Annual Report & Financial Statements 2014
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Medical Council of Ireland
Annual Report 2014
Table of Contents Council President Statement
5
Chief Executive Officer’s Review
6
The Role and Functions of the Medical Council
7
Statement of Strategy 2014-2018
9
The Medical Council’s Vision, Mission and Values
10
Council Members
11 & 12
Fact Box
13
Strategic Objective One
14 - 18
Strategic Objective Two
19 - 23
Strategic Objective Three
24 - 26
Strategic Objective Four
27 - 31
Strategic Objective Five
32 & 33
Strategic Objective Six
34 & 35
Risk Management
36 - 39
Financial Statements for year ended 31st December 2014 40 - 62 Appendix A -
63 - 67
Appendix B -
68 - 73
Appendix C -
74 - 84
Appendix D -
85
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President’s Statement I am pleased to submit the Annual Report of the Medical Council for the year ended 31 December 2014. In March 2014, the Medical Council launched its new Statement of Strategy 2014 – 2018 which sets the direction for the organisation over the next five years, including six core objectives which will be addressed and measured by performance indicators put in place by Council. Outcomes are now a key measure in all aspects of life and in this strategy we have rightly put the focus on knowing exactly what our job is, in order to always stay on the right path. I am fully committed to this strategy being the guide for the Medical Council and plan to keep it on the table at each of our meetings so that we can be reminded why we are here, why we are taking this journey, and what exactly it is we want to achieve. I would like to thank the Council and staff for their commitment to the implementation of this strategic plan. While the Medical Council is best-known for its role in dealing with complaints against doctors, promoting good professional practice and overseeing doctors’ continuing professional development is a core part of our business. In March, the Medical Council published new research on the views of the public and the profession on what it means to be a good doctor in Ireland. The report, Talking about good professional practice, found high levels of trust in doctors from members of the public, with over 90% of patients satisfied with the level of care they received from their doctor. Our role as regulator is to examine the views of the public we serve and the profession we regulate and then agree with them the course of action we believe will have the best effect in enhancing patient safety. This report underlines the continuing need to focus on defining and embedding appropriate values throughout doctors’ professional lives. We are now embarking on an important piece to assist us in doing this. Consultation commenced in 2014 on the development of our new guidance on good professional practice, and following inputs from doctors, patients and partner organisations, we hope to publish a draft document for further consultation in 2015. Another important part of the Medical Council’s work is investigating complaints where there’s a concern that a doctor didn’t maintain good professional practice. At the end of 2013, the Medical Council appealed a High Court decision in the case of Corbally vs the Medical Council to the Supreme Court, in order to receive clarity on the definition of poor professional performance, which is one of the most common grounds of complaint investigated by the Medical Council. This ruling had a significant impact on our work in 2014, as following this ruling, in order for a finding of poor professional performance to be made arising out of a single incident or error it had to be ‘very serious’. The impact of this case is evident in the lower number of fitness to practise inquiries during the year. The Supreme Court ruling will offer clarity, and the Medical Council can then work with the Department of Health and other partner organisations to make sure that systems support the appropriate handling of concerns about doctors. Finally, I would like to thank every member of Council, for their contributions throughout the year, in particular Vice President Audrey Dillon and each committee chair, the Chief Executive Officer, Caroline Spillane and all Medical Council staff for their continuing dedication and hard work in 2014.
Professor Freddie Wood President
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Chief Executive Officer Review I am pleased to introduce our report for 2014, which outlines our activities throughout a productive year of strategic change. In March, our new Statement of Strategy was launched which ultimately sets the direction for the Medical Council over the next five years. The development of this strategy was enriched by the involvement of 1,000 members of the public, 700 doctors and over 40 partner organisations who shared their views on our work and Council’s decision-making. 2014 was also a year that posed financial challenges, which we have sought to address. The legislation prevents the Medical Council from diversifying its revenue in the way we would wish and unfortunately most of the burden falls on doctors who fund the Council’s activities through their annual registration fees. We have engaged in rigorous financial planning to address the financial deficit we’ve been running and the Medical Council has made it a priority to ensure a surplus position by 2017 in order to address the accumulated deficit. Progress on this goal is already evident in our 2014 financial statement. To reduce our administration costs, there was a continued emphasis on business process improvement this year, with the focus on enhancing the efficiency and the overall experience of the registration function for doctors. A Charter of Expectations was published in April, which formalised the Medical Council’s commitment to improving services in handling registration queries. Operational excellence in registration processing was also evidenced through the redesign of operating procedures, improved business intelligence and a new system for internal quality review. New arrangements for the assessment of applications for registration in the Specialist Division were implemented in 2014, to streamline this process and make it more efficient for applicants. 2014 also saw the publication of the first-ever national survey of trainee doctors, Your Training Counts in December. This was an extremely important new project as it enabled us to identify areas for improvement and inform our work. It is vital now that we work with partner organisations involved in medical education and training to replicate the good practice highlighted in the survey and address the less positive issues arising. Your Training Counts was launched at our Education and Training Seminar which brought additional focus to the area of supportive learning environments, which is an ongoing priority for the Medical Council. Research and communication were a continued focus this year as they are areas which we are working to improve for both professionals and members of the public. The Medical Council’s education area of the website was shortlisted for an Eircom Spider award in the User Experience category, acknowledging its design and usability across traditional desktop and mobile devices. It is a priority for the Medical Council to improve its online communications, and we will continue to develop and maintain the high standards as acknowledged by this nomination. My colleagues at the Council remained focused on ensuring our work throughout the year was always carried out with the six key strategic objectives of the new Statement of Strategy in mind. I would like to recognise the support of officials at the Department of Health, as well as our colleagues at the Health Service Executive, postgraduate medical training bodies, medical schools, patient representatives and doctor representatives, for their continued commitment to engagement throughout the year. I would also like to thank the members of the Council for their continued support in our work during the year, particularly the President and Vice President, Professor Freddie Wood and Dr Audrey Dillon. Finally, I would like to thank the staff of the Medical Council for their unwavering dedication to best practice across all aspects of the organisation. 2014 was a year of great developments and change which has helped us to improve our organisation as a whole and I look forward to continued progress in 2015.
Ms. Caroline Spillane Chief Executive Officer 6
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THE ROLE AND THE FUNCTIONS OF THE MEDICAL COUNCIL Established by the Medical Practitioners Act 1978 (updated in 2007), the principal functions of the Medical Council are to: Establish and maintain the register of medical practitioners Set and monitor standards for undergraduate, intern and postgraduate education and training Specify and review the standards required for the maintenance of the professional competence of registered medical practitioners Specify standards of practice for registered medical practitioners including providing guidance on all matters related to professional conduct and ethics Conduct disciplinary procedures
Maintaining the register of doctors
Safeguarding education quality for doctors
Good professional practice in the interests of patient safety and high quality care Setting standards for doctors’ practice
Responding to concerns about doctors
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Maintaining the register of doctors: The Medical Council ensures that only properly qualified doctors are registered and allowed to practise in Ireland. The Medical Council’s register lists the details of these doctors, whose qualifications are recognised by the Council. It provides assurance to the public of a doctor’s good standing and continuing competence.
Overseeing doctors’ education, training and lifelong learning: The Medical Council is responsible for setting and monitoring standards for education and training throughout the professional life of a doctor: undergraduate medical education, intern and postgraduate training and lifelong learning.
Setting professional standards for doctors: The Medical Council is the independent body responsible for setting the standards for doctors on matters related to professional conduct and ethics. These standards are the basis to good professional practice and ensure a strong and effective patient-doctor relationship.
Responding to concerns about doctors: Where a patient, their family, employer, team member or any other person has a concern about a doctor’s practice, the Medical Council can investigate a complaint. When necessary it can take appropriate action following its investigation to safeguard the public and support the doctor in maintaining good practice.
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Statement of Strategy 2014 -2018 The Medical Council this year introduced the Statement of Strategy 2014 – 2018. This plan sets out the direction of the Council for the next five years and outlines six strategic objectives to be addressed which will be underpinned by five core values, which are absolutely fundamental to how we work.
Strategy Wheel
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The Medical Council’s Vision, Mission and Values Vision: The Medical Council’s vision is:
Mission: The Medical Council’s mission is:
Values: The core values of the Medical Council are:
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COUNCIL MEMBERS
Prof. Freddie Wood
Dr Audrey Dillon
Dr John Barragry
Dr Anthony Breslin
Ms Katharine Bulbulia
Mr Declan Carey
Ms Anne Carrigy
Dr Seán Curran
Dr Rita Doyle
Ms Mary Duff
Prof. Fidelma Dunne
Dr Bairbre Golden
Dr Ruairi Hanley
Mr Seán Hurley
Prof. Alan Johnson
Ms Marie Kehoe-O’Sullivan
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Prof. Mary Leader
Councillor Sally Mulready
Ms Margaret Murphy
Mr John Nisbet
Prof. Colm O’Herlihy
Dr Michael Ryan
Ms Cornelia Stuart
Dr Consilia Walsh
Ms Catherine Whelan
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Fact box
19,049 doctors were registered in December 2014, an increase of 889 doctors on 2013
59% of those registered were male and 41% were female
45% pass rate on both the computer-based and clinical-based pre-registration examination system
308 complaints made to the Medical Council this year
649,956 visits to website this year, an increase of 22% on last year
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STRATEGIC HIGHLIGHTS AND KEY ACTIVITIES Strategic Objective 1: Develop an effective and efficient register that is responsive to the changing needs of the medical profession Entry to the medical register allows doctors to practise medicine in Ireland. The Medical Council’s work in the registration process is of pivotal importance to patients by making sure that the necessary safeguards are in place before a doctor earns the right to practise. Pre-Registration Examinations In 2014, there were 603 pre-registration examinations sat to gain entry to the Irish medical register, with 45% of the 392 who sat the computer-based examination successful, and 45% of the 211 who sat clinical examinations successful. These examinations verify that doctors who qualified outside of Europe meet the standards necessary to practise safely here. Registration requirements vary depending on where in the world a doctor qualified, and also which division of the register they wish to apply to for registration.
Pre-Registration Examinations
Total Sitting Exam
Pass Rate
Level 2 2013 (computer-based examination)
374
55%
Level 2 2014 (computer-based examination)
392
45%
Level 3 2013 (clinical-based examination)
180
68%
Level 3 2014 (clinical-based examination)
211
45%
A programme to develop the Pre-Registration Examination System was also commenced in 2014. Work will continue in 2015 on an assessment blueprint, arrangements for external examining, and revision of the computer based aspect of pre-registration examinations. This included streamlining processes for the Level 2 computer-based examination and establishing a new standard setting method for the Level 3 clinical-based examination.
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Registration Initiatives A number of initiatives were launched in 2014 to enhance the efficiency and the overall experience of the Medical Council’s registration function for doctors. Following consultation with doctors and other partner organisations a Charter of Expectations was published in April, which formalised the Medical Council’s commitment to enhancing service in handling registration queries. As well as this, new arrangements were established for doctors to provide feedback on the registration function.
Charter of Expectations
There have also been improvements in the use of online facilities with a web service being updated to enable doctors to restore their registration. The Medical Council is also introducing an electronic annual certificate which will replace the type of hard-copy ‘annual retention’ certificate issued to date. From 1st July 2015 onwards, doctors will receive their Annual Registration Certificate electronically. Operational excellence in registration processing was also evidenced through the redesign of operating procedures, improved business intelligence and a new system for internal quality review.
