Topical Issue Debate

Superlevy Fine

I thank the Ceann Comhairle's office for the opportunity to raise this important issue. It goes without saying that we all welcomed the end of milk quotas on 1 April. It provided an opportunity for the dairy industry to expand and reach its undoubted potential, given Ireland's natural advantages in grass production, know-how, technique and climate. This is a new era for production but, unfortunately, a legacy of the old regime has seen quite a number of farmers being badly hit by steep superlevy bills. The total cost to the industry is approximately €69 million, a significant sum that will ultimately come out of the production cycle in the dairy sector.

Varying amounts are due to be paid. With the European Commissioner, Mr. Phil Hogan, the Minister has endeavoured to provide a facility whereby the bills can be paid over a three-year period, but I have discovered that the superlevy bills of a number of farmers are such that three years would not be adequate to meet their needs. Many of these farmers are in heavily borrowed situations, having expanded in anticipation of harmonising with the new regime from 1 April, and they now find themselves with exceedingly large bills.

I was a Deputy when the milk quota regime was introduced in 1983. Its restrictive impact on the expansion of the dairy industry over that time is known by us all and has been articulated many times in this Chamber. In a European context, the amount of overproduction in Ireland is relatively modest. I do not have the statistics in front of me, but I suspect that other member states are under their production thresholds. There must be a case for revisiting this issue with the Department and then with the Commission, having regard to the serious and profound implications for a sizeable number of dairy farmers across the country.

My information is based on the experience of several producers in the north east. They are genuine producers that started on a small scale, expanded rapidly and are now significant enterprises. If the future sustainability of these enterprises is jeopardised by large superlevy bills that must be paid over a relatively short period of 36 months, the issue must be revisited.

I exhort the Minister to speak to his former colleague in this House, Commissioner Phil Hogan, to see whether this matter can be revisited in the overall context of some over-production in Ireland and some under-production in other EU member states. There is a very strong case to be made for such an approach. It is certainly worth trying. If the Minister succeeds, he will do a great service to the many farmers who will be seriously adversely affected by an excessively demanding superlevy bill.

I thank the Deputy for raising this issue and thereby giving me an opportunity to provide the House with an update on this important issue and clarify a number of aspects of it. The milk quota regime ended on 31 March 2015. The overriding sentiment throughout the country from farmers to processors and along the value chain is that the abolition of the milk quota presents a massive opportunity for the Irish dairy sector. While it is obviously unwelcome that producers will face a superlevy bill in respect of the final year of the milk quota system, it is unavoidable at this stage. The first thing I would like to clarify in terms of the Deputy's issue as it has been outlined is that revisiting this issue is not possible. The rules governing the imposition of a superlevy were set by regulations agreed at EU level. It is not possible for me to adjust the superlevy rules on a unilateral basis.

In the years leading up to quota abolition, I proposed action at EU level on numerous occasions to mitigate the impact of a superlevy. The mechanisms I proposed included an adjustment to the butterfat coefficient, a front-loading of quota increases, a reduction in the superlevy or a type of EU flexi-milk arrangement which would have operated as long as overall EU production was within quota. The last of those proposals involves the kind of thing the Deputy has just outlined. In light of the opposition of a significant number of member states, it became clear as we approached the end of the quota era earlier this year that there was no realistic prospect of any agreement on these proposals. I assure the Deputy that we pushed this in an aggressive way at Council of Ministers level to try to achieve what we were seeking. We had a majority of countries supporting us but there was a blocking minority of countries insisting on no change.

In the absence of any agreement among member states on my proposals, my focus switched to mitigating the effects of the superlevy by facilitating staged payments by farmers in a year in which cashflow would be of utmost importance due to expansion costs coupled with current market pressures. In this context, I welcomed the agreement of arrangements with the Commission, following consistent requests from Ireland and other member states, to allow member states on a voluntary basis to permit the payment by milk producers of the superlevy liability in three annual instalments without interest. The first instalment must be collected by the milk purchaser in the normal way and paid to my Department before 1 October 2015. The two subsequent payments must be paid by the same date in 2016 and 2017 respectively. I recognise the burden that is being placed on milk suppliers because of the high superlevy levels. For that reason, I have decided to avail of these new voluntary arrangements here in Ireland. Officials in my Department are finalising procedures for the collection of the first instalment before the end of September 2015 and the introduction of a scheme to collect the remaining instalments at the end of September in 2016 and 2017. I expect to announce the details of the scheme in the near future.

