Mike Kennelly (Fine Gael)
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I welcome the Minister of State. I am speaking on a promise I made to the people of north Kerry that, when I became a voice for them in the Seanad, I would do what I could to reinstate out-of-hours SouthDoc services in Listowel. SouthDoc is an out-of-hours GP service operating across Kerry and Cork, providing urgent medical care when a person's regular GP is unavailable. It is designed for situations that require prompt attention but are not life threatening. This issue affects the everyday lives, well-being and safety of the people of north Kerry. An out-of-hours SouthDoc service needs to be reinstated in Listowel as soon as possible. As it stands, there is no out-of-hours GP service in Listowel or anywhere else in north Kerry. Residents in this large rural region from Astee to Abbeydorney - I will give the Minister of State a geography lesson - Ballylongford to Ballyduff, Ballybunion to Ballyheige, Moyvane to Kilflynn, Tarbert to Lixnaw, Duagh to Causeway, Lyracrumpane to Finuge and into Listowel town - that is the area - require this emergency service to be reinstated. This large area has a growing population, as many do, an elderly population and a large sporting population, so the need outscores any claim against it.

Right now, these people must travel to Tralee after hours to access urgent care. For many, that is a 40 km to 50 km journey one way. In a medical emergency at night with young children or for elderly and vulnerable patients, that is not safe, fair or sustainable. I mentioned Astee. If there is a game there today before 8 p.m. and there is a casualty and stitches are required for a young person, by the time they get to Tralee and back, the cut would probably have closed up itself. It is not fair.

Listowel is significant regional town. We are fortunate to have a new, modern primary care centre that provides an excellent range of wrap-around services - GPs, nurses, physiotherapists, mental health support and more - but we do not have an out-of-hours GP service. That is the missing piece in a system that should be built to serve people where they live, not force them to travel long distances in distress.

What message does that send to the people of north Kerry? That their health is less important? That their distance makes them second-class citizens? That is how many in our community feel. Parents tell me they are terrified when their children get sick in the middle of the night. Elderly residents are delaying getting help and local emergency departments are already under pressure because there is no nearby alternative for a basic out-of-hours service. This is not just a convenience issue, it is a public health issue that is only getting worse.

We are not asking for something extraordinary. We are asking of the same level of access to care that other towns of a similar size and population have. If the infrastructure is available and in Listowel, then an out-of-hours service must follow. In the Minister of State's own area of west Cork, he is well aware of the SouthDoc service in Clonakilty into Bantry and Skibbereen and even over to Macroom. We need this service, which his own area has.

I call urgently on the Minister for Health, the HSE and the management of SouthDoc to do the right thing and re-establish an out-of-hours SouthDoc space in Listowel, give the people of north Kerry what they deserve - safe, timely and local medical care no matter the hour. Healthcare access should not depend on your postcode. We need action now before this gap in service leads to even greater harm.

Christopher O'Sullivan (Cork South-West, Fianna Fail)
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I thank Senator Kennelly for raising this Commencement matter, which I am again taking on behalf of the Minister for Health. He is absolutely right. We have the same service in Cork South-West. I understand that reconfigurations have happened over recent years and that these have caused concern. Consolidation and reconfiguration happen, and this causes concern. I hope to allay some of those concerns. If there are any questions I cannot answer, I will revert to the Minister.

I will outline how the service works. GPs are private practitioners. Most of them hold contracts with the HSE for the provision of health services on its behalf. GPs contracted under the general medical services, GMS, scheme are required to make suitable arrangements to enable contact to be made with them or with a locum or deputy for urgent care outside of normal practice hours. The GPs participate in GP out-of-hours co-operatives as a means of meeting this contractual requirement. As the Senator will be aware, the SouthDoc co-operative provides out-of-hours urgent GP care within Cork and Kerry. While they are private organisations, the HSE provides substantial funding to support out-of-hours co-operatives through service level agreements, so the HSE does have a role here. There are many factors involved in the delivery of the SouthDoc service including the availability of doctors, staff and infrastructure. Delivery of the service is supported by a bespoke patient management system and a call centre where all patient calls are acknowledged, documented and triaged. The co-operative provides a medical service to a population of approximately 736,000 in addition to visitors to the area. It dealt with over 200,000 patient contacts in 2024.

