Dáil Éireann debate -
Tuesday, 4 Jul 2023

Vol. 1041 No. 3

Saincheisteanna Tráthúla - Topical Issue Debate

Animal Welfare

Deputy Jennifer Whitmore

I believe that we, the Department and the Minister should refuse to grant licences for the upcoming hare coursing season. It will come as no surprise to anyone that I am strongly opposed to hare coursing. I am strongly opposed from an animal welfare perspective and also from the perspective of the protection of our biodiversity. The hare is a protected species under the Wildlife Acts. I recently introduced legislation that would prevent the Minister from issuing licences under that Act for the capture of hares for the purpose of hare coursing.

I am not alone in my opposition to hare coursing. In fact, only 9% of the population agrees with hare coursing, according to a RED C poll conducted a number of years ago. It has been reported that both line Ministers, the Minister of State, Deputy Noonan, and the Minister, Deputy Darragh O'Brien, are opposed to hare coursing. That raises the question why we still allow hare coursing, who is making these decisions and why they are being made.

I am pleased that the Minister of State, Deputy Carroll MacNeill, is taking this issue. This is not her area but she has a legal background. I raise the licences that are issued for the purpose of capturing hares for hare coursing and whether it is possible for any club to adhere to the licence conditions as they are currently written. It is possible that all clubs have to this point been operating outside the conditions of that licence. Under section 38, the licence grants the Irish Coursing Club, ICC, a licence to capture live hares subject to the conditions specified. Condition No. 10 specifies, "Injured or pregnant hares shall not be taken under the licence." Absolutely and categorically, no pregnant hares shall be taken under the licence. I do not believe it is possible for anyone to determine whether a hare is pregnant upon capture. We are getting into the specifics of animal biology here but female hares have a gestation period of 50 days. They can have three litters, which means they are probably pregnant for half the year. It would be nearly impossible to determine during early pregnancy whether a hare is pregnant.

In its guidance, the ICC states, "any hare which is obviously pregnant, shall not be coursed and shall be released back to the wild". The licence condition does not state "obviously pregnant". It categorically states "pregnant". There is no possible way that any club would have the capacity to determine whether a hare is pregnant. Any female hare that is captured could be pregnant without anyone understanding or knowing it and, therefore, I believe the majority of clubs are operating outside the terms of that licence. In light of that fact, I ask the Minister for Housing, Local Government and Heritage to review the licence and not to issue licences for the upcoming year because there needs to be an examination of the situation and the terminology used. I ask the Minister of State to consider the matter.

Minister of State at the Department of Finance (Deputy Jennifer Carroll MacNeill)

I thank the Deputy. I have a policy on never commenting on somebody, whether they look pregnant or not. Even if they are close to giving birth, I still never comment and leave it as a matter for themselves. Of course, one can never tell the state of another person's pregnancy. I am not trying to be facetious in any way. The Deputy has raised an interesting analysis of the licence application and the Act. I am not in a position to make any sort of legal determination or adjudication on the issue but she has taken an unusually interesting angle on the issue. She has said that the licence conditions refer to hares that are pregnant. A person or a hare is either pregnant or not in the same way they are dead or not. There is no ambiguity in the matter. This raises important questions for licensing.

I am instructed by the Department to reply that regulated hare coursing is administered by the ICC, as the Deputy will be aware. As I am sure she will be also aware, statutory responsibility for the Greyhound Industry Act resides with the Minister for Agriculture, Food and the Marine. Licences are required by the ICC under the terms of the Wildlife Acts on behalf of their affiliated clubs to facilitate the capture of hares. Regulated coursing meetings take place during the open season dates between 26 September and end of February of the following year.

The ICC applies to the Minister for Housing, Local Government and Heritage on an annual basis for each of the aforementioned licences. Where licences are approved by the Minister, the conditions of same are set out and communicated with the ICC, as the Deputy has set out. Regional officers of the National Parks and Wildlife Service, NPWS, attend coursing meetings, as resources allow, to monitor compliance with the conditions of the licenses. I am not sure how they assess the matter the Deputy has raised. Did I heard her correctly stating that the matter in question falls under section 10 of the licence?

Deputy Jennifer Whitmore

It is under condition No. 10.