The Deputy can read for himself the remainder of the answer, which comprises a broad assessment of where the dairy industry is currently at. Of course I recognise that many farmers are under pressure on this issue. It is also true to say that many farmers have already paid a significant portion of the superlevy fine that will apply to them. It has been collected by their co-ops as they have delivered milk over the last 12 months in anticipation of the development of a superlevy problem. Many farmers have paid a significant amount of the superlevy fine already. Others will now be able to plan on the basis of three interest-free instalments over the next three years. They are working with their co-ops to do that in a way that makes sense from a cashflow point of view. Having spoken to those involved in the industry at processor and farming levels, I believe we have made the best of a difficult situation in terms of superlevy pressure.

I thank the Minister for his response but I have to say I am disappointed with it. I note from his script that it is intended to bring in new regulations to cover the three instalment payments. I put it to the Minister, on the basis of the figures I have seen on a number of individual farms in various circumstances, that a three-year period will be simply inadequate for them. I ask him to go back and see if it is possible, at a minimum in the extreme cases, to get a much longer period for these repayments. If he can achieve this, he will do a very good service for a number of progressive, hard-working and expanding dairy farmers in this country. It would be a good day's work for the future of the dairy industry. This problem is not confined to the north east, it is found across the country. While the number of individual cases is not huge, I am aware of people who are concerned that this will push them over the cliff. If that happens, it will do a great disservice to the industry as a whole.

I come from the southern part of County Cork, which is one of the dairy heartlands of the country. I have spoken to many dairy farmers about this issue. We need to be honest about a couple of things here. The superlevy is not a surprise. Farmers knew it was coming. Many farmers factored it in last year in the context of the price they were then being paid for milk. They calculated that they would have to pay some amount of superlevy in the context of their expansion plans. Many farmers who were being paid over 40 cent a litre last year, by the time bonuses are taken into account, factored in a superlevy fine of 28 cent a litre for some of the extra milk they were producing beyond quota. Obviously that is a much more difficult prospect now because milk prices have come back substantially since then. I recognise that. Of course there is an obligation on co-ops to work with dairy farmers who were expanding, investing and factoring in the cost of the superlevy, but are now under some pressure, to ensure they manage their cashflow in a way that makes sense for the repayments they have to make and the superlevy they have to accommodate over time. My understanding is that such arrangements are being reached within co-ops at the moment to ensure those farmers who are encountering difficulties have a plan to work those difficulties out within their co-ops.

Rather than telling people what they want to hear, I have to be honest with them. The deal we have now, which was outlined by the Commission and into which countries can buy if they want, involves a three-year interest-free staged payment. The Minister for Agriculture, Food and the Marine has to pick up the tab for financing that deal so that farmers can actually manage it on an interest-free basis. That goes way beyond what the Commission has ever done before in terms of facilitating a superlevy. I would have liked the Commission to have gone further. It has been suggested that months after this decision was made, we should fundamentally change it now just for Ireland. I do not see that happening without getting a significant number of countries to support it, which I do not think will happen at this late stage.

I suggest we should focus on the practicalities that are now facing farmers. They are trying to work through those financial practicalities with their co-ops to make sure nobody goes out of business.

Rail Services Provision

This is an old chestnut: overcrowding on the train service from Dublin to Ballina, Castlebar and Westport. Regularly at weekends there is overcrowding, people are standing and sitting all over the place. It does not seem to be a very safe or satisfactory service for Iarnród Éireann to deliver. The most recent big flare up was at the June bank holiday weekend when many people were travelling to Bloom and other festivals. There was a severe case of overcrowding on the train leaving Heuston Station. Listening to people’s complaints I have to think there must be a better way to manage this. Will the Minister intervene with Iarnród Éireann and ask it to do something about it? It does not seem to consider putting on extra carriages or to factor in online bookings. I am told that many bookings are made online but Iarnród Éireann does not seem to cater for these passengers. It might be possible to provide a bus service for the people at Heuston. Some may be going to Athlone but there are many on the Mayo train, who are elderly and so on. It really is not satisfactory.

This may seem to be a small point to bring to the Minister’s attention but it reflects the value placed on the service that the number of the platform for the Ballina-Westport-Castlebar train goes up only ten minutes before the departure time. It is platform No. 7, which is way down the station. There is a stampede down the platform although people could have been notified earlier. Staff have raised this issue. These are practical measures that could be taken to address what has been complained of for forever and a day. From a health and safety point of view people pay to travel on the train but they are not being facilitated. They should be dealt with in some shape or form better than they are now.

