Shane Ross (Dublin South, Independent)
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I rise unapologetically to make a plea which has come to me from local interests who are very fearful of developments in the ambulance service. I applaud the motion and Fianna Fáil for recognising the work that has been done by paramedics over a long period of time. I deplore the fact that delays in ambulance response times have far exceeded both nationally and internationally accepted norms. We have a crisis in our ambulance service which is recognised in this motion.

I specifically wish to state that I have had representations from people in the Nutgrove area of south Dublin who are very fearful that if the HSE takes over this and other areas, it will force a closure of bays in Nutgrove and other areas in the centre of south Dublin. This will mean that the response times will be further reduced. It will mean that people in this area which is the centre of my constituency - I am talking about areas like Dundrum, Ballinteer and Sandyford - will not be reached in such good time because the ambulance in the Nutgrove area will be removed and replaced by those in locations decided by the HSE.

I plead with the Minister to consider giving an instruction to the HSE so people in south Dublin are not neglected or deprived by decisions of this sort and do not have to make representations to him and me in the future to ask to keep the Nutgrove bay open so that they are not dependent on Loughlinstown and Tallaght which are outside this area and too far away and to ask that we ensure that those response times are guaranteed to remain within the 11-minute or even ten-minute period, which they have traditionally been.

Clare Daly (Dublin North, Socialist Party)
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We sometimes hear about the need for those in power to take action before it is too late. For Wayne McQuillan who was stabbed in Drogheda in New Year's Eve, it is already too late because it took the ambulance 32 minutes to get to him after the initial call. The Minister of State may be aware that his distraught family attended the Oireachtas Committee on Health and Children when we heard from representatives from the ambulance service earlier this year. It is a bit rich for Fianna Fáil to clap our paramedics on the back when the cuts to the forefront of this were begun on its watch. Nonetheless, the reality is that we have a dysfunctional ambulance service which is undermining the quality of the work put in by our very dedicated paramedics on the front line. Against that backdrop, the suggestion that Dublin Fire Brigade would be removed from administering that service is absolutely ludicrous when it is coming to light that HSE mismanagement has been responsible for much of the problems that exist in the ambulance service. In my constituency, a HSE ambulance driver told me how they received a new ambulance vehicle which had 70,000 miles on the clock. He reported how six crew members turned up for a shift with only two ambulances to put them to work. Obviously, "Prime Time" elevated many of these stories. The proof shows that Dublin Fire Brigade, which covers 40% of national calls on 7% of the national budget, has the best response times in the country. If anything, we should be holding back and looking at the idea put forward of a national capacity review. In my opinion, the outcome of that will be that the ambulance model that has been adopted in other countries is the best for patient safety and that there should be no undermining of that service in the short term because other people's lives, like that of Wayne McQuillan, will be forfeited as a result.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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I rise to support the motion on the ambulance service requesting adequate funding for the service. Anybody who has an eye to see or an ear to hear knows that the ambulance service is under-funded, under-resourced, understaffed and under-equipped and that it compares unfavourably with our neighbours in Northern Ireland and particularly Scotland. We have about 1,600 staff while Scotland, which has a similar population, has 4,500 staff and double the funding. It is widely accepted that the ambulance service in this country is in crisis. The Minister has looked for a review from HIQA. The unions and staff associations have been looking for a resource study for a number of years and I believe the HSE has finally agreed to such a study.

