Billy Kelleher (Cork North Central, Fianna Fail)
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I move:

That Dáil Éireann:acknowledging the:

— selfless dedication to their work, of the paramedics in our ambulance service;

— high quality of care that they provide; and

— uniquely pressurised nature of the work they undertake;

recognises that:

— there is nationwide concern and disquiet about the provision of ambulance services;

— this situation can be exacerbated by delays in accident and emergency wards;

— in 2013 only one in every three people with life-threatening conditions were responded to within the target time;

— delays in ambulance response times far exceed both national and international accepted norms;

— large areas of the population right across the country are regularly left without any local ambulance cover;

— the Health Service Executive lowered the ambulance response time targets to 80 per cent in 2012 and 70 per cent in 2013; and

— the centralisation of control and dispatch has led to concerns about a lack of local knowledge and the impact that can have;

notes that:

— the Republic of Ireland, with a population of 4.6 million, has an ambulance service that employs less than 1,600 staff and an annual budget of €137.4 million;

— Northern Ireland, with a population of 1.7 million, has an ambulance service that employs just fewer than 1,200 staff with an annual budget of £62 million (€78 million); and

— Scotland, with a population of 5.3 million, has an ambulance service that employs over 4,500 staff with an annual budget of £203.5 million (€258 million);

believes that:

— while paramedics do their utmost to provide a service to the highest international standards, this is impossible with current budgets;

— it is essential that paramedics be properly resourced to carry out their work; and

— such resources are not currently forthcoming from the Government; and

calls for the ambulance service to be appropriately resourced so as to ensure a safe and efficient service nationwide.

At the outset I must put on record the selfless dedication to their work of the staff of the national ambulance service and their diligence in providing an extremely valuable service at the most difficult times. It is important when discussing these issues that we do not try to deflate morale, that we are conscious of the pressures the staff are under and the fact that they are working in extremely difficult circumstances and that they have their arms tied, in a way, due to lack of resources.

We tabled this motion because we have had serious concerns for some time about the national ambulance service. This has been highlighted time and again. I have tabled numerous parliamentary questions over recent times to elicit information from the Department, the Health Service Executive and from the Minister about the national ambulance service and the views they hold on it. There appears to be a disparity between the views of officialdom, what is happening with the ambulance service on the ground and the type of service it provides to the citizens of this country. This was brought to a head in the "Prime Time" programme, which was very damning of the management of the national ambulance service, the Department, the HSE and the lack of resources available to the men and women who provide emergency cover throughout the State.

We have heard a great deal recently about Health Information and Quality Authority, HIQA, reports and HIQA carrying out a due diligence analysis of the national ambulance service. Any investigation or critique of the ambulance service will show that it is under-resourced, not only with regard to vehicles but also in terms of staff. Until there is an acknowledgement by the Minister and the HSE that this is a key problem in the delivery of safe emergency care, we are all wasting our time. The reason we tabled this motion was to highlight the inadequacies and deficiencies in the service and, hopefully, to get a positive response from the Minister and others who, to date, have been denying there is a problem in the national ambulance service. I do not believe the Minister is not aware of the problem, but there appears to be a reluctance to admit the difficulties and challenges the people in the service face daily in trying to deliver safe care.

Many individual incidents have been highlighted. There have been many tragic cases and I do not wish to add to the families' grief by naming them in this House and consistently keeping them in the public domain, but they have been identified and catalogued on numerous occasions. They were repeated again in the "Prime Time" programme. If people are to have confidence in the transition to hospital groups or trusts and the downgrading of some accident and emergency departments, they must know definitively that an ambulance service will be available to them when they require it.

A look at the statistics and data that have been compiled will show the service is simply not meeting the guidelines laid down by HIQA regarding first responder and an ambulance arriving on time, which is within 18 minutes and 59 seconds. These are specific times and they are provided for a reason. They represent international best practice and if these targets are reached, lives will be saved. Unfortunately, the service only reaches the targets 63% or 64% of the time. That is simply unacceptable.

When one compares the resources and time responses in the Republic with those in Northern Ireland and in Scotland, it is easy to see why the ambulance service is incapable of delivering the service that every citizen in this country expects and deserves. We simply do not have enough personnel or vehicles. There have also been some issues with the transition to a national call centre, but given that this transition might bring about more efficiencies in time, the key issue is personnel and vehicles.

There is a further issue. The Minister has put great emphasis on his successes and achievements in reducing the number of people waiting on trolleys in emergency departments, but there is another cohort of people that will have to be counted as well. It is not just the number of people waiting on trolleys but also the number of people waiting in ambulances to be brought into the emergency department. That is happening. The amount of time that ambulances are tied up outside emergency departments throughout the country is simply unacceptable, for many reasons. There are situations now where emergency vehicles arrive at the emergency department with their patients but they cannot unload the patient into the emergency department because of overcrowding. Cases have been identified to the Oireachtas health committee where ambulances have had to wait three and four hours before they could unload the patient. That is a bizarre waste of the time of personnel, who should be back on the road providing other emergency cover, and of the vehicle, which is tied up for hours, while the patient is in the ambulance when they should be in the emergency department.

There is a major problem in that regard and I hope the Minister will acknowledge it and address it in terms of resourcing. I understand the constraints under which the Department and the Minister are working. However, to deny there is a problem is an issue of major concern.

With regard to the Dublin Fire Brigade and the efforts of the HSE to seize it, I often wonder why we take the route of reconfiguration and reform when the Dublin Fire Brigade has been providing a valuable service in a very efficient manner for many years. It has a dedicated workforce of advanced paramedics and paramedics. The idea is that the HSE would annex it and subsume it into its organisation, which is not, to say the least, a shining example of efficiency in terms of the use of resources.

I only have a short time to speak but there is another area of the use of resources which I will refer to in more detail when replying to the debate tomorrow night. It is the issue of some of the national ambulance service management personnel and the use of emergency vehicles. This is an area which I believe the Committee of Public Accounts should investigate. If the committee does not investigate it, the Minister should.

It is simply unacceptable that we have scarce vehicles traversing this country not on call or in response to emergency calls but parked outside the homes of senior management. This is an unacceptable practice and must be examined, and I hope the Minister has asked for a full audit of it. If he has not asked for an audit, the Comptroller and Auditor General should be brought in to investigate the use of public funds for this purpose. It should also be referred to the Committee of Public Accounts, because this is simply an unacceptable use of scarce assets.

Some of the figures have been supplied to me in a very diluted way. I tabled several parliamentary questions and while I respect that those who reply to them are doing their duty, sometimes I receive couched answers and we should also look at that. The bottom line is that the National Ambulance Service does not have the resources and is overstretched. It is servicing a population of about 4.6 million people. It has not got the capacity to deliver a safe, efficient and effective service. The Minister is putting people's lives at risk by not putting adequate resources into it. He is putting huge stress and pressure on the personnel who provide emergency cover for our citizens every day and night. He needs to do an awful lot more to address this. I know he has asked the Health Information and Quality Authority to investigate, but what is HIQA investigating? Can HIQA subsequently inform the Minister that his resourcing of the National Ambulance Service is inadequate and that, to comply with international best practice, it needs additional personnel and additional vehicles? If the report suggests that, will he increase recruitment and funding?

We tabled this motion to highlight the palpable fear that exists. This is not scaremongering; this is happening every day and night in communities throughout the country. Rural Ireland is a case in point, where people simply do not know, if they are involved in an accident or if they need an emergency response vehicle or an ambulance, whether it will come on time, within a reasonable time, or at all. I believe this motion was tabled for one reason, which is to try to get the Minister, the HSE and the management at the National Ambulance Service to accept that they are not meeting the critical response times necessary to save lives. If they continue, lives will be lost, so I urge that the motion does not fall on deaf ears and a meaningful response is provided.