There is one early bird service from Mayo, through Castlebar. That train ordinarily arrived in Dublin at 8.30 a.m., which was good for people going to meetings or medical appointments and all the other appointments they come to in the city. It has now been pushed back by ten minutes and many people regularly use that train, including those who drive from my town, Ballina, to Castlebar. People find it difficult to make the deadlines they made before. The service has been pushed back to accommodate an express service out of Cork. There is a service every hour from Cork during the working day and into the night whereas there are four trains out of Mayo and back. People feel that they are being treated as second-class citizens, that the focus is on a high-speed train out of Cork and the Mayo train has been pushed back to convenience a further service for Cork.

People from Ballina have to drive 25 miles to the early bird train from Castlebar although there is a train station in Ballina that links to the Castlebar station. Why do they not get a service directly from Ballina instead of having to head to Castlebar? They are willing to use the train service.

Is it now policy to have unmanned train stations, because this seems to be happening in Castlebar? Do people have to buy tickets from a machine and if there is a problem with the machine and they get on the train, will they be booked for not having a ticket? Is there a facility to buy a ticket on the train? I understand there is only a driver on the train now. The Minister for Transport, Tourism and Sport might address some of these issues in the interests of equity for Mayo passengers.

The provision of rail services is an operational matter for larnród Éireann in conjunction with the National Transport Authority. As the matter had been raised by the Deputy, I contacted the NTA on this matter.

The NTA has entered into a public service contract with larnród Éireann for the provision of rail passenger services. The contract specifies the service and capacities to be provided for intercity, commuter and DART services. Intercity services generally operate over regional distances, while commuter services serve commuter belt areas with a greater stopping frequency. There are key stations on the rail network where passengers are able to avail of either an intercity or commuter rail service. larnród Éireann continually manages the capacity of its services on both a short-term and a long-term basis to ensure it provides the optimum capacity on all its services through the timetable for the company's customers.

Earlier this year, there was significant pressure on capacity on Friday evening services from Dublin to Westport in particular, and the company responded by increasing the seating capacity by 200 seats on Friday through adding extra carriages on the 17.10 Friday service only. This service alone now provides in excess of 300 additional seats for Westport line customers on a Friday and on the 18.15 Heuston to Westport service on Fridays. The company therefore maximises available capacity on Fridays, including public holiday Fridays. However, there can be occasions when there is demand in excess of seating capacity, and the company regrets any inconvenience this causes for customers.

All trains are designed to accommodate standing safely and are certified to do so by the Railway Safety Commission, RSC. In urban rail services internationally, including Ireland, full loading is the norm at peak times. However, it is accepted by larnród Éireann that it is desirable from a comfort point of view that those travelling longer distances outside the commuter area should have a seat for their journey.

Furthermore, some intercity services also serve commuter stops, serving a dual commuter and intercity purpose. For example, the 17.10 Heuston to Westport service on Fridays serves Newbridge, Kildare, Monasterevin and Portarlington, among others, and the 18.15 service has high demand from Tullamore and Athlone daily commuters. Pressure on capacity eases significantly after commuter customers alight at these stations.

The NTA will continue to monitor and review the loadings on rail services through the Dublin commuter belt with a view to identifying whether service adjustments are necessary to achieve a more balanced passenger distribution across the various services. In particular, a review of the last annual rail census will inform the adequacy of the current train set configuration in relation to passenger loadings on the network.

The NTA is undertaking a review of its public service contract with larnród Éireann. As part of this review, the performance regime is to be reviewed and consideration given to the feasibility of including specific passenger capacity targets that limit the number and frequency of passengers standing on the network.

What I described to the Minister goes beyond the item set out as a Topical Issue matter. The service does not compare with the Cork service.

I understand all passenger services are subsidised. People in County Mayo are entitled to have an early bird service arrive in Heuston Station at the scheduled time in order that they can conduct business in Dublin. They should not be delayed because their train is required to make way for a new train service from Cork, which is already well serviced. The general attitude appears to be that certain services are secondary.

In some circumstances, passengers must stand on a train for the three or three and a half hour journey to County Mayo. The problem is not confined to commuter areas. While there is pandemonium until commuters disembark, people still cannot secure seats further west than the commuter towns on the route. Iarnród Éireann should address the problem in a better fashion. If the company does not have sufficient capacity, it should be able to deal with passengers turning up to board a train rather than loading them on like cattle.