In these circumstances, there should be no more service cuts and certainly no more service cuts in south Tipperary. I commend the Tipperary Ambulance Action Group which is opposed to the cuts across south Tipperary and came together to campaign on this issue. It has completed a comprehensive study of the ambulance service in south Tipperary. The study confirms that on the basis of the current ambulance service configuration in the county which is based on three stations - Clonmel, Cashel and Tipperary town - the current staffing levels and equipment in those stations, in excess of 55% of the population of south Tipperary cannot be given an adequate service that meets the minimum response times. What does the HSE want to do? On top of a crisis, it wants to introduce further cuts. This is completely ridiculous and I am calling on the Minister to stop any cuts in the ambulance service, not just in south Tipperary but throughout the country, and to ensure that the service is properly funded and staffed.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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There is a major crisis in the national ambulance service - a crisis that leads to deaths. The estimate is that one person per month dies unnecessarily as a result of the under-resourcing and the cuts that have been imposed on the ambulance service. It does not get any more serious than that. People are dying unnecessarily. The cuts the Government is imposing - not just the recruitment embargo that impacts on these services but the more general cuts across the health services - are exacerbating this situation. When the Minister downgraded the accident and emergency services at St. Columcille's Hospital in Loughlinstown, we predicted that it would cause a crisis in St. Vincent's Hospital and this has now been confirmed by the consultants in St. Vincent's. This leads directly to further problems in terms of emergency vehicle response times because as the firefighters and ambulance drivers are reporting, ambulances are then queuing up for hours outside emergency departments because those departments are overwhelmed and under-resourced and there are not enough beds in the hospitals. All of these things are combining to cause a life-threatening crisis which the Minister intends to make worse by attacking one part of the emergency services that is working, namely, Dublin Fire Brigade which provides ambulance services in Dublin. Dublin Fire Brigade provides 40% of the emergency responses and must survive on only 9% of the budget. The Minister wants essentially to pillage that service in order to compensate for the crisis in the national ambulance service. It is outrageous.

It is very simple. The resourcing levels in our fire and ambulance services must be brought up to international standards, there must be no more cuts and the Minister must lift the recruitment embargo so that we have the vehicles and resources to provide the services that save lives.

Catherine Murphy (Kildare North, Independent)
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We are trying to improve our accident and emergency units yet there is a difficulty in getting the people who most need to arrive there in a timely fashion to these units and a difficulty in how it is organised. The recent "Prime Time" report highlighted in a more global way what many of us saw locally and was very useful from that perspective.

I would also like to commend the front-line workers but shifts are not being covered and ambulances are just not there. In Maynooth, for example, there is no ambulance on a Thursday so do not get sick in Maynooth or the surrounding area on Thursdays between 9 a.m. and 9 p.m. The ambulance is substituted by a paramedic on a motorbike, which might be all right in some circumstances but certainly not if one needs to be rushed to hospital having had a heart attack or been involved in a road traffic accident.

The minimum response times are set for a good purpose. They are set because there is a need in very specific circumstances, like in the case of a heart attack, to get people to a hospital within a certain period of time or their chances of survival will reduce. Last year in my constituency, a man and his young son were in view of Naas General Hospital but there was no ambulance available to be deployed. Gardaí succeeded in resuscitating the man at the side of the road but he did not survive. He may not have survived even if he had been taken to the hospital by ambulance but in reality he was not given the kind of chance that he deserved. Not only was he an unfortunate victim in this situation, but his young son was with him at the time and the trauma of seeing this incident will stay with him forever. There is clearly an issue and we are all seeing it. How the service is managed and run and the resources that go into it really need to be got right and I have concerns that it is not at the moment.

Paul Connaughton (Galway East, Fine Gael)
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I am grateful for the opportunity to speak on this motion. There is no doubt, following the recent "Prime Time" programme, that there is a heightened level of concern and worry over the ambulance service. Even if we were to go down the route of taking on new recruits and supplying more ambulances, it would take time. The question is how we can move the service on in the short term over the next six to 12 months. I have spoken to paramedics on the ground and while they would all like extra resources, they understand that there would be a time delay.