John Browne (Wexford, Fianna Fail)
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I compliment Deputy Kelleher on tabling this motion. It gives us an opportunity to express our concern and to highlight the difficulties faced by people in our constituencies waiting on the ambulance service. There is nationwide concern and disquiet about the provision of ambulance services, with delays in ambulance response times far exceeding national and international recommended norms. Large areas of the population throughout the country are regularly left without any local ambulance cover. While dedicated and professional staff do all they can, it is obvious that more resources will be required to address the deficit in service provision.

Several incidents and many recent media reports have brought the quality of our ambulance service to the fore over recent months. The "Prime Time" television programme gave a very comprehensive and revealing insight into the problems on the ground. Alarmingly, it also seemed to indicate a management culture that is effectively in denial about the scale of the difficulties. While watching the programme, I was amazed that the person in charge of the ambulance service would not accept there was a problem and that there will be a problem down the road unless extra resources are made available. He seemed to be programmed to give the one stock reply that everything was fine, when we all know the ambulance service is not what it should be. The ambulance service management should spell out clearly to the Minister the difficulties involved, instead of saying that everything is rosy when it is not. It is clear the service is underfunded and understaffed and, while it remains this way, it will be impossible for the ambulance service to meet the recommended response times.

As the National Ambulance Service Representative Association pointed out after the "Prime Time" broadcast, "we do not have the personnel or the vehicles to meet these targets and it is time for the National Ambulance Service to accept that these targets are unrealistic unless cutbacks are reversed". That is not a political charge from this side of the House, but is coming from the National Ambulance Service Representative Association.

My county of Wexford is certainly under-resourced, especially at night. There are only three ambulances operating during the night in Wexford, which has a population of 140,000. That population increases to 190,000 people in the summer, when Dubliners and many other visitors come to their holiday homes in the county. Wexford General Hospital and the ambulance service are expected to provide an adequate service, despite no increase in funding from the Department of Health. This is causing major problems because, on many occasions, there are only two ambulances operating because the third ambulance has gone to Waterford Regional Hospital with a patient who requires orthopaedic attention. As a result we have only two ambulances at night for a population of more than 140,000. There were more ambulances at night in Wexford in the 1970s and they had a carrying capacity of two, yet now we only have a carrying capacity of one. This highlights the reduction in service that has taken place and which does not in any way meet the need of the population.

There is much disquiet that the closure of the Wexford control centre will occur when the new national control centre is in operation, and there is certainly a lot of disquiet about that because people feel that while it is diverted to Dublin, they will not have the local knowledge or the expertise on the townlands and communities involved. This is not a move in the right direction.

There are only four advanced paramedics in Wexford. I understand more will be trained and allocated to different counties in future. The advanced paramedics do a great job. They are essential before the ambulance arrives and it is important there is more training of advanced paramedics sooner rather than letter.

With a population of 4.6 million, Ireland has 1,600 ambulance service staff. With a population of 1.7 million, Northern Ireland has 1,200 staff, while Scotland employs 4,500 staff and has a population of 5.3 million. That proves without doubt that the National Ambulance Service in this country is underfunded and understaffed. Perhaps the Minister can comment on how he expects the services to be provided in this country with a lot fewer staff than our counterparts in Northern Ireland or in Scotland.

Deputy Kelleher spoke about the delays in the accident and emergency departments, and certainly we have had huge delays at the accident and emergency department in Wexford General Hospital, and I am sure it is the same in every other hospital in the region. Overcrowding at accident and emergency departments causes difficulties for ambulances when they arrive with new patients as they cannot deal with any new calls until they transfer their patients to the care of the hospital. Information released under the Freedom of Information Act to The Irish Timesshows that many ambulances are regularly being held up for an hour or more at emergency departments when the HSE's target turnaround time for these ambulances is 20 minutes. We can see the farcical situation that exists there. Throughout the country in 2012 and 2013, these targets were being missed.

In the east, ambulances were regularly delayed by at least an hour in approximately 40% - and up to 48% - of cases in the first eight months of 2013. In the north west, almost one in five ambulances had a turnaround time of more than an hour last December. That cannot be said to meet the times designated by HIQA in any way. In the midlands, ambulances were held up for at least an hour in more than 80% of cases in January, March, May and July of last year before they were able to transfer patients to accident and emergency departments and depart on new calls.

The difficulties that are being faced by the ambulance service and its staff will continue as long as the Department of Health is not making funds available to the HSE. I do not think the Minister is being told the truth or being given the facts. If one were to listen to what the head of the ambulance service had to say on "Prime Time", one would think everything was grand. The reality on the ground is that things are not working out fine. Things are not what they should be. The Minister should spend some time visiting hospital services. He should go to accident and emergency departments to see the situation where ambulances are operating.

The episode of "Prime Time" to which I refer suggested that many rapid response vehicles are being used as company cars, in effect, by some staff of the National Ambulance Service. I hope that is not the case. According to "Prime Time", this is what is happening. The use and apparent abuse of these vehicles raises serious issues that must be confronted by the management of the National Ambulance Service. The National Ambulance Service Representative Association has valued each of these high-specification vehicles at approximately €100,000. Ambulance people have pointed out to me that the €6 million which was spent on such vehicles would buy 24 much-needed ambulances.

Perhaps the Minister will explain in his reply what he is doing in response to the recent "Prime Time" investigation. I am aware that HIQA is now involved. The practices that were depicted on "Prime Time" are not desirable and should not be tolerated in this House. As the head of this country's health service, the Minister should not be tolerating them. It seems from the evidence that was outlined on "Prime Time" that rapid response vehicles are being put to significant personal use and are making little if any contribution to the provision of emergency care. As I have said, this is intolerable.

It seems that many vehicles are not being used at night or at weekends to attend emergency call-outs. This calls into question the efficiency of the system. Why are we spending huge amounts of money purchasing such vehicles if we are not using them to provide services in the intended manner? It was highlighted clearly on "Prime Time" that we did not get value for money in the case of the recent purchase of vehicles at a cost of €100,000 each. I ask the Minister to clarify in his response if he has found out whether the "Prime Time" allegations are true. If so, what has he done to ensure ambulance personnel and management do not continue to use these vehicles in this manner? Will they now be used to provide the important emergency services that are required by people who are suffering from heart attacks or other ailments and need to get to hospital as quickly as possible?

Éamon Ó Cuív (Galway West, Fianna Fail)
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Tá áthas orm go bhfuil deis agam cúpla focal a rá maidir leis an tseirbhís otharcharranna. Is dócha gurb é an rud is suntasaí ar fad ná cé chomh fada agus a bhíonn ar mhuintir an iarthair fanacht ar otharcharr. Tá sé léirithe nach mbíonn ach 45% de ghlaonna amach i gceantar an iarthair ann laistigh den am atá molta le haghaidh cásanna éigeandála a bhaineann le taomanna croí, srl. Ní bhíonn ach 49% ann laistigh den am i gcásanna an dara grád síos, a bhaineann le cásanna práinneacha eile. Dá mbainfí as leithéidí cathair na Gaillimhe agus baile Chaisleán an Bharraigh, is dócha go mbeadh an figiúr sin i bhfad níos ísle amuigh faoin tuath san iarthar. Glacaim leis go bhfuil áiteanna san iarthar nach dtarlaíonn sé seo ar chor ar bith.

