Medical Inquiries

I raise an issue that is causing increasing concern among employers throughout the country, particularly small and medium-sized businesses. It is an issue that deserves serious attention from the Government. I refer to the growing use of online medical consultations to obtain sick certificates and, in particular, to questions being raised about the adequacy of clinical assessments before certificates recommending periods of absence from work are issued. Let me be clear that this is not about questioning the rights of employees who are genuinely unwell. Those rights must be protected. Nor am I suggesting that online medical consultations do not have a legitimate and important role in modern healthcare. However, we must also recognise that the system needs to work fairly for everyone, including employers who ultimately carry significant financial and operational responsibilities when employees are absent. I have been contacted by employers who are increasingly concerned about what they are experiencing. One employer recently reported that two employees working on the same project received medical certificates from the same online medical practice on the same day recommending exactly the same period of absence – two weeks. I stress that I am not making allegations against the employees or medical practitioners involved. However, these examples raise legitimate questions about the process, the level of clinical assessment taking place and the safeguards in place. For an employer, these situations have real consequences. Businesses have projects to deliver, customers to satisfy and contractual obligations to meet. Other employees must often carry the additional workload when colleagues are absent. For a larger organisation, these challenges may be manageable, but for a small business employing 20, 30, 50 or 100 employees, a sudden absence of even a small number of employees can have a significant impact. There is also a direct financial consequence, with employers required to meet their statutory sick pay obligations where the qualifying conditions are satisfied, in addition to the cost of replacement labour and lost productivity. Are we confident the system has sufficient safeguards to ensure medical certificates, particularly those recommending extended periods away from work, are supported by an appropriate clinical assessment? The Medical Council has been very clear that doctors providing remote consultations must maintain the same professional standards as those providing face-to-face consultations. I fully support that principle. However, we also need to examine the wider picture, including the commercial platforms through which these consultations are provided and which are responsible for ensuring that appropriate standards are maintained. I ask that the Minister address four specific matters. First, will the Government engage with the Medical Council to examine whether clinical assessment standards are being applied appropriately when online consultations result in extended periods of certified absence? Second, will the Government examine what oversight exists in respect of commercial online medical certificate services and whether additional safeguards are necessary? Third, will it consider a review of the medical certification arrangements to ensure they strike the right balance between protecting employees and providing reasonable assurance to employers? Finally, will the Government commit to engaging with employer representative organisations, particularly those representing SMEs, so that the practical impact on businesses is properly understood? We should not have to choose between protecting workers and businesses. Both are absolutely essential. Employees who are genuinely ill deserve support and protection but, equally, employers which provide jobs, invest in their businesses and contribute to our economy deserve to have confidence that the systems they are required to operate are fair, robust and not open to misuse. I ask that the Minister recognise that this is a growing concern and commit to examining it properly before it becomes an even greater problem for Irish businesses.