They would also like to see some form of education of the people so that they would understand what the emergency service actually does. I have been contacted by a number of paramedics who said that there is still a certain element of the population who see the emergency service as a taxi service to the hospital. In one case, an individual was in the waiting room of an accident and emergency department in a hospital. He saw ambulances coming in and out and noted that patients were being brought straight in and did not have to wait. He got it into his head that he would be seen quicker if he was in an ambulance. He left the accident and emergency department, went home and called an ambulance. That was an absolute waste of that ambulance's time. Some GPs, but by no means all, who do not want to take a chance or risk with a patient will ring an ambulance. That is also a waste of an ambulance's time, particularly if the situation is not life threatening. People must remember that our paramedics are very highly skilled and trained. The first line of care does not start at the door of the hospital - it starts when the person is met by the paramedic. That is the level of training and skill that paramedics have. They are not simply there to pick up people on the side of the road, put a blanket over them and bring them to hospital. People have to understand more about what our emergency services do.

We would like to see more resources going into this area and I call on the Minister to do everything he can on the embargo on staff and so forth in the long term. However, it is important to remember that the job these people do is so highly specialised that getting additional staff is not going to happen overnight. We have heard a lot about the dynamic deployment of staff, which is all well and good but it is more suited to the bigger towns and cities. In County Galway and rural Ireland, that is not so simple. Response times of eight, ten or 12 minutes are just not going to happen. We must accept the fact that it will not happen in the more remote areas. If an ambulance gets to someone within eight minutes but the person dies, is that a success? If an ambulance gets there within nine minutes and the person survives, is that a success? While we are all hell bent on targets tonight, have we actually considered what is best for the patient and what happens to him or her?

Jim Daly (Cork South West, Fine Gael)
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I welcome the opportunity to contribute to this debate. Of all of the issues that can be debated in this House, very few will generate the kind of emotion that debates on the ambulance service will do. Myself and my colleagues from west Cork have had some first-hand experience of this recently when there was a major reconfiguration of the service there. During the debate a lot of agendas and scores were being settled.

While I do not ever like to play party politics, it is ironic for the party opposite to have tabled this motion, given that it gifted this Government a service that clearly was not working as it should. They then criticise us when we take on the amount of reform that we have done, through the National Ambulance Service, despite having promised not to do Punch and Judy politics. This is a classic example of opposition for the sake of it. Indeed, some other speakers are guilty of that charge too. I regret that is the case. Everybody opposite has spoken about more resources but I have yet to hear any of them say where they would like the resources to be taken from. Until people stand up and take courageous decisions and rise to that challenge, a lot of what they are doing is empty, nauseating and very dispiriting. It is no wonder that people are so cynical about politics.

I mentioned the reform agenda and the reconfiguration that took place. Experience in west Cork demonstrated that the service was in need of very substantial reform. We have moved away from a system where ambulances were on call. In the past, when somebody called an ambulance, a call went through to the drivers who were in bed asleep. It could take up to 20 minutes to mobilise drivers, get them into the ambulances and on the road, heading to rural parts of west Cork. Thankfully, that system is now gone and we have moved to an on-duty system. Ambulances are on duty 24 hours a day and people can now call an ambulance and it is ready to go immediately. In addition, a more important development is the introduction of rapid response cars. There was an issue with ambulances going from places like Clonakilty or Dunmanway to Cork city, waiting outside the accident and emergency department for the trolley to come back, with the ambulance parked up and two paramedics sitting there for hours on end, leaving areas without cover. In that context, I wholeheartedly welcome the introduction of rapid response cars that never leave the area. They constantly drive around and are deployed so that they are within 20 minutes or less of any area in west Cork. If my dad, who is in his 83rd year, had a stroke - God forbid - or my young fella started choking, I would be very grateful to see a rapid response car at my door within ten or 15 minutes, with two highly trained paramedics and the best of equipment in the back. People need to start recognising and appreciating the value of that and understanding that it does not always have to be an ambulance.

I concur with the previous speaker on the issue of waste. Paramedics will tell one about people ringing up with very minor and trivial issues but the ambulance crew has no choice but to collect them and bring them to hospital. They can then be left for hours outside the accident and emergency department waiting for the patient to be seen and either discharged or admitted. The new paramedic cars are a very substantial development and I commend the Minister, the HSE and the National Ambulance Service on their introduction.