Ba mhaith liom a fháil amach ón Aire, i bhfianaise na díospóireachta a bhí againn cheana féin ar an gceist seo, céard atá i gceist aige a dhéanamh. Cuireadh in iúl don Aire cheana gur tháinig muid aníos le freagra ar an gceist seo, le maoiniú Stáit; sé sin, go mbeadh otharcharranna deonacha ar fáil sna ceantair is faide ó bhaile ionas go mbeadh seirbhís ar fáil iontu. Tá sé ráite linn le gairid go bhfuil fadhbanna traenála ann. Ba mhaith liom freagra sonrach a fháil ar dhá cheist. An mbeadh sé níos fearr otharcharr sciobtha le daoine traenáilte - ach b'fhéidir gan iad a bheith traenáilte ag an ardleibhéal amach is amach - a bheith ar fáil, nó gan otharcharr ar bith a bheith ar fáil laistigh den am atá molta? B'fhéidir go bhfuil an tríú rogha i gceist. Cén fáth nach féidir daoine deonacha a thraenáil suas go dtí an caighdeán a bheadh ag teastáil? Tá na daoine sásta an obair a dhéanamh go deonach, tá na feithiclí ann agus tá an trealamh is nua-aimseartha ar fad curtha ar fáil. Breathnaíonn sé gurb fhearr leis an gcóras drochsheirbhís a chur ar fáil - d'fhéadfadh go mbeadh sé ródhéanach i go leor de na háiteanna seo - seachas suí síos agus féachaint conas is féidir acmhainní an phobail a úsáid.

Ní chreidim go mbaineann sé seo le hairgid amháin. Creidim go mbaineann sé le dearcadh, le heaspa nuálaíochta agus le heaspa tuisceana. Tá sé cineál áiféiseach gur féidir le ceann de na hotharcharranna seo dul go dtí cluiche peile, seó caorach nó imeacht eile mar sin ar eagla go bhfaigheadh duine éigin taom croí. Áirítear go mbeadh sé feiliúnach le feidhmiú i gcás éigeandála den sórt sin, ach ní bhraithim go mbeadh sé feiliúnach an rud ceannann céanna a dhéanamh dá mbeadh éigeandáil ag do theach nó mo theach. Ní thuigim an míniú atá ar an scéal sin. I gcás an t-otharcharr is gaire domsa, ar an bhFairche, bhí an dochtúir sáite isteach san obair pobail a bhí i gceist ansin. Bhí sé bainteach leis an otharcharr. Tá a fhios agam i gcásanna éigeandála go mbíodh sé sásta dul leis an othar isteach go Gaillimh. Tuigeann na pobail tuaithe go gcaithfidh siad cur ar a son féin, agus go minic nach féidir na seirbhísí a thabhairt chomh fada leo i dtráth ceart.

Ba mhaith liom ceist na seirbhísí ar Oileáin Árainn a ardú leis an Aire i gcomhthéacs an costas agus, dar liomsa, an mhístuaim a bhaineann leis an gcóras atá á oibriú ag an HSE i láthair na huaire. Tá caint ann go bhfuil comhghleacaí an Aire, sé sin Aire Stáit na Gaeltachta, ag iarraidh deireadh a chur leis an tseirbhís aeir go dtí Oileáin Árainn. Ba mhór an trua dá dtarlódh sé sin, ós rud é go n-úsáideann na seandaoine ar fad ar na hoileáin, nach mór, an tseirbhís aeir. Bhí socrú ann ar feadh na mblianta fada, dá dtarlódh éigeandáil i rith an lae agus dá mbeadh duine le tabhairt go Gaillimh ar chomhairle an dochtúra, go mbainfear na suíocháin amach as an eitleán - go minic, bheadh an t-eitleán ar Inis Mór nó ar cheann eile de na hoileáin ar aon chaoi - agus go gcuirfear an t-othar isteach. Tógfar é nó í go dtí na Minne agus tagadh an t-otharcharr as Gaillimh chomh fada leis na Minne. Bhí ar an HSE beagáinín airgid a híoc le hAer Arann, ach i gcomhthéacs an airgid a bheadh i gceist, bhí an socrú sin saor.

Mar mhalairt ar sin, níl an HSE sásta aon airgead a híoc le hAer Arann. Cuireann siad glaoch ar an ingearán as an tSionainn nó an t-ingearán as Áth Luain le teacht isteach agus an t-othar a thógáil ón oileán. Mar is eol don Aire, tá costais ingearáin in aghaidh na huaire i bhfad níos mó ná costais eitleáin atá ar an láthair ar aon chaoi. Ní bheadh i gceist ach cúpla céad euro leis an eitleán a fháil le haghaidh turas mar sin. Is eol don Aire go bhfuil costas mór ag baint leis na hingearáin troma sin a thabhairt chomh fada leis na hoileáin. Mar nach bhfuil ar an HSE íoc go díreach as an ingearán, is cosúil go gceapann siad go bhfuil sé níos saoire ar an Stát ingearán a thabhairt isteach seachas eitleán Aer Arann a úsáid. Ar ndóigh, dá mbeadh an t-ingearán ag tabhairt othar nach raibh chomh tinn sin go Gaillimh nuair a tharla éigeandáil amuigh san fharraige, ní bheadh an t-ingearán ar fáil leis an obair a dhéanamh.

Mar sin, is cosúil go bhfuil córas ar bun atá mí-éifeachtach, atá ag cosaint airgid agus atá ag cur as do sheirbhísí. Dé réir mar a thuigim, ag éirí as seo uilig, bhí ar an dream atá ag plé le cúrsaí sláinte agus leighis ar na hoileáin níos mó úsáide a bhaint as an mbád tarrthála le cúpla bliain anuas ná mar a baineadh as le fada an lá. Glacaimid uilig atá ag plé leis na hoileáin leis gurb é an t-ingearán an t-aon réiteach san oíche, mar nach bhfuil aon bhealach ag na heitleáin dul ann i rith na hoíche. Nuair atá siad ag dul isteach is amach as na Minne i rith an lae - go minic, bíonn siad ar na hoileáin ar aon chaoi - níl dua ar bith úsáid a bhaint astu. Mar sin, is sampla é seo de bhealach eile ina bhfuil airgead á chur amú ag an Stát. Níl taobh amháin den Stát ag cur ceiste ar an taobh eile den Stát faoi céard atá ag tarlú.

Go ginearálta i dtaobh na bhfigiúirí, deirtear go bhfuil staitisticí agus bréaga ann agus gur féidir staitisticí a iomrascáil le freagra ar bith a fháil. Ar ndóigh, tá sé an-éasca a rá go náisiúnta go dtagann na seirbhísí seo ar an láthair laistigh den oiread seo achar ama, nó laistigh den tréimhse atá leagtha síos. Cén fhad a chaithfidh na hotharcharranna dul i mBaile Átha Cliath? Cén t-aistear bóthair atá i gceist? Ar ndóigh, tá an chuid is mó den daonra suite thart ar mhórcheantar Bhaile Átha Cliath. Ní thugann sé sin léargas cruinn ceart ar na fadhbanna atá roimh na pobail tuaithe i dtaobh na seirbhísí seo. Sílim go mbeadh sé thar a bheith spéisiúil dá mbeadh an tAire agus an Roinn in ann mapa a réiteach agus a fhoilsiú a leagann amach cé mhéad de ghlaonna a bhíonn ar an láthair taobh istigh den sprioc ama, ach é a bheith réitithe ar bhonn tíreolaíochta seachas ar bhonn daonra. Dá ndéanfar é sin, bheadh sé soiléir go bhfuil spotaí dubha móra millteacha in áiteanna sa tír nach bhfuil éinne ag caint fúthu. Tá an Rialtas in ann na figiúirí a fháil ceart trí staitisticí na tuaithe a mheascadh le staitisticí na cathrach.

Mar sin, tá jab mór le déanamh ag an Aire. Tá cothromas le fáil. Tá pobal na tuaithe sásta a gcuid féin a dhéanamh leis an bhfadhb a réiteach. Is cosúil go bhfuil dearcadh righin diúltach don nuálaíocht agus d'aon cur chuige a réiteodh fadhbanna ag an HSE. Is léir nach bhfuil an tAire ag rá leo go gcaithfidh siad breathnú ar chóras nua-aimseartha agus plé a dhéanamh leis na pobail. Teastaíonn seirbhís agus cothromas ó phobal na tuaithe mar aon le pobal na cathrach.

Dara Calleary (Mayo, Fianna Fail)
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I thank Deputy Kelleher for the opportunity to debate this motion.

