Seanad Éireann - Volume 154 - 01 April, 1998

Adjournment Matter. - Royal Colleges of Surgeons and Physicians.

Dr. Henry: I thank the Minister for Marine and Natural Resources for taking this matter. I always seem to strike on evenings when the Minister for Health and Children is busy. The Minister for the Marine and Natural Resources is either the fourth or fifth Minister who has taken matters I have raised on the adjournment in place of the Minister for Health and Children, who always seems to be otherwise occupied.

I wrote to the Minister for Health and Children in respect of this matter a month ago. I received a holding letter from him but no further information. A problem has arisen for medical practitioners regarding equivalence of postgraduate diplomas from the Royal Colleges of Surgeons and Physicians in Ireland with those in the United Kingdom as a result of the December 1997 amendment regulations to the European Specialist Medical Qualifications Order, 1995, and its interpretation by the specialist training authority of the medical royal colleges in the United Kingdom.

The amended order contains transitional provisions to enable doctors in non-training grade posts to be considered for inclusion in the United Kingdom specialist register. The new paragraphs, which have the effect of allowing experience to be considered in addition to training, have been inserted into Article 12 of the European Specialist Medical Qualification, 1995 (part V — Transitional Provisions, Existing Specialists), paragraph (2)(c)(ii), which requires certain applicants who wish to have their name included in the specialist register to have “qualifications awarded in the United Kingdom”. It is here that difficulties for those with post-graduate diplomas from the Royal Colleges in Ireland begin.

[1432] In its interpretation of the UK statutory instrument, the specialist training authority, in its general information sheet revised in January 1998, sets out the requirements they will use to consider doctors in non-training grade posts for inclusion in the specialist register. These are detailed, on pages 5 and 6 of the information sheet, in Article 9 which allows national health service consultants in post before 1997, doctors “accredited” as trained before 12 January 1996 and any others “whose UK training was completed to the standard required in the UK at the time” to be considered for inclusion in the register.

Article 9, importantly, has a fourth paragraph which confirms that the specialist training authority, in any assessment for specialist registration of experience gained by doctors in non-training grade posts, will exclusively consider only those doctors “who have UK qualifications awarded”.

Considerable confusion has resulted from the fact that the wording of the term “UK qualifications awarded” in the specialist training authority's information sheet is not the same as that in the 1995 order, which refers to “qualifications awarded in the UK”. Such qualifications could include Membership of the Royal College of Physicians in Ireland which is awarded in Belfast, because the college has conducted examinations in that city since 1993 as part of its attempts to improve North-South co-operation. The phrase “qualifications in the UK”, excludes Membership of the Royal College of Physicians (UK) which is awarded in Hong Kong, Malaysia, etc. That is another matter, but worse is to come.

In annex C on page 9 of the information sheet the requirements which the specialist training authority will seek for recommending an entry in the specialist register are listed. The term “UK qualifications” is further defined in this annex as a “UK postgraduate specialist medical qualification (obtained by formal assessment or examination)”. In the sentence which follows it is stated that “Irish Qualifications” are dismissed and excluded as follows: “Holders of only Fellowships or Membership of the Irish Colleges (or specialist qualifications from other EEA Member States and overseas Countries) will not qualify as these cannot be regarded as a UK qualification”. This is hardly evidence of “parity of esteem” and it takes no account of the equivalence which has existed for centuries between the colleges.

The direct effect of the United Kingdom legislation and its interpretation by the specialist training authority has been to disallow from registration as specialists in the UK a small number of doctors in non-training grade posts who have not been previous national health service consultants, accredited as trained prior to 1996 by the relevant college in the UK, whose training has not been completed in the UK or who “only” hold Irish post-graduate qualifications. I accept that these people cannot become specialists but their qualifications are suitable for them to join the ranks of ordinary doctors who ably support the United Kingdom's national health service.

[1433] Doctors with Irish qualifications who understood at the time that their diploma was equivalent — as it was, and still is, with regard to entry into higher specialist training — are particularly puzzled. These doctors have been informed that one solution would be for them to sit an equivalent UK examination. Though this is theoretically possible, it is not a practical proposition at this late stage in their career. The only other route would be for them to compete with others for a position as a specialist registrar and then undertake several years of higher specialist training in the UK.

The small number of doctors directly affected represent a large constituency of non-UK and non-EU doctors who have for many years been encouraged to provide service support in hospitals in the United Kingdom and Ireland. Independently, and through the British Medical Association, these doctors have been drawing attention to their perception of injustices and deception brought about by these new arrangements.