An additional €3.6 million has been invested in the ambulance service this year but I am a firm believer that it is not all about resources. It is about how we do what we do and that is the difference between this Government and our predecessors. The solution to everything from Fianna Fáil for 14 years was to throw more money at it, with the result that we quadrupled the bill for health during that time.

Billy Kelleher (Cork North Central, Fianna Fail)
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Fine Gael used to accuse us of not spending enough.

Jim Daly (Cork South West, Fine Gael)
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To quadruple or increase by 400% the health bill is nothing short of shameful. Deputy Kelleher can protests all he likes and sometimes he doth protest too much but it is not about how much we spend. That is not how we are going to be judged and that is not the solution. It is about how we do what we do and about getting value for money because ultimately, we are answerable to the taxpayers. This is not the Government's money nor is it the money of the Department of Health or the Minister. This is the taxpayers' money. We must ensure that reform is what we are all about.

I acknowledge the introduction of intermediate vehicles which serve a very good purpose in transporting patients who are not critically ill. Deputies will have seen them on the road and they are an extremely welcome development. I commend the Minister on the reforms introduced to date and also the paramedics on the wonderful work they do every day. To call the system dysfunctional is disgraceful.

Gerald Nash (Louth, Labour)
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I wish to focus on the matter of HIQA response times which are fundamental to this motion. Response time targets were set in 2010 for HIQA. Incredibly, those targets were laid down by a Government that, extraordinarily, did not seem to have the first clue about the capacity of the ambulance service to deliver on those very targets.

In other words, the then Government, including Deputy Kelleher, the Minister for Health and HIQA imposed targets without any kind of detailed analysis of the service's ability to meet the very targets they set down in 2010. It was what might be described as a Hail Mary pass to the ambulance service, hit and hope, with no clue as to the number of emergency vehicles, personnel or equipment available to meet the very targets they were determined to hold the HSE and the national ambulance service to. This is a damning indictment of the system presided over by the movers of this motion. It is yet another example of back-of-the-envelope style governance from Fianna Fáil, which Deputy Kelleher turned into a fine art.

The motion appears to have been scribbled down on the back of a cigarette packet. It implies that there has been a reduction in funding to the national ambulance service in recent times, whereas in fact since 2012 there has been a marked increase in the resources available to the service. Extra money is available - up by €9 million on 2012.

Neither is there any acknowledgement in the motion of an important development in the ambulance service which will take place this year. That is the migration from the blunt metric of measuring ambulance response times to a system of measuring actual clinical outcomes. Bizarrely, under the current set of indicators, if a patient subsequently dies but the ambulance has arrived on time - and within the target response time set down by HIQA - that is considered to be a good call. Nowhere else would this be considered acceptable, so I am glad that is set to change.

The motion conveniently ignores the fact that a full-scale capacity review of the ambulance service across the State has been initiated. I understand that the review, which will take six months to complete, is under way. Fianna Fáil abjectly failed to have one done before response time targets were introduced, yet now they conveniently choose to ignore the fact that the capacity review is under way at all. It has not been mentioned in the motion.

The ambulance service is unrecognisable now compared to ten or 15 years ago. The staff are extremely well trained to top international standards. It is about time we had that capacity review and I am pleased it is under way. If extra resources are required, I am sure a way will be found to secure them for the staff and citizens who rely on the service. If the service needs to be reorganised, I am certain that staff and management will respond accordingly.

Michael Kitt (Galway East, Fianna Fail)
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I must ask Deputies to stick to their time allocation because we have a very short period. I call Deputy Áine Collins.

Áine Collins (Cork North West, Fine Gael)
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I also welcome the opportunity to speak on this issue. Recently, alarmist headlines have been appearing in local newspapers. Deputy Moynihan has been saying that ambulance services in north Cork are a cause for serious concern. A HSE worker claimed that people will die as a result of these changes. These exaggerated claims are adding to people's concerns, particularly in rural areas. Changes in systems always cause some concern, but this concern is unjustified. We live in changing times with new technologies, new ways of treating emergencies, better qualifications and a free hospital environment. There are new centres of excellence where patients are assessed on the scene and transported to the most appropriate hospital. This could involve by-passing the nearest hospital to a specialised unit where better results can be achieved. The national ambulance service is not static and must regularly evaluate its resources in line with new developments in medical treatment and advancing technologies.

