Kevin O'Keeffe (Cork East, Fianna Fail)
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I thank the Minister of State, Deputy Catherine Byrne, for coming into the Chamber today but I must say I am disappointed that, again, the Minister of State with line responsibility, Deputy Jim Daly, did not see fit to be here. This is the second time for me to raise the issue here and although he is a Corkman I do not know where his loyalties lie at this stage. I spoke on the issue previously in November 2017. The issue is the filling of the permanent medical officer position at St. Patrick's community hospital in Fermoy. There are many other issues in my constituency that I would love to raise in the Topical Issue debate in this Chamber but I feel that I need to further emphasise the importance of filling the vacancy for the medical officer position.

I remind the Minister of State of the contents of the programme for Government. I refer to page 53 which relates to health, which states: "Efforts to increase access to safe, timely care as close to patients' homes as possible will be a priority for the new Partnership Government". It also states on page 55: "The HSE will be mandated to employ GPs on a salaried basis where needed and put in place support structures and staff". How does the Minister of State stand over the current situation in Fermoy?

Herein lies the kernel of the problem. First, there is not a full uptake of respite beds at present in St. Patrick's community hospital and, second, some eligible patients end up being sent to alternative nursing home or community hospital locations. That is not good enough, as we have a state-of-the-art facility in Fermoy. Families are being pressurised to second GPs to provide cover when the availability of a respite bed arises. I remind the Minister of State that not all patients or their GPs are from within the confines of Fermoy. Some patients who have been allocated a respite bed at St. Patrick's community hospital cannot avail of the care there. The reason is that their own family doctors cannot put themselves in a position to travel to the hospital and attend to them if and when the need arises. The offer of a bed, therefore, has to be declined. The HSE can cause a cold relationship between families and their doctors by passing on the blame. That is not going down well in the area.

In fairness to the HSE, it has communicated with me. It acknowledged the problem but does not consider it to be a crisis situation. How can we allow a situation where there is a half-filled temporary position to continue? The situation is beginning to reverberate around the entire north Cork area. The HSE seemed to indicate there was no problem in the context of Fermoy but in recent weeks I was shown a letter which was written to a constituent who was seeking a respite bed for her mother in another facility. She was advised that due to circumstances beyond the control of the HSE the availability of respite to clients across the north Cork community services area has recently been reduced. The letter went on to say that this had greatly increased the demand for respite services in Nazareth House in Mallow. That suggests the problem in Fermoy is starting to have a knock-on effect on other community hospitals. I urge the Minister of State to intercede or to ask the Minister with line responsibility to take urgent action to address the issue.

Catherine Byrne (Dublin South Central, Fine Gael)
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I apologise that the Minister is not here. I do not know where he is but I have been asked to respond.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I hope he is not missing.

Catherine Byrne (Dublin South Central, Fine Gael)
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He is gone missing but I do not know where he is. I am sorry that he is not here.

On behalf of the Minister of State, Deputy Jim Daly, I thank Deputy O'Keeffe for raising this issue. The Health Service Executive is responsible for the delivery of health and personal social services, including those at facilities such as St. Patrick's community hospital, Fermoy. Fermoy Community Hospital is an integral part of the Fermoy community and plays a major role in the care of older people from the town and the surrounding areas. The hospital currently has 71 beds, 54 of which are for long-term care with the remaining 17 providing convalescence, respite and palliative care. Medical cover in Cork and Kerry community hospitals and nursing units is provided by medical officers who are local general practitioners employed under contract by the HSE. This service is not a full time, on-site service, with GPs visiting at agreed times and when required during normal day time working hours. Out-of-hours cover for all residents is provided by SouthDoc after 5 p.m. on weekdays and at weekends or bank holidays. The Deputy will be aware that the provision of full medical officer cover has proven difficult at Fermoy since September 2017, following the retirement of the one of the local GPs, and more recently with the resignation of another in March 2018.

Medical cover at Fermoy Community Hospital is currently provided by a local GP. The latter provides 0.8 whole-time equivalent medical hours cover. In effect, this means that full medical cover is provided for all 54 long-term care residents, three convalescent patients and one palliative care patient, in addition to any respite admissions who are registered patients of the GP's practice. The HSE has acknowledged that the difficulties in attracting a GP or GPs to take on unfilled parts of the medical officer post is impacting on the take-up and full use of the nine respite beds in Fermoy. However, respite beds which are managed through public health nurses in the community remain open and are being utilised. It should also be pointed out that the other community hospitals and nursing homes in the surrounding areas are offered and utilised when respite care is required.

Due to the lack of full medical officer cover, respite admissions require a person's own GP to complete the assessment and administration process and to be available, if required, during the core hours of 9 a.m. to 5 p.m. It should be noted that difficulties have arisen when some GP practices in the local area have advised that they are unable to provide medical cover for their patients during respite due to work pressures and capacity issues within their own practices. Cork Kerry Community Healthcare continues to seek a permanent and sustainable solution to providing full medical cover at Fermoy Community Hospital. The GP who currently provides this service has indicated to the HSE that he is willing to provide full medical officer cover to the hospital once he has resolved the GP locum situation that continues to be problematic for him and his practice.

Kevin O'Keeffe (Cork East, Fianna Fail)
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I thank the Minister of State for her reply. As I said previously, the response is glamorous but it does not solve the problem. The Minister of State has said that there has been a problem in Fermoy since September but the problem did not start then. The HSE would have been aware that a problem was going to arise well before September 2017. I do not want to be seen to be repeating myself. In that context, the Minister of State was here on the previous occasion when I raised this matter. She promised then that she would ask the Minister to get back to me with more constructive answers but I have heard nothing. I have been in communication with the HSE on the matter in the meantime and have received various different answers. At one point, the HSE, in a rushed response - the Ceann Comhairle may recall this - referred to five days but forgot about the other two days in a week.

As I indicated earlier, this is having a knock-on effect throughout north Cork. It is jeopardising other families who have access to other community hospitals in the area. Previously, these families were getting more than the minimum respite period because they were able to avail of respite at other facilities but now they are being restricted. If families cannot get a GP to go with their loved ones to the respite care unit in Fermoy, the HSE diverts them to Mallow or, in some instances, to other nursing homes. Questions arise in this context too because many families send their loved ones to nursing homes at their own expense. Those nursing homes often have more beds than community hospitals but are not required to provide full medical officer cover. Why is the requirement for such cover so rigorously enforced for community hospitals? Ironically, SouthDoc is situated on the same driveway as Fermoy Community Hospital. SouthDoc has a resident doctor available 24-7. Why can the HSE not liaise with SouthDoc when locums cannot fulfil their temporary contracts?

Catherine Byrne (Dublin South Central, Fine Gael)
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Again, I thank the Deputy for raising this very important issue. Respite care availability is an issue with which all public representatives deal on a daily basis. I am sorry that this is the second time that Deputy O'Keeffe has had to raise this issue in the House. I have been present on both occasions to deliver the departmental response. I emphasise to the Deputy that when I deal with a Topical Issue matter in this House, I go back to the Minister with line responsibility and explain the situation, verbally and by email. I am sorry that today's answer does not meet the Deputy's requirements. However, I reiterate that the GP who is currently providing cover is willing to provide full medical officer cover but, unfortunately, he is having problems finding a locum to fill in for him in his practice. I read a report on this matter before coming to the Chamber. The HSE is willing, ready and eager to fill this post but has not been able to do so to date. In view of the Deputy's ongoing concerns and the fact that he believes that today's reply is not adequate, I will make it my business to contact him either later today or Monday and speak to him about the matter again at length. I offer my apologies to Deputy O'Keeffe.