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No. of doctors registered on each division of the Medical Register 2014 2014 Proportion of medical register
No. of Doctors
General Division
45%
8633
Specialist Division
42%
7929
Trainee Specialist Division
8%
1555
Intern Registration
4%
800
Supervised Division
1%
106
Visiting EEA
0%
26
DIVISIONS
Total
19,049
Trend in total number of doctors registered at year end, 2010-2014 20,000 19,500 19,000
18,770
19,049
18,812
18,500
18,184
18,160
18,000 17,500 17,000 2010
2011
2012
16
2013
2014
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Applications for Specialist Registration Certain applications for specialist registration require an assessment by a postgraduate medical training body in Ireland who advise the Medical Council on the applicant’s eligibility for specialist registration. New arrangements for the assessment of applications for registration in the Specialist Division were launched in 2014, to streamline this process, ensure consistency of assessment, and make it more efficient for applicants.
Monitoring Group Activities Monitoring systems are in place where the Council attaches conditions to a doctor’s practice. Such conditions could be imposed following disciplinary action taken by the Medical Council. In December 2014, 26 doctors were monitored to ensure compliance with the conditions imposed on their practice.
No. of Doctors’ being monitored by the Medical Council Monitoring Group
2014
2013
No of doctors with Monitoring Group as at 31.12.2014
26
22
No of New doctors with Monitoring Group 2013
9
8
5*
11*
No longer with Monitoring Group 2013
*Please note this figure is not included in the number of doctors with the Monitoring Group as at 31 December 2014
The Medical Workforce Intelligence Report In August 2014, The Medical Council published its second annual Medical Workforce Intelligence Report. It contains data on the number, age, and specialist qualifications of doctors registered to practise in Ireland and on their working arrangements, day-to-day practice and region of qualification. The purpose of the report is to enhance patient safety and better support good professional practice among doctors, through generating and providing intelligence about the medical workforce in Ireland. The Medical Council’s work in this area has, for example, informed the Strategic Review of Medical Training and Careers Structures (Health.Gov.ie) and medical workforce planning undertaken by the Health Service Executive.
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Ms. Caroline Spillane and Dr. Paul Kavanagh at the launch of the Medical Workforce Intelligence Report
Medical Workforce Intelligence Report: the statistics
1 in 10
21.4%
46.3%
doctors aged 25-29 years exited the practice of medicine in Ireland
of doctors are aged 55 or older
of doctors are registered as specialists
41.3%
1 in 3
12.9%
of registered doctors are women
doctors practising medicine in Ireland qualified elsewhere
of doctors practising outside Ireland only
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Strategic Objective 2: Create a supportive learning environment to enable good professional practice The learning environment plays a pivotal role in shaping doctors’ practice throughout their professional lives. The Medical Council placed significant emphasis in 2014 on developing supports and improving standards in medical education and training. Quality Monitoring and Enhancement of Undergraduate Medical Education and Training The Medical Council continued its accreditation activity in evaluating basic medical programmes, and the bodies that deliver them. Programmes which deliver an Irish degree, whether based in Ireland or overseas, are assessed against international best practice standards, using the World Federation for Medical Education Guidelines. During 2014, inspections were undertaken in University College Cork, National University of Ireland Galway (NUIG), Perdana University – Royal College of Surgeons in Ireland, Malaysia, and Royal College of Surgeons in Ireland, Bahrain. Monitoring and accreditation reports can be viewed on the Medical Council website.
Professionalism Guidelines The Medical Council developed A Foundation for the Future – Guidelines for Medical Schools and Medical Students on Undergraduate Professionalism, with partner organisations and students consulted during the drafting process. The guidelines are intended to support medical schools in fostering professionalism among students, and in dealing with any professional deficits. The guidelines have been welcomed by medical schools as reinforcing their work in this key area of the undergraduate curriculum and will be launched in 2015.
Anatomy The Medical Council’s Inspector of Anatomy Professor D. Ceri Davies inspected a number of anatomy departments in medical schools during 2014. A framework for an Irish code of practice for the practice of anatomy was agreed during 2014, with work on this code of practice to continue in 2015. In addition, the Medical Council updated its policy for receiving returns from licenced institutions, and developed guidance to support the involvement of observers in Council’s work in the area of anatomy. The Medical Council continues to maintain a database of anatomy donors and 113 donations were made to medical schools in Ireland during the year.
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The full returns are: No. of anatomical donations
Medical School National University of Ireland Galway
17
Royal College of Surgeons in Ireland
40
Trinity College Dublin
14
University College Dublin
16
University College Cork
26
Total
113
Intern Medical Education and Training The Medical Council continued its oversight of the standards of education and training of interns which is delivered by the Intern Training Networks on training sites which have been inspected and approved by the Council. Three new intern training sites came on stream to support the delivery of the 2013/14 intern training programme, and these sites were inspected in early 2014 – bringing the number of intern sites inspected and approved by the Medical Council to 51. In continuation of arrangements which commenced in 2011, the Medical Council issued certificates of experience to interns who successfully completed their intern training, and these certificates were issued on the recommendations of the six Intern Network Coordinators.
Medical Specialties A number of new specialties were recognised by the Medical Council in 2014 – Intensive Care Medicine, Neonatology, Pain Medicine and Vascular Surgery. This followed a considerable period of engagement with representatives of the specialties, and completion of a two-stage recognition process. In each instance, Ministerial consent to the Medical Council’s decision was sought and received in line with legislation. The recognition of new specialties is a mandate for the establishment of new programmes of specialist training, and is an opportunity for eligible doctors to register as specialists in these specialties, once the necessary standards have been defined in conjunction with the relevant training body.
Your Training Counts The first annual national trainee experience survey, Your Training Counts, was conducted between April and July and findings were launched by the Minister for Health, Leo Varadkar TD in December 2014. The response rate to this was high with 53% (or 1,636) trainees responding. This has contributed to an evidence base for informed decision-making, and is a baseline from which the Medical Council can track continuous improvement in subsequent annual surveys. To allow for international comparisons, the report utilised questions from previous medical education surveys in the Netherlands and UK. The
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survey will be conducted annually and will identify necessary changes to the training system to improve doctors’ experience. It will also monitor the extent to which they feel any changes are making a difference.
Medical Council CEO, Ms. Caroline Spillane, Minister Dr. Leo Varadkar TD and Medical Council President, Prof. Freddie Wood at the launch of Your Training Counts
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Your Training Counts: the statistics
9 in 10
3 in 10
29%
felt well prepared for their next role
reported personal experience of bullying
said their role and responsibilities were not explained to them
Teamwork
61%
9 in 10
rated as one of the most positive aspects of the clinical environment
rated the quality of induction as good or better
rated the quality of care to patients as good or very good
Postgraduate Training Sites In July 2014, the Medical Council approved criteria for the evaluation of training sites which support the delivery of specialist training. While training sites are already subject to review by postgraduate medical training bodies and other partner organisations, this is the first time that the Medical Council has articulated its expectations of training sites in this area. The development of these criteria took into account the following – (a) the criteria which are currently applied by the Medical Council in its evaluation of sites for undergraduate and intern training purposes; (b) the criteria applied by postgraduate training bodies in Ireland in their selection and evaluation of clinical training sites; and (c) the criteria and inspection processes which are applied within and outside the State by bodies performing similar functions to those of the Medical Council. The criteria were published and shared with all relevant training sites, and inspections of sites will commence in 2015.
Professional Competence All doctors have a legal requirement to keep their knowledge and skills up-to-date by meeting professional competence requirements set by the Medical Council. Each year, a sample of doctors are audited to ensure compliance, and the Medical Council has the power to begin disciplinary procedures where a doctor has been found to be neglecting this legal duty. In 2014, the Medical Council made complaints against 13 doctors who despite renewing registration with the Medical Council for 2014/2015 had not responded to the audit requirements. To continue to improve existing systems for maintaining professional competence, a draft patient feedback questionnaire was developed by the Medical Council in consultation with members of the public and the medical profession. Further work will be undertaken to pilot this in 2015 to determine how patient feedback can best support doctors in their maintenance of professional competence. The Medical Council renewed its arrangements with recognised postgraduate medical training bodies for operation of professional competence schemes 2014-2015.
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Good Professional Practice Guidance for Doctors A process for reviewing existing and developing new guidance on ethics and professionalism for doctors was also agreed by the Council in 2014. A consultation process on existing guidance was conducted which resulted in feedback from the profession, partner organisations and the public. This helped identify key topics for root-and-branch review or development, and a series of workshops commenced in the third quarter of 2014. Both the workshops as well as the updating of existing guidance will continue into 2015. In response to amendments to legislation at the beginning of the year, the Medical Council approved and published updated guidance on abortion within its current edition of the Guide to Professional Conduct and Ethics for Registered Medical Practitioners.
Doctors’ Health The Medical Council Health Committee plays an important role in supporting doctors to continue in practise during illness once there is no risk to patient safety. In December 2014, 35 doctors were supported by the health committee, most commonly for addiction and mental health reasons.
Health Committee
2014
2013
35
35
No of new doctors with Health Committee in 2014
8
9
Released from Health Committee in 2014
8*
10*
No with Health Committee as at 31.12.2014
*Please note this figure is not included with number of doctors with Health Committee as at 31 December 2014
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Strategic Objective 3: Maintain the confidence of the public and profession in the Medical Council’s processes by developing a proportionate and targeted approach to regulatory activities The Medical Council’s processes for complaints about doctors are designed to safeguard members of the public, and focus on investigating complaints in a robust and fair manner. Specialist training of Case Officers Specialist training was delivered to case officers in investigative skills over a number of months, resulting in the award of a Certificate of Investigative Skills, independently accredited and awarded by the Chartered Institute of Arbitrators. This specialist training supports the dedicated work of the case officer team, who assist the Preliminary Proceedings Committee in investigating complaints, in an empathetic yet fair and objective manner. Six case officers completed the Certified Investigator Training Programme.
From L to R: Ms. Caroline Spillane, Ms. Carol Fitzgerald, Ms. Diana Pacheco, Mr. Conor Doyle, Mr. John Sidebottom.
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Investigation of Complaints In 2014, 308 complaints were received by the Medical Council. Each complaint is investigated by the Preliminary Proceedings Committee (PPC) with the help of a dedicated case officer before a decision is made. During the year, the PPC referred 26 cases for a fitness to practise inquiry, 8 complaints were referred to another body or authority and 4 doctors were referred for a performance assessment of their practice.
Corbally v Medical Council & Ors Case In 2013, the High Court interpreted the definition of ‘Poor Professional Performance’, which is one of the most common grounds of complaint investigated by the Medical Council. This judgment raised the standard test to be applied in determining whether a finding of Poor Professional Performance can be made by the Fitness to Practise Committee. Following this ruling, in order for a finding of Poor Professional Performance to be made arising out of a single incident or error it had to be ‘very serious’. The impact of the High Court decision in the case of Corbally v Medical Council & Ors was seen in both the number of referrals from the Preliminary Proceedings Committee (PPC) to Fitness to Practise Inquiry, and the number of inquiries held. The Medical Council appealed this Judgment in the public interest, to seek clarification on the definition of ‘Poor Professional Performance’ and the test to be applied. Given the importance of this ruling to patients and doctors in Ireland, an expedited date for this appeal was sought and granted. This Supreme Court Appeal was heard in October 2014, with a decision expected in early 2015.
Fitness to Practise Inquiries There were 19 inquiries completed in 2014 – this figure is a reduction on the previous year (previously 39 inquiries completed in 2013).This is due in part to the impact of the Corbally High Court ruling, in addition to factors outside of the control of the Medical Council, such as pending criminal prosecutions and investigations ongoing to prepare for the inquiry.