A service that is stuck in antiquated services is no longer the best way of serving patients in changing times. Having ambulances stuck in areas that are not being used is not the best use of our scarce resources. There would be just cause for concern if the ambulance service was not continually taking into account changes in our infrastructure and medical technology, as well as improved methods of treatment.

In the past, artificial lines on a map sometimes designated which ambulance would respond. The newer system ensures that the nearest appropriate response is mobilised to the location of the incident. Under the new system resources will be sourced from all stations within Cork and surrounding counties to support the delivery of pre-hospital emergency care.

The new national ambulance control centre is a single point of contact for answering and directing all emergency calls. This will reduce the potential for error regarding boundaries which in the past have not always enabled the nearest available resource to be dispatched in the case of an emergency.

The system also ensures that the most appropriate skilled paramedic or advanced paramedic will be dispatched based on a patient's clinical needs. This will help to achieve the best possible outcome for patients. In the past because there was not the same pre-hospital assessment, a patient was taken to the nearest hospital which in many instances did not have appropriate facilities to deal with the particular incident. For instance, all patients seriously injured in a road collision, fall or assault are assessed on the spot, provided with immediate treatment and then transported to the hospital that has specialist expertise to treat the injuries, even though this may not be the nearest hospital.

It is estimated that this can lower mortality rates by up to 25%. Equally, all children are now only transported to hospitals with a specific paediatric expertise on that hospital site. In the past, children were often taken to the nearest hospital which may not have had any paediatric or appropriate staff to deal with the situation.

Medical science, devices and systems are advancing and changing continuously, which is welcome. However, this demands constant changes in transforming the health service, all of which are aimed at improving outcomes for patients and clients. The national ambulance service has a key role to play in this process and in doing so will encounter challenges in the current environment. However, the main objective is to strive continually to provide the highest level of pre-hospital emergency care, including getting a paramedic to the scene within eight minutes and, ideally, an ambulance within 19 minutes.

I agree with the statement contained in the amendment and acknowledge the selfless dedication of our paramedics and the high quality of care they provide. I had a private experience of this recently and I can say that the paramedic arrived within 12 minutes, while the ambulance arrived within about half an hour of the paramedic. The care provided was absolutely excellent. I commend the amendment to the House.

Eamonn Maloney (Dublin South West, Labour)
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In the course of this debate we can all agree not only on the importance of the national ambulance service but also the very good service provided over the decades, along with the changes that have occurred within the service. Irrespective of which side of the motion we are on, I think we can all agree to that. I have no disagreement with some of the comments that were quite rightly made last night about the professionalism of those working within the ambulance service and the level of care those men and women provide.

It is appropriate to say that, like those working with the fire brigade and frontline hospital services, we do not appreciate ambulance service staff until we need them in our own homes. It is only when such services are required on our doorstep that we appreciate their value.

People working for the ambulance service in Dublin and elsewhere can describe the changes that have taken place. That is because nothing stands still and Irish society has changed so much, including lifestyles and increased car ownership. All these societal changes, in turn, influence the sort of service that is provided by the national ambulance service which has had to change with them. Ambulance staff will testify that this is not a problem.

Both trade unions representing ambulance staff in Dublin, SIPTU and IMPACT, have welcomed the review of the service in the city. That is a good and progressive thing.

I will not go into too much of the detail as most previous speakers have referred to it, but we await the outcome of the review. A review of services is not necessarily a bad thing. In fact, it has more positives than negatives. If it leads to a better ambulance service, we should welcome it. That is what the people who provide the Dublin Fire Brigade ambulance service are saying. They welcome the review and, particularly, its independence, which is very important. I await the outcome of the review. We will all take notice of it and see what beneficial changes can be made.