Deputy Jennifer Carroll MacNeill

It is under condition No. 10. In the most recent season, NPWS officials monitored some or all elements of 30 of the meetings held to ensure compliance with the agreed conditions. Veterinary staff from the Department of Agriculture, Food and the Marine also carry out inspections during the coursing season to monitor compliance with the rules governing animal welfare relating to greyhounds and hares.

The ICC submits various reports to the NPWS as required by the conditions of the licences, including control steward reports on the operation of coursing meetings, veterinary reports and hare capture and release reports.

Deputy Jennifer Whitmore

Under the licence, what those involved in coursing are required to produce is information on when the hares were captured, the number of hares captured, if they were injured and whether veterinary care was required.

They are not required to ascertain the sex of the hare. In all the details contained in the reports, I cannot see any reference to male or female. I went through 20 reports of hare coursing clubs. In any of those reports which account for probably close to 1,000 hare captures, I cannot see anywhere where they state that a female hare was deemed to be pregnant and released. Considering that there are 1,000 hares captured and the sex ratio is 50:50, and that a female hare is usually consistently pregnant or lactating, it is bizarre that there is no record of any hares being released in that regard.

This is an unusual angle, but the coursing entities have been operating outside - it has been impossible to operate within - the terms and conditions that have been set for them. I am not saying that it is on them but they have been operating outside the terms of that licence. In light of that, I ask that the licence for the upcoming season be refused until the Minister can carry out an analysis of those conditions and whether or not it is possible to be in compliance with them.

Deputy Jennifer Carroll MacNeill

As the Deputy says, it is an unusual angle, but it remains eminently fair. It is a condition that is set out by another party. As the Deputy stated, she went through the records and not only could she not find evidence of whether hares were identified as male or female, she also - I do not mean this to be funny - could not find evidence of whether the pregnancy status or otherwise of female hares was established. Therefore, there are two subsets of analysis that have not been completed. If it is a condition, one would expect that there would be some analysis in relation to compliance or otherwise with, as the Deputy says, condition 10. This is an important matter. Deputy Whitmore's commitment to animal welfare is shown by the extent of the investigations she has undertaken. I appreciate that anybody looking in on these proceedings could take a wry view, but it is a serious matter. I appreciate what the Deputy is saying.

The licence for the upcoming 2023-24 season is under consideration at present. The Deputy's views, alongside those of interested stakeholders and parties, will be included in the deliberations relating to the licence.

The National Parks and Wildlife Service has commenced a major project to review and update wildlife legislation. As the Deputy will be aware, it is a multiyear project. It is looking at every facet of our wildlife legislation, including the Acts, European Union regulations and related statutory instrument. In excess of 200 issues have been identified so far. Each of those will need to be examined and worked through more closely as the project develops. It will involve several phases of public consultation. The Department of Housing, Local Government and Heritage expects the first phase of formal consultations to commence later this year.

The Department, I am informed, would welcome the Deputy's input into this review. It would be valuable because if we are to set conditions, we have to be serious about them. If we are not to test the analysis against it, whether or not the pregnancy status or otherwise of the hares is tested for is a different issue. We should either not set the condition or set it and monitor it. However, we have to be serious about the matter.

An Ceann Comhairle

It occurs to me, without having a position one way or the other on this, that this is something Deputy Whitmore should bring back to the House in September or October when, presumably, the necessary studies will have been completed. I do not know if we have ultrasound for hares-----

Deputy Jennifer Carroll MacNeill

Pregnancy tests.

An Ceann Comhairle

-----but whatever needs to be done should be done.

Deputy Jennifer Whitmore

Apparently, it is ultrasounds one would need.

Deputy Jennifer Carroll MacNeill

Ultrasounds.

Deputy Jennifer Whitmore

Yes.

Water Quality

An Ceann Comhairle

The second matter is from Deputy Buckley. The Deputy wishes to discuss the continued and long-running boil water notice in east Cork and the need to resolve the issue permanently.

Deputy Pat Buckley

I thank the Minister of State for taking this matter. The Ceann Comhairle introduced it well. Indiana Jones, I would say, has not been around as long as this issue. This has been going on for approximately seven years. This boil water notice in the Whitegate area affects more than 10,000 people in Midleton, Ballinacurra, Cloyne, Ballintotis, Rathcoursey, Saleen, Upper Aghada, Whitegate, Ballycotton, Churchtown, Trabolgan and all the surrounding areas.