Inquiries Held
2014
2013
Completed
19
39
Adjourned
4
1
33
26
Pending as at 31/12/13
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Outcomes of Inquiries
2014
2013
Professional Misconduct
8
14
Relevant medical disability
0
0
Poor professional performance
2
10
No finding/ Fit to engage in practice of medicine / no case
5
6
Undertaking pursuant to Section 67 of the Medical Practitioners Act
4
9
Research and Engagement A project was commenced in 2014 to review complaints data from 2008-2012, and offer an overview of complaint numbers, outcomes and redress. This project will for the first time provide both a qualitative and quantitative analysis of complaints over a five year period, and will inform the Medical Council’s work in a number of areas, including the development of its guidance on good professional practice. This research will be published in 2015, and shared with employers, policy makers, patient and doctor representative bodies and other relevant partner organisations. To improve processes, there was ongoing engagement with partner organisations throughout the year including patient representative groups, indemnifiers and legal representatives. The Medical Council contacted all participants in the complaints process to review their experience and perception of the Medical Council complaints process during 2014. There was ongoing collaboration and sharing of knowledge, experience and practice with other Health Regulators, with senior staff providing support to the Nursing and Midwifery Board, and information sharing arranged with CORU. A workshop was held for HSE Clinical Directors in September on ‘responding to concerns about doctors’ practice’, which was led by Prof Pauline McAvoy, recently retired Interim Medical Director of the UK’s National Clinical Assessment Service (NCAS).
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Strategic Objective 4: Enhance patient safety through insightful research and greater engagement Engagement with the public, doctors and partner organisations continued to be a focus for the Medical Council in 2014, while the Council’s research focus broadened during the year, with a range of research projects undertaken. Research Projects Research underpins decision making for the Medical Council, and it has made it a priority to inform its own work and that of the wider health system through the provision of information and research. There were a number of research projects published throughout the year, including:
Talking about good professional practice, capturing the views of both patients and doctors on what good practice in Ireland means to them.
The Medical Council Workforce Intelligence Report, providing practice and workforce information
Your Training Counts, the Medical Council’s first ever survey of all trainee doctors in the country
The Medical Council also partnered with the Health Research Board (HRB) and the Health Service Executive (HSE) to commission two new research projects to address policy needs in medical education research. The first project, led by Professor Eilish McAuliffe in University College Dublin, will develop a ‘learning in action’ research model targeted at medical interns and senior doctors to enhance medical professionalism. The second project, led by Dr Deirdre Bennett in University College Cork, will aim to provide an overview of the opportunities and challenges that exist for trainee doctors’ learning, while working in clinical environments. Medical Council research was presented in national and international forums, as findings were shared with delegates at the International Association of Medical Regulatory Authorities (IAMRA) conference in London, and the Irish Network of Medical Educators (INMED) conference in Belfast.
Online A new website area for students and trainees was launched in January. The area contains information about each stage of medical education from medical school to postgraduate specialty options and proved to be engaging for trainees, with visitors looking through the new area for an average of over five minutes per session. It was positively reviewed, and was shortlisted for an Eircom Spider award in November and an eGovernment award in December for the interactive and engaging user experience it provided. Online engagement with the Medical Council improved in 2014, with a 28% increase in the number of unique website visits over the course of the year.
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Website Performance Metrics
649,956 visits to the website this year, an increase of 22% on last year.
Top five origins of visitors were Ireland, United Kingdom, Pakistan, India, Saudi Arabia and 32% of the overall visits were from countries overseas.
New Student Website Area
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Working with Partner Organisations The Medical Council has a number of ‘Memoranda of Understanding’ in place to facilitate information sharing with partner organisations including the HSE, HIQA (the Health Information and Quality Authority) the HPRA (Health Products Regulatory Authority) and the PSI (Pharmaceutical Society of Ireland). Management of the existing Memoranda of Understanding and identification of future MOU opportunities took place during the year.
Education and Training Seminars The education and training seminar held on 8th December 2014 brought additional focus to the area of supportive learning environments, an ongoing priority for the Medical Council. There were two keynote speakers – Dr Megan Joffe and Dr Debbie Cohen. The seminar was attended by key partners in the area of medical education in Ireland and included the launch of the Your Training Counts survey report. The Council hosted a medical leadership summit to review current trends in the area of lifelong learning for doctors in September. Leaders from the USA and the UK shared insights with their Irish counterparts on the subject of ‘maintaining professional competence’ among doctors.
Working with National and International Partners In September, the Medical Council hosted the annual meeting of International Physician Assessment Coalition (IPAC) & Coalition for Physician Enhancement (CPE), two international organisations which share learning about effective ways to prevent, detect and deal with concerns about doctors’ practice. The event provided a forum for information sharing among delegates from all over the world on the remediation of doctors’ performance.
Dr. Steve Miller speaking at the International Physician Assessment Coalition (IPAC) & Coalition for Physician Enhancement (CPE) conference
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The Medical Council was represented at the seventh Irish Network of Medical Educators (INMED) annual scientific meeting, which took place in February in Queens University, Belfast. INMED is a voluntary group of healthcare education professionals which takes an ‘all-island’ approach to co-operation, innovation and information exchange in relation to medical education and training and this year’s theme was ‘creating supportive learning environments’. The Medical Council, HSE and the Forum of Postgraduate Training Bodies hosted a Careers Day for Medical Interns and Students in September. A new Student and Trainee Consultative Panel was formed by the Medical Council, comprising students and trainees from medical schools and non-consultant hospital doctor training posts in Ireland. This assisted the Medical Council in tapping into the views of the consumers of medical education and training.
Prof. Freddie Wood speaking at the Careers Day for Medical Interns and Students
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A medical student speaks to Ms. Jessica Wu and Ms. Sarah Lowther of the Medical Council at the Careers Day for Medical Interns and Students
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Strategic Objective 5: Build an organisational culture that supports leadership and learning Activities in 2014 focused on implementing best practice in governance and human resources Staffing and Performance Management The Medical Council’s Performance Management Development System (PMDS) was updated in 2014 to reflect the new organisational strategy and ensure staff awareness of their roles in achieving same. This system clarifies annual performance indicators for staff members and provides an organisational learning and development framework to facilitate up-skilling of staff. The Medical Council faced resourcing challenges in 2014, with an average headcount of approximately 20% less than in the previous year. In line with public sector policy, activities were outsourced where it was not possible to maintain service due to the reduced staffing levels. Sanction was received in late 2014 to commence recruitment of staff in early 2015.
Medical Council Learning and Development A learning and development plan for Council was drafted by the Nominations and Development Committee and a total of six tailored training courses were delivered under this plan. Work was also undertaken to review the competencies and criteria required for membership of the Fitness to Practise and Preliminary Proceedings Committees.
Employee Wellbeing Employee wellbeing remained an organisational focus and a number of events were organised by the Medical Council’s wellbeing group focusing on health and employee welfare. Awareness raising activities were conducted for stroke and heart health, while a ‘Step Challenge’ was undertaken by staff in November. Staff engaged in charitable activities for a number of organisations during the year including the Irish Cancer Society, the Laura Lynn Children’s Hospice, Childline and the Rathmines Women’s Refuge.
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Annual Report 2014
Medical Council staff enjoying the bake sale for Daffodil Day
Governance Activities An Annual Governance Appraisal for the Medical Council was developed and disseminated to all Council members. Responses from the appraisal were discussed at an externally facilitated session, resulting in a number of recommendations and actions. A review of the Medical Council’s Corporate Governance Framework was carried out resulting in a revised and updated corporate governance handbook for Council.
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Strategic Objective 6: Develop a sustainable and high-performing organisation An emphasis was placed on business process improvement in 2014, with a continued focus on providing services in a cost-effective manner. Statement of Strategy In March, the Medical Council launched its Statement for Strategy for 2014-2018, clarifying its objectives over the five year period. Development of the statement of strategy followed consultation with 1,000 members of the public, 700 doctors and approximately 40 partner organisations. The Strategy was launched by Minister of State for Primary Care, Alex White TD at an event for partner organisations in Dublin Castle. The strategy will be implemented through annual business plans and measures of success have been clearly outlined in the document to allow for evaluation at the end of the period.
From L to R: Prof. Freddie Wood, Medical Council President, Ms. Caroline Spillane, Medical Council CEO and Minister of State for Primary Care, Alex White TD at the launch of the Statement of Strategy 2014 - 2018
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Business Process Improvement Building on the successful implementation of a business process improvement initiative in our Registration section in 2013, a further initiative commenced in 2014, focused on improving the complaints handling process. Using the LEAN Six Sigma methodology, a number of actions were identified to improve process efficiencies. This work will continue into 2015 and expand into other areas of the organisation. All staff have been engaged, to varying degrees, in two key cross-organisational projects: (a) Development of an information governance framework for the organisation, to ensure all information and data is appropriately handled by the Medical Council; and (b) Development of an Excellence in Customer Service strategy for the organisation, to ensure our services remain responsive to the changing and varied needs of our key customers. Work continues into 2015, commencing with an information and data risk management exercise; and a focus group event, to learn more about our customers’ needs. The focus on operational efficiency included developments in the organisations information technology infrastructure, including the implementation of improved web filters, hardware and software updates.
Financial Overview A quality assurance framework was developed to better monitor and understand business delivery, risk and compliance. Quarterly reports on performance against financial targets were provided to the Audit, Strategy and Risk Committee and the Council, which were also furnished with reports on risk management activities in line with Medical Council risk management policy. There was an increased focus on financial planning throughout the organisation, reflected in reduced costs in a number of areas in 2014. The Medical Council is committed to meeting its obligations to the Government’s Public Service Reform agenda and successfully signed up to a number of the Office of Government Procurement (OGP) contracts. A number of procurement related initiatives were conducted in 2014 with a view to heightening procurement awareness and achieving value for money where purchasing goods and services with new contracts for catering, security, cleaning and planned preventative maintenance established. The Medical Council engaged in litigation with its landlord Tanat Limited during 2014 relating to the terms of its tenancy of Kingram House.
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Risk Management Chief Risk Officer: Niamh Muldoon Introduction to Risk Management The Medical Council is committed to effectively managing its risk on a formal basis to support better decision-making based on a clear understanding of risks and their likely impact. In pursuit of this objective, the Council has set out a generic framework consisting of a series of simple but well-defined steps to support ongoing risk management, to raise the awareness of risk and the need to manage it consistently and effectively across all levels of the organisation. The Medical Council, as any organisation, must accept an element of risk across its activities. However, as a public interest organisation, the Medical Council will seek to mitigate risk as far as possible. Its key role is to protect the interests of the public when dealing with medical doctors and as such, its risk appetite is generally low to zero. It recognises however, that to successfully deliver on its mission, to enhance its public service role and provide a greater return to key stakeholders, it must be prepared to avail of opportunities where the potential reward justifies the acceptance of a certain level of additional risk. In recognition that risk may arise at multiple levels in varying forms, from taking strategic decisions to implementing supporting actions, a risk register is compiled at regular intervals throughout the year, and reported to the Audit, Strategy and Risk Committee, and the Council.
