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Medical Council Statement to the Public Accounts Committee Thursday 17th May 2018

Opening Statement by Mr Bill Prasifka, CEO Medical Council, and Dr Audrey Dillon, Chairperson of the Ethics and Professionalism Committee and a member of the Medical Council, to the Oireachtas Public Accounts Committee, 9am, Thursday, 17th May, 2018.

Chairperson and members of the Committee, on behalf of the Medical Council, I welcome the opportunity to discuss this important issue with the Committee.

I will say a few brief words about the role of the Medical Council. This is very relevant in the context of this discussion and recent media commentary.

The Medical Council is the statutory body responsible for the regulation of doctors in Ireland. Its purpose is to protect the public by promoting and ensuring the highest standards among doctors. From the day a student first enters medical school until the day he or she retires from practice, the Medical Council works to ensure medical education and training remains up to date and is benchmarked to the highest international standards.

The Medical Council sets standards for all undergraduate education and postgraduate training of doctors and also requires that all doctors fulfil ongoing professional competence requirements to ensure they keep their knowledge and skills up to date throughout their professional lives.

The Medical Council provides guidance to doctors on matters relating to conduct and ethics through its Guide to Professional Conduct and Ethics for Registered Medical Practitioners.

The Medical Council is also where the public may make a complaint against a doctor.

The Committee in its meeting last week raised two topics which relate to the Medical Council, namely the ethical guidance to registered medical practitioners and the complaints process. I will endeavour to briefly cover both these detailed and complex topics.

The Medical Council has a five year term and each Council is tasked with reviewing and updating its guidance to registered Medical Practitioners. The current Council, whose five year term finishes at the end of May, reviewed the Ethical Guide and published the 8th Edition of the Guide in May 2016 following a consultation process.

This guide sets out the principles of professional practice that all doctors registered with the Council are expected to follow. Doctors should use their judgement to apply the principles to their practice.
In the guide the term ‘you must’ is used where there is an absolute duty on the practitioner to comply with the principle that follows. The term ‘you should’ is used to describe best practice in most circumstances, accepting that it may not always be practical to follow the principle or that another approach may be appropriate in particular circumstances. The practitioner should use their judgement in such cases.

Having been dealt with under “adverse events” in the 7th Edition, published in 2009, of the guide the Council developed guidance on open disclosure and duty of candour which are dealt with in paragraph 67 of the Guide, stating:

  • “Open disclosure is supported within a culture of candour. You have a duty to promote and support this culture and to support colleagues whose actions are investigated following an adverse event. If you are responsible for conducting such investigations, you should make sure they are carried out quickly, recognising that this is a stressful time for all concerned. 
  • Patients and their families, where appropriate, are entitled to honest, open and prompt communication about adverse events that may have caused them harm. When discussing events with patients and their families, you should: 
    • acknowledge that the event happened;
    • explain how it happened;
    • apologise, if appropriate; and 
    • assure patients and their families that the cause of the event will be investigated and efforts made to reduce the chance of it happening again.”

Other areas of the current Ethical Guide which are worth highlighting are paragraph 32.1 which deals with disclosure after death, paragraph 63.1 which deals with Patient safety and advocacy for medical practitioners in management roles, paragraph 64 culture of patient safety which also covers adverse events and paragraph 65 raising concerns which deals with the responsibly of the practitioners to raise a concern about a system or service structure which could lead to unsafe practices or impact on patient safety. I have provided the full text of these paragraphs as supplementary information, in addition to a copy of the 8th Edition of the Guide to Professional Conduct and Ethics for Registered Medical Practitioners for the members of the committee.

In relation to Deputy Farrell’s question from last week’s Committee meeting relating to the “the processes it goes through to deal with medical personnel who are the subject to medical negligence cases and an outline of its role and follow-up activity with them” I would like to clarify a few points.

A complaint can only be made against a registered medical practitioner by an individual. In some circumstances the Medical Council itself can decide to become a complainant when it has concern to do so. This could happen in a number of scenarios such as a case be heard in another forum or highlighted in the media. Each case is treated as unique and individual and as such it is investigated this way.

In relation to follow-up activity with a practitioner who has had conditions on his/her registration following a fitness to practise inquiry, the nature of the follow up would vary widely depending on the nature on the case, for example it could include:

  • the practitioner must work with a nominated person acceptable to the Medical Council, to formulate a Professional Development Plan, specifically designed to address issues highlighted 
  • They may have to undertake to complete a professional competency scheme with a training body
  • That the practitioner must meet with a nominated person, acceptable to the Medical Council, on a regular basis to discuss progress towards achieving the aims set out in the Professional Development Plan. The frequency of these meetings to be agreed with the Medical Council
  • That practitioner must agree to supplying reports on his progress in relation to the Professional Development Plan to the Medical Council when requested
  • That the practitioner must provide evidence to the Medical Council of ongoing and regular participation in relevant continuing medical education and/or continuing professional development activities

The Medical Councils Monitoring Committee has the responsibility to ensure that all conditions are being met with and they report to the each meeting of the full Medical Council.

Further information about the complaints process has been provided to the Committee as supplementary information.

I am happy to take questions from the Committee however I must highlight in advance that I am prevented from answering some questions on the current situation due to our role as the regulator of individual doctors and any answer I may be asked to provide may prejudice any potential complaint we receive on this topic.