The most recent occasion on which I raised this matter was 31 January last. However, it dates back to St. Valentine's Day 2016 and remains ongoing. Local Sinn Féin county councillor Danielle Twomey is trying to get answers from Irish Water but we are getting bog-standard replies. I suspect that the Minister of State's script will contain phrases such as "turbidity", "not tenable", "a new plant" and, probably, "a date for completion". People are extremely frustrated. The area between the towns and villages I mentioned is very rural in nature. Many elderly people live there. Public transport services are poor, which makes it very difficult for these people to get to the shops. That is a problem because they have to buy bottled water constantly.

I will not mention anybody with medical problems, but we also have people who are running businesses there. We have a couple of hotels in Garryvoe and Ballycotton. We have shops. We have businesses, including restaurants, and those who own them are all frustrated.

I do not like coming in here over and over again to raise this matter. All that has changed since I came in here and started raising it in 2016 is that Irish Water has become Uisce Éireann. That is the only difference.

In January 2013, I mentioned, particularly as this really frustrates the residents and others in the area, the fact that we have Whitegate oil refinery and the gas station. We also have the old power plant. There is an alternative water source. I mentioned that again in January but it seemed to fall on deaf ears.

There was an incident, maybe two weeks ago here in Dublin, where there was a burst water main. It was on the national news. They had tankers out in a couple of hours, and yet for the past seven years these people in east Cork have not got as much as a bottle of water from Irish Water in compensation. They have spent thousands of euro in the past seven years.

I genuinely think what is happening is not good enough for the people of east Cork. We are being treated as second-class citizens. We are being ignored. The standard of treatment plants that are going in there - I know it because I worked in sewerage and water for years - is not even up to the standard of the one that is to be built in White Bay. It is called "White Bay" for a reason, namely, the beach there. It will not be popular because a percolation system to break down the sewage and smut is going to be put in place there. However, that is a matter for another day.

I am raising this matter because clarity is needed. There should be a meeting with Uisce Éireann at which the concerns of the residents living in the area and the heartache they are going through can be outlined. They understand that progress takes time, but they do not want to be ignored. I was frustrated to hear from our councillor, who is dealing with the people in the area, about the lack of information. Some of these people find out that the boil notice is on or off, as Uisce Éireann has it up on its website. As stated, this is a rural area. People do not have Internet in some places. Some people do not use computers. They find out what is happening when they see a newspaper advertisement maybe four days after the boil notice has been issued. These people have been consuming the water. They do not know if they will get sick or whatever.

I am here tonight to plead with the Minister of State and the Department to try to get a meeting at which myself and others - I do not care who is present - can discuss this matter with Uisce Éireann, attempt to have it resolved and obtain clarity for the residents in that area.

Deputy Jennifer Carroll MacNeill

I thank Deputy Buckley for raising the issue of providing safe drinking water in east Cork. I ask him to forgive the fact that it is me taking it rather than a line Minister. If the latter were the case, the Deputy might receive a more direct response.

I appreciate the Deputy’s concerns for the communities to which he referred. As he is more than well aware, this is a very serious issue. Otherwise, he would not be raising it repeatedly in the House.

The operation of Whitegate regional public water supply is a matter for Uisce Éireann, which, since 1 January 2014, has had statutory responsibility for it. In turn, the Environmental Protection Agency, EPA, as the environmental regulator, is responsible for setting quality standards and enforcing compliance with EU directives and national regulations for the provision of drinking water.

The Department has made inquiries with Uisce Éireann about this matter. I am informed that the boil water notice currently in place for the Whitegate public water supply was issued following consultation between Uisce Éireann, Cork County Council and the HSE. Uisce Éireann is pursuing a permanent solution to address the frequent boil water notices that the people of east Cork have had to put up with in recent years. That involves a major upgrade of the water treatment plant. A contractor has been appointed to undertake the design and construction of the plant. Land has been acquired and a planning application was submitted in January. Planning permission was approved by Cork County Council in May. However, following the statutory process, appeals have been lodged with An Bord Pleanála which, of course, will delay progress. The proposed works will include a new coagulation, flocculation and clarification system, a new filtration system and a new disinfection system.