Role of the Board of Council and Committee: Audit Strategy and Risk The Board of the Medical Council leads on the appetite, tolerance and management of risk, with the support of the Audit Strategy and Risk Committee, who oversee the quarterly risk register reports. The risk register is designed to identify, manage and mitigate potential material risks to the achievement of the Council’s strategic and business objectives. A sectional Risk Register is compiled by each section of the Medical Council administration, and coordinated and reported to the Audit Strategy and Risk Committee and the Medical Council, by the Chief Risk Officer. In line with the Medical Council’s Risk Management Policy, risk management is reflected in the dayto-day business operations of the offices of the Medical Council. Risk and control functions are under the oversight of the Audit Strategy and Risk Committee, and the Chief Risk Officer in addition reports directly to the board of the Medical Council. Independent assurance supplements internal structures through the use of internal and external audit. The level of risk tolerance and appetite by the Medical Council is explained below. A sample of the principal risks and uncertainties facing the Council in the short to medium term are also set out below, together with the principal measures in place to mitigate against such risks. This is not an exhaustive statement of all relevant risks and uncertainties. The mitigation measures that are maintained in relation to these risks are designed to provide a reasonable, but not absolute, level of protection against the impact of the events in question.
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Risk Appetite The Medical Council has set a number of guiding risk appetite statements across the following risk categories: Category
Assessment
Risk Appetite Guiding Statements The Council’s key role is to protect the interests of the public when dealing with medical practitioners. Its principle roles in doing so are: • assuring the quality of undergraduate education of doctors • assuring the quality of postgraduate training of specialists • registration of doctors • disciplinary procedures
Strategic
• guidance on professional standards / ethical conduct
Medium Risk Appetite
• professional competence The Council will take opportunities where considered justified by the potential economic and societal rewards, despite a greater level of inherent risk. Its risk appetite in relation to certain new strategic and policy decisions is generally low, due to its critical public interest role. However, in certain circumstances where the need for a progressive change or advancement is deemed appropriate the risk appetite will be medium. Any such actions require consideration and approval by the senior management team and the Council. The organisation will in all such cases seek to mitigate the inherent risks in the implementation of these decisions, to the extent possible.
Finance & Funding
Medium Risk Appetite
The Medical Council is funded almost exclusively by the annual payments of registered doctors; no funds are received from government or other sources. Its funding arrangements are as such relatively stable and allows for an element of long term strategic planning. Its risk appetite in this area reflects its strategic risk appetite and is generally low to medium. The Council will maintain its high financial stewardship standards and will continue to ensure that financial commitments do not exceed available resources. Its risk appetite in relation to financial stewardship is low.
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Category
Reputational
Operational
Compliance
Assessment
Medium Risk Appetite
Low Risk Appetite
Zero Risk Appetite
Risk Appetite Guiding Statements As the Council’s key role is to protect the interests of members of the public in their dealing with medical doctors it is important that there is confidence in the integrity of its activities and processes and that it is seen to offer a tangible return to all its stakeholders. Its risk appetite in relation to perceived failures in this area is generally low. The Medical Council recognises that it must always be conscious of its critical public duty but that in certain cases it may be necessary to advance unpopular initiatives or take unpopular stances where it is considered appropriate in the interests of protecting the public. Its risk appetite in this area is generally medium. Operational includes the management of its principle roles as described above and also the management of all support functions which enable the fulfilments of its principle roles. The Council has developed a comprehensive and rigorous framework including policies and procedures to support operational management and as such its appetite for risk in this area is generally low. The Council defines policies and procedures to support its legal and compliance requirements. The Council expects full compliance, and will avoid any risk or uncertainty in this area. As such its risk appetite in the category of compliance is generally zero.
Snapshot of key risks as of December 2014 Regular reports are provided to the Audit, Strategy and Risk Committee and Council on the principal risks facing the organisations. A summary of the key risks as at December 2014 is provided below:
Personnel Workforce Planning An inability to fill vacant roles has led to a loss of skill and increased workload for remaining staff. This has presented challenges in a number of areas and effected operational efficiency in 2014. Implications for 2015 – It will be imperative that vacant posts are filled as soon as possible in 2015, and the Medical Council will work with the Department of Health to develop a more sustainable approach to manpower planning.
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Legal and Regulatory Compliance Legislative Developments The Medical Council has seen its work affected by case law developments in 2014, which have had an impact on its role and remit. Further legislative developments, such as the introduction of professional indemnity legislation, will have an impact on the Medical Council’s work in 2015. Implications for 2015 – the Medical Council will seek to work closely with the Department of Health in 2015 to inform legislative developments and seek change, where it believes it is necessary in the interests of patients and doctors.
Doctors’ Fitness to Practise The Medical Council deals with complaints against doctors, and the complaints systems are designed to address issues with doctors’ competence and fitness to practise in order to best protect the public. Systems must operate within a strict legislative framework with decisions open to legal challenge. There is a reliance on others to notify the Medical Council of potential issues with doctors’ practise, which leads to an ongoing risk that the Medical Council are not well informed, or in a position to take action. Implications for 2015 – The Medical Council will continue to engage with employers and colleagues within the health system so that concerns about doctors are addressed at the appropriate level within the health system. Suggested legislative amendments will be progressed with the Department of Health with a view to ensuring that the legal framework underpinning the complaints systems is as robust as possible. On-going engagement with stakeholders to ensure increased communication and a clear understanding of the role of the Medical Council.
Financial Tenancy arrangements at Kingram House The Medical Council is engaged in legal action with its landlord Tanat Limited relating to the terms of its tenancy of its offices at Kingram House, Dublin 2. Implications for 2015 – The Medical Council will seek to conclude this litigation and secure terms which will offer financial clarity for the organisation in the coming years.
Technology IT Systems Much of the Medical Council’s activities are conducted online, with its website the primary information source for both patients and doctors, and with all practising doctors now able to maintain their registration through the use of online systems. As is the case of most organisations today, the dependence on online systems poses a risk for the Medical Council. Implications for 2015 - Existing business continuity processes will be refined and tested to ensure the Medical Council’s systems are in line with best practice from both technology infrastructural and data protection perspectives.
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Annual Report 2014
FINANCIAL STATEMENTS 2014 COUNCIL MEMBERS AND OTHER INFORMATION President
Professor Freddie Wood
Vice President
Dr Audrey Dillon
Chief Executive Officer Ms Caroline Spillane
Council
Professor Freddie Wood
Mr Sean Hurley
Dr Audrey Dillon
Professor Alan Johnson
Dr John Barragry
Ms Marie Kehoe-O’Sullivan
Dr Anthony Breslin
Professor Mary Leader
Ms Katharine Bulbulia
Councillor Sally Mulready
Mr Declan Carey
Ms Margaret Murphy
Ms Anne Carrigy
Mr John Nisbet
Dr Sean Curran
Professor Colm O’Herlihy
Dr Rita Doyle
Dr Michael Ryan
Ms Mary Duff
Ms Cornelia Stuart
Professor Fidelma Dunne
Dr Consilia Walsh
Dr Bairbre Golden
Ms Catherine Whelan
Dr Ruairi Hanley
Offices:
Auditors:
Kingram House
Comptroller & Auditor General
Kingram Place
Dublin Castle
Dublin 2
Dublin 2
Solicitors:
Bankers:
McDowell Purcell
Bank of Ireland
The Capel Building
Rathmines Road
Marys Abbey
Rathmines
Dublin 7
Dublin 6
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COUNCIL’S REPORT The Council present their report and the audited financial statements for the year ended 31st December 2014.
Principal Activity The Medical Council is the statutory body for the registration and regulation of doctors engaged in medical practice. The primary objective of Council is to protect the public by promoting and better ensuring high standards of professional conduct and professional education, training and competence among registered medical practitioners. Established by the Medical Practitioners Act 1978 (updated in 2007), the principal functions of the Medical Council include
Establishing and maintaining the register of medical practitioners;
Approving and reviewing programmes of education and training necessary for the purposes of registration and continued registration;
Specifying and reviewing the standards required for the purpose of the maintenance of professional competence of registered medical practitioners;
Specifying standards of practice for registered medical practitioners including providing guidance on all matters related to professional conduct and ethics;
Disciplinary procedures.
The Council has a membership of 25 including both elected and appointed members. Under the provisions of the Medical Practitioners Act 2007, the Council is comprised of 13 non-medical members and 12 medical members representing a range of medical specialties, teaching bodies and members of the public and stakeholders, all of whose appointments have been approved by the Minister for Health. The current Council’s period of office is 2013 to 2018. The Medical Council is funded by the payments of registered doctors; no funds are received from government or other sources.
Internal Audit The Council has an internal audit function outsourced to BDO for the provision of this service 2014 – 2017, (Chartered Accountants and Registered Auditors).
Books of Account To ensure that proper books and accounting records are kept, the Council has established an internal finance department and have employed appropriately qualified accounting personnel and have maintained appropriate computerised accounting systems. The books of account are located at the Council’s office at Kingram House, Kingram Place, Dublin 2. Approved by the Council on 20th May 2015 and signed on its behalf by Professor Freddie Wood
Ms Caroline Spillane
President
Chief Executive Officer
Dated: 20th May 2015
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STATEMENT OF COUNCIL RESPONSIBILITIES Section 32 of The Medical Practitioners Act 2007 requires the Council to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the Council and of the income and expenditure for that year. In preparing these financial statements, the Council is required to:
select suitable accounting policies and apply them consistently
make judgements and estimates that are reasonable and prudent
prepare the financial statements on the going concern basis unless it is inappropriate to presume that the Council will continue in operation
state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the financial statements.
The Council is responsible for keeping proper books of account which disclose with reasonable accuracy at any time the financial position of the Council and which will enable it to ensure that the financial statements comply with Section 32 of the Medical Practitioners Acts 2007. The Council is also responsible for safeguarding the assets of the Council and hence taking reasonable steps for the prevention of fraud and other irregularities. Approved by the Council on 20th May 2015 and signed on its behalf by
Professor Freddie Wood
Ms Caroline Spillane
President
Chief Executive Officer
Dated: 20th May 2015
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STATEMENT ON INTERNAL FINANCIAL CONTROL Responsibility for system of internal financial control On behalf of the Council I acknowledge our responsibility for ensuring that an appropriate system of internal financial control is maintained and operated. The system can only provide reasonable and not absolute assurance that assets are safeguarded, transactions authorised and properly recorded and material errors or irregularities are either prevented or would be detected in a timely period.
Key Control Procedures The Council has taken steps to ensure an appropriate control environment by:
Establishing a dedicated Audit, Strategy & Risk Committee chaired by a council member other than the President;
Clearly defining management responsibilities and powers;
Appointment of internal auditors;
Developing a culture of accountability at all levels of the organisation.
The Council has established processes to identify and evaluate business risks by:
Identifying the nature, extent and financial implication of risks facing the organisation including the extent and categories which it regards acceptable;
Assessing the likelihood of identified risks occurring;
Working closely with the Department of Health and other Government departments and agencies to ensure support for achieving the goals of the Medical Council.
The system of internal financial control is based on a framework of regular management information, administration procedures including segregation of duties and a system of delegation and accountability. In particular it includes:
A comprehensive budgeting system with an annual budget which is reviewed and agreed by the Council;
Regular reviews by the Council of periodic and annual financial reports which indicate performance against forecasts;
Setting targets to measure financial and other performance;
Procedures to ensure compliance with public procurement policies and directives;
An Internal Audit function is in place and the Internal Auditors operate in accordance with the Framework Code of Practice for the Governance of State Bodies. The function is overseen by the Audit Strategy and Risk Committee.
During the year ended 31st December 2014 the following controls were reviewed/ implemented:
Monthly management accounts with explanation of significant deviations from budget;
Annual Accounts for 2014 with explanation of significant variances;
Annual budget plan for 2015; Internal audits were performed by BDO on Data Security and Privacy, IT spend management, monitoring processes and Management information.