At the end of February, Ms Laverne McGuinness, the deputy director-general of the HSE, addressed the Joint Committee on Health and Children along with the managers of the ambulance service. At that meeting, she stated:

The primary role of the ambulance service is to deliver a responsive emergency service to the public in pre-hospital emergency care situations, with patient care at the heart of this service. Care begins immediately at the time the call is received right through to the safe transportation and hand-over of the patient to the receiving hospital.

In County Mayo tonight there are two ambulances based in the Castlebar region, one in Ballina and, since it is Tuesday, one on call in Belmullet. If they get called out of the county, as they do given the approach of operating on a regional basis, there will be no ambulance. The Minister will know Belmullet as his roots are there. Erris is the size of County Louth. We are saying that but one ambulance on call there tonight is good enough for the people there. Anybody taken seriously ill in Belmullet tonight will immediately be brought to Mayo General Hospital so the ambulance will be gone from the region for at least two hours. That is for a basic call. We saw the consequences of this recently. Former Deputy Dr. Jerry Cowley had to deliver a baby because the ambulance that was to bring a pregnant lady from Achill to Castlebar was late arriving.

Deputy Jerry Buttimer chaired the meeting at which Ms McGuinness was present. She and the managerial staff were genuine in their belief that the original model is the way to go. However, the practical consequences in large rural areas are such that the model does not work as desired. We are not scare-mongering in that there have been deaths, including in Donegal and Louth. The case in Louth was particularly tragic because it was in a large urban setting that the response did not happen. It is not fair to lay the blame completely at the Minister's door. Deputy Brown stated the Minister is not being given the full picture. He has a reputation for carrying out on-the-spot checks and calls. I encourage him to make an on-the-spot call some night to the national ambulance call centre to determine the cause of what is happening

When one examines the HIQA target and the reality pertaining to calls, one realises fewer than one third of calls are within the target time. Perhaps HIQA in its upcoming review will revise the appropriate target time so people will have a realistic expectation as to when an ambulance called will respond to their need. They just might need to find another way of getting their loved one or other sick person the care they need straightaway.

It very much boils down to resources. As my colleagues have pointed out, resources have been made available, including jeeps and rapid vehicles. On the "Prime Time" programme, we saw how they are being used. It is now three weeks since the "Prime Time" programme but there has been no adequate explanation given for the use of the vehicles in the meantime. If the resources the Minister has provided are not being managed in such a way as to put patient care at the centre, it is another issue that either the Minister or HIQA will have to consider in the context of the review.

It has been incredibly difficult to obtain answers to parliamentary questions on the national ambulance service. The reason Minister of State Deputy Kathleen Lynch became involved is that she replied on behalf of the Minister to a topical issue. I raised with her the difficulty in obtaining a response to a question. On one occasion, it took three months to get basic information back. On another occasion, I asked how many ambulances had left County Mayo to answer calls in other counties, and vice versa. I was told that information on response times on a county basis, in addition to the number of occasions on which ambulances from outside County Mayo are deployed to answer calls in the county, is not available. The ambulance service does not record these data. The location of one's vehicle, or any company asset, and the service it is providing at any given time is basic management information, yet it cannot be provided. In order to measure how the regional policy is working, surely the ambulance service should have at its fingertips the location of the four ambulances on call in County Mayo tonight.

It should be able to tell this tomorrow, if someone goes looking for it for any reason. The same applies to any county in terms of where the ambulances were tonight or this time last year, if they have any basic management information system in place to record ambulances. I presume they have tracker systems and GPS. This strikes me as a very strange and unco-operative system in terms of trying to get basic information on how such an important service works.

When we think outside the box in terms of the ambulance service, it can work. The emergency aeronautical service has been a huge success and has directly saved lives, and the Minister might clarify if there are any plans to expand that. However, there is also enormous frustration among the staff of the service. As with all public service workers, they are subject to all of the cuts of recent years. Ambulance personnel in particular have to cope with extra pressure and trauma due to their place at the front line of our emergency services. There is also the question of the definition of, for example, those within the service who have trained and qualified as paramedics and who do the duty of a paramedic but who only get paid as an EMT, which is a grade below paramedic. There are quite a number of such people within the service.

I put that question to Mr. Dunne on the night of the committee meeting and he avoided answering it. To be honest, putting down another PQ to the ambulance service and waiting a few months for a response is a waste of my time. I would like the Minister to look into this and to explain what are the divisions within the service which mean very qualified and dedicated people feel alienated from their colleagues because of some sort of grade issue. These people are doing the same job as those working with them, but those working with them are getting paid more.

In the view of Mr. Dunne, we apparently have the best ambulance service in the world. We do not. The notion that he thinks that is actually quite frightening, as is the notion that he was able to go on "Morning Ireland" and express this in the context of the programme he had viewed the day before, and in the context of the fact some of his workers bravely co-operated in the making of that programme and gave their version of events inside Leinster House. We have the best ambulance workers in the world, of that I have no doubt, and all of us know of examples where they have responded to calls. All of us will stand with them when they face God knows what or when they get a call at any stage. I have seen this personally. However, have we the best service in the world? Have we a service that actually treats the best ambulance workers in the world with respect? Clearly, we do not. Have we a service that is run and managed with what it aspires to have, namely, to have patients and patient care at the heart of the service? There is no way we can say that, under this alignment and this way of running things, patient care is at the heart of the service. I say we must give the people who work in the service the service they deserve, give the people who need the service the service they deserve and give the country the ambulance service it needs based on its geographical make-up.

James Reilly (Dublin North, Fine Gael)
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I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

“acknowledges ambulance service personnel for the high quality of care they provide;

recognises that:

— in the 12 months of 2013, ambulance services responded to over 281,000 emergency calls, an increase of almost 14,000 calls on 2012;

— since 2011, the National Ambulance Service has implemented response time standards on a phased basis, in tandem with planned service improvements;

— in order to drive improvements in response times, a new target has been set in the national service plan for 2014, for 80% of life-threatening calls to be responded to within 19 minutes, when last year’s target was between 68% and 70%;

— response time indicators are not clinical indicators and do not measure patient outcomes, accordingly the National Ambulance Service, in line with other jurisdictions, is developing clinical outcome indicators for pre-hospital emergency responses;

— ambulances are now strategically deployed - they are not located at a single station during a shift but where they are most likely to be required;

— the National Ambulance Service is currently developing a national emergency department turnaround framework to ensure consistent and rapid intervention to any delay in ambulance turnaround times;

— ambulance turnaround times at hospitals are monitored on a continuous basis via the command and control centres and an escalation policy is operated in the event of any issues arising; and

— dedicated emergency aeromedical support is provided to rural areas, particularly in the west, where land transit times may not be clinically appropriate;

notes the:

— significant reform programme which is currently underway to reconfigure the way the Health Service Executive, HSE, manages and delivers pre-hospital care services, to ensure a clinically driven, nationally co-ordinated system, supported by improved technology;

— single national control system, due for completion in 2015, will improve our control and dispatch performance thereby improving response times;

— ongoing reform of rostering practices whereby the practice of ‘on call’ rostering is being replaced with ‘on duty’ rostering which leads to faster deployment as the crew is in position to respond immediately to calls; and

— development of the intermediate care service, which transports patients between facilities thus freeing up emergency vehicles to focus on emergency calls;

further notes that:

— three separate reviews are currently under way, the aim of which is to improve our ambulance services;

— a national capacity review is currently under way to determine the level and use of resourcing required for a safe and effective service now and into the future;

— the Health Information and Quality Authority is currently reviewing the governance arrangements of pre-hospital emergency care services to ensure the timely assessment, diagnosis, initial management and transport of an acutely ill patient to an appropriate health care facility;

— a joint review of the Dublin Fire Brigade ambulance service has been commissioned by Dublin City Council and the HSE, to determine the best model for emergency care provision in Dublin; and

— despite the pressure on the health care budget generally, this Government has prioritised ambulance services and additional funding of €3.6 million and 43 staff have been provided in the national service plan 2014; and

commends the Government on its commitment to the further improvement of pre-hospital emergency care services.”

