Pat Gallagher (Donegal, Fianna Fail)
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Go raibh maith agat.

Carol Nolan (Offaly, Sinn Fein)
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Like Deputy Cowen I am absolutely outraged and appalled by the decision to close MIDOC services in Edenderry and Birr without any consultation or communication with public representatives or the general public. It is outrageous. We will not accept it. We are asking for solutions to be put forward and for our services to be reinstated, because we will not tolerate or accept this ridiculous decision, which puts patient safety at risk. It was unacceptable for public representatives to learn of these closures from constituents who were unable to access the services a few short weeks ago. People in Edenderry, Birr and north Tipperary depend on the vital basic services that MIDOC offers in these towns. As I say, we will not be tolerating or accepting these closures, so what we want is a move towards reinstating and developing our health services to satisfaction in Offaly. Like many rural counties we are being left behind and we need our primary care facilities developed.

The closure of these services was met with great anger and frustration at a recent public meeting held in Birr and attended by hundreds of constituents. Neither the HSE or MIDOC representatives attended this particular meeting. This was another insult to the general public and to the public representatives. The Minister for Health, Deputy Simon Harris, and the Minister of State have a responsibility here. I am calling for the Minister of State to intervene immediately to ensure that these services are not removed, but improved.

As a TD for Offaly I will be pursuing this issue, seeking for the services to be reinstated and nothing less than that. I outlined this position at a meeting with the HSE representatives and other public representatives from the county only last Tuesday. It was disappointing that this meeting had to be adjourned due to the absence of MIDOC representatives. We were informed at this meeting that a risk assessment had been carried out by GPs who had concerns about the practice of one GP working alone in the centres. While we all agree that GPs should have a safe working environment, who is responsible for a risk assessment for our constituents as patients? They run a risk too if this goes ahead. Patient safety should always be of paramount importance and the closures will have a very serious impact on their safety.

We are all aware of the GP shortage. What plans does the Government have to address this issue? What plans does the Minister of State have to develop primary care centres in Offaly? I call on him to put forward solutions to address this shortage, instead of allowing MIDOC to close vital and basic out-of-hours services in our towns. As the decision to close the services was not based on an independent review, but a review commissioned by the GPs, I am calling for the reinstatement of services. It was not done properly.

Pat Gallagher (Donegal, Fianna Fail)
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I note that two wrongs do not make a right.

Carol Nolan (Offaly, Sinn Fein)
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Tá brón orm. Bhí orm é sin a rá.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputies Barry Cowen and Carol Nolan for raising this very important issue. I want to begin by reassuring the Deputies that there has been no reduction in funding or total GP clinical time allocated to the MIDOC services. Second, I understand the decision to reorganise MIDOC services in Offaly was taken by participating GPs in conjunction with the HSE and that they believe the revised arrangements will ensure a better out-of-hours services can be delivered to patients, with increased availability for call-outs and home visits to patients where clinically indicated.

The MIDOC service was established in the west Offaly region in December 2002 by the HSE and the GPs who volunteered to provide the service. A review of MIDOC services in Offaly was undertaken by the participating GPs in 2017. The review identified a number of concerns regarding the satellite sites in Edenderry and Birr, concerning clinical risks, the ability to respond effectively to medical emergencies and risks faced by locum doctors working alone. It is important to note that only limited out-of-hours cover was provided in Birr and Edenderry. The service was part-time only and home visits from these sites were not possible. On some days the service was only open for two hours and on other days no service was provided at all. For presentations outside the limited operating hours of both satellite centres, patients already had to attend the nearest full-time treatment centre, which would have been in Tullamore, Athlone or Longford.

In light of these concerns, and to ensure the quality and safety of patient services, the decision was taken that from 2 April 2018 MIDOC would operate only one fully-functioning treatment centre in Tullamore that covers the entire Offaly population. This is in line with other MIDOC centres across the midlands. The HSE has reviewed the current monthly activity levels of the out-of-hours services in Offaly and I understand the Tullamore treatment centre will be more than capable of absorbing patients from Birr and Edenderry. An additional doctor has also been assigned duty in Tullamore during weekends and public holidays to facilitate the more effective management of emergency call-outs to the entire county, including Birr and Edenderry. Additional administrative support will also be provided to free up doctors' time, resulting in more patient contact and a more effective overall out-of-hours service. As the Deputies will be aware, local HSE management met with the public representatives from Birr and Edenderry on 17 April to discuss the reorganisation of MIDOC services.

At this meeting, the Health Service Executive accepted the need for improved public communication around such service changes in future and this is undoubtedly the case. The HSE has requested a further meeting between public representatives and Midoc and the Deportment has asked the HSE to keep it updated on developments.

I again reassure the Deputies that there has been no reduction in funding or total general practice clinical time allocated to the Midoc service. The HSE and the general practitioners participating in Midoc remain committed to providing a safe and effective out-of-hours service to all patients in County Offaly.

Carol Nolan (Offaly, Sinn Fein)
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With respect, funding was not flagged as an issue. The Minister of State wishes to give himself a pat on the back for the great job he and the Government are doing, but he would be wrong to do so. We have been informed that two basic and vital services will be withdrawn from our towns. The Minister of State did not address that issue or the fact that the review to which he referred was not independent. Apart from general practitioners, no one was consulted and Midoc and the HSE learned of it at a later stage. The Minister of State did not address the crucial issues.

I found deeply worrying a statement made by the Minister in a reply to a parliamentary question that he is statute barred from engaging in the process initiated by the HSE to review the delivery of health services. He is the Minister for Health. As public representatives, we are the first line of communication between our constituents, as patients, and the Minister. All of us are committed to mechanisms to achieve the best clinical outcomes for every patient, wherever they are in the country but particularly the most vulnerable and isolated citizens. The Minister should note that these closures will not be accepted. He must find an immediate solution and establish an independent review.

Finian McGrath (Dublin Bay North, Independent)
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I am standing in for the Minister and I will bring to his attention the concerns and views expressed by Deputies Nolan and Cowen.

On the public consultation, the decision to provide general practitioner out-of-hours cover for the population of County Offaly was taken by the general practitioners who participate in Midoc in conjunction with the Health Service Executive on foot of an independent review which identified specific concerns regarding locum doctors working alone at the Birr and Edenderry Midoc sites. Local HSE management met public representatives from Birr and Edenderry on 17 April to discuss the reorganisation of Midoc services.

Finian McGrath (Dublin Bay North, Independent)
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At that meeting, the HSE accepted the need for improved public communication. It followed up with a request for a further meeting between public representatives and Midoc. This request has been submitted to Midoc and is being considered. We are, therefore, moving on the issue.

Finian McGrath (Dublin Bay North, Independent)
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As of 1 March, there were 24 vacancies in the general medical services, GMS, scheme nationally. As there are almost 2,500 general practitioners contracted to provide services under the GMS scheme, this constitutes a relatively low vacancy rate of less than 1%. All vacancies are currently covered by locum general practitioners and a GP service continues to be provided in all the affected areas.

The HSE national primary care division has undertaken a national review of the current GP out-of-hours service and a final report is expected to be completed by the end of the second quarter of 2018. We are, therefore, listening to concerns.

Finian McGrath (Dublin Bay North, Independent)
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The report will make recommendations on the future provision of out-of-hours general practitioner services. I will bring the concerns raised by the Deputies to the attention of the Minister.