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STATEMENT ON INTERNAL FINANCIAL CONTROL (CONTINUED) The Council conducted a review of the effectiveness of the system of internal financial control for the year ended 31st December 2014.
Signed on behalf of the Medical Council Professor Freddie Wood President
Dated: 20th May 2015
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COMPTROLLER AND AUDITOR GENERAL Report for presentation to the Houses of the Oireachtas
The Medical Council I have audited the financial statements of the Medical Council for the year ended 31 December 2014 under Section 32 of the Medical Practitioners Act 2007. The financial statements, which have been prepared under the accounting policies set out therein, comprise the statement of accounting policies, the income and expenditure account, the statement of total recognised gains and losses, the balance sheet, the cash flow statement and the related notes. The financial statements have been prepared in the form prescribed under Section 32 of the Act, and in accordance with generally accepted accounting practice in Ireland.
Responsibilities of the Members of the Council The Council is responsible for the preparation of the financial statements, for ensuring that they give a true and fair view of the state of the Council’s affairs and of its income and expenditure, and for ensuring the regularity of transactions.
Responsibilities of the Comptroller and Auditor General My responsibility is to audit the financial statements and report on them. My audit is conducted by reference to the special considerations which attach to State bodies in relation to their management and operation. My audit is carried out in accordance with the International Standards on Auditing (UK and Ireland) and in compliance with the Auditing Practices Board’s Ethical Standards for Auditors.
Scope of Audit of the Financial Statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements, sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of • whether the accounting policies are appropriate to the Council’s circumstances, and have been consistently applied and adequately disclosed • the reasonableness of significant accounting estimates made in the preparation of the financial statements, and • the overall presentation of the financial statements. I also seek to obtain evidence about the regularity of financial transactions in the course of audit. In addition, I read the Council’s annual report to identify material inconsistencies with the audited financial statements. If I become aware of any apparent material misstatements or inconsistencies I consider the implications for my report.
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Opinion on the Financial Statements In my opinion, the financial statements, which have been properly prepared in accordance with generally accepted accounting practice in Ireland, give a true and fair view of the state of the Council’s affairs at 31 December 2014 and of its income and expenditure for 2014. In my opinion, proper books of account have been kept by the Council. The financial statements are in agreement with the books of account.
Matters on which I report by exception I report by exception if • I have not received all the information and explanations I required for my audit, or • my audit noted any material instance where money has not been applied for the purposes intended or where the transactions did not conform to the authorities governing them, or • the information given in the Council’s annual report is not consistent with the financial statements, or • the statement on internal financial control does not reflect the Council’s compliance with the Code of Practice for the Governance of State Bodies, or • I find there are other material matters relating to the manner in which public business has been conducte I have nothing to report in regard to those matters upon which reporting is by exception.
Patricia Sheehan For and on behalf of the Comptroller and Auditor General 25 May 2015
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Annual Report 2014
ACCOUNTING POLICIES for the year ended 31st December 2014
Basis of Preparation The financial statements are prepared in accordance with generally accepted accounting principles under the historical cost convention as modified by the revaluation of land and buildings and comply with financial reporting standards of the Financial Reporting Council, as promulgated by Chartered Accountants Ireland. The following accounting policies have been applied consistently in dealing with items which are considered material in relation to the financial statements.
Tangible fixed assets and depreciation Tangible fixed assets are stated at cost or at valuation, less accumulated depreciation. The charge to depreciation is calculated to write off the original cost or valuation of tangible fixed assets, less their estimated residual value, over their expected useful lives as follows: Buildings
- 2% straight line
Leasehold Improvements
- 5% straight line
Office equipment
- 20% straight line
Fixtures and fittings
- 12.5% straight line
Computer equipment and software development
- 33.3% straight line
The premises at Lynn House are subject to a policy of revaluation every 5 years with an interim valuation in year 3 per FRS 15- Accounting for Fixed Assets. The premises were last valued at an open market basis at 18th December 2013. It is the policy of the Medical Council to revalue its Artwork fixed assets every 5 years. Software development costs on major systems are treated as capital items and are written off over the period of their expected useful life from the date of their implementation.
Investments Investments held as fixed assets are stated at their market value. Any surplus or deficiency is accounted for through the statement of total recognised gains and losses and the income and expenditure account respectively. Income from investments together with any related withholding tax is recognised in the income and expenditure account in the year in which it is receivable.
Foreign currencies Monetary assets and liabilities denominated in foreign currencies are translated at the rates of exchange ruling at the balance sheet date. Transactions, during the year, which are denominated in foreign currencies, are translated at the rates of exchange ruling at the date of the transaction. The resulting exchange differences are dealt with in the income and expenditure account.
Income Fees, other than retention fees, are recognised as income in the year in which they are received. Retention fees are charged annually in respect of practitioners who apply to continue on the Council’s register. Retention fees and other income are recognised as income in the year to which they relate.
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Pensions Medical Council operates a defined benefit scheme which is funded annually on a pay as you go basis from monies available to it and from contributions deducted from staff salaries. Pension Scheme liabilities are measured on an actuarial basis using the projected unit method. Pension costs reflect pension benefits earned by employees in the period and are shown net of staff pension contributions which are retained by Medical Council. Actuarial gains and losses arise from changes in actuarial assumptions and from experience surpluses and deficits and are recognised in the Statement of Total Recognised Gains and Losses for the year in which they occur. Pension liabilities represent the present value of future pension payments earned by staff to date. The pension reserve represents the funding deficit on the pension scheme obligations.
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INCOME AND EXPENDITURE ACCOUNT for the year ended 31st December 2014
Income
Notes
2014 â‚Ź
2013 â‚Ź
Retention fees
9
8,159,700
7,714,867
Registration fees
1
2,239,376
1 ,672,149
Miscellaneous income
1
607,876
631,347
11,006,952
10,018,363
3
3,375,298
3,125,425
3/10
1,241,424
1,106,771
644,226
729,741
119,394
248,351
1, 218 223
1,099,181
Total income Expenditure Wages and salaries Pension Costs Council and meeting expenses
3
Staff recruitment, training and education Rent and rates Legal expenses
2
1,891,145
2,479,879
General administration
2
988,505
1,111,421
Consultancy and other professional fees
2
476,137
352,202
Finance charges
61,416
41,933
Audit fees
14,000
13,941
420,826
440,916
17,165
8,427
(10,467,759)
(10,758,188)
539,193
(739,825)
Interest receivable
99,799
91,277
Investment income
30,095
34,858
669,087
(613,690)
Depreciation
5
Advertising Total Expenditure Operating surplus/(deficit)
Surplus/(Deficit) for the year
11
The results for the year refer to continuing operations. The Statement of Accounting Policies, Cash Flow Statement and the notes on pages 16 - 24 form part of the financial statements. Approved by the Council on 20th May 2015 and signed on its behalf by Professor Freddie Wood
Ms Caroline Spillane
President
Chief Executive Officer
Dated: 20th May 2015
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Medical Council
Annual Report 2014
STATEMENT OF TOTAL RECOGNISED GAINS AND LOSSES for the year ended 31st December 2014
Notes
2014 €
2013 €
Surplus/(Deficit) for the year
11
669,087
(613,690)
Actuarial gain/(loss) on pension liabilities
10
781,000
754,000
Revaluation gain on investments
6
145,329
89,294
Revaluation loss on Buildings
5
0
(900,000)
1,595,416
(670,396)
Total Recognised surplus for the year
Approved by the Council on 20th May 2015 and signed on its behalf by Professor Freddie Wood
Ms Caroline Spillane
President
Chief Executive Officer
Dated: 20th May 2015
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Annual Report 2014
BALANCE SHEET as at 31st December 2014
Notes
2014 €
2013 €
Fixed Assets Tangible assets
5
2,924,798
2,913,920
Financial assets
6
3,105,835
2,939,900
6,030,633
5,853,820
1,416,187
1,432,777
13,416,395
10,686,496
14,832,582
12,119,273
(6,095,496)
(5,100,924)
8,737,086
7,018,349
14,767,719
12,872,169
(11,900,134)
(11,600,000)
2,867,585
1,272,169
Current Assets 7
Debtors Cash at bank and in hand Current Liabilities (Amounts falling due within one year) Creditors
8
Net Current Assets Total Assets less Current Liabilities (Before Pensions) Non-current Liabilities Pension Liabilities
10
Net Assets
Capital and Reserves Revaluation reserve
11
350,750
205,421
Accumulated surplus
11
14,416,969
12,666,748
Pension reserve
11
(11,900,134)
(11,600,000)
2,867,585
1,272,169
Total
The Statement of Accounting Policies, Cash Flow Statement and the notes on pages 16 – 24 form part of the financial statements. Approved by the Council on 20th May 2015 and signed on its behalf by Professor Freddie Wood
Ms Caroline Spillane
President
Chief Executive Officer
Dated: 20th May 2015
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CASH FLOW STATEMENT for the year ended 31st December 2014
Reconciliation of deficit for the year to net cash outflow from operating activities 2014 2013 € € Surplus/(Deficit) for the year
669,087
(613,690)
1,081,134
954,000
(99,799)
(91,277)
420,826
440,916
16,590
176,607
994,569
(256,322)
(30,095)
(34,858)
27,824
28,122
3,080,136
603,498
2014 €
2013 €
3,080,136
603,498
81,467
43,762
Capital expenditure
(431,704)
(358,915)
Increase/(Decrease) in cash
2,729,899
288,345
Net funds at beginning of year
10,686,496
10,398,151
Net funds as at 31 December 2013
13,416,395
10,686,496
10,686,496
10,398,151
2,729,899
288,345
13,416,395
10,686,496
Difference between pension paid and pension charge Interest received Depreciation Decrease/(Increase) in debtors Increase/(Decrease) in creditors Investment income Management fee Net cash inflow/(outflow) from operating activities
Net cash inflow (outflow) from operating activities Return on investments Interest received
Analysis of change in net funds At beginning of year Cash flows Net funds as at 31st December 2013
Approved by the Council on 20th May 2015 and signed on its behalf by Professor Freddie Wood
Ms Caroline Spillane
President
Chief Executive Officer
Dated: 20th May 2015
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NOTES TO THE FINANCIAL STATEMENTS for the year ended 31st December 2014
1. INCOME Income items are made up as follows: 2014 €
2013 €
218,944
191,135
1,841,534
1,354,034
19,458
3,205
159,440
123,775
2,239,376
1,672,149
2014 €
2013 €
4,512
11,099
47,033
33,504
Examinations
215,433
294,736
Certificate of good standing
143,391
120,685
57,402
79,077
Registration fees Internship General registration Restoration to General Register of Medical Practitioners Specialist registration fees
Miscellaneous income Service Fees Accreditation Fees
Late Payment Fee
9,650
8,928
Rental Income
53,083
70,778
Other
77,372
12,540
607,876
631,347
Legal costs recovered
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2. EXPENDITURE Expenditure items are made up as follows: 2014 €
2013 €
688,925
543,147
1,204,792
1,650,840
(2,572)
285,892
1,891,145
2,479,879
Legal Expenses Legal and professional Part V (a) inquiries Part V (b) High Court & Supreme Court proceedings
The legal provision provided for High Court litigation and appeals has decreased in comparison to previous years yielding a negative provision in this particular class.