Significant upgrades will also be made to other aspects of the Kilva water treatment plant site. The EPA will ensure that the new plant meets all applicable standards before this supply is removed from its remedial action list. The Department’s priority is to ensure people’s health is protected and that adequate water is available for all consumers, citizens and residents. We want to see the notice lifted without undue delay, but obviously only when the HSE and the EPA have confirmed the water supply is safe.

As part of budget 2023, the Minister, Deputy Darragh O’Brien, secured funding of more than €1.65 billion to support water services. That includes €1.56 billion in respect of domestic water services provision by Uisce Éireann. The overall investment will deliver significant improvements in public water and wastewater services, as the Deputy is aware, improve water supplies right across Ireland, including rural Ireland, and support a range of programmes delivering improved water quality in our rivers, lakes and marine areas, making a significant contribution to addressing Ireland’s needs.

Very little of that is any comfort if you happen to be living with a boil water notice tonight. I hope that project can be completed as soon as possible.

Deputy Pat Buckley

I thank the Minister of State for her response. Her statement is pretty similar to that in Cork Beo of 23 January; it just included fancy new words such as "coagulation, flocculation ... clarification [and] filtration system". When I previously had a response on this the filtration system and UV system were referenced. The previous excuse was that Irish Water was ordering a part. I remember saying that Irish Water, six years down the road, was ordering a part and if it went to wish.com or Early Express it would probably get the part faster. That is one point I wanted to make.

However, the biggest frustration I have when I represent the people of east Cork, especially in the Whitegate area and all the other areas I mentioned, is the lack of communication and information, in addition to the lack of empathy for people who are suffering. I do not like pitting people against each other but a major incident in Dublin can be sorted in a day, and emergency water supply can be sorted within two hours, yet we are seven years down the road on this issue and somebody has not even got a bottle of water from Irish Water, not to mind an apology. I have met people, and we have seen this in respect of the RTÉ scandal, who will not pay their television licence anymore. I suspect many of these businesses are now very frustrated with water rates because they are paying for something they are not getting.

I appeal to the Minister of State. I understand she is delivering the Minister's response. Her answer referenced the website and the 24-hour customer line. People do not actually get that information. When we knock on doors, we give people information leaflets. That is the old-style way. It is the way Uisce Éireann will have to go back to because parts of the area are very rural. I thank the Minister of State for taking this Topical Issue and the Ceann Comhairle for selecting it. As I said, however, it gives little solace to the people of east Cork. I hope not but, unfortunately, we will revisit this matter.

An Ceann Comhairle

I am sure the Deputy will keep plugging away at it.

Deputy Jennifer Carroll MacNeill

I did not intend to read out the email address or phone number because I suspected people were already well aware of them, they would be of little assistance in circumstances where a seven-year boil notice was in effect, and that it probably was not the most efficient way of communicating. If it is an on-off thing, I suggest that an app on mobile phones that everybody is plugged into is a much more effective way of providing information, in a proactive way, to actually assist people who need to know whether a boil notice is in effect.

Not everything in Dublin is perfect. I come from Dún Laoghaire where we have a very Victorian water system that has many complications, but we do not suffer from the same ongoing issue as the people of east Cork suffer in this regard. I will not set out Uisce Éireann's primary function to provide clean, safe drinking water to customers to a Deputy who is representing constituents who have not experienced that for the past period. It is a matter of urgency that this issue be resolved to make sure that people have clean water.

Hospital Services

Deputy Marian Harkin

I apologise to the Minister of State; I am recovering from laryngitis but I really wanted to raise this issue. It is a crucial issue concerning how a 17-year-old, a young person who is a child under Irish law, was treated at an emergency department at the weekend. I received a message from a constituent at the weekend outlining how this young person cut the top off his finger. He was brought to NoWDOC in Carrick-on-Shannon, but it was closed and his sibling drove him to Sligo hospital. He was bandaged there and told to go to Galway. They drove to Galway, which at this point was 145 km away, and arrived there at about 9 p.m. that night. When he arrived in Galway, he had the other part of his finger with him on ice and in a plastic bag. He was told that there was no one to see him at the hospital. He was in excruciating pain and was told he could either go home and come back the next morning at 7 a.m. or that he could get bed and breakfast accommodation as no trolleys were available.