Will the Minister ask Iarnród Éireann to explain the reason it cannot schedule the early bird Cork train, rather than the Mayo train, to arrive ten minutes later? I do not know of any good reason not to do so, other than that the company intends to provide a premium service to one area and not to another area.

Is Iarnród Éireann pursuing a new policy of leaving stations unmanned? This problem is occurring in Castlebar. What happens when people who are unable to use ticket machines at a station board a train and are found not to have a ticket?

I ask for equity in the train service to County Mayo as I do not wish to raise these issues again and again.

I emphasise again that Iarnród Éireann, in response to increased demand, increased capacity by more than 300 seats on the 5.10 p.m. and 6.15 p.m. train services to County Mayo.

On the knock-on effects of changes in the Cork service and the early service from County Mayo, as the Deputy will be aware, I do not determine the arrival times of particular train services. This is a matter for Iarnród Éireann to decide and it does so in response to demand. However, I will refer the matter raised by the Deputy to the company. I accept that when trains arrive later than 9 a.m., it affects the ability of passengers to attend meetings or arrive at work on time. I will ask Iarnród Éireann to respond to the Deputy on the point she raises in this regard.

There has not been a change in Iarnród Éireann's policy on the manning of train stations. When it is appropriate and feasible the company's preference is always to have personnel present at train stations. If the Deputy has information to indicate a recent change in the manning of a station in her constituency, I will refer it to Iarnród Éireann, with a view to obtaining some clarity on the matter for her.

General Practitioner Services

I thank the Ceann Comhairle for selecting this Topical Issue for discussion as it is an important matter that is causing grave concern throughout County Donegal. As the Minister will be aware, NoWDOC has provided out-of-hours general practitioner, GP, services in County Donegal since 2001. Two years ago, when the out-of-hours service was threatened with closure, Caredoc started to provide GP out-of-hour services, while Nowdoc continued to provide the Health Service Executive back-up service for the out-of-hours service. In recent weeks, Caredoc has proposed changes to the service, under which two of the current three centres would close for what is known as the "red eye shift", which extends from midnight until 9 a.m. The doctors in question would then be redeployed to a centre in Letterkenny, which would cover an area stretching from Gweebarra Bridge to Malin Head, which is probably larger than most counties. This has created serious concerns about the level of service that will be available to people in the relevant areas, especially west Donegal and the Inishowen Peninsula, and how the service will be managed.

Caredoc has claimed the changes are being made because an insufficient number of doctors is available to cover the so-called red eye shift. I believe the proposal is a cost-saving measure aimed at reducing the overheads in running the service. NoWDOC's call-out ratio and service indicators are very good and it provides a service in a timely fashion to those who urgently need care. People are concerned that this excellent out-of-hours general practitioner service will be undermined and further reduced in future.

When the Nowdoc was being established in 2000-01, there was considerable apprehension among service users that they would lose contact with their family doctor and a gulf would emerge between service users and their general practitioners. However, users are now confident in and happy with the service. Any proposal to change the delivery of a health service causes considerable concern and anxiety among its users.

Three general practitioners currently provide an out-of-hours service in the region, one each in Carndonagh, Letterkenny and Derrybeg, respectively. It has been proposed to reduce the number of GPs operating the service to two and base both in Letterkenny. As a general practitioner, the Minister will be aware that when someone is struck with a serious illness between midnight and 8 a.m., time is of the essence. Deputies Thomas Pringle, Pearse Doherty and I all live about one hour's drive from Letterkenny hospital. Moreover, there are inhabited islands off the coast of Donegal. Tory Island has a population of 200 and Arranmore has a population of approximately 600. There is no doubt, therefore, that if the proposed changes are implemented, the level of service in County Donegal will be reduced.

Deputies Pringle, Doherty and I all attended a public meeting last Monday night. All those in attendance were apprehensive and concerned. It was significant that the four general practitioners present did not express confidence in the proposed new service. As the specialists working at the coalface, their views should be taken into consideration before any changes are made to the service.

I thank the Ceann Comhairle for selecting this matter for discussion.

