There is a dangerous confusion at the heart of current Government thinking on reform of the medical profession. In the wake of the report on the grossly abnormal rate of Caesarean hysterectomies at the Lourdes hospital in Drogheda, Minister for Health Mary Harney has again repeated the mantra that more lay people are to be involved in the Medical Council, writes Mary Raftery
This is presented as a sort of panacea for the ills within the medical profession so clearly outlined by Judge Maureen Harding Clark in her report. The Minister and indeed doctors believe that self-regulation for the profession is acceptable so long as more lay people become part of the process. However, there are two clear and distinct strands involved here.
One is the business of clinical audit and peer review, whereby the practice of doctors will be subject to regular examination.
It is clearly imperative that this become mandatory for all doctors, and that it be carried out in a fully transparent manner, with results available for public inspection.
While there is a role here for non-medical people, particularly in ensuring complete transparency, this process is more appropriately driven by doctors themselves. Lay people, by definition, lack the detailed knowledge necessary to judge the increasingly specialised nature of medical practice.
The second strand, which is currently also the responsibility of the Medical Council, is the investigation of complaints against doctors. It is here that the process of self-regulation has been exposed as being most seriously flawed.
We have heard numerous stories of the Medical Council rejecting even without a hearing complaints from patients that they have been damaged by doctors. The council claims that the problem here is not that doctors are allowed to regulate themselves - it is rather that the legislation is outdated and cumbersome, leading to over-legalistic procedures. It argues that a new law combined with increased lay involvement on the council will solve the ills.
I have some small experience in this area. For five years during the 1990s, I was one of two lay members appointed to the board of the Dublin Dental Hospital. With no specialist knowledge of dentistry, I felt that my ability to have any significant impact was extremely limited.
This is not to criticise either the board or the hospital - far from it. It is merely to point out that it has been my direct experience that the influence of lay people, serving in a voluntary capacity in complex areas of which they have no expert knowledge, is in danger of being seriously exaggerated.
Other jurisdictions have confronted this problem. New Zealand, for instance, has split the two strands mentioned above. The business of clinical audit and the monitoring of standards and training is left to the profession, under the aegis of its medical council, which remains doctor-dominated. However, the investigation of complaints and concerns was removed from the council in 1994. It is now the responsibility of the Health and Disability Commissioner. His office is wholly independent and is staffed by professional investigators who are not doctors, but can call on specialist knowledge as required.
The New Zealand commissioner actively encourages complaints to be made to his office.
The commissioner also has the power himself to initiate an investigation into any matter of public concern in the health area.
This ability to be proactive, rather than simply waiting for complaints to come in, is a key strength. Another is the entire separation from the medical profession.
New Zealand established this independent, stand-alone complaints body after a number of serious scandals involving sub-standard doctors came to light. The political decision to end the self-regulation of the medical profession was swift and widely welcomed by the public.
Their clarity in identifying and separating the different strands required to ensure medical standards and public confidence could usefully be copied in this country. The Harding Clark report shows us in detail just how dangerous it is to have any organisation or group operating without effective, independent oversight.
It is simply not enough to throw a few more lay volunteers on to a medical council board.
This kind of tinkering around the edges of a system which is fundamentally flawed will do nothing to restore our seriously shaken confidence in the medical profession. Neither will it provide an adequate remedy for those who are damaged by doctors' errors.
But it seems that this is all we are going to get. Mary Harney described herself during the week as a fan of self-regulation. She is, however, part of a Government which is, entirely correctly, in the process of removing the privilege of self- regulation from both lawyers and gardaí.
This leaves the medical profession as the last major bastion where professionals are safe from outsider interference and control.
It is impossible to fathom how, in the wake of the Lourdes hospital scandal, Mary Harney could be such a fan of this.