The family had to drive back to Carrick-on-Shannon. His dad said they were on their way home none the wiser, with the lad with half a finger home with him and the other half left in a fridge in Galway hospital. It was 115 km back to Carrick-on-Shannon, another 115 km back to Galway in the morning, and then another 115 km back that afternoon. It was almost 500 km in total. Apart from the fact that nobody should be turned away from hospital, a child was turned away. I do not know what the Minister of State thinks but I think this is completely and totally unacceptable. I hope this will be dealt with by the Minister for Health. It is a pity he is not here tonight but I am glad the Minister of State is present.

Deputy Jennifer Carroll MacNeill

What age was the child?

Deputy Michael Fitzmaurice

I thank the Minister of State for coming in. It is a pity the Minister for Health is not present. I think an inquiry needs to be held into this. The child is 17 years of age. He had an accident. NoWDOC is in chaos in Carrick-on-Shannon. This child went to Sligo hospital but it does not have the facilities to deal with his situation. We are supposed to have so-called centres of excellence that include Galway hospital. The Minister of State's buddy, the Minister, Deputy Eamon Ryan, does not want to see a new road built, when we talk about the need for it, between Sligo and Galway, which would cover Collooney and all that area. It is being blocked at the moment. That youngster went into the hospital in Galway with his parents. The exact words they were told was that the hospital would put the part of the finger that was cut off in the fridge. They were given tablets or whatever to try to kill the pain. The words that were used were: "Get a B&B and come in in the morning at 7 a.m. and we will try to do something."

It is disgraceful that in what we call a centre of excellence a youngster of that age is treated in that way. Whatever the hope was of saving the finger, there was no hope when they had to head home again, leave part of the finger in the fridge, come back in the morning, and then wonder if it would be sewn together. The game is over at that stage. I am not a doctor but I know that much. We talk about health services improving. It is unbelievable that for emergency surgical cases that come in, where quick movement is needed, that all this family was told in Galway hospital was that the finger would be put in a fridge and they should get bed and breakfast accommodation. You would swear that family was raking money in. Following all their trauma, they headed home and had to come back the next morning. Unfortunately, my understanding is that the finger was not saved. That child has to live life. If he were to do a trade or something, it will unfortunately probably be a hindrance to him. At least if you made an honest rattle at it, or tried to solve it, everything would be done, but nothing was done. It is a disgrace.

An Ceann Comhairle

I suspect if that child was taken to a bush hospital, he might have got better care than what the Deputies described.

Deputy Jennifer Carroll MacNeill

Not necessarily, a Cheann Comhairle. Emergency surgical services are an issue everywhere. I understand this involves a 17-year-old child. I have a response for the Deputies around the provision of emergency surgical services. However, I will say I have an 18-month-old child who required emergency orthopaedic surgery. We turned up at Crumlin hospital, which is a paediatric centre of excellence, on at Saturday night at 11 p.m. The registrar and surgeons do not come in until 7 a.m. the following morning.

I am not saying it is a solution but I managed to get emergency surgery at 10 o'clock on a Sunday morning. A lot of it is a matter of the rostering of registrars and consultants who can identify and prepare for surgery at whatever time of the day or night.

The Deputies also raise a really important question of the costs of children in hospital. As they have said, they were to go and stay in a bed and breakfast or take two round trips as it will turn out by the time they get back. The cost of petrol is really very significant. It is something I have tried to highlight again and again. I do not mean to sound trite but when people are in a children's hospital, the last thing they are thinking about is costs. Costs, however, are extremely important. The additional needs payment is available to people - I have confirmed that through the Minister, Deputy Humphreys - to be able to recoup some of those very difficult costs, such as bed and breakfast costs, very significant petrol costs, or other childcare costs. Indeed, the family may have had other children who may have been younger. They would have had to leave not once, but twice late at night and they would have had to make sure they got the care that was necessary. I really am very sorry to hear that the matter was not resolved and that the finger was not saved.