2014 €
2013 €
General Administration 92,857
87,055
Light and heat
106,140
96,435
Repairs and maintenance
122,795
130,008
758
4,798
118,613
176,637
File administration and storage
43,739
43,701
Telephone and modem charges
32,159
42,620
249,649
279,788
Caretaking and cleaning
49,740
37,061
Security
43,876
44,683
Accreditations
13,705
94,034
Research
85,086
65,176
General expenses
29,388
9,425
988,505
1,111,421
2014 €
2013 €
385,915
287,016
Communication fees
49,624
47,658
IT Consultancy fees
40,598
17,528
476,137
352,202
Insurance
Equipment maintenance Printing, postage and stationery
Computer costs
Consultancy and other professional fees Business consultancy
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3. EMPLOYEES AND REMUNERATION Number of employees The average number of persons employed during the year was 59 (2013: 58)
2014 €
2013 €
Wages and salaries
3,095,382
2,871,890
Social welfare costs
279,916
253,535
3,375,298
3,125,425
1,241,424
1,106,771
4,616,722
4,232,196
The staff costs are comprised of:
Pension costs
3.1
Ms Caroline Spillane is the Chief Executive Officer of the Medical Council. Ms Spillane received a salary of €136,276 in 2014 covering the period from 1 January 2014 to the 31 December 2014. The gross salary paid includes an adjustment in line with requirements specified under the Haddington Road Agreement. The pension entitlements of the Chief Executive Officer do not extend beyond the pension entitlements in the public sector defined benefit superannuation scheme.
3.2
Pension-related deductions of €230,969 were paid to the Department of Health during the year including €70,292 deducted from staff salaries during 2013. An amount of €14,455 was due to the Department at year-end
3.3
No Bonus payments were made to staff during 2014.
3.4
An amount of €96,626 was paid in fees to thirteen eligible Council members in 2014 as follows:
Ms Katharine Bulbulia
€7,696
Prof. Alan Johnson
€7,696
Ms Margaret Murphy
€7,696
Dr John Barragry
€7,696
Ms Anne Carrigy
€7,696
Prof.Colm Herlihy
€7,696
Dr Rita Doyle
€7,696
Dr Michael Ryan
€7,696
Dr Bairbre Golden
€7,696
Ms Catherine Whelan
€7,696
Dr Ruairi Hanley
€7,696
Prof. Freddie Wood
€11,970
Also €19,153 was paid to Council members in relation to reimbursable travel and subsistence expenses. 3.5
In addition to the expenditure noted in 3.4 above a total of €528,447 was incurred on Council Meeting and operations as follows. •
€266,174 in Travel and Subsistence expenditure incurred by Council members, Committee members and staff on official Council operations.
•
€150,540 in respect of allowances paid to 52 people who are members of sub committees and working groups. The individual payments ranged from €300 to €11,970.
•
€41,874 in respect of catering costs for Council, Sub-Committee and Inquiries.
•
€69,859 in respect of training costs for Council members. 55
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4. TAXATION Section 32 of the Finance Act 1994 provides exemption from taxation on investment income of The Medical Council. The Medical Council is, however, not entitled to a repayment of D.I.R.T. where this has been deducted from deposit interest. The Medical Council is a Non Commercial State Sponsored Body within the meaning of Section 227 Taxes Consolidation Act and Schedule 4 of that Act. The Medical Council does not charge VAT on its fees and it does not reclaim VAT on its purchases.
5. TANGIBLE FIXED ASSETS Buildings & Leasehold equipment Cost or Valuation
Office Equipment
Fixtures and fittings
Computer Equipment
Total
€
€
€
€
€
2,997,491
301,591
1,476,895
2,754,973
7,530,950
248,117
30,922
4,081
148,584
431,704
3,245,608
332,513
1,480,976
2,903,557
7,962,654
As at 1 January 2014
693,102
295,741
1,116,850
2,511,337
4,617,030
Charge for the year
111,115
9,403
90,702
209,606
420,826
At 31 December 2014
804,217
305,144
1,207,552
2,720,943
5,037,856
At 31 December 2014
2,441,391
27,369
273,424
182,614
2,924,798
At 31 December 2013
2,304,389
5,850
360,045
243,636
2,913,920
As at 1 January 2014 Additions At 31 December 2014
Depreciation
Net book value
Listed amongst the values for fixtures and fittings is a small selection of decorative art which is situated in the offices at Kingram House. This artwork is valued in line with the directives of FRS 30- Heritage Assets. It currently has a carrying value of €10,313.
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6. FINANCIAL FIXED ASSETS 2014 €
2013 €
2,939,900
2,796,356
145,329
89,294
30,095
34,858
(27,825)
(28,123)
18,336
47,515
3,105,835
2,939,900
2014 €
2013 €
1,013,724
1,169,888
Trade Debtors
262,729
81,441
Sundry Debtors
139,734
181,448
1,416,187
1,432,777
Listed Investments Value At 1st January Increase in value of investment Investment income Management fee Interest income At 31st December
7. DEBTORS
Prepayments
Included in prepayments is an amount of €726,300 being an upfront rent payment on the Kingram House property paid 11th March 2008.
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8. CREDITORS 2014 €
2013 €
Trade creditors and accruals
1,335,717
783,633
Deferred Income - Retention fees (Note 9)
4,238,203
3,923,191
521,576
394,100
6,095,496
5,100,924
Amounts falling due within one year
Provision for legal costs
Movement in legal provision: 394,100
Legal provision at 1 January 2014
(308,615)
Utilised in 2014
436,091
Provided for in 2014
521,576
9. DEFERRED INCOME - RETENTION FEES This related to fees received in respect of periods after the year end.
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10. PENSION COSTS A. Analysis of total pension costs charged to Expenditure 2014 €
2013 €
Current service costs
720,000
610,000
Interest on Pension Scheme Liabilities
640,000
630,000
(118,576)
(133,229)
1,241,424
1,106,771
Listed Investments Cost
Employee contributions
B. Movement in net Pension Liability during the financial year 2014 €
2013 €
11,600,000
11,400,000
Current Service Cost
720,000
610,000
Interest Costs
640,000
630,000
Actuarial (gain)/loss
(781,000)
(754,000)
Pensions paid in the year
(278,866)
(286,000)
11,900,134
11,600,000
2014 €
2013 €
11,900,134
11,600,000
781,000
754,000
(7%)
(6%)
Listed Investments Cost Net Pension Liability at 1 January
Net Pension Liability at 31 December
C. History of defined benefit obligations
Defined benefit obligations
Experience gains on scheme liabilities amount
Percentage of Scheme Liabilities
The cumulative actuarial gain recognised in the Statement of Total Recognised Gains and Losses amounts to €2,905,000.
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D. General Description of the Scheme The pension schemes are defined benefit final salary pension arrangements with benefits and contributions defined by reference to current “model” public sector scheme regulations. The scheme provides a pension (1/80th per year of service), a gratuity or lump sum (three eightieths per year of service) and spouse’s and children’s pensions. Average retirement age is a member’s 62nd birthday. Pre 1 April 2004 the minimum pension age is 60 and the maximum retirement age is 65. For new scheme entrants that have been appointed to public sector employment on or after 1 April 2004, the minimum pension age is age 65 and there is no fixed retirement age. Pensions in payment (and deferment) normally increase in line with general public sector salary inflation. The valuation used for FRS17- Retirement Benefits (Revised) disclosures has been based on a full actuarial valuation at 31st December 2014 by a qualified independent actuary taking account of the requirements of the FRS in order to assess the scheme liabilities at 31st December 2014.
The principal actuarial assumptions were as follows:
2014
2013
Rate of increase in salaries
4.0%
4.0%
Rate of increase in pensions in payment
4.0%
4.0%
Discount Rate
5.5%
5.5%
Inflation Rate
2.0%
2.0%
Mortality basis: PMA80 (C=2000) for males and PFA80 (C=2000) for females with a deduction of two years in each case.
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11. RESERVES
Pension reserve
Revaluation reserve
Accumulated surplus
Total
€
€
€
€
(11,600,000)
205,421
12,666,748
1,272,169
Revaluation of investments
-
145,329
-
145,329
Revaluation of Buildings
-
-
-
-
Surplus for the year
-
-
669,087
669,087
781,000
-
-
781,000
(1,081,134)
-
1,081,134
-
11,900,134
350,750
14,416,969
2,867,585
1st January 2014
Pension Actuarial gain for the year Transfer to pension reserve At 31st December 2014
The pension reserve represents the cumulative cost of pensions less amounts paid out to date. The transfer in the year represents the difference between the full cost of pensions recognised in the income and expenditure account in the year and the amounts paid out in the year.
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12. OPERATING LEASE COMMITMENTS The Medical Council signed a five year lease agreement for its new premises, Kingram House, at an annual rent of €820,000 on 10th March 2008. The lease expired on the 31st December 2012. There was also an option to purchase the shareholding of Tanat Limited (incorporating Kingram House) for a fixed price. This option expired on 31st March 2011. As the Council did not exercise its option then the owners of Tanat Limited had a call option whereby the Council were obliged to enter into a long term lease of twenty years at an annual rent of €820,000. This 20 year lease commenced on the 1st January 2013 and will expire on 31st December 2032. The terms of the lease were subject to Litigation and the judgement found in favour of Tanat Ltd. The Council had appealed this decision and all paper in relation to the Notice of Appeal had been lodged with the Supreme Court and the appeal entered on the Supreme Court list. Since the balance sheet date the Council has executed the 20 year lease and settled all outstanding litigation with Tanat Ltd.
13. CONTINGENT LIABILITIES A number of High Court proceedings have been taken against The Medical Council. The Council is vigorously defending the proceedings and is satisfied that they will not be successful and have not provided for any liability arising thereon. Council’s costs in relation to defending the proceedings have been provided for in note 8.