Frank Feighan (Roscommon-South Leitrim, Fine Gael)
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Is that agreed? Agreed.

James Reilly (Dublin North, Fine Gael)
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At the outset I would like to thank the Deputies for raising this issue and providing me with the opportunity to reaffirm to the House this Government's commitment to the development of our ambulance service. I will deal with some of the points raised. In recent years we have made a very significant investment in the ambulance fleet, in new technology and in our workforce. Indeed, in 2014 an additional €3.6 million and 43 staff have been provided to the National Ambulance Service in the HSE service plan. A major reform programme is now under way to reconfigure pre-hospital care services in Ireland. This reform programme will ensure a clinically driven, nationally co-ordinated system, supported by improved technology. Our aim is to provide a service that is safe, high quality, timely and patient centred, with at all times the outcome for patients at its core.

First, however, let me address the issue of response times. There have been a number of media reports recently regarding delayed responses, and I want to take the opportunity to confirm that responding to emergency calls within target is a key objective of the National Ambulance Service. It is acknowledged, however, that response times around the country vary, based on a number of factors including geographic and demographic challenges, as in the west, which was referred to by a number of Deputies; road networks; the use of emergency ambulances for inter-hospital transfers; and hospital hand-over times.

HIQA has set emergency response time targets and these have been implemented by the National Ambulance Service on a phased basis since 2011, in tandem with planned service improvements. In the case of calls classified as Echo, which are life threatening cardiac or respiratory calls, the 2013 target set by the HSE was that 70% of such calls should have a patient-carrying vehicle on scene within 19 minutes. In the case of Delta calls, which are calls for life threatening conditions other than cardiac or respiratory, the target was 68%. Notwithstanding the fact that the volume of emergency calls increased last year by, from memory, some 1,000 a month, national responses for Echo calls were less than 1% below the target of 70%, with some regions performing as high as 79%. For Delta calls, national performance was just under 4% less than the target of 68%. Therefore, it is not true to say that, in the case of serious illness, only a third of calls are met within the target time, as it is over two thirds. I would also point out that while the National Ambulance Service did not reach its targets in 2013, it responded to more calls within the target time than in 2012. If the volume of calls had remained constant, there would have been an even more significant improvement in response times.

I have to point out to the Deputies opposite that in their term of 14 years in government, they never bothered to mention response times, let alone measure which ambulances were in County Mayo or outside it at any given moment.

Billy Kelleher (Cork North Central, Fianna Fail)
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That is factually incorrect. There were guidelines of ten minutes, 20 minutes and half an hour. They were there.

Dara Calleary (Mayo, Fianna Fail)
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What has this Government done in three years? Is two hours an improvement?

James Reilly (Dublin North, Fine Gael)
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We are here and we are improving it in a methodical fashion. However, the Deputies have a very short memory - a convenient amnesia brought about, I suppose, by too many years in government.

Dara Calleary (Mayo, Fianna Fail)
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The Minister does not suffer from it.

James Reilly (Dublin North, Fine Gael)
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In order to drive improvements in response times, the bar has been raised this year and a new target has been set in the national service plan for 80% of all life threatening calls to be responded to in less than 19 minutes this year. It is worth noting that when this Government took office, as I said, there were no response time targets at all as the previous Government was not even measuring them.

Billy Kelleher (Cork North Central, Fianna Fail)
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That is factually incorrect and the Minister knows it. He is directly misleading the House. He knows there were target times.

Frank Feighan (Roscommon-South Leitrim, Fine Gael)
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The Minister, without interruption.

James Reilly (Dublin North, Fine Gael)
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I beg Deputy Kelleher's pardon. There was not and they did not measure them, so how could they know? This is the Fianna Fáil modus operandi, of course: if you say it often enough, it becomes so. This goes right back to Charles J. Haughey and his approach to life.

Frank Feighan (Roscommon-South Leitrim, Fine Gael)
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The Minister, without interruption.

James Reilly (Dublin North, Fine Gael)
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I should, however, caution that while response times are helpful for performance measurement, they give a very narrow view of service performance and should not be used in isolation. Accordingly, when we are assessing performance, we should also have regard to patient outcome indicators. I am pleased that the first outcome key performance indicator, which is for the return of spontaneous circulation in the emergency department for heart attacks under certain defined circumstances, is being introduced by the National Ambulance Service this year.

The National Ambulance Service is proactively seeking to improve response times and has put in place a performance improvement action plan. The plan has 57 action points including improving call-taking allocation and dispatch and crew mobilisation times; appropriate targeting of emergency and intermediate care vehicles; and improving emergency department turnaround times.

A key measure of the reform programme is the national control centre reconfiguration project. The National Ambulance Service has operated in eight ambulance regions with no interconnection of radio and computer systems. This has delayed improvements in emergency response times, particularly at regional boundaries, where the nearest ambulance may be in the neighbouring region. A reconfiguration project is under way to establish a single national ambulance control centre on two sites, with significant investment in new voice, data and mapping technologies. This is in line with best international practice and will allow the National Ambulance Service to deploy emergency resources more effectively and efficiently, regionally and nationally, rather than within small geographic areas. The national control centre will be located in Tallaght and Ballyshannon, with the project expected to be completed next year.

In 2013, under the control centre migration plan, Cork, Tralee and Navan control centre functions moved to the national ambulance service control centre at Townsend Street, which has operated a computer-aided dispatch platform since November 2013. National digital radio, TETRA, is now online in the former east region - that is, Dublin, Kildare and Wicklow - Cork and Kerry, and the former north east - that is, Louth, Meath, Cavan and Monaghan. It will roll out to other areas during 2014, starting with the former west area.

In co-operation with staff, the National Ambulance Service, NAS, is successfully moving from on-call rostering where staff are off-site waiting to be summoned to on-duty rostering where paramedic crews are in their stations or vehicles during shifts. This leads to faster deployment as the crew is in position to respond immediately to calls rather than the average on-call deployment of over 20 minutes.

A key performance issue has been the use of emergency ambulances for routine inter-hospital patient transfers. NAS is developing dedicated non-emergency patient transport through the intermediate care service for routine transfers. This frees up emergency resources for emergency tasks improving response times and performance. The intermediate care service with over 73 intermediate care staff and 36 vehicles now operates in Cork, Galway, Sligo, Letterkenny, south Dublin, Mayo, Limerick, Louth, Monaghan, Cavan, Kerry, Waterford, Sligo and Roscommon. Further staff will be assigned in 2014. This obviously frees up more emergency vehicles to deal with emergencies.

As I indicated, improving turnaround times in emergency departments is addressed in the performance improvement action plan. Ambulance turnaround times at hospitals are now monitored on a continuous basis via the command and control centres. When an issue regarding turnaround time arises, NAS operates an escalation policy. This escalation policy involves contact via the command and control centre to the hospital emergency department and the dispatch of an ambulance resource manager to the emergency department to assist in the mitigation of the delay. I should also mention that NAS is currently developing a national emergency department turnaround framework to ensure consistent and rapid intervention to any delay in ambulance turnaround times. In response to Deputy Browne's allegation that there are regular hour-long delays, the turnaround time is not reported in the performance monitoring report but NAS is now gathering this data. However, the average time turnaround in Wexford General Hospital in March was 22 minutes and 42 seconds and times of one to two hours occurred in under 5% of cases. In response to Deputy Calleary, I will check out the delays in responses to parliamentary questions. That is not in anyone's interests and should be addressed.

