Paul Gavan (Sinn Fein) | Oireachtas source

The Minister of State is very welcome. I wish to raise the issue of health services in County Clare, with specific reference to the drastic curtailment of the Shannondoc service. As no doubt she is aware, Shannondoc is an urgent out-of-hours GP co-operative that was established in 2002. Its main purpose was to provide an urgent out-of-hours GP service to the people of the County Clare area. On November 14 of last year, despite protests from the local community, the service was massively scaled back in the county. Both Shannondoc centres at Kilrush and Ennistymon have relocated to Milltown Malbay on weekdays from 6 p.m. to 8 a.m. and on weekends the service is operational until 7 p.m. As Kilrush has such a large catchment, Shannondoc decided that it would introduce a nurse service on weekday evenings for an additional two hours to enable remote video consultations to soften the blow of taking the doctor away fully.

According to the HSE, which funds Shannondoc to the tune of nearly €5 million each year, the reason for the scaling back of the service is not related to funding. According to Shannondoc, the reduction in service is as a result of the inability to attract doctors to work in rural areas combined with a lack of available locums. Changes in immigration law in 2015 have also been cited as making it unattractive for locums. The long-standing failure to complete negotiations for a new GP contract has also been cited.

With the withdrawal of the Killaloe service, patients in east Clare now face the prospect of travelling to Nenagh, Limerick or Ennis to be seen by a GP after 6 p.m. We are informed that neither the Minister nor the HSE can determine or make changes to the decision of individual practitioners. The HSE promised to keep the situation under review every three months for the next 12 months. I ask the Minister of State to give me the details of that review in her reply. I would be interested to hear how the review got on and what were the results. A HSE spokesperson has been quoted as saying that the HSE might consider a rethink of the situation if there were "significant or adverse consequences to these changes". I wish to repeat that: If there are significant or adverse consequences to these changes, the HSE may consider a rethink of the situation.

What does that mean? Does it mean that it might reconsider the situation if a few people die? If so, how many deaths are required? This is a publicly funded service and families rely on it. What will the Minister do? Are the Minister and the Minister of State telling the people of County Clare that they do not deserve the same level of out-of-hours GP services as the rest of the country? Are people in rural parts of Ireland now expected to be treated as second-class citizens? I remind the House that, in the context of County Clare, the hospital in Ennis has been downgraded. Fianna Fáil took care of that. It only runs a 12-hour accident and emergency unit. There are no maternity services in County Clare. People living in remote parts of the county cannot get sick after 6 p.m. because the nearest doctor is stationed an hour's drive away. That is the same length of time it would take them to drive to the hospitals in Limerick or Galway, which happen to be the two hospitals worst hit by over-crowding.

I want answers with regard to the review, the action her Department is taking to address the situation, the GP contract negotiations and the visas issues that have been raised previously with the Minister.