I thank the Deputy for raising this important matter. I will try to address his four questions in my opening contribution, while fully recognising what has been raised on behalf of businesses. Regarding businesses, particularly small businesses, I meet many family businesses and independent operators who are under significant pressures, including rising labour and operational costs. Where an employee is absent for an extended period, it creates real challenges for them in terms of staffing, service delivery and day-to-day running of the business. It is understandable, therefore, that employers want confidence that medical certificates are being issued following an appropriate clinical assessment and that there are clear standards underpinning the process. Of course, we must also ensure that employees who are genuinely unwell are protected. I know the Deputy is not challenging the merits or legitimacy around that. The challenge is to strike a fair balance between the rights of employees and the legitimate concerns of employers. The Sick Leave Act 2022 introduced Ireland’s first statutory entitlement to employer-paid sick leave. The scheme commenced on 1 January 2023 with an initial entitlement of three days increasing to five days on 1 January 2024. The purpose of the legislation is to provide employees with a minimum level of financial protection when they are unable to work due to illness or injury, particularly those in lower-paid or precarious employment. The legislation does not interfere with more favourable sick pay arrangements already provided by employers. Under the Act, an employee must provide a medical certificate from a registered medical practitioner stating that he or she is unfit to work due to illness or injury. I appreciate, however, that simply requiring a certificate does not necessarily address every concern an employer may have about the assessment underpinning it, particularly where certification is provided online. It is important to clarify that services providing medical certificates online operate on a private basis. They are not provided by the HSE nor are they provided by general practitioners under their HSE contracts where they fall outside the scope of those contracts. Doctors are clinically independent practitioners and must make decisions based on their professional expertise and experience. They are responsible for the clinical decisions and certifications they issue. Importantly, the use of telemedicine or online appointments does not remove or diminish a doctor’s professional obligations. As referenced by the Deputy, the Medical Council of Ireland permits doctors to provide telemedicine services but its guidance makes clear that the same standards of professional conduct and practice apply as would be expected in an in-person consultation. The Medical Council’s guide to professional conduct and ethics also states that a medical practitioner should only sign a certificate, report or document following a review of the patient’s condition. The decisions recognise the needs of the employee but also ensure that employees have income protection where the practical and financial pressures are being faced by those who are being assessed to be unfit to work. The legislation is kept under constant review. I acknowledge that employers are entitled to raise legitimate concerns, as the Deputy has raised on the floor of the Dáil, about the certificate process. Maintaining confidence in medical certification is an important process for both employees, employers and the wider public.

I thank the Minister of State for his response but I want to emphasise that simply pointing to existing regulation and professional guidelines does not necessarily address what employers are experiencing on the ground. The question is whether those arrangements are working effectively in practice. I am hearing from employers all over the country, including in my constituency of Carlow-Kilkenny, who are feeling increasingly frustrated because they have very little visibility or reassurance around the process through which these certificates are being issued, particularly when an online consultation results in an absence of one or two weeks. I return to the examples I mentioned earlier. These are not hypothetical situations. These are genuine experiences being reported by employers who are trying to manage their businesses, meet deadlines and retain staff. I am particularly concerned about smaller businesses, which simply do not have the resources or flexibility to absorb repeated and extended absences but there is also a wider policy consideration here. We have introduced statutory sick pay obligations for employers and there have been discussions about extending those entitlements but if we are asking businesses to carry greater responsibilities, surely we must also ensure that the certification system underpinning those responsibilities is robust and properly overseen. This is not about restricting legitimate healthcare or challenging the professional judgment of doctors. It is about ensuring that appropriate assessments take place and that there is accountability across the system. Will the Minister of State commit to bringing the Department of Health, the Medical Council and the relevant employer representative organisations together to examine online medical certification practices, the adequacy of clinical assessments and whether additional safeguards are required? This is a reasonable request, which would be welcomed by employers across the country. We need to get ahead of this issue rather than wait until confidence in the system is further undermined.

I thank the Deputy for raising this important matter. I reiterate that I understand why the issue is a concern for employers. An extended absence can place considerable pressures on a business, particularly when replacing staff or covering additional shifts can be difficult. It can also be costly for the business. It is entirely reasonable that employers want confidence that the medical certificate process is supported by appropriate clinical assessment. As I said earlier, the Medical Council guidance is clear that doctors who are providing telemedicine services must meet the same professional standards as they would in an in-person consultation. It also states that a doctor should only issue a certificate following a review of the patient's conditions. We are public representatives. We are not clinicians or doctors. They are professionally responsible for the clinical decisions they make and while the Medical Council regulates medical practitioners and promotes appropriate professional standards, it is important to ask the question as to what assessments they are undertaking. I will speak to the Minister for Health about this. On the Deputy’s point, the objective is very much to protect employees who are genuinely unwell under the legislation. We all have a responsibility to do that while also recognising there are real pressures on employers in maintaining confidence in the certification process. The concerns raised by the Deputy should be taken seriously. I will review that with the Minister for Health.