The Minister should not lose sight of the significance of Deputies McGinley and Pringle as well as myself speaking with one voice on this issue, as it is rare that this occurs in the House. This issue goes to the core of services to rural communities. Deputy Mac Lochlainn asked me to express his support for the position the two previous speakers and I are taking on this matter, which affects west County Donegal and the Inishowen Peninsula. Under the current proposal, Derrybeg and Carndonagh will lose a permanent general practitioner service from midnight until 9 a.m. in two phases. In the first phase, the service will be lost from Sunday until Thursday, while in the second, which would be implemented in the summer, the service would be lost completely.

This issue goes to the core of the type of service people want to maintain in their area. They do not want the current service to be diminished as it would result in many people waiting for 45 minutes for a doctor to arrive. The Minister has visited west Donegal. In winter months, the main road to the area is frequently closed due to frost and so forth. People in the area do not want to take risks.

The out-of-hours general practitioner service also serves island communities. I wrote to the Minister and chief executive officer of the Health Service Executive in February welcoming an intervention of the HSE in appointing an interlocutor to negotiate between Caredoc, the HSE and general practitioners on the unfolding crisis in the out-of-hours service. The problem is that Caredoc was about to withdraw from the out-of-hours service in February.

GPs say one of the big problems is that the HSE removed the financial support that was there to fund these doctors during the red-eye shift about five years ago. Caredoc is losing a huge amount of money as a result of this and, therefore, wants to reduce the number of doctors from three to two. It will have its own version of the story. I have been dealing with this since 2011 and raised it umpteen times in the Chamber.

I want to say go mbeidh sé inglactha ag pobal na Gaeltachta agus pobal Inis Eoghain má théann sé seo ar aghaidh. Beidh go leor daoine agus go leor agóidí le feiceáil ar na sráideanna má théann sé ar aghaidh. Tá súil agam go n-éisteoidh an tAire. I hope the Minister listens to the concerns of the public and does not wash his hands of the matter by saying it is an issue for the HSE. This is an issue concerning services to rural areas. I could tell the Minister stories about lives that were saved as a result of the NoWDOC service being very close to the individuals involved. I hope a solution can be found to this problem.

I thank Deputies McGinley, Doherty and Pringle for raising the issue as it gives me an opportunity to update the House on the matter. I am taking the debate on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch, who is on Government business elsewhere.

The NoWDOC GP out-of-hours service is a partnership arrangement between the GPs affiliated with the NowDoc service and the HSE. The service provides out-of-hours GP care to patients in the north-west catchment area. In November 2013, the GPs engaged with Caredoc Ltd. to manage the GP out-of-hours services in Donegal, south Leitrim and north Roscommon on their behalf. The HSE entered into discussion with Caredoc and the GPs regarding a formal service arrangement in November 2014. A number of issues were discussed to facilitate the development of a sustainable and efficient service into the future. These included further development of the clinical governance structures, ICT development, liaison and monitoring arrangements, GP deployment arrangements and funding. An independent facilitator was put in place in early 2015 with a view to having a memorandum of agreement signed by the parties by the end of May 2015.

It was also agreed that the issues of GP deployment and funding could only be addressed through a comprehensive review of the current call activity and GP resources. The Caredoc GP clinical lead reviewed the available data and in recent weeks and the HSE has validated this to ensure that call activity data is accurate for the agreed review period and reflects the predicted call activity levels. The completed review indicates that there are few calls after midnight on the red-eye shift and that the current level of GP resources allocated to this period could be safely reduced while maintaining the service response times in line with the current performance standards and well within the response time standards of the Royal College of General Practitioners. The review also indicates that the red-eye GP resource in Carrick-on-Shannon and Mountcharles would remain as per the current arrangements, with the potential to reduce the duty GPs in the north Donegal area by one during the red-eye period. This measure is also being considered in the context of providing GP cover arrangements that are sustainable into the future and to assist in addressing difficulties that currently exist in recruiting sufficiently qualified and vocationally trained GPs to cover red-eye shifts. The possibility of having such a reduction implemented over two phases has also been considered to allow phase 1 to be analysed in detail before proceeding to phase 2. The arrangements for phase 1 would see a reduction in cover for the five weekday nights only, as these are not as busy.

Following the review, the GPs and Caredoc have indicated their intention to submit a formal recommendation regarding GP deployment in the out-of-hours service. As part of the consultation process with stakeholders, the HSE, the GP clinical lead and Caredoc personnel met with Oireachtas Members and Donegal County Council members of the Western Health Forum last Friday to discuss the review process and possible outcomes. The HSE, GPs and Caredoc continued their discussions today. All parties will now reflect on the contributions from elected representatives to ensure that agreement can be reached on service delivery arrangements so that services continue to be provided in a safe and efficient manner. All services will remain as per the current arrangements until this process is concluded.

