Paul Coghlan (Fine Gael)
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I welcome the Minister of State to the House.

Terry Leyden (Fianna Fail)
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I thank the Minister of State, Deputy Helen McEntee, for attending. Roscommon has drawn three of the Commencement matters today, which shows how active are Roscommon Senators. There is also one from Mayo.

I ask the Minister for Health, Deputy Simon Harris, to resolve the outrageous circumstance in which a two-year old child is being pursued for €100 by Intrum Justitia for attending the accident and emergency department at Portiuncula Hospital in November 2015. Like all children under six years of age, this child from Roscommon town has a GP visiting card. Her parents' income is just €400 per week. She was rushed to the accident and emergency service at Portiuncula Hospital last November. Unfortunately, as the Minister of State knows, we have no accident and emergency service in Roscommon at the moment thanks to a decision taken by Senator Reilly when he was Minister for Health in the Fine Gael Government in 2011. Her distressed mother phoned Westdoc when her daughter took ill in the middle of the night last November. The Westdoc personnel told her to give the child Calpol, which the child then vomited up. Her temperature continued to rise. It was the middle of the night and Westdoc told her to go and get Nurofen. No shops were open locally which sold Nurofen and the Westdoc personnel said there was nothing else they could do. The family then drove to Portiuncula Hospital to seek immediate medical attention for their very ill child.

The Westdoc doctor should have seen a child whose temperature was rising out of control and who was vomiting. Had a Westdoc doctor seen her and been unable to address her symptoms, he or she would have signed a letter for the accident and emergency department exempting her from any charge. As a former chairman of the Western Health Board, I find it morally wrong that a two-year old child, who is covered under the GP visit card and was not provided with a service by Westdoc, is now receiving threatening letters from Intrum Justitia in respect of legal action on a bill of €100. It is an international company and I have named already the directors from Sweden and elsewhere.This is an international company and I have already named its directors who are from Sweden and elsewhere. This issue must be resolved immediately for the family concerned and an assurance given that all children under six attending accident and emergency departments will not be billed and their families pursued by a legal debt collection agency.

It should be noted that the child in question had to be brought to Portiuncula Hospital as the accident and emergency department for Roscommon town which was located in Roscommon hospital was closed by the last Fine Gael-led Government weeks after taking office in the summer of 2011, despite promises delivered in the square of the town to keep the department open. The current situation is totally inadequate and unacceptable to the people of Roscommon and surrounding areas who have had no accident and emergency services at Roscommon County Hospital, now known as Roscommon University Hospital. The name was changed but the hospital did not have its status improved. The HSE has failed to deliver a rapid response ambulance service in County Roscommon which was promised since the wrongful closure of the accident and emergency department five years ago.

The family to which I refer then received a letter from Saolta requesting the money. When I was chairman of the former Western Health Board and such issues came before me, I would have dealt with them more pragmatically, especially given the fact that the family made the effort to contact WestDoc but that service would not see the child and would not give the family a referral letter. Indeed, WestDoc could have supplied such a letter retrospectively, pointing out that the family had contacted the service. The family made an effort to contact a GP before attending the accident and emergency department at Portiuncula Hospital. Given the circumstances, this matter should be resolved and the fee waived. Frankly, the bill has been sent to the child but the child is only two years old and does not have €100. The family is simply not in a position to pay it.

Helen McEntee (Meath East, Fine Gael)
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I thank Senator Leyden for the opportunity to address the House on this matter.

First, it is important to point out that it is not appropriate for me to comment on any individual or specific case. However, I have been advised that this issue has been resolved favourably for the people involved. I cannot go into any more detail in that regard.

Regarding charges for attendance at emergency departments, there is a statutory fee of €100. This fee is payable by patients who do not have a medical card and who attend an emergency department without a referral letter from a GP. The fee is, of course, applicable to a patient's first visit as part of an episode of care but patients with medical cards do not have pay this fee. It is important to remember that this fee for presenting at and emergency department is the only outpatient charge currently payable in our public hospital system.

Expanding and utilising primary care services to best effect is a core element of an integrated approach to alleviating pressures on our emergency departments. There are now 13 community intervention teams in place and in the first half of 2016, these have reduced hospital bed requirements by approximately 73 beds per day. A total of 92 primary care centres have opened with a further 39 at the preliminary stages of development. A project to increase access to diagnostic services in GP surgeries is currently delivering approximately 1,300 ultrasound scans per month while the GP minor surgery pilot project has delivered just over 4,200 procedures since commencement. Also, in the first half of 2016 usage of out of hours GP services increased by 14% over 2015. In September the HSE published the winter initiative 2016-17 which provides €40 million of additional funding for winter preparedness. Under this initiative, community intervention team services are being expanded in four regions and the availability of aids and appliances in primary care has been increased to facilitate patients being discharged from hospital back to their own homes. The Department of Health continues to work with the HSE to develop and expand primary care services but also to ensure that these services work effectively in order to reduce the necessity for patients to attend emergency departments.

Without going into the details of the particular case referred to by the Senator, we must make sure that when doctors or nurses on call feel that they can fast track a patient to the appropriate care, that is taken into account and the charges are not applied. Again, I would stress that I am advised that this matter has been resolved favourably for those involved.

Terry Leyden (Fianna Fail)
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I thank the Minister of State for her reply. It is a pity that the Department did not inform me before now that the matter was resolved.

Helen McEntee (Meath East, Fine Gael)
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I was informed that information was forwarded to the Senator.

Terry Leyden (Fianna Fail)
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I have a letter here, dated 12 October, which states the very opposite. That letter says that the child was liable for the charge because the child's family has a GP visit card, not a full medical card. This issue has been going on for weeks and weeks. I thank the Minister of State for being here this morning but she could have been saved the trouble of appearing before the House if someone had phoned me and told me that the matter had been resolved. I would then have withdrawn the commencement matter.

While the 92 primary care centres are very welcome, there is an issue with regard to staffing. Furthermore, I repeat the fact that we do not have an accident and emergency department in Roscommon meant that the child to whom I refer had to be brought to Portiuncula Hospital. That is a fact.

Again, I thank the Minister of State.

Helen McEntee (Meath East, Fine Gael)
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I was advised that information was sent to the Senator but perhaps it has not reached him yet. I apologise for that.