred enactment of the necessary legislation until next January.

One could go on and on listing several other examples of the delayed implementation of health legislation, including amendments, but probably the most prominent two are the Protection of Life During Pregnancy Act just passed in August and the still long-awaited Health Information Bill (HIB).

Twenty-one years on from the X case, and almost a year after the death of Savita Halappanavar, legislation to protect women’s lives is, however, still not operational.

Meanwhile, the HIB, which will offer significant and revolutionary advances in the use of and protections afforded to personal health information in Ireland, was initially expected by end of September 2010 at the very latest.

Expressing anxiety over delays in enacting the Bill, HIQA in March said the legislation would feed into new national requirements for open disclosure, and the work it was doing on developing unique identifiers for patients was also dependent on its enactment.

Moves are currently underway that may result in the implementation of proposed changes to the Medical Practitioners Act (MPA) 2007.

Proposed amendments to the MPA must now be placed high on the agenda, given that amending the Act was part of the Government’s legislative programme, and Hawkins House has confirmed it had been in discussions with the Medical Council in relation to a range of amendments.

The medical regulatory body has identified many areas in which the legislation could be amended and improved, and has informed the Department of Health of its analysis.

The Department has in turn commissioned the Health Research Board (HRB) to carry out an “evidence review” of the registration of medical practitioners in a number of countries, including Ireland, with a view to amending the legislation.

Problems with the way the Fitness to Practise (FTP) procedures are governed through the Act and issues around registration would seem the most pressing, and pressing they are:

Apart from the fact that regulation is becoming increasingly expensive and FTP is a significant driver of costs in this regard, medical practitioners contesting in the elections for the current Council held earlier this year voiced concerns at the adversarial nature of how the regulatory body impacts on the daily lives of individual doctors, which had even prompted suicidal thoughts in some of them.

Prospective Council members voiced their concerns over public FTPs, with two doctors, previously subject to FTP inquiries, among the candidates who contested the vote.

Former Medical Council President, Prof Kieran Murphy, also hopes the Act can be changed so that members of the Council are no longer required to be involved in almost all of its activities, including FTP inquiries. The problem is that members have to be involved in so many of the operational details that there is very little time for policy or strategy, which IMT submits is not a good situation for any organisation to find itself in.

On the issue of legislative delays, the Protection of Life During Pregnancy Bill’s tumultuous passage through the Dáil, on to the Seanad and then into the hands of the President, was one fraught with debate.

While many people think the law went too far and could open the floodgates for “abortions”, probably just as many think it the most restrictive piece of abortion legislation in Europe.

It will criminalise any woman, or girl, who procures an abortion outside the confines of the legislation, punishing her and anyone who assists her with up to 14 years in prison. It will not allow for abortion where a woman is pregnant as a result of rape or incest or where she is carrying a foetus with a fatal abnormality.

It differentiates between a physical and a mental threat to a woman’s life, and will compel her, if she is suicidal, to submit to assessment by up to six doctors. It will not protect her health where the pregnancy threatens it, even if it threatens lifelong injury. These are just some of the criticisms by those who think the Act does not go as far as it should have.

Given the amount of criticism from both sides of the divide, one gets the feeling that this legislation is unlikely to be the end of the matter.

And judging by these few examples, it’s a long road to the enactment of legal amendments, but only time will tell exactly how long that road is for the MPA and how comprehensive and effective those changes will be when they are eventually made.

4 October 2013

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