The majority of emergency surgical services provided in the area referred to by the Deputies fall under the Saolta University Health Care Group, which serves a population of 830,000 and provides acute and specialist hospital services to the west and north west, including Galway, Mayo, Sligo, Donegal, Roscommon, Leitrim and parts of adjoining counties.

Geography is a major challenge for the group because the population is dispersed and rural, with approximately one sixth of the national population being spread across one third of the land area of the State. The combined budget for the hospitals under the remit has risen from €795 million in 2018 to more than €1 billion in 2023, an increase of more than 35%. Key hospitals in the region providing 24-7 emergency medicine services include Sligo, Galway and Letterkenny. Sligo University Hospital, which is a model 3 hospital, delivers a wide range of local and regional services on an inpatient, day case and outpatient basis, including certain specialities, acute medicine and acute surgery, as well as a number of regional specialities provided on an outreach basis to Letterkenny University Hospital.

In 2023, the budget allocation for the hospital was €175 million, which was up from €130 million in 2018. Between the end of 2020 and December 2022, staff had increased more than 13.6%. Galway University Hospital is a large, busy hospital. As the Deputies will be aware, this Government has allocated significant additional resources to the hospital to meet the needs of the patients. Its staff has increased by 13% since 2020 and the hospital’s budget has increased from €338 million in 2018 to €441.7 million in 2023. Similarly, Letterkenny hospital’s budget has increased from €131 million in 2018 to €178 million in 2023. Its staff has increased by 18% since 2020.

However, access to high-quality services, including emergency surgical services, is a necessary priority for the Government, as is providing these services as close to home as possible, particularly late at night when emergencies actually happen, as appropriate and in line with Sláintecare. The investment underlines the Government’s commitment to improving services for the people across the north west.

Deputy Marian Harkin

I thank the Minister of State for not just reading what was before her. She gave us lots of statistics but none of them mattered to a child who presented at Galway University Hospital. Anybody under the age of 18 under Irish law and the UN Convention on the Rights of the Child is a child and should not be turned away. I can understand that perhaps with rosters that there may have been a difficulty. It is not acceptable but I can understand it. Yet, to tell people to get a bed and breakfast or go home and do a 230 km round trip is simply not acceptable. Trying to get a bed and breakfast booking in Galway during the summer is difficult, never mind the cost of it. My question is this: Galway University Hospital is a level 4 hospital. Is it an acceptable that a child can be sent back, turned away and told that there are no trolleys, no room at the inn and to go home or get a bed and breakfast?

Deputy Michael Fitzmaurice

A total of €22 billion is being spent on health in this country. It is ironic that the Minister of State says that a sixth of the population is in that area, which covers one third of the country. It is a big area and we should try to bring the services as close as we can. These people were prepared to travel. There is no question of that.

Deputy Jennifer Carroll MacNeill

Yes, I know. I was not saying there was.

Deputy Michael Fitzmaurice

These people were prepared to travel 115 km each way. Yet, we did not have a service in the whole of the west of Ireland. We did not have it in Letterkenny, Sligo, Castlebar, Roscommon or Galway, which was to be the centre of excellence. It is a damning indictment of our country - and I come from the agricultural sector - that if that night I had an animal that lost part of its foot or was sick in any way, I would have had a vet at my house in 15 minutes. Yet, when it comes to a human being, we are not able to stitch on a part of a finger. That says it all about the state of our country at the moment.

Deputy Jennifer Carroll MacNeill

The question of timing is very important, particularly the time patients arrive at a hospital. They can end up with a very long wait until 7 or 7.30 the following morning when the surgical teams come back in. Therefore, if they turn up at 11 p.m., and I have personally experienced this they can either stay until 7 a.m., or they can go home and come back.

In my case, I was in Crumlin, the services were not available. Whether people are in the north west or in Crumlin, they will have the same experience from a paediatric care perspective. The surgical services are available from 7 a.m. If we take out the question of going home and coming back, the services are available from 7 a.m. The only way to remedy that is a different contracting model for consultants and registrars to provide surgical services overnight. On the question of emergency surgery, timeliness really is very important. I do not know what time it was possible to come back to the hospital to avail of that surgery.