I noted earlier that one of the factors affecting response times is geographic and demographic challenges, particularly in isolated rural areas such as in the west of Ireland. One of the ways in which we have met this challenge is through the establishment of the emergency aeromedical support service. This is a pilot project between NAS and the Air Corps which provides dedicated aeromedical support in the west and other areas, specifically where land transit times would not be clinically appropriate. The emergency aeromedical support service completed 368 missions in 2013, one third involving STEMI-type heart attack patients who need time-critical transfers to primary percutaneous coronary intervention, PCI, units for treatment. In other words, they need a stent within 90 minutes of the onset of the heart attack. A review of the pilot project found a clinical need for the service and that it should be established on a permanent basis. An inter-service group is examining how best to do this. Agreement has been reached with my colleague, the Minister for Defence, to extend aeromedical support by the Air Corps until June 2014, pending decisions on how best to establish a permanent service. With 14 years in government and more money than one could count, Fianna Fáil could never put an air ambulance service in place. Another vital service provided by NAS is the neo-natal retrieval care service, which was expanded in December 2013 to a 24-hour, seven-day-a week service. This service transports critically ill infants with their clinical care teams to high acuity care. It has now completed over 100 transfers.

The ambulance service is under scrutiny in a way that has never happened before. Three reviews are taking place at present with a view to further improve our ambulance service. First, HIQA is conducting a review of governance arrangements in pre-hospital emergency services to ensure timely assessment, diagnosis, management and transport of acutely ill patients to appropriate health care facilities. This review includes an assessment framework designed against the national standards for safer better health care.

The objective of the review is to seek assurance that NAS has in place a clear strategic direction with implementation plans and control measures for the national service; robust governance and leadership arrangements at all levels within the service; clearly defined schemes of delegation; appropriate controls in place through service-level agreements with third parties delivering services on behalf of the national service; appropriate quality and risk management arrangements; a well-organised, skilled workforce with a culture of continuous improvement; and the use of care pathways, clinical outcomes and other performance indicators that demonstrate that the ambulance service is both safe and effective. It is anticipated that the review will lead to a range of recommendations aimed at ensuring NAS is enabled to develop and benchmark its services using modern outcome indicator data used by similar ambulance services internationally. At my request, HIQA brought forward this planned review of NAS and I am pleased that the review has now commenced. I understand that the review will be completed by the end of the year.

Second, NAS has commissioned an independent national capacity review to determine the level and use of resourcing required for a safe and effective service. The capacity review is a tool used by many emergency medical services around the world in order to identify the volume and location of resources required to achieve optimal effectiveness and efficiencies, improve performance and deliver a better service to the patient. The capacity review will be undertaken by the Association of Ambulance Chief Executives from the UK. The association has wide international experience in operational and strategic reviews of this kind. The review has begun and it is expected to be completed in the third quarter of this year.

Finally, in the context of the development of the national control system, the Dublin City Manager and the HSE's chief operating officer commissioned a joint review of Dublin Fire Brigade's ambulance service. The review will consider all aspects of Dublin Fire Brigade's ambulance operations, including the capacity and capability of ambulance services. The review will inform consideration of the best model for provision of emergency medical services in the greater Dublin area. There has been much speculation about this review and I am aware of the concerns raised by some about the future of the service. I assure those concerned that I fully appreciate the long arid proud tradition of service provided by Dublin Fire Brigade to residents of Dublin. This review is not in any way a negative reflection on that service, rather it is a means to establish the best way forward in light of the move to a single dispatch system.

The three reviews are being conducted in parallel in a concerted effort to examine our pre-hospital emergency care services throughout the country with a view to identifying the best way to enable them to meet the challenges of the future. I look forward to the recommendations of all three reviews, which will be considered in a holistic and coherent manner. I am confident that the recommendations will guide us in the provision of a modern, forward looking service that is capable of delivering the best possible outcomes for the public.

I will touch on a few points that were raised around rapid response vehicles and issues raised by Deputy Ó Cuív about the air service to the islands. There is no discrimination between country and city as he would try to allege. Clearly, rural Ireland presents a greater challenge because of its geography and demographics. I am not aware of any diminishing of service to the islands. In addition, we also have the air ambulance service to support that. Both advanced and ordinary paramedics are very highly trained and can undertake a very high level of medical assessment and treatment - potentially life-saving treatment in many cases. Therefore, NAS has invested significantly in recent years in training ambulance staff to very high standards in both paramedic training, which is two years, and advanced paramedic training, which is an additional ten months, and the purchase of rapid response vehicles. As highlighted on RTE, an internal investigation and review are ongoing as to the use of rapid response vehicles. However, it is important to say that in the first three months of this year, officer vehicles responded to more than 630 incidents and over 250 of these were outside working hours. That is an average of seven responses a day, almost three of which have been outside working hours. It would not make sense to have these vehicles locked up in a station with the officer concerned having to drive a distance to get the vehicle to do the call. In the same way, we do not have people on call at home anymore but have them either in the depot or sitting in the ambulance ready to go.

Clearly, much has been achieved in reconfiguring and remodelling our ambulance service. In this regard, I acknowledge the very significant contribution made by ambulance personnel throughout the country whose commitment and dedication are second to none. As Deputies have acknowledged, they are working day and night to do the best by their fellow citizens. While we are making progress, I accept that we have more to do.

I am determined to make further progress in order that all our citizens have access to the efficient, modern ambulance service they deserve, regardless of where they live in the country. To this end, I assure the House that the National Ambulance Service will continue to modernise and reconfigure its services to ensure emergency pre-hospital care is delivered in an appropriate and timely manner.

I point out to Deputy Kelleher that I stood where he is now when his Government, despite all its resources, did not even measure response times and ambulances queued up regularly outside hospitals, especially in Dublin. We have increased the availability of ambulances through the use of our new intermediary care ambulances for inter-hospital transfer patients. The outcome for the patient is the key here. That is influenced not just by the ambulances but by the presence of our paramedics and advance paramedics who can ensure treatment gets to the patient as quickly as possible.

I do not talk about my achievements-----

Dara Calleary (Mayo, Fianna Fail)
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That would be a short conversation.

James Reilly (Dublin North, Fine Gael)
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-----but rather of the progress made by the excellent men and women in our health service who work day in and day out. What they have achieved and the progress they have made is remarkable, despite the fiscal fiasco Fianna Fáil left us. They have managed, despite reductions in staff and budgets, to realise a 34% reduction in the number of our people who must wait for long periods on trolleys, a 99% reduction in the number of our citizens who wait longer than eight months for inpatient treatment and a 95% reduction in the number who have to wait longer than a year for an outpatient appointment - something Deputy Kelleher's Government, despite all the money it had and all the time it was in government, would not even measure because it did not want to know.

We will continue to modernise, reform and improve our health service, including the National Ambulance Service, always with the goal of improving outcomes for patients because that is our core mission.

Billy Kelleher (Cork North Central, Fianna Fail)
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In the interests of correcting the record, response times were measured prior to this Minister taking office. He might correct the record in that regard tomorrow night or at some stage in the future. They were in the HSE service plans for years-----

James Reilly (Dublin North, Fine Gael)
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They were never measured.

Billy Kelleher (Cork North Central, Fianna Fail)
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Deputy Reilly should have read them when he was in opposition but obviously he did not.

Jerry Buttimer (Cork South Central, Fine Gael)
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Before Deputy Calleary leaves us, I wish to say I am really disappointed the Fianna Fáil Party, which promised an end to Punch and Judy politics, would come before us with a motion which, at its core, has nothing positive to offer, a bit like that party's health plan.

Patient care is at the heart of what we are about as people, whether as public health practitioners or public advocates and Members of the Dáil. At the end of his speech, the Minister referred to advance paramedics. I wish to put on the record of the House that we had an incident in our family where a member had to have an advance paramedic call to the scene of an accident. That advance paramedic was fantastic, professional and highly competent. He made his diagnosis quickly and made the injured person feel comfortable and reassured. I put on record that we have competent and highly skilled staff in our National Ambulance Service who deserve our support, be it in terms of the rhetoric we use or the resources we allocate. In particular, it behoves no one in this House to go on the public record or the public airways to stir up fear and hysteria just to score political points. Unfortunately, there are some, not necessarily those present, who have done that.

