Professions need tighter regulation

Comment: Barriers to entry, restrictions in the marketplace and lack of consumer choice should be alien to a modern and progressive…

Comment: Barriers to entry, restrictions in the marketplace and lack of consumer choice should be alien to a modern and progressive country. Fine Gael has been highlighting these issues repeatedly over the past three years. However, much work remains to be done and one area that requires immediate review is the self-regulation of professional bodies.

Judge Maureen Harding Clark's report into the events at Drogheda's Lourdes Hospital has once again raised serious questions about the self-regulation of professionals. The judge recalls how, after concerns were raised about Dr Neary's practices, he sought to have a number of his cases reviewed by "three established, eminent and practising consultant colleagues attached to the major teaching hospitals in Dublin".

The three obstetricians considered Dr Neary's files and accepted the explanations provided by him. Two of the obstetricians reported that "we find no grounds to suspend Dr Neary or to place any restrictions on his practice - public or private". The third obstetrician concluded that Dr Neary had "no case to answer".

As we now know, a subsequent independent review by a UK-based obstetrician found major concerns about Dr Neary's practices. He was subsequently struck off the medical register.

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This short description of a critical issue in the Neary case again highlights one of the great dangers of self-regulation by professions.

Many professionals often justify self-regulation on the basis that only their profession can truly evaluate the work of a professional colleague. Whether it is accountancy, law, engineering or any branch of medicine, the professionals tell us that public servants or lay people cannot understand the intricacies of the trade or make proper judgments when issues of misconduct or malpractice arise. There is some merit in this argument.

However, as the Neary case indicated, there is an inherent danger in peer review that the reviewer will be motivated by compassion and collegiality for their fellow professional, rather than compassion and concern for the patient or the consumer.

The lessons from this are significant for the medical profession in particular, but also for other professions.

Fine Gael has called for the establishment of an over-arching supervisory structure for the myriad of self-regulatory bodies within the medical profession. Without such a body, patients with complaints are entirely reliant on self-regulating professions to investigate their colleagues.

A good model for this type of regulator or regulators is the Irish Auditing and Accounting Supervisory Authority (IAASA). This was established to supervise how accountancy bodies regulate and monitor their members and to promote adherence to high professional standards within their profession. IAASA is a new body but it potentially provides a model for other professions to be overseen by a state authority in a manner which would instil greater public confidence in the professions.

Professions jealously protect self-regulation. But they must be aware that public scepticism of professionals is growing.

Currently, the Irish Financial Services Regulatory Authority has a role in approving the establishment and rules of stock exchanges but it does not regulate them. It is appropriate to discuss this issue in the context of forthcoming EU directives dealing with the appropriate regulatory regime for stock exchange dealing.

A forthcoming examination by the Oireachtas Joint Committee on Enterprise and Small Business is critical so that Irish investors can continue to have confidence in the regulatory function of the stock exchange. The interests of investors should unquestionably continue to take precedence.

A jealous defence of self-regulation tends to go hand-in-hand with the placement of barriers to regulation. I do not believe that the restrictive entry practices of solicitors, barristers, auctioneers and other professions are in any way sustainable.

The deference with which doctors, accountants, engineers, solicitors, priests and indeed politicians have been held in the past is no longer evident. As a society, we have a much better educated population, a more mature and better informed population and a people who are increasingly prepared to assert their rights and demand the highest standards from whomever is providing them with a service.

It is only when professional bodies demonstrate strong elements of openness, for example, by having public hearings of disciplinary cases, and of transparency (by publishing the results of disciplinary cases) that public confidence will be enhanced in those professions.

Personally, I have much more regard for a professional body which goes out of its way to inform the public when it has disciplined a member than one which seeks to hide that information.

The involvement of lay members on disciplinary investigative committees by professional bodies is also essential. However, it is important that these lay members be truly independent and truly representative of a broad public interest and not simply other professions.

Many professions will regard the Neary case as one for the medical profession and not relevant to them. But the actions of the three obstetricians in question and the fallout which came from that could have implications for many other professional bodies. It is a lesson that all should learn well.

Phil Hogan is enterprise, trade and employment spokesman for Fine Gael.