Of equal or even greater significance to us is the perception that Irish qualifications are not of equal value in other contexts. This is despite the fact that the Royal College of Physicians is governed by its second charter, the William and Mary Charter of 1692 — its first charter was granted in 1667 by Charles II — and the Charter of the College of Surgeons, dating from the 1780s, is of almost equal antiquity. The college was in existence long before the Act of Union, not to mention Partition. The competent authorities in the UK have the duty to protect the UK register of specialists from entry by inadequately trained specialists, but surely this must be done in the context and spirit of the EU directive.

Very delicate negotiations are taking place in Ireland and the UK regarding the establishment of special North-South as well as east-west bodies, which must be to some extent beyond present EU considerations. Health is an area stressed by members of the British and Irish Governments as one where co-operation should be promoted. As a member of the Forum for Peace and Reconciliation I organised a session on this subject. This year the College of Physicians in Ireland is establishing an office in Belfast believing the cross-Border training we are promoting is in tune with the wishes of both Governments. Health boards in the Border areas are co-operating more. Specialised units and research units in both jurisdictions are collaborating daily.

We now have this Exocet from the specialists' training authority. My colleagues on the British-Irish Interparliamentary body were surprised when I told them of it as it had not been before the Houses of Parliament in Westminster. However, my esteemed colleague on the British-Irish Interparliamentary body, Kevin McNamara, MP for Hull North, knew about it because he had also received complaints and was under the impression the regulation had been deferred.

[1434] Despite strong efforts in recent years to facilitate the free movement of doctors in these islands and especially of those in training, on the basis of equivalence of training qualifications, it has proved most difficult to overcome a very negative attitude in some quarters to the principle of parity of esteem. For example, this is evident in some of the statements emanating from the UK Department of Health. Phrases such as “qualifications in the UK”, the specialist training authority “only” Irish qualifications, the Joint Committee on Higher Medical Training reduction in Irish representation on the JCHMT committee, totally without our agreement, to that of “observer” status and the setting up of a Northern Ireland Committee of Medical Colleges which has taken upon itself the role of giving advice to the chief medical officer in Northern Ireland on the allocation of merit awards etc. are not very productive.

When the Minister for Foreign Affairs said this afternoon he was looking forward to a fundamental change in the relationship between bodies in the UK and the Republic of Ireland I do not believe he envisaged debacles such as I have outlined. From both a professional and political standpoint, the action by the specialist training authority will have a negative effect on all our efforts to improve North-South and east-west relations. I ask the Minister for the Marine and Natural Resources to ask the Minister for Health and Children to contact the Minister for Health and Social Services in London to have this regulatory instrument withdrawn immediately.

Minister for the Marine and Natural Resources (Dr. Woods): I would like to confirm that the Minister for Foreign Affairs did not intend that interpretation when he spoke here this afternoon. I am speaking on behalf of the Minister for Health and Children; and perhaps the Senator can settle for a former Minister for Health on this occasion.

I thank the Senator for raising this important and timely issue. The bodies responsible for organising and supervising post-graduate medical training, including the Royal College of Physicians of Ireland and the Royal College of Surgeons in Ireland, have always operated on an all-Ireland basis and draw their membership from both jurisdictions. In addition, the Irish training bodies have enjoyed very close relations with their opposite numbers in England and Scotland. These relationships have extended to participation in inspections of training hospitals in each other's countries, as well as examining students.

As a result of this close co-operation these bodies have extended reciprocal recognition to each other's qualifications. In the case of surgeons, this has developed to the point where all candidates for fellowships in these islands take a single inter-collegiate examination. Successful candidates then choose to have the fellowship awarded by the college of their choice.

[1435] New arrangements for the organisation of higher medical and surgical training in the United Kingdom have created difficulties for the continuation of these arrangements as heretofore. Most of these problems have been dealt with. A recent difficulty has arisen from a decision of the specialist training authority in the United Kingdom that certain doctors holding Irish qualifications who have been working in non-training grade posts in the UK will not be accepted for entry to the specialist register in the UK on the basis that they do not possess a qualification granted by a UK training body.

While this decision would not affect those seeking entry to higher training now or in the future it does, to some degree, reduce the level of reciprocity which has traditionally prevailed. It could, therefore, be interpreted as casting doubt on the status of the Irish qualifications.

I am glad to inform Members that this issue has [1436] been raised at the highest level with the appropriate authorities in the UK. It would be regrettable if these long standing arrangements, which are a perfect example of the benefits to be gained from North-South and east-west co-operation in these islands, were to cease at the point where the two Governments were seeking to expand the scope for co-operation.

I thank the Senator for raising this issue. I accept it is an important one and it has already been raised at the highest level in the UK. I will convey the Senator's concern to the Minister for Health and Children.

Dr. Henry: I appreciate the Minister, Deputy Woods, put an enormous amount of work into the Department of Health during his term of office there and he will understand the urgency of this issue for medical graduates in this country.

The Seanad adjourned at 8.20 p.m. until 10.30 a.m. on Thursday, 2 April 1998.