Mattie McGrath (Tipperary South, Independent) | Oireachtas source

The service always kicks the problem back to the GPs, as is happening with medical cards for the over 70s. They are the people who should be looked after above all. We all hope to reach that age with the help of God, le cúnamh Dé. It is nice to have some reassurance but that is what is going on unless some Minister tackles it, and not when he comes back from his Christmas holidays and is exasperated by the problem of having so many people on trolleys. I wish him well any time he takes a holiday, but what happened on the last occasion? They closed down the official side of the system for almost two weeks. Anybody who is self-employed will know that one cannot close down a service for even 24 hours because the system must go on. No letters were sent out, no discharge letters or correspondence from doctors. They will do the same thing next Christmas and laugh at us all. It is disgusting, immoral and unhelpful.

We are losing rural GPs, as the Leas-Cheann Comhairle knows being from a rural area. There are a number of vacancies in South Tipperary and Tipperary generally. In one area we failed to get a rural GP because there was no rural GP practice allowance. It was well earned and negotiated by the general practitioners' union. It was there to support them in rural areas because they need different equipment and a different dispensary set-up as there are all kinds of disadvantages. We failed to get a GP there, however, and I have been told that there are 39 GPs in the queue awaiting approval for the rural GP practice allowance. We cannot approve one or two because of that.

We are lucky in Clogheen, which is a huge area with a wonderful small district hospital, St. Theresa's. Two GPs who gave wonderful service wanted to retire for the last three years but could not do so. Eventually, God was on our side because He delivered an angel to us called Dr. Melanie O'Reilly. She applied for and got the job, so the community is blessed. She had to invest in the surgery because it was old and much equipment was missing, but she has been denied the rural GP practice allowance. If she has to leave because she cannot afford to stay, our district hospital will be gone as well.

We have heard so much in this debate about step-down beds. They are vital to taking those discharged from acute hospitals and allowing them to recuperate with wonderful care. However, if Dr. O'Reilly is assigned to hospital cover and leaves the rural GP practice, our hospital is dúnta, finished. That will be another 22-bed hospital gone. It is a wonderful institution whose matron, Anne Halley, and her staff have given sterling service. I was to have had a meeting tomorrow morning with the senior management there because she is not getting the support she needs. The situation is archaic. I plead with the Minister from the bottom of my heart, in as calm and rational manner as I can, to deal with management. There are silly issues ongoing between senior managers about who is taking responsibility for community care and acute care. They have been fighting over this for two years. I have had meetings every couple of months and something was supposed to happen, yet the meetings are futile and a waste of time. Senior managers have arrived to talk to the matron and myself. They appear to listen attentively and promise this, that and the other, yet they do nothing. Someone needs to catch these people and knock heads together - I do not mean physically - and get them to take responsibility. We need to have management accountability and a support service for this hospital, which is a great institution with a wonderful young matron. She will be driven out of the job, however, if she does not get up-line support.

HIQA is due to revisit the hospital. Following HIQA's last inspection, recommendations were made but they have not been carried out because the management in South Tipperary General Hospital would not go out to do fire inspections, although duty bound to do so. I hate to have to say it, but the situation is disgraceful and frustrating. I discussed the matter with the Minister on an earlier occasion, but I am so frustrated that I am saying it on the record now. It is a wonderful institution with wonderful staff. My own mother died there and it is a wonderful hospital. Many people were born there in the past, but now it has been abandoned because it is out in the sticks. The HSE management in the south east would prefer if it was in the ocean off Ardmore. They do not want to know about it.

There is a negligence of care by senior management and I do not say that lightly. They have a duty of care and are being paid for that responsibility but they will not take it and support the matron of that institution. A meeting was to be held there tomorrow morning at 10 o'clock but it has been cancelled because it could not be arranged. That is what is going on. I sought the meeting three weeks ago, although I should not have to be involved in it at all. However, senior management are wilfully neglectful of their onerous responsibility. I will give the Minister all the details afterwards. Support structures are meant to be there for the matron, her assistant and staff. After one of our meetings, we thankfully got permission to recruit some extra staff to come up to a minimum safety level. Whatever way the interviews were organised, however, the three wonderful nurses had to be re-interviewed. I do not understand it but it is a joke. Why would our nurses and junior doctors not be on aeroplanes to other countries when they are getting that kind of treatment here?

If there was any kind of management in the South Tipperary hospital system we would not have half the queues, chaos, costs and expenses that exist. I salute rural GPs who are the engine room, main arteries and front line. They need to be supported, as do urban GPs. They are all self-employed people. My own GP practice in Clonmel has about five doctors and it is like a small industry with 20 staff. They are employers paying taxes and wages, yet they have sleepless nights. Apart from the duty of care, they are wonderful employers in villages and towns. One will not see anyone with placards about zero-hour contracts outside those surgeries. They need to be supported, not stripped of resources.

We should not have divisive issues like those that arose at the conferences held last weekend, with one conference accepting a proposal and the other not.

We do not need that. They need to be able to help the people. They do not need their surgeries full of under-sixes because it is free. Some people unfortunately will attend because they do not have to pay for it. I always supported the fact that there should be some charge for medical cardholders for GP visits and some charge for prescriptions. Unfortunately, the prescription card has gone too dear now. There are no free lunches and I accept that.

The GPs have to be supported. From the point of view of their own sanity, they cannot stick it. It is not financially viable. They have to pay the banks. Some of them have invested hugely in their own surgeries. Some are getting into the new primary care centres. They are willing to put their money where their mouth is. They have spent a lot on their training and are still upskilling. They have set up practices starting with one doctor, expanded and employed other doctors. Many in County Tipperary and other counties are group doctors now and they have nurses and all kinds of services. They are taking enormous pressure off the hospitals, doing bloods and everything else. The hospitals would be chaotic, submerged and not able to function only for the front-line GPs doing this. They need a bit of respect, support and, above all, the rural GPs need that allowance. I do not know what it is, €25,000 or whatever, but it is a damned lot of money when they have to raise it to buy beds and the equipment that is needed in a modern surgery. Sometimes GPs leave and take away some equipment with them because they are still working. It is their equipment and they are entitled to take it but it leaves a person with nothing.

We have a wonderful angel of a doctor, a gem to have, and that is hard to get because many rural practices cannot get anyone. We are blessed. She comes over the mountain from Lismore, which is a nice spin, and is dedicated and committed to working with and serving the people and providing a service seamlessly and with no fuss. She needs the support, as does St. Theresa's Hospital and the matron and staff. This is probably replicated in many other places. I know it is in Carrick-on-Suir and in St. Patrick's in Cashel. Wonderful matrons and staff under huge pressure are now being forced to collect money off patients. Mar fhocal scoir, I ask the Minister to please take seriously what I am saying and have it investigated and I will give him any details that he needs.

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