SouthDoc constantly reviews its service provision to ensure its continued viability. With specific regard to Listowel, a service consolidation plan was implemented in January 2024. Three doctor teams, those at Castleisland, Listowel and Tralee, were consolidated to provide a more sustainable out-of-hours service to the people of north Kerry. While routine appointments are scheduled in Tralee, the service plan includes the retention of the Listowel treatment centre for urgent appointments based on clinical need. A dedicated home visit division then provides care for patients unable to attend an out-of-hours treatment centre. In addition, the plan includes the direct employment of doctors to supplement the local GPs in the out-of-hours service and the addition of locum doctor supports at weekends and on public holidays.

SouthDoc has advised that these changes were essential to maintaining the SouthDoc service in the north Kerry area. It reports the implementation was necessary to alleviate service pressures that were undermining the sustainability of both the daytime and out-of-hours general practice service for patients. The HSE advises that the revised model of service is showing positive results, with both Listowel and Tralee reporting an increase in expressions of interest from GPs to join daytime practice in these areas. SouthDoc states it is committed to the long-term continuation of the provision of the out-of-hours service in the north Kerry region. All treatment centres in the area remain available to the out-of-hours service as necessary. The provision of this service will continue to be evaluated by SouthDoc and the HSE on an ongoing basis.

That is an outline of the consolidation efforts that were made. Similar efforts were made in Cork South-West, which did cause concern. From what we have seen so far, there has not been a drop-off in the level of service patients are getting. The critical point here, which the Senator alluded to, is trying to attract GPs to work in areas like north Kerry and Cork South-West. That is the key challenge. The more GPs we can get to take up positions in rural areas, the more comprehensive an out-of-hours service we can provide. I hope this consolidation will attract more GPs to the north Kerry area, which would allow the service to get back to the levels the Senator has talked about.

Mike Kennelly (Fine Gael)
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I thank the Minister of State for the reply. I have seen this before. Let us be honest. I will go back to what I said in my opening contribution; the population here has grown nearly twofold. We should be thankful that it has. During the Covid pandemic, many of the kids came home to live and work in the area and in their family homes. They have stayed in the area. Football team numbers are increasing. Everything is increasing. However, what has unfortunately been decreasing is emergency out-of-hours care services. The out-of-hours service contract covers from 6 p.m. to 8 p.m. every evening. In Listowel, it was initially from 6 p.m. to 11 p.m. but that has disappeared. It is okay to say that someone will come out if it is important but, at the top end of north Kerry, that is not 25 minutes later but five hours later. It is just not good enough. For many people, it is not accessible although, if you do not have transport, someone will come out.

In the context of health, it is a case of picking and choosing. It is not sustainable. It is not something that can continue until we get a full service in the primary care centre in Listowel, as I have mentioned. To take anything else out of this is just not good enough.

On the out-of-hours service, the two areas of Ballybunion and Ballyheigue are on the Wild Atlantic Way. The population grows threefold or fourfold during the summer months. When do accidents happen and when do kids fall? It is almost always out of hours. There is nothing fast available. If I travel to Listowel tomorrow morning, the accident and emergency department will probably be clogged up. I would be clogging that system up and clogging up the whole HSE format. I ask for a written statement from the HSE that it will review this situation and what I have stated here on the floor of the Seanad as soon as possible. We need this. It is an urgent medical call from the people of north Kerry to the HSE and to SouthDoc management, who have not been forthcoming. Many councillors from the Listowel area have asked for these boys to come to the table and they have refused. I ask the HSE to review this with SouthDoc and to come back to the people of north Kerry with a positive answer.

Christopher O'Sullivan (Cork South-West, Fianna Fail)
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I will absolutely request such a review. The Senator is right. SouthDoc has its own management structures and board. The HSE has very little input into its day-to-day running but it does fund the service so it must expect an appropriate level of service. The Senator gave a good lesson on the geography of Kerry. I am familiar enough with north Kerry. It is very similar to west Cork in many ways in that it is huge geographically. You have got peninsulas and inlets, so it is geographically awkward and requires a bespoke approach to out-of-hours services. In some instances where patients find it difficult to go to the SouthDoc centre, the idea of GPs being driven out to visit homes can work. For example, where an older person would find it difficult to make the journey, that can work. I take the Senator's general point and will go back to the Department of Health and the Minister to ask for a review as soon as possible.