The overall question is the availability of surgical services overnight, whether that is in Dublin, Crumlin, the west or the north west. Emergency surgical services are really a matter for the consultant contract. I hope that will improve in the very significant extension of hours that will follow from the consultants’ contracts. I hope that will be of benefit to people who are looking for emergency surgical procedures, because I am not sure that there is a geographic issue here. As I said, I have a very direct personal experience of this in Crumlin hospital and there would not have been any different outcome in terms of timing whether I had been Crumlin or the north west. Whether people stay at home or come back, the service is not available because staff will not be there until 7 a.m. or 7.30 a.m. I am not saying that is good enough, but I am saying that the extension of the contracting hours to up to 80 hours per week over six days should, as I understand it, provide significantly extended hours of operation for the surgical services. That really seems to be what is at issue here.

General Practitioner Services

Deputy Christopher O'Sullivan

I am not sure how familiar the Minister of State is with west Cork.

Deputy Jennifer Carroll MacNeill

Very.

Deputy Christopher O'Sullivan

That is very good. I would usually be trying to sell the place to her. I would tell everyone how great the place is and would say that it has everything, yet, unfortunately, the one thing it lacks is an abundance of GPs. That is why I am raising this Topical Issue.

The Minister of State is familiar with the area. It is a vast area and it is geographically unique. In many places, there will be one GP and one GP practice, maybe with a couple of practice nurses, covering a vast area. This is the problem. It is putting services under pressure and it means in many instances that families and other people living in the area and even visitors are struggling to access GP services. This pressure that is being put on GPs is also putting the really important out-of-hours South Doc services at risk. It has become so bad that GPs are getting to the situation where they are unable to just take a week’s holiday, which is very sad. It is not good enough for the GP. It is also not good enough for the service users and the people living in that area. That has to change.

Unfortunately, the situation has disimproved over the past number of years. I would like to mention the GP for the Beara Peninsula, which is the furthest west tip of west Cork. She is based in Castletownbere, which is the town that is relevant to that area. The GP is unbelievable. She is so dedicated to her work, to the people of the Beara Peninsula and to the patients who she serves. She rarely takes lunch.

She never gets home when she is supposed to get home and she is unbelievably dedicated to what she does. She was in a position to take a week's holidays with her family, which is an important thing for her and her family to do. However, for the retired GP who had offered to cover for her during this week, her medical insurance ran out the day before she was due to start providing cover for the GP in the area. The insurance could not be renewed, which is ridiculous. This meant that this GP, who has dedicated her life to serving the people of Castletownbere had to make the heartbreaking decision of closing her practice temporarily, leaving the people of this vast geographical area on the furthest south-west tip of Ireland without GP cover.

That is not good enough but unfortunately that scenario I have just painted is the reality on the ground. GP services are under pressure, out-of-hours SouthDoc services are under severe pressure and families moving into the area are failing to get access to a family doctor. Something needs to happen. I understand that 350 training places are being made available in 2024, so I want to know when that is happening and how soon it might be happening. There is also talk of 100 non-EU GPs being recruited to try to ease the pressure. Recruiting 100 GPs will not be anywhere near enough so I would like to see that number increased. When can we expect to see these non-EU GPs recruited?

Then there is this strategic review that we are expecting. We need to see that published as soon as possible so that we can move on, reform and bolster large parts of Ireland with the GP cover that is needed to serve communities. I am looking forward to the Minister of State’s response. I appreciate the Minister for Health is not here but I am sure she will do an incredible job of representing him.

Deputy Jennifer Carroll MacNeill

I thank the Deputy for raising this matter on behalf of his constituents. In recent years, general practice has had to do more as demand for services, life expectancy and the population have increased. The Government has taken a number of measures to improve the recruitment and retention of GPs, and to increase the number of GPs practising in the State. The 2019 GP agreement provides for an additional €211 million in expenditure for general practice, an approximately 40% increase on the funding provided prior to the agreement. The agreement has introduced a €2 million annual fund to support GPs in areas of urban deprivation. Rural practice supports have been increased by 10% under the agreement also.