14. APPROVAL OF FINANCIAL STATEMENTS The financial statements were approved by the Council on 20th May 2015.
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APPENDIX A - COMMITTEE MEMBERS Audit Strategy & Risk Committee
Preliminary Proceedings Committee
Members (10)
Members (17)
Mr. Seán Hurley (Chair)
Ms. Anne Carrigy (Chair)
Professor Freddie Wood (President)
Ms. Kathleen Beggan
Dr. Audrey Dillon (Vice President)
Ms. Katharine Bulbulia
Dr. John Barragry
Ms. Margaret Murphy
Ms. Anne Carrigy
Dr. Angela McNamara
Dr. Anthony Breslin
Dr. Ailis NiRiain
Dr. Seán Curran
Dr. Michael McGloin
Ms. Catherine Whelan
Dr. Colm O'Herlihy
Mr. Stephen McGovern
Dr. Anthony Breslin
Mr. Terry Mc Wade
Dr. Rita Doyle Ms. Catherine Whelan Professor Diarmuid O'Donoghue
Education, Training and Professional Development Committee
Dr. Winifred O'Connell
Members (12)
Dr. Joseph Duignan
Professor Colm O’Herlihy (Chair)
Dr. Tim Ryan
Ms. Katharine Bulbulia
Dr. Patrick O'Carroll
Mr. Declan Carey
Dr. Anne Jeffers
Dr. Anna Clarke Dr. Ruairi Hanley Dr. John Jenkins
Monitoring Group
Professor Alan Johnson
Members (5)
Ms. Marie Kehoe-O’Sullivan
Ms. Mary Culliton (Chair)
Dr. Jacinta Morgan
Ms. Cora McCaughan
Dr. Siun O’Flynn
Dr. Eammon Breatnach
Professor Arthur Tanner
Mr. Brendan Broderick
Professor Freddie Wood
Dr. Declan Woods
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APPENDIX A - COMMITTEE MEMBERS Nominations and Development Committee
Health Committee Members (12)
Members (4)
Dr. Rita Doyle (Chair)
Professor Freddie Wood (Chair)
Dr. Abdul Bulbulia
Dr. Audrey Dillon
Ms. Veronica Larkin
Dr. Anthony Breslin
Dr. John Latham
Ms. Margaret Murphy
Dr. Timothy Lynch Dr. Claire McNicholas
ICT Sub Committee
Professor James Lucey
Members (4)
Dr. Peter Staunton
Mr. John Nisbet (Chair)
Dr. Blanaid Hayes
Ms. Eileen Fitzgerald
Mr. Rolande Anderson
Mr. Paul Hamill
Dr. Eamon Keenan
Mr Declan McKibben
Ms. Barbara Lynch
Ethics and Professionalism Committee
Anonymous Complaints Committee
Members (12)
Members (3)
Dr. Audrey Dillon (Chair)
Dr. Audrey Dillon
Professor Freddie Wood
Ms. Cornelia Stuart
Dr. John Barragry
Dr. Consilia Walsh
Ms. Katharine Bulbulia Dr. Sean Curran Mr. Christopher Cowley Dr. Bairbre Golden Dr. John Jenkins Professor Alan Johnson Dr. Barry Lyons Ms. Sunniva McDonagh Ms. Margaret Murphy
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APPENDIX A - COMMITTEE MEMBERS continued Fitness to Practise Committee
Fitness to Practise Committee (continued)
Members (46)
Professor David Morgan
Dr. Michael Ryan (Chair)
Dr. Michael McDermott
Mr. John Nesbit
Mr. Michael Brophy
Ms. Cornelia Stuart
Ms. Mary Culliton
Professor Mary Leader
Ms. Melanie Pine
Professor Fidelma Dunne
Dr. Deirdre Madden
Dr. Consilia Walsh
Professor Damien McLoughlin
Mr. Declan Carey
Dr. John McAdoo
Professor Alan Johnson
Dr. Danny O’Hare
Ms. Mary Duff
Mr. Frank McManus
Ms. Marie Kehoe-O’Sullivan
Ms. Ger Feeney
Mr. Seán Hurley
Dr. Eamann Breatnach
Dr. Ruairi Hanley
Dr. John Casey
Ms. Catherine Earley
Ms. Gloria Kirwan
Dr. Nuala Healy
Ms. Úna Marren Bell
Mr. Brendan Healy Mr. Paul Murphy
Registration & Continuing Practice Committee
Mr. T.C Ewing
Members (13)
Mr. Gerard Magee
Dr. Anthony Breslin (Chair)
Mr. Stephen Kealy
Ms. Katharine Bulbulia
Ms. Mary Buckley
Dr. Consilia Walsh
Mr. John Kincaid
Ms. Mary Duff
Dr. Mary Henry
Professor Freddie Wood
Dr. Geraldine Corrigan
Professor W. Arthur Tanner
Dr. Abdul Bulbulia
Ms. Mary Culliton
Ms. Annette Durkan
Dr. Terry McWade
Ms. Winifred Jeffers
Dr. Mary Holohan
Ms. Joan Tattan-Dennis
Ms. Anne Pardy
Ms. Meg Murphy
Dr. Niamh Macey
Mr. Peter Mooney
Ms. Lorraine Horgan
Mr.Tim O’Neill
Dr. Muiris Houston
Mr. Denis Doherty
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APPENDIX A - COUNCIL MEMBER MEETING ATTENDANCE
28th & 29th January 2014
21st & 22nd May 2014
27th & 28th March 2014
18th & 19th Sept 2014
16th & 17th Dec 2014
Total no. of meetings attended
9th & 10th July 2014
5th & 6th Nov 2014
6
Council Member Dr. John Barragry
Dr. Anthony Breslin
7
Ms. Katharine Bulbulia
7
Mr. Declan Carey
7
Ms. Anne Carrigy
6
Dr. Sean Curran
6
Dr. Audrey Dillon (Vice President)
7
Dr. Rita Doyle
6
Ms. Mary Duff
6
Professor Fidelma Dunne
5
Dr. Bairbre Golden
6
Dr. Ruairi Hanley
7
Mr. Seán Hurley
6
Professor Alan Johnson
7
Ms. Marie Kehoe O'Sullivan
6
Professor Mary Leader
5
Councillor Sally Mulready
3
Ms. Margaret Murphy
7
Mr. John Nisbet
5
Professor Colm O'Herlihy
6
5
6
Dr. Michael Ryan
Ms. Cornelia Stuart
Dr. Consilia Walsh
7
Ms Catherine Whelan
7
Professor Freddie Wood (President)
7
66
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APPENDIX A - MEDICAL COUNCIL STAFF LIST (as at 31 December 2014) CEO - Caroline Spillane
Human Resources
Registration
Department
Naoimh McNamee
Philip Brady
Communications/ CEO’s Office
Operations & ICT
Eoin Keehan
Lorna Farren
Jim McDermott
Ann Curran
Barbara O'Neill
John Cussen
Davinia O'Donnell
Jana Tumova
Aoife Fitzsimons
Simon O'Hare
Corporate Governance & Council
Kris Pakosiewicz
Mary Atkinson
Lisa Molloy
Professional Development & Practice
Alan Armstrong
Jan Fitzpatrick
Paul Kavanagh
David Griffith
Claire Lako
Fergal McNally
Fiona Waters
Corp Services, Procurement & Facilities
Grainne Behan
Jessica Wu
Michelle Navan
Sarah Lowther
Simon King
Katie Charmant
Professional Standards
Karl Sullivan
William Kennedy
Donagh O'Doherty
Niamh Muldoon
Nicola Hodgkinson
Aoife Mellett
Teresa Byrne
John Sidebottom
Strategic Projects
Jane Horan
Úna O’Rourke
Ciara McMorrow Derek O'Connor Clare Naidoo Chloe Ryder Education & Training Anne Keane Paul Lyons Karen Willis Elizabeth Molloy Aoise O'Reilly Finance Wendy Kennedy Breid Foster Deirdre Foley Cilla Hickey
Roslyn Whelan Elva Tarpey Carol Fitzgerald Diana Pacheco Conor Doyle Alicia McGrath Tolulope Bosede
Roseanne Fox
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APPENDIX B - REGISTRATION STATISTICS The Medical Council ensures that only appropriately qualified doctors are registered and allowed to practise in Ireland. The register lists the details of these doctors whose qualifications are recognised by the Council. It provides assurance to the public of a doctor’s good standing and continuing competence. The register is published on www.medicalcouncil.ie so that the public can check whether a doctor is listed.
Pre-Registration Examination Statistics In advance of being registered all doctors undergo a Level 1 assessment and verification of their documentation. Eligible candidates are then required to sit or be exempted from Levels 2 and 3 of the Medical Council’s pre-registration examination system.
Pass
Fail
Total
Level 2 (computer-based examination) 2013
207
167
374
Level 2 (computer-based examination) 2014
176
216
392
Level 3 (clinical-based examination) 2013
123
57
180
Level 3 (clinical-based examination) 2014
96
115
211
Total Sitting Exam
Pass Rate
Level 2 2013 (computer-based examination)
374
55%
Level 2 2014 (computer-based examination)
392
45%
Level 3 2013 (clinical-based examination)
180
68%
Level 3 2014 (clinical-based examination)
211
45%
68
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APPENDIX B - DIVISIONS OF THE MEDICAL REGISTER There are six divisions of the medical register. There were 19,049 doctors on the medical register in December 2014, an increase of 889 doctors on the register compared to the same period in 2013.
2014 Proportion of medical register
No. of Doctors
General Division
45%
8,633
Specialist Division
42%
7,929
Trainee Specialist Division
8%
1,555
Intern Registration
4%
800
Supervised Division
1%
106
Visiting EEA
0%
26
DIVISIONS
Total
19,049
No. of doctors in each division of the register 2010-2014 DIVISIONS
2014
2013
2012
2011
2010
General Division
8,633
7423
7,223
8, 308
9, 345
Specialist Division
7,929
7567
7357
7,095
6,534
Trainee Specialist Division
1,555
2355
2,506
2,389
2,139
Intern Registration
800
788
676
670
752
Supervised Division
106
18
287
232
0
26
9
135
118
0
19,049
18,160
18,184
18, 812
18,770
Visiting EEA Total
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Appendix B Trend in total number of doctors registered at year end, 2010-2014 20,000 19,500 19,000
18,770
19,049
18,812
18,500
18,184
18,160
18,000 17,500 17,000 2010
2011
2012
2013
Age range of doctors on the register
2014 Gender of Doctors Registered Total No. of doctors registered %
Male
Female
Total
11,192
7,856
19,049
59%
41%
2013 Gender of Doctors Registered Total No. of doctors registered %
2014
Male
Female
Total
10,666
7,494
18,160
59%
41%
70
Age Range
2014
2013
20-35
6,354
5,775
36-45
5,132
5,008
46-55
3,952
3,907
56-64
2,374
2,264
65-69
666
641
70-80
496
479
81-90
74
82
Over 90
1
4
Total:
19,049
18,160
Medical Council
Annual Report 2014
APPENDIX B - CATEGORIES OF APPLICANT FOR REGISTRATION In line with legislation, there are different registration requirements depending on where a doctor graduated from Medical School. The categories of applicant highlight the global nature of the medical workforce in Ireland.
Categories of Applicant
2014
Category 1 (Qualified in Ireland)
64%
12,204
66%
11,972
Category 2 (EU Citizen qualified in EU/EEA)
10%
1,855
9%
1,617
3%
556
2%
400
23%
4,434
23%
4,171
100%
19,049
100%
18,160
Category 3 (Non-EU Citizen qualified in EU/EEA) Category 4 (Qualified outside EU/ EEA) Total
2013
Category 1 - Graduates of Irish medical schools Category 2 - EU citizens who graduated in an EU medical school and/or their qualification are recognised under EU directive 2005/36/EC (recognition of professional qualifications for EU citizens). Category 3 - Non-EU citizens who are graduated in an EU medical school and/or their qualifications would be recognised under EU directive 2005/36/EC (recognition of professional qualifications) if they were an EU citizen. Category 4 - Doctors who do not meet the criteria for any of the above categories.
Categories of Applicants on the Register
556 1855
4434 Category 1 12,204
Category 2 Category 3 Category 4
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APPENDIX B - HEALTH COMMITTEE STATISTICS The Health Committee supports both doctors with relevant medical disabilities and those who have provided undertakings to the Fitness to Practice Committee to undergo medical treatment. Doctors Attending the Health Committee 2014
2013
43
45
Reasons for Referral to Health Committee
2014
2013
Alcohol Only
8
3
Alcohol & Drug
6
7
Drug Only
5
8
22
24
Neurological Disorder
1
2
Co Morbidity- Hepatitis/Drug Misuse
1
1
43
45
2014
2013
Self
13
14
Third Party
15
15
FTP Section 67
5
4
FTP Inquiry
9
12
Registration Conditions
1
0
43
45
Mental Disability
Total
Source of Referral to Health Committee
Total
Note: Section 67 of the Medical Practitioners Act states that: 1) The Fitness to Practise Committee may, at any time after a complaint is referred to it, request the registered medical practitioner the subject of the complaint to consent to undergo medical treatment.
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Appendix B Conditions imposed on a doctor’s registration The Medical Council can impose conditions on a doctor’s registration. Compliance with registration is overseen by the Council’s Monitoring Group.
2014
2013
26
22
No of new doctors with Monitoring Group
9
8
Doctors no longer with Monitoring Group
5*
11*
No of doctors with Monitoring Group as at 31 December
*Please note this figure is not included in the number of doctors with the Monitoring Group as at as at 31st December 2013.