Michelle Mulherin (Mayo, Fine Gael)
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Legitimate questions and concerns have been raised on foot of the motion. However, it is ironic that the party across the House is moving it when it has sent the chickens home to roost on this and so many other issues wreaking havoc on society. Out of service to the people and to ensure they are getting a proper ambulance service, the matter must be examined.

I refer to a number of welcome initiatives which have been undertaken by the National Ambulance Service, including the development of an intermediate care service, which is specifically focused on the delivery of inter-hospital transfers. That frees up existing emergency resources to focus on responding to emergency calls. Issues such as the ones to which Deputy Connaughton referred can be tackled this way. Where acute ambulance services are required, they are ring-fenced and the resources are not used for run of the mill work that could be done by lower grade non-health transport.

In my area, I welcome the frequent use of the air ambulance. Ours is the third largest county and there are vast rural areas where there is no way an individual suffering a severe heart attack could get to University College Hospital, Galway within the golden hour to be treated properly. I am aware of many cases in which the air ambulance has been called out and all has been well for the individuals concerned. I am glad to say so. It is a welcome, nuanced approach to the sort of health care sensitivity we need for people in rural Ireland.

I acknowledge the development and support of training for advanced paramedics. Their service means that people can receive treatment and early intervention even before they reach hospital. That can help medical staff in hospitals to do their job and ensure the best possible outcome for patients.

There is no denying there is cause for concern, and certainly in my own county in relation to response times in certain cases. I understand why. There is a personnel problem. If a member of a two-person team goes out sick, there is no overtime available to allow the team to operate with someone else. This is in a vast rural county which has bad roads. The periods of time people have had to wait in some cases are unacceptable.

As part of the review, the cost of the contracts of private ambulance operators must be considered. I am told that the particular contract which affects Mayo, which I understand is a national contract, could be done for half the price by a local operator to the same standard. However, the rules around procurement do not allow it. The challenge is, perhaps, to take money from those contracts and invest it in the direct employment of ambulance personnel.

I pay tribute to the ambulance staff and paramedics on the ground who do a very fine job. Many people have had great experiences with them. I am particularly familiar with the personnel operating in my county. I welcome the review of ambulance services, which is timely. There has been a great deal of scaremongering and we understand how that works in politics. However, we all want to know there is a sound ambulance service. I look forward to the review of response times. I expect resources to be put into the areas, particularly rural areas, that need them on wider bases than size of population.

Anthony Lawlor (Kildare North, Fine Gael)
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I welcome the opportunity to speak on the motion. I agree with only two lines of it, which are the references to "the selfless dedication to their work, of the paramedics in our ambulance service" and "the high quality of care that they provide". I will speak first about targets and ambulance response times, which are vital. The current targets are not satisfactory. We are moving the target to 80% but should be setting an even higher one. We need to set a standard for the people to believe. It is ironic that Fianna Fáil has mentioned targets for the first time in the context of the ambulance service. The only target Fianna Fáil ever set was a target of 300,000 people who would become unemployed during the tail end of its reign. It was a disgraceful target.

My concern is about the centralisation of control and dispatch. Local knowledge is vital. We need further training on that for paramedics, particularly those who are newly qualified. Wherever they are sent, they should have proper coaching on locations. The thing I took from the "Prime Time" documentary was that it is sometimes important for a patient to know how long an ambulance will take to arrive or where it is coming from. If a person was close to a hospital but the ambulance was coming from a more distant location, he or she might be moved in a different way. We may have learned from the failures that have occurred to give people more information.

The current system is undergoing a transformation. It is vital to change the way we do our business. The most important thing to do is find a smarter way to spend the money we have. We are modernising and reconfiguring. It is important to ensure there are no longer county boundaries or districts within the ambulance service. We are introducing reforms. It is important to recognise that quality of care is not necessarily about the presence of an ambulance but the attendance of a person who has the relevant knowledge. In that regard, the attendance of a rapid response vehicle was vital in an incident at a swimming pool in Maynooth. The crew member had the necessary knowledge of how to treat the children involved. It is vital to look at getting people to the scene to help rather than necessarily to demand an ambulance every time.

