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Dr Colm Quigley, President of the Medical Council, addresses guests at 2007 Annual Dinner

7 December 2007

Minister, members of the Medical Council, staff of the Medical Council, distinguished guests and friends.

My address to you this evening will be short but not sharp. It is about one thing alone. Trust.

From my earliest days as a medical student in Cork, through every day of my subsequent training, it was ingrained into me that medicine starts and centres on the doctor patient relationship. To every medical practitioner amongst us here, it is a basic axiom that the good of our patient is our moral compass. The glue in this relationship is trust. It has underpinned medicine and found expression since the Hippocratic Oath of the fourth century BC.

So what has changed? Nothing has changed in the importance of this relationship between doctor and patient. What has changed is the complexity of the world in which we live. We no longer live 'village life' in which relationships of trust are established by our own direct experience and that of our families. Most normal, reasonably healthy people rely on many medical practitioners in the course of their lives. Yet, it is only a few generations ago when they would have had no need to go beyond the village doctor. Today, in our vastly more complex society, we all expect all sorts of systematic assurances. We can no longer rely on village reputation to assess integrity and competence.

This is a feature of society, not just of medicine. For example, because food comes through many stages before we pick it up from the supermarket, every modern society has rigorous procedures to protect us.

Step back, say, 150 years. 1857. The industrial revolution was in full swing and social structures were set on a path towards complexity. This was two years before Charles Darwin had published 'The Origin of Species'. It was five years before the American civil war began and eight years before slavery was abolished in the United States. Still, it was a year before the General Medical Council was established in the UK, in 1858. The Medical Practitioners Act 1927, yes eighty years ago, set up the Medical Registration Council for Ireland. This was replaced by the current Medical Council under the 1978 Act. We look forward to the imminent commencement of the 2007 Act.

The history of medical regulation is driven by the recognition by doctors that increasingly complex societies must evolve procedures to maintain the relationship of trust that had existed for millennia. It is not about inventing something new. It is about holding onto the most valuable thing we must have. Trust.

That trust has taken a serious battering in Ireland in recent years. There have been tragic cases where people in this country placed their trust and were let down. The confidence of the public and patients in our health care system and perhaps our doctors has been badly shaken and damaged. Where there is any damage to the trust with which patients approach doctors then patient care is likely to suffer. That trust must be restored. It is our responsibility as doctors to do so.

It was against this background that that the Oireachtas passed the Medical Practitioners Act, 2007. There was effectively no opposition within our parliament to the central features of this legislation. This Act is what our patients want. It is the law now and will be implemented, we expect, from early 2008. As you know, this Act will make it mandatory for all doctors to maintain their competence and undergo performance assessments over a five year cycle in order to maintain their ability to practice medicine. This process will be similar to what is happening in Australia, New Zealand, Canada, the US, the UK and gradually throughout the rest of Europe.

The village in which we now live is not only complex but also global. It is critically important that the standards of Irish medicine are comparable to the finest international standards. The new Act and the Medical Council's Professional Competence Programme will ensure that this is the case. Today the Medical Council considered the initial written reports on two pilot projects involving professional practice review of doctors and performance assessments on site for five doctors. The views of over 2,000 patients of their doctors and their medical practice have been assessed in these pilot programmes. The results of these will be published in the New Year. The experience we glean from this will help shape the model which will be extended to include all registered medical practitioners. This will ensure that doctors will benefit from the feedback of their colleagues, medical and non medical, and their patients as to their practise. This is a quality enhancement for doctors.

This, in truth, is a development that will help reassure our patients and the wider public that we as a profession are willing to stop, listen and learn from them. In this complex society, it introduces a new form of glue to bind the doctor patient relationship.

Much attention has been focused on the provision that the Medical Council may have a majority drawn from outside the medical profession. The more far reaching provisions of the new Act are those that ensure that a very large number of doctors will be engaged more deeply into the regulation of the profession in Ireland.
The major challenge for the profession is to adapt to the changes imposed upon us by the new Act where it will be mandatory for us to engage in peer review, audit and performance assessment and to record our involvement in these and related competence assurance activities. This will require continued engagement and partnership with you the professional training bodies and the profession at large.

