Ireland should introduce legislation where doctors’ fitness to practise would be assessed regularly at hospital level instead of by the Irish Medical Council after a patient has suffered, a cancer expert has said.
Prof Tom Keane, former head of the National Cancer Control Programme, said a legislative clinical governance model was “hugely lacking” in Ireland.
He said he frequently read about tragic cases before the medical council “of a doctor that was unable to diagnose or was clearly deficient in some area and had worked in two or three hospitals before somebody twigged the fact”.
Appearing before the Oireachtas Committee on the Future of Healthcare, Prof Keane asked why issues of competency were determined at the level of the medical council.
“There needs to be something at the level of the hospital where clinical governance ensures that physicians who work in the hospital, or the surgeons, meet a standard of care which is assessed and monitored locally,” he said.
“In Canada I ran a department in Vancouver that had 50 specialists. Every year they had their appointment renewed based on their performance. There was no such thing as privileges to practise for life if you were appointed. You were appointed and your performance was reviewed annually and if you were deficient in some way, it was identified and remedial action was taken.”
‘Real necessity ’
Prof Keane said they did not wait until a patient suffered for action to be taken at a higher level. He said there was a “real necessity in Ireland” for a governance model that monitors care at the local level, “not coming from 30,000 feet and trying to determine how things are going to be”
Prof Keane also said Ireland should introduce legislation which would ensure the same cancer surgery standards existed in private hospitals as in public hospitals.
He said when he was working on the cancer programme in Ireland, he laid out technical standards for the performance of breast cancer surgeries and that within a short period of time the private sector withdrew almost completely from breast cancer surgery.
“A lot of them saw cancer surgery as being very resource-intensive and something that, in many cases, they weren’t capable of meeting the requirements,” he said.
“The Health Information and Quality Authority did commit at the time, which I thought was very important, to push for legislation which would ensure that where private hospitals were to engage in cancer surgery they would be held to the same standard as the public sector.
“To my knowledge that legislation never happened and I think it is still something that, for completeness, should ultimately occur.”
Hiqa said on Wednesday that it “continues to have concerns about the absence of full regulatory powers across public and private healthcare provision. Ireland lags behind a significant number of EU and non-EU states in this regard.”