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APPENDIX C COMPLAINTS AND FITNESS TO PRACTISE INQUIRY STATISTICS Source of complaint The Medical Council protects the public interest by responding to complaints made about doctors using a fair and robust process. Anybody can make a complaint about a doctor. This includes members of the public, a doctor’s employer, other healthcare professionals or the Medical Council itself. Origin of Complaints Received
2014
2013
4
7
18
28
4
1
238
335
Other Irish Regulatory Body
0
1
Patient Advocacy Group
0
1
Solicitor or Solicitors firm not acting on behalf of a member of public (i.e. complaining about a failure to furnish a report etc)
9
9
The Medical Council – the doctor’s conduct came to the attention of the Medical Council whether through the media or otherwise*
17
14
The Medical Council, having been notified by a body in another state
18
4
308
400
Healthcare Institution (private hospitals, nursing homes etc) Healthcare professional HSE Member of the Public
Total
*The Medical Council became the complainant in 35 complaints in 2014. Where information is received from a party who did not wish to become the complainant against a doctor, the Medical Council can become the complainant. Of 308 complaints received in 2014 there were 366 doctors involved.
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APPENDIX C COMPLAINTS AND FITNESS TO PRACTISE INQUIRY STATISTICS Complaints made against doctors by division of register Divisions
2014
2013
General Division
113
143
Specialist Division
245
340
Trainee Specialist Division
7
15
Intern Registration
1
3
Supervised Division
0
2
366
503
Total
Complaints made against doctors by age range Age Ranges
2014
2013
20-35 years
26
34
36-45 years
87
126
46-55 years
122
153
56-64 years
88
135
65 + years
43
55
366
503
Total
Proportion of doctors complained against compared to the proportion of total doctors registered by age
12%
Over 65
6% 24%
56-64
12%
% complained about 34%
46-55
21%
% on the register
23%
36-45
27% 7%
20-35
33% 0%
10%
20%
30%
40%
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APPENDIX C COMPLAINTS AND FITNESS TO PRACTISE INQUIRY STATISTICS Complaints made against doctors by gender Gender
2014
2013
Male
263
358
Female
103
145
Total
366
503
19,049
18, 160
1.9%
2.7%
No of doctors on the register against
Complaints made against doctors by area of qualification 2014
2013
Categories
Total
Total
Qualified in Ireland
274
377
Qualified in EU/EEA
34
57
Qualified outside EU/ EEA
58
69
366
503
Total
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APPENDIX C COMPLAINTS AND FITNESS TO PRACTISE INQUIRY STATISTICS Proportion of doctors complained against compared to the proportion of doctors registered by region of qualification
75%
Qualified in Ireland
64%
Qualified elsewhere in EU/EEA
Qualified Outside EU/EEA
% complained about
9%
% on the register
13%
16% 23%
0%
10%
20%
30%
40%
50%
60%
77
70%
80%
Medical Council
Annual Report 2014
APPENDIX C COMPLAINTS AND FITNESS TO PRACTISE INQUIRY STATISTICS Types of complaints received There were 308 complaints received in 2014. Categories of complaint reflect the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners. Each complaint received can be categorised on numerous grounds, i.e., clinical care, communication, record keeping. For example, a complaint might be in relation to poor communication but may also mention failure to refer a patient. Accordingly, the categories do not equate to the number of complaints received in a year. Categories of Complaint Received
2014
2013
2012
Criminal Convictions
1
0
5
Informing Medical Council of other regulatory proceedings/ decisions, criminal charges and/or convictions.
4
4
8
Breach of the Medical Practitioners Act 2007
16
1
3
Dishonesty
20
14
13
Total
41
19
29
2
1
3
Treating patients with dignity
65
34
32
Refusal to treat
16
25
29
Conscientious objection
4
0
0
Emergencies
6
4
4
Appropriate Professional Skills
48
46
25
Adequate language Skills
11
11
0
Communication
91
114
106
Physical and intimate examinations
8
15
19
Personal relationships with patients
2
2
6
Assisted Human Reproduction
0
0
1
End of life care
1
2
4
254
254
229
Professional Conduct
Responsibilities to Patients Reporting obligations concerning abuse of children/elderly/ vulnerable adults
Total
78
Medical Council
Annual Report 2014
APPENDIX C COMPLAINTS AND FITNESS TO PRACTISE INQUIRY STATISTICS Categories of Complaint Received
2014
2013
2012
Maintenance of accurate and up to date patient medical records
12
19
15
Confidentiality
17
13
12
Total
29
32
27
26
1
4
Reporting concerns about colleagues
5
3
1
Professional relationships between colleagues
7
14
9
Professional Indemnity
3
3
0
Accepting Posts
1
1
0
Treatment of relatives
0
4
0
Advertising
1
4
4
Premises and Practice Information
2
1
5
20
27
20
Certification
4
4
16
Prescribing
23
34
28
Referral of patients
19
22
11
Locum and rota arrangement
1
0
0
Telemedicine
1
1
0
Retirement and transfer of patient care
1
0
2
Fees
2
7
0
Total
116
126
100
Medical Records and Confidentiality
Professional Practice Maintaining competence
Medical reports
79
Medical Council
Annual Report 2014
APPENDIX C COMPLAINTS AND FITNESS TO PRACTISE INQUIRY STATISTICS
Categories of Complaint Received
2014
2013
2012
Alcohol Abuse
1
1
0
Drug Abuse
0
3
1
Mental or behavioural illness
0
5
3
Physical illness
0
1
3
Total
1
10
7
5
17
12
Clinical investigations and examinations
54
80
77
Diagnosis
90
123
105
Follow up care
51
74
55
Surgical Procedures
22
32
33
Continuity of care
26
29
13
Total
248
355
295
Total No of Categories
689
796
688
Relevant Medical Disability
Treatment Consent
80
Medical Council
Annual Report 2014
APPENDIX C COMPLAINTS AND FITNESS TO PRACTISE INQUIRY STATISTICS Complaints Considered by the Preliminary Proceedings Committee All complaints about registered doctors received by the Medical Council are considered by a screening committee, called the Preliminary Proceedings Committee (PPC). The PPC considers all complaints received, directs the appropriate investigations to be carried out by case officers, and considers all information gathered in the course of the investigation before determining the appropriate outcome for the complaint. The PPC ultimately decide whether the case should go forward for an inquiry by the Medical Council’s Fitness to Practice Committee. Equally, the PPC can determine that no further action is required, that a matter should be referred to another body/authority/competence scheme, or indeed, mediation, if they feel it is appropriate. The PPC decision is then considered by the Medical Council. Complaints received in any given year may be carried over to the next year. Therefore, there is a difference between the number of decisions (prima facie and non prima facie) and the number of complaints received.
Decisions Made by the Preliminary Proceedings Committee Decisions Made
2014
2013
2012
2011
2010
24
32
56
39
55
252
346
306
299
227
Mediation
0
9
5
6
16
Referred to Professional Competence Scheme
6
5
6
-
-
Referral to another body
8
9
9
1
-
13
12
15
22
16
303
413
397
367
314
2014
2013
2012
2011
2010
Completed
19
39
41
37
43
Adjourned
4
1
2
8
3
33
26
33
22
33
Prima Facie Decision (a Fitness to Practise inquiry was called) No further action
Withdrawal Total No of decisions made
Inquiries Held
Pending (as at 31/12/13)
81
Medical Council
Annual Report 2014
APPENDIX C COMPLAINTS AND FITNESS TO PRACTISE INQUIRY STATISTICS 2014
2013
*No. of inquiry days
42
67
Average No of days per inquiry
2.2
1.8
* includes 9 days FTPC Callover meetings - Fitness to Practise Callover meetings take place before a panel of three Fitness to Practise Committee (FTPC) members. The purpose of the Callover is to fix dates for hearings, decide as to whether an inquiry will be held in private/public/part public and any other preliminary issues that may arise.
Outcomes of Inquiries
2014
2013
Professional misconduct
8
14
Relevant medical disability
0
0
Poor professional performance
2
10
No finding/ fit to engage in practice of medicine / no case
5
6
Undertaking pursuant to section 67 of the Medical Practitioners Act
4
9
2014
2013
Cancellation of registration (2007 Act)
1
4
Conditions
4
11
Suspension
0
1
Advise / admonish / censure
7
18
12
34
Sanctions Imposed on a Doctor by Council
Total
82
Medical Council
Annual Report 2014
APPENDIX C COMPLAINTS AND FITNESS TO PRACTISE INQUIRY STATISTICS Transparency The Medical Council strives to carry out its work in an open and transparent manner to ensure the confidence of doctors and the public. In March 2009, the first public inquiry was heard under the Medical Practitioners Act 2007. Inquiries are held in public unless an application is made by the complainant, the doctor, or a witness to hold all, or part, of the inquiry in private, and the Fitness to Practise Committee is satisfied that it would be appropriate in the circumstances to do so. Before 2009, all inquiries were held in private. In 2014, on foot of applications from parties involved in inquiries, there was an increase in the number of private inquiries. This was due to the specific nature of the complaints, which included:
Complaints of a Sexual Nature / Sensitive Nature (5) Applications by Doctors/Witnesses based on the sensitive nature of the allegations regarding alleged sexual assault, inappropriate examinations, inappropriate comments of a sexual nature etc.
Health Grounds (2) Applications by the respondent doctors where concerns regarding their health were raised before the Committee.
Knock On effect of High Court ruling in Corbally v Medical Council v Ors 2013 (3) These matters concluded at callover stage as a result of an application to dismiss being brought by the doctors’ legal teams, following the Corbally High Court decision, wherein the standard for Poor Professional Performance was redefined.
Treatment of a Personal/Intimate Nature (1) Application based on clinical care of an intimate or personally sensitive nature.
Concluded at Callover by means of an Undertaking (3) Such matters were dealt with at a callover by way of an undertaking acceptable to the Fitness to Practice Committee, which resulted in no inquiry being held, all callovers being in private.
Matter linked to Previous Inquiry, held in Private (1) This inquiry was related to the facts of a previous inquiry, which was held in private, and so to allow the inquiry hear details, privacy was required.
Inquiries held in Public/Private/Part Public
2014
2013
Public
4
25
Private
9
11
Concluded at preliminary private hearing (callover*)
6
1
Part private
0
2
*Fitness to Practise Callover meetings take place before a panel of three Fitness to Practise Committee (FTPC) members. The purpose of the Callover is to fix dates for hearings, decide as to whether an inquiry will be held in private/public/part public and any other preliminary issues that may arise.
83
Medical Council
Annual Report 2014
APPENDIX C - COMPLAINTS AND FITNESS TO PRACTISE INQUIRY STATISTICS Requests for Private Fitness to Practise Inquiries Private Inquiries
2014
Requested by complainant or witness
4
Requested by doctor
5
*The Medical Council cannot seek to hold an inquiry in private, such applications must come from another party, i.e. the doctor, a witness or complainant.
84
Medical Council
Annual Report 2014
APPENDIX D – FREEDOM OF INFORMATION STATISTICS FOI Stats 1 Jan 2013 - 31 Dec
No. of Freedom of Information Requests
2014
2013
2012
2011
3
2
4
0
Requests received in current year
33
9
25
16
Cases answered in Current year
35
8
27
12
1
3
2
4
2014
2013
8
4
18
3
Refused
6
0
Withdrawn/Outside FOI
3
1
2014
2013
Personal
22
5
Non Personal
14
4
0
0
Brought forward from previous year
Live cases at year end
Status of Requests Granted Part Granted
Type of Requests
Mixed
85
Medical Council
Annual Report 2014
87