There will also be a duty on the HSE and the Department of Health and Children - and indeed the Minister - to ensure that adequate time and other resources are made available to doctors in active practice to ensure that time devoted to ensuring patient safety and quality of care do not necessarily impinge on service. The expectation that safety measures do not cost is simply not acceptable. Safety does have a cost but it is a cost for which we as a society must be prepared to pay.

It is not just doctors who are regulated. It is very heartening to see that the Health Information and Quality Authority have the role of assessing the public hospital system. However it is absolutely vital that wherever medical care is delivered, however doctors interact with patients, that the place, premises, hospital or clinic is appropriately licensed for that interaction. It is simply not acceptable to have private hospitals, private clinics, eye surgery clinics or cosmetic surgery clinics unregulated into the future. Any place where a doctor is engaged in medical practice must be appropriately licensed. Indeed it may well be necessary for doctors in practice in such sites to question the governance of such sites, to be assured of patient safety and to take a leading role in ensuring that licensing does occur. I am aware that many private hospitals engage in a form of accreditation where their standards are assessed and accredited by an external accrediting agency. That is very appropriate and is to be a lauded. Nevertheless, it is most important that the state ensures that all of its citizens are protected by a licensing system. We have it for registered medical practitioners. We must also have it for all premises where doctors treat patients.

I return to the single thought for this evening, trust, and what must be done in any complex society if we are to maintain that critical ingredient of successful medicine. This is a matter for us in the Medical Council, for the training bodies, for every medical practitioner, for all of us.

It is in the best interest of the medical profession in that it can assure patients that their society is now actively involved in regulating the medical profession but that it is at a an overall supervisory level. We will be asked to self regulate more with peer review, with audit and with active engagement by doctors in reviewing their colleagues' performance. It will be up to each and every one of us to support this self regulation by being involved actively where possible and we would hope that this will be done on a professional basis with proper training for such assessors with payment to recognise its importance. We would expect vastly more doctors - somewhere between 80 and 120 - being involved at any one time with our committee assessments and other matters. They will have to come from the training bodies and from the profession at large. As time goes on, there will be much greater involvement of doctors and self regulation into the future.

We know that the vast majority of doctors are practicing excellent medicine every day of their working lives. We need to collect and record that fact. We also know that underperformance by a small number of doctors may harm patients. We must identify underperformance where it exists and address the issues that arise from it. One of those issues is that we must inform the Medical Council where we have significant concerns about a colleague. Our duty to protect patients takes precedence over concern for that colleague. Maintaining the trust of our patients requires us to be our brothers' and our sisters' keeper.

My colleagues in the Medical Council and I are absolutely committed to ensuring that the regulation of doctors is kept independent, that there will be a strong voice of the profession in the Council in the future, that we as a profession will engage in the self regulatory process and embrace it. That way, we will ensure that the trust of patients in us as doctors and as a Medical Council will be well founded.

My colleagues on the Medical Council and I wish to express our warm gratitude to the staff of the Council for their high levels of professionalism and dedication. Trust in the integrity and competence of the Medical Council is made possible by their high standards.

The Medical Council's principal purpose is to protect patients. Our secondary focus is on preserving standards in medical practice, supporting doctors in their efforts to maintain and improve their standards and to ensure the safety of patients in their encounters with doctors in all aspects of their practise.

At all times, we must remember what this is for. Going back to where I started this evening, in the middle of the 19th century, I quoted Disraeli:-
"I repeat... That all power is a trust - that we are accountable for its exercise - that, from the people, and for the people, all springs, and all must exist."

I hope that you have an enjoyable evening and that 2008 will be a successful year for the Medical Council, for our training bodies and for all involved in health care.

Thank you.

Dr Colm Quigley, F.R.C.P.I.,