Our National Ambulance Service has undergone change and we must recognise that more change is needed. It is also important to put on record that lives are saved by first responders, advance paramedics, paramedics and ambulance crews. I welcome the National Ambulance Service action plan which calls for improved mobilisation times for crews, improvements in the timing and dispatching of ambulances, and engagement with the development of community first responders. It would be fair to say the safety of patients is of concern to those who work in the ambulance service. I very much welcome the service's commitment to reviewing its operations. As Deputy Calleary mentioned, members of the Oireachtas Committee on Health and Children had, earlier this year, a very interesting, frank and open discussion on ambulances and the role of the ambulance service. It is imperative we thank the men and women of our ambulance service.

It is also fair to say, in the context of change, that there have been issues around call-out times, how we locate ambulances and the numbers available at certain times of the day. Anyone involved in the health area should not shy away from scrutinising how we allocate resources. Those engaged in this debate will acknowledge we have met people in our constituency offices who have had issues with call-out times for ambulances to come to their loved ones. The people involved are real and it is very distressing when an ambulance is delayed for whatever reason, whether one is in Monaghan, Donegal, Roscommon, Cork or Louth. It is imperative to remember in the course of this debate that it is not about percentages or statistics but about people and their lives. Everything we do should be about improving the quality of the pre-hospital care provided to the citizens we represent.

I welcome the additional €3.6 million and 43 staff as part of the national service plan. It is welcome because, as Members know, our ambulance service straddles the four provinces and services both urban and rural areas, with different population masses. That presents a very important challenge. I very much welcome the undertaking of a capacity review. That review must be thorough, honest and it must be published in full. When we publish it, we will have a roadmap for continued modernisation and reform of the ambulance service.

The "Prime Time" programme was welcome because it raised many concerns that need to be addressed by all involved in the health area. Those who criticise must remember this is about the allocation of resources and the reform of a service which puts people at its core. I beg to differ with Deputy Kelleher in the context of the figures because by my reckoning, understanding and research, it is only since this Government came into office that there has been monitoring of the figures.

I will conclude by saying that 281,000 emergency calls were processed in 2013, 14,000 more than the previous year. A total of 56,833 emergency calls concerning life-threatening situations were answered within 19 minutes. There are tremendous people working in our ambulance service and they deserve our support.

Joe McHugh (Donegal North East, Fine Gael)
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This is a very important debate. When we debate an issue such as ambulance cover, we must acknowledge it is a highly emotive subject, as a recent example in my county illustrates. That was highly emotive and highly charged because a family lost a loved one. Time will tell exactly what happened, what should have happened and what should not have happened. I would like to put on record again the death of Mrs. Porter on the side of the road in Carndonagh. She was on a footpath waiting, along with her loved ones, for nearly an hour for an ambulance. That was wrong and should not have happened. I expect any investigation into such a situation will prove management systems were not working properly and were not functioning in the best interests of citizens. On that particular night in Donegal there was a helicopter nearby, a number of ambulances at Altnagelvin Hospital in Derry and up to four ambulances at Letterkenny General Hospital. While there were also emergency responders available, there was no effective communications system in place to ensure an ambulance got there on time. My constituency colleague, Councillor Bernie McGuinness, has argued repeatedly there should be two ambulances in Inishowen in order that when one is dispatched, emergency cover is still available. That should be taken into consideration in this debate.

Many Irish companies are embracing new changes within the United Kingdom and are using new technology for effective communication systems. As regards the Minister's contribution concerning the new mechanisms, no doubt new technology will be embrace that aspect also. It is not just for paramedics and others involved in emergency services, but also for the public. Citizens should be able to pick up their iPhones and see exactly where there is emergency cover at a given time. If someone is telephoning in sick and cannot go to work, a replacement system should be in place to ensure a proper, fully functioning, open and transparent communications system so that unnecessary delays do not occur.

Members of this House can debate politically to and fro, while referring to governments past, present and future. However, there is no accountability in this country when it comes to people in charge losing their jobs. The only people who lose their jobs are Members of this House because people will say: "We'll get rid of the last shower and will put in the new crowd to give them a chance". Ultimately, however, there is no accountability. There should therefore be a buck-stopping mechanism for those in well paid public service and Civil Service management jobs.

The aftermath of the flooding of Letterkenny General Hospital left a sour taste in the mouths of many local people who are asking questions about why it received planning permission. How did an engineer sign off on a building for which there was no proper system to ensure the culvert was cleared? All these questions are in the minds of the public, including those who have lost loved ones. Where does the buck stop? The media will have a field day blaming Government Ministers and other politicians for this and that. It is time we grew up in this House, however, and sought a mechanism whereby people in responsible positions, who are in charge of life-or-death scenarios, should be fully accountable. The buck needs to stop with them. If people are in charge when things go wrong, heads should roll. We need to debate that matter here.

There are protection mechanisms for people working in the public service. Many people in the public service are on very low wages, but a minority of staff are on very high salaries with highly responsible jobs. They are in charge of deciding whether people live or die, so we need a mechanism whereby the buck stops with them. People who are not performing in the right capacity should lose their jobs.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I wish to share time with Deputy Gerry Adams.

Frank Feighan (Roscommon-South Leitrim, Fine Gael)
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Is that agreed? Agreed.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I welcome this motion on the perilous state of our ambulance services, which was tabled in the name of the Fianna Fáil Deputies.

This Government has deliberately ignored, tried to gloss over or even dismiss many issues during its term of office, including the impact of its austerity policies on the most vulnerable, and the deepening housing crisis. I have not seen the Government completely ignoring any crucial issue as it has done with the ambulance situation.

In two recent engagements with the Minister for Health, Deputy James Reilly, I raised the ambulance crisis. At the Committee on Health and Children, and during ministerial questions, I prioritised this key matter of public health and safety. I can only describe the Minister's responses to me as dismissive in the extreme. He levelled the disgraceful accusation of "shroud-waving" at me and, by extension, at all who are raising concerns about our ambulance services.

There was not a syllable of acknowledgement from the Minister of the concerns raised in recent weeks. There was no hint of recognition of the deep hurt caused to many families who have seen loved ones suffering and, in some tragic cases, losing their lives in circumstances where ambulances arrived on the scene of accidents or medical emergencies far outside the HSE's target time. From a Minister for Health that is not good enough, to say the least.

The recent "Prime Time" investigation exposed the extent of what we know exists in this State - a crisis in our ambulance services as a direct result of cuts. There is huge public concern at the total inadequacy of emergency ambulance cover across huge swathes of the country. It is unacceptable that ambulances are often arriving too late and that people are dying as a result.

It is unacceptable that target times set by HIQA are not being met and, in fact, have been increased by the HSE. It is unacceptable that only one in every three people with life-threatening conditions was responded to by the ambulance service within the target time last year. I have said that again purposely because the Minister refutes it.

The Minister for Health needs to significantly increase the number of trained personnel and the number of ambulances as a matter of urgency. The Minister must also tackle HSE mismanagement of the service. For example, there is a scandalous misuse of rapid response vehicles as personal cars for managers, sitting outside their homes for long periods or parked in fleets at national HSE meetings, instead of serving the regions they are supposed to serve.

We cannot improve the ambulance service without significantly increasing personnel and infrastructure. Has the Minister compared the service in this State with the Six Counties and Scotland? The facts speak for themselves. With a population of 1.7 million the ambulance service in the Six Counties employs just under 1,200 staff, with 300 vehicles deployed from 57 bases and an annual budget of €78 million. Scotland, with a population of 5.3 million has 4,500 staff and 450 vehicles, including a full time air-ambulance, 100 bases and an annual budget of €258 million. Yet this State, with a population of 4.6 million, employs less than 1,600 staff, deployed from 87 bases, of which at least 10% are not 24-7, and has an annual budget of €137.4 million.