The Minister's response simply outlines what has happened to date in relation to the service. The one thing that was missing from the reply was that while we met with Caredoc and NoWDOC last Friday to discuss the service, there was no consultation with any service user on the changes that are taking place. It is outrageous that health services would envisage such a major change that changes the whole structure and functioning of this GP out-of-hours service without that consultation. The GPs have a contract to provide an out-of-hours service to their clients in a certain way, but they do not bother to consult with them in relation to it.

The service must be maintained as it is. The Minister refers to the call-out figures. If one looks at the numbers, it may not justify it, but what value are we going to put on the fact that one person could be saved? I have never had an accident driving my car, but it does not mean I stop wearing my seat belt. The service must be provided and security must be provided to the community. This must be figured into the consultation process that is taking place. I am sad to say it is lacking from the consultation so far. The service must be maintained, as must the confidence of the public in Donegal.

What shocked me and, I am sure, my colleagues is that this was presented to us last Friday almost as a fait accompli. There was very little consultation with users, public representatives or others. Even members of the health forum, on which five Donegal members sit, were not aware of the changes being proposed. Does the Minister agree that the delivery of a health service affects and concerns everyone and that there should be far more consultation? I would like to get the Minister's view of the fact that there will be a serious reduction in the level and quality of service if this goes ahead. Deputy Doherty has already said that NoWDOC has saved lives. Deputy Doherty and I know that, unfortunately, people from our own area have passed away on the way to Letterkenny. All of these things must be taken into consideration. While the Minister says discussions and negotiations are continuing, I hope the views of the Members here, the people we met last Monday and of people in general and, in particular, of the GPs will not be overlooked when the final decision is arrived at.

I have been around long enough to recognise a box-ticking exercise. With no disrespect to those who were present at the meeting, it was a box-ticking exercise. The reason the meeting took place was that Deputy Pringle and I, among others, including the public, were raising concerns in the media for a number of weeks in relation to NoWDOC. We had a structured, normal quarterly meeting with the HSE at which this item was on the agenda. We were then told this was part of the consultation. Does the Minister know that in 2011 NoWDOC made the very same proposal to the HSE? The HSE then appointed a three-person panel to review the safety of the proposal and that panel rejected it on safety grounds. I got a letter from the HSE saying that when the GPs agreed their proposal with Caredoc, it would be independently assessed on a health basis. I asked the acting HSE manager who would carry out the review and was told that the meeting on Friday with us, the elected representatives, was part of that independent assessment. How the hell can I as a public representative assess the safety of reducing the NoWDOC service from three doctors to two?

There are two things I ask the Minister to do. First, I ask him to clarify whether the HSE is providing any funds to fund GP cover out of hours anywhere in the country. Second, I ask the Minister to ensure that an independent safety audit is done in relation to the NoWDOC proposal outside of the GPs, the clinical lead, Caredoc, and the HSE, who have been involved in that tripartite discussion since February.

I hear the Deputies' concerns and acknowledge their desire for further consultation. I understand that there is always anxiety when there is any change to health services, even where the change is for the better or results in a higher quality service. The HSE provides funding for out-of-hours services all over the country.

Does it provide funding for GP cover directly?

Deputy Doherty is eating into my time; I may not be able to answer all the questions the Deputies asked. I am familiar with the NoWDOC service, having spent an evening providing it when I did my undergraduate GP training in Carndonagh a long time ago. It is a very good service. It is important to bear in mind that GPs are a scarce resource and their time must be used efficiently. It does not make sense to have a GP up all night seeing one or two patients when the next day there is no one to see the 12 or 15 patients he or she would have seen had he or she been rostered during the day instead.

It is particularly difficult to get actual qualified GPs, vocationally trained GPs, to cover the red-eye shift. What happens instead all over the country is that people who are not fully qualified GPs, who are other types of doctor, fill in at night time and that is a quality issue as well which needs to be borne in mind. It is better to have one or two properly qualified GPs providing a service than to have three who are not actually GPs but are doctors without a general practitioner qualification. Of course this is ultimately a local matter and has to be resolved by agreement of KDOC, the GPs in Donegal and the HSE locally. It is not a decision that is subject to ministerial approval, sign-off or a veto.

The Dáil adjourned at 10.20 p.m. until 9.30 a.m. on Thursday, 11 June 2015.