As was announced this week, agreement has been reached with the Irish Medical Organisation to extend eligibility for GP visit cards to people who earn up to the median household income and to children aged six and seven. Approximately 500,000 additional persons are expected to become eligible for free GP care under this expansion, the largest expansion of access to GP care without charges in the history of the State. That new GP agreement includes additional capacity supports to enable the expansion and retention of staffing within general practice. It includes additional supports for GP out-of-hours services and a pilot scheme to assist rural GPs to source locum cover for leave. A new form of practice grant will also be made available to GPs for additional support staff, in addition to an increase in the existing practice support subsidy. The total financial package will amount to approximately €130 million in 2024.

The number of GPs entering training has more than doubled, from 120 in 2009 to 258 in 2022, with 285 places available this year. Some 350 training places are planned for next year. The HSE is also working with the Irish College of General Practitioners on a programme, as the Deputy said, to bring 100 non-EU GPs into the country this year. That initiative, which has already commenced, with 25 posts started in January 2023, is planned to extend up to 250 GPs by the end of 2024. The initiative is targeted at rural areas, areas of urban deprivation and those difficult-to-fill posts in various geographical locations across the country.

The terms of reference for a strategic review of general practice have recently been published. That review will commence shortly and will be completed this year. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice, including GP capacity issues, and I hope it will set out the measures necessary to deliver a more sustainable general practice.

Deputy Christopher O'Sullivan

The Minister of State mentioned the extension of GP visit cards to more than 50% of the population. Approximately 500,000 more people will be eligible for GP visit cards. This is fantastic and it is going to mean that those who most need GP care or assistance will have access to it. It goes a long way to addressing what has been a huge issue within our health service for a long time, namely, affordability. This is reformative and it has to be welcomed on all fronts.

There is always a "but" and this measure will compound the issue I have just outlined to the Minister of State. That is the pressure that rural GPs in particular are under because of the difficulty they have in getting locum cover. It is an exercise in itself for a GP to try to get cover, whether it is through locum services or ringing around to friends or retired doctors. It is a huge effort and it is not really fair. We welcome this measure of the 500,000 extra people getting access to GP visit cards but we need to put measures in place now to bolster these services. GPs in rural areas have been warning of this scenario for a long time. They have been warning many of us that this was going to happen. It is happening and they are under pressure. My message to the Minister of State to bring back to the Minister for Health - and I will bring it to his attention as well - is that measures need to be put in place straight away to ensure the supports are there for GPs, GP practices and practice nurses.

Deputy Jennifer Carroll MacNeill

I mention the locum services and the Deputy highlighted the difficulty in getting insurance. I invite him to bring that to me directly as Minister of State with responsibility for insurance. If there is a systemic issue, I will raise it. I will discuss it with Insurance Ireland and try to find a route for it. It seems that getting locums often involves asking people who have retired to help. We are living longer lives and working longer lives. People may wish to do locum or flexible working and it should be easier to get insurance. I am happy to pick that element up with the Department of Health and I ask the Deputy to provide me with more information on that.

It is important to analyse the rate of increase in GPs entering training contracts relative to the rate of increase of population. It is clear that it is a significant expansion relative to 2009 but whether it is going to keep pace and get ahead of pace with the continued population growth, as ahead of profile as you might have expected that to be, is important to analyse. There is an opportunity to bring non-EU GPs in and to benefit from the influx of immigration that we have had into this State, which includes a range of skilled and less skilled people and professional and non-professional people. We must take advantage of the skills they bring to Ireland. To make sure that is well distributed around the country, so that everybody benefits from that, is an important initiative and one which warrants intense focus and scrutiny by the Deputy and every other Deputy in the House.

The number of doctors training to work as GPs in the country has increased significantly in recent years and will continue to do so. However, the question is: how is it analysed versus population growth and the distribution of that? More work needs to be done to improve GP services further and to cater for increased demand. The strategic review of general practice will examine a comprehensive range of issues, including GP capacity services in rural areas, such as west Cork, and identify that change is needed for a better GP service in the future.

An Ceann Comhairle

I thank the four Deputies for raising these matters and the Minister of State for being here to deal with them.

Cuireadh an Dáil ar athló ar 10.59 p.m. go dtí 9.12 a.m., Dé Céadaoin, an 5 Iúil 2023.

The Dáil adjourned at 10.59 p.m. until 9.12 a.m. on Wednesday, 5 July 2023.