These figures speak for themselves. More importantly, however, survivors and families of victims of traumatic accidents and medical emergencies have spoken out and must be listened to. This ambulance service is one of the key pillars of our health services, literally a life support system. I want to pay special tribute to all who work in our ambulance services, and all the emergency services. We need to make very clear that when we express concern over response times, lack of coverage of large parts of the country with ambulance services and other problems facing the system, we are in no way criticising the dedicated work of ambulance crews. They are providing a modern, highly skilled and efficient service, but within the severe limits of the resources made available to them by Government.

Paramedics have yet to receive the proper recognition that their work deserves. The inadequate resources allocated to the service by successive governments, including the present Government, place them under enormous pressure on a personal and professional basis.

Of course, it is not all about resources. I acknowledge that ways of working have been improved and improvements are continuing but there is a limit. It is clear to me that there is a crisis in terms of the inadequate Government allocation to this vital service.

I agree with National Ambulance Service Representative Association, NASRA, which stated that targets are not being met because of shortages of personnel, infrastructure and funding. No amount of re-arranging or playing with figures can disguise that. Both NASRA and SIPTU point to the unfavourable comparison of this State with the Six Counties and Scotland, as I have mentioned.

My own region, comprising counties Cavan, Monaghan, Louth and Meath, is expected to survive with 12 ambulances available at any one time. I know from direct personal experience, and from the experience of my constituents, that the cover is totally inadequate. That is replicated across the State.

Another important aspect of this issue, though not mentioned in the motion, is the situation regarding Dublin. The Dublin Fire Brigade responds to 40% of the total number of emergency calls in the 26 Counties, yet it receives only 7% of the HSE's total ambulance budget.

There is a huge concern in Dublin that the HSE is now attempting to take control of the Dublin Fire Brigade ambulance service and that this will result in a worse service given HSE management's obvious incompetence and mismanagement. Hundreds of firefighters of the Dublin Fire Brigade, who provide an excellent service, including an excellent ambulance service, in our capital city, protested recently at Dublin City Hall with their friends, families and supporters.

The level of concern in Dublin and the lack of trust in the HSE was clear at a recent meeting of Dublin City Council's strategic policy committee at which it was noted that the Dublin Fire Brigade provided a professional and efficient ambulance service, that the veracity of data included in a recently disclosed internal review of the ambulance service was poor and questionable, that the committee supported one national review of the ambulance service as recently discussed at the Joint Committee on Health and Children and that the full cost of the ambulance service provided on behalf of the HSE by Dublin City Council was not being recouped. Calls were made for a national capacity review of the ambulance service and establishment of a national ambulance authority. The lack of confidence expressed by some committee members in the ability of the HSE to run the ambulance service was clearly representative of a wider view.

Sinn Féin fully supports the retention of the Dublin Fire Brigade ambulance service and opposes a HSE takeover. While we support the motion before us, we would go further and urge real reform as well as proper resourcing of ambulance services. HSE management cannot be trusted to run the ambulance service. We call for a State-wide audit of ambulance services with a view to increasing the number of front-line personnel and improving the infrastructure in order to bring the service across the State up to a safe and efficient level. Government cutbacks have meant that services across the State are insufficient and lives throughout the length and breadth of the jurisdiction are being put in jeopardy as a result. It is critical to remember the requirement to have cross-Border co-operation in responding to certain situations. That will be impacted unfavourably on foot of the cutbacks. Sinn Féin calls for a truly national ambulance service, including cross-Border co-operation and integration, outside the remit of the HSE and under a new national ambulance authority for the island of Ireland.

Gerry Adams (Louth, Sinn Fein)
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I pay tribute to the emergency workers, including ambulance crews and paramedics, who carry out vital work under very difficult circumstances without, in many cases, adequate resources and support. In 2008, there were 320 ambulances serving 4.5 million citizens in the State. Last year, the number had fallen to 265, dropping at night to a mere 113. The State has only half the paramedics per capitaof the North. Cuts by this Government and its predecessor have led directly to this situation.

I have warned a number of times of the risk to patient safety because of more cuts to the number of ambulance services available to cover the entirety of my constituency from Dundalk to Drogheda and all the places in between. In June 2011, a citizen died on the streets of Drogheda while waiting for an ambulance to arrive. In January 2012, it took 30 minutes for an ambulance to get to a fatal accident in Drogheda's town centre. At the beginning of this year, a young local man, Wayne McQuillan, died from stabs wounds. He had to be taken to hospital in a Garda car because of the slowness of the ambulance to arrive at the scene of the incident. The recent RTE "Prime Time" investigation revealed that despite life-threatening absences of available ambulances, rapid response vehicles costing taxpayers €100,000 each are parked for weeks outside the homes of senior management. Surely, this is unacceptable. Of all the crises under the Government, this one surely requires urgent action. I welcome the Fianna Fáil Private Members' motion and call on all Deputies to support it.

Finian McGrath (Dublin North Central, Independent)
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I am grateful for the opportunity to speak on this urgent and important debate on our ambulance service. Our paramedics do amazing work. This is a very important part of the engine room of our front-line services and it is vital to the provision of a quality health service generally. We can have all the talk we want about reform and change, but this is an opportunity to do something to ensure all our citizens get a decent and safe health service. I take the opportunity to commend and pay tribute to all of those in our front-line ambulance service, especially on the north side of Dublin.

When one looks at the facts, it is an eye opener. One can see clearly the gaps and urgent need for action. The Twenty-six Counties with a population of 4.6 million have an ambulance service which employs fewer than 1,600 staff and has an annual budget of €137.4 million. In the North of Ireland, which has a population of 1.7 million, there is an ambulance service which employs just under 1,200 staff with an annual budget of €78 million. Scotland has a population of 5.3 million and its ambulance service employs more than 4,500 staff and has an annual budget of €258 million. That is the reality on the ground and the reason we must fund our ambulance service, particularly on the north side of Dublin but nationally as well.

There is nationwide concern and disquiet about the provision of ambulance services. Delays in accident and emergency situations are a major issue. In 2013, only one in every three people with life-threatening conditions was responded to within the target time. Delays in ambulance response times far exceed internationally accepted norms. Large areas of the country are regularly left without local ambulance cover. While paramedics do their utmost to provide a service to the highest international standards, it is impossible for them to do so within current budgets. It is essential that paramedics be properly resourced to carry out their work. I call tonight for the ambulance service to be appropriately resourced to provide a safe and efficient service nationally.

Thomas Pringle (Donegal South West, Independent)
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I welcome the opportunity to contribute to the debate on the ambulance service and the crisis within it. The crisis is driven by a lack of investment and development over the last number of years. There is no doubt that the staff in the ambulance service are 100% committed to it. It has been said by other speakers, but bears repeating. They are highly trained and the development of advanced paramedics over the last number of years is very significant. It means ambulance crews can respond fully when they arrive on scene. Unfortunately, cases like the tragic one we saw in Carndonagh in Donegal in recent months, where a woman injured in a car accident lay on the side of the road waiting for an ambulance, are too common across rural Ireland. These situations drive this motion. We cannot allow them to continue. It is symptomatic of what has happened to our health services across the board. A lack of investment and a lack of funding is causing the crisis. There are not enough ambulance crews available to respond to emergency calls. That the number of active-service ambulances has reduced by 55 since 2008 shows the crisis that exists.

In south-west Donegal, there is an ambulance station in Killybegs and one in Donegal town. There used to be two ambulances on call at each but now there is only one ambulance on call at each with a further one to travel over and back between the two to provide cover. It is a reduction in service no matter what way one looks at it. The best possible response time from Killybegs to a call from Glencolmcille is 30 to 35 minutes. There is no way national targets and HIQA standards can be met in rural parts of Ireland with the level of ambulances and crews we have. That is the problem that must be addressed. The only way to deal with this is to provide the necessary ambulances and crews. Crews are highly trained and dedicated and will play their part in saving the lives of our citizens if we step up to the mark to provide for the service into the future.