There has been criticism of where the service has gone. The statistics indicate that there are in fact 300 more paramedics than there were in 2008 at the end of the Celtic tiger period. The population was not that much different then but the spend by the previous Government on the paramedic service was abysmal. We have 534 vehicles in the ambulance fleet, which is an increase of 74 since 2010. Rapid response vehicles represent an exciting way forward.

We have spoken throughout the debate about target times. It is not always about that. The most important thing to do is to try to save people's lives. If an ambulance arrives late according to the target time but saves a person's life, that is the most important thing. I support fully what we are doing to reform the service and ensure we get people on the scene as quickly as possible, albeit not necessarily in an ambulance.

Patrick O'Donovan (Limerick, Fine Gael)
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I welcome this opportunity to speak. The motion has been tabled in the aftermath of the "Prime Time" programme which raised many very serious issues. As somebody who has had recourse to use the ambulance service on more than one occasion I must state my experience has been very positive and I compliment and pay tribute to the men and women who operate out of the Mid-Western Regional Hospital in Limerick.

The practices in place in some of our hospitals mean ambulances travel massive distances of geographical terrain thanks to reconfiguration. The motion proposed by Fianna Fáil does not bemoan the fact it reconfigured the hospitals in the mid-west and left us with the system we have whereby huge distances are covered. Perhaps it should have used this opportunity to apologise but it did not.

Timmy Dooley (Clare, Fianna Fail)
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What?

Patrick O'Donovan (Limerick, Fine Gael)
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Ambulances cover vast geographical areas and unfortunately, because of the practices which have grown, ambulances must wait for patients to be seen before they can be released for duty.

The revelation in the programme which showed high-powered vehicles purchased at great expense by the HSE being parked up must be investigated. It was a source of annoyance for the ambulance staff themselves. I welcome the commitment made on intermediate vehicles which will help. The staff are doing an outstanding job.

It never fails to surprise me that Fianna Fáil consistently uses its Private Members' motions to remind the people of the mess it left after it, and the way it devastated the health service. It is a great pity Fianna Fáil Deputies do not have a chat with their research office; rather than tabling motions which remind people of the mess they left they should use their Private Members' time to suggest something constructive. It gives us an opportunity to remind Fianna Fáil-----

Timmy Dooley (Clare, Fianna Fail)
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We are trying to remind you what you promised and failed to deliver.

Patrick O'Donovan (Limerick, Fine Gael)
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The ambulance service is much better today than when Fianna Fáil was in government. Targets are now in place that did not exist previously.

Timmy Dooley (Clare, Fianna Fail)
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Wrong.

Patrick O'Donovan (Limerick, Fine Gael)
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Whenever Fianna Fáil Members table a Private Members' motion it decides to remind the people of Ireland of the bags it made of running the country, fair play to them.

Timmy Dooley (Clare, Fianna Fail)
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God help us, Deputy O'Donovan should sit down before the ambulance comes to collect him. The men in white coats will come for him if he keeps going with that stuff.

Kathleen Lynch (Cork North Central, Labour)
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We do not use that type of language any more.

Michael Kitt (Galway East, Fianna Fail)
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I commend Deputy Kelleher on the motion. I like the mention he made of providing an ambulance service of the highest international standard. It is a noble aspiration. He clearly pointed out the great work done by paramedics, but they need to be properly resourced. It would be very difficult to have a service which is of the highest international standards if the budget is cut.

I will speak about rural areas because it is more difficult to establish an ambulance base in such areas and to have a safe and efficient ambulance service when cutbacks are made. The example I will use is the town of Tuam which has an ambulance base. I was one of many public representatives who fought for more than 15 years to have a base established there. When we got it we expected a 24-hour service but what we got was a day service and even this is not fully operational. It is disappointing a town such as Tuam, which is not small and has a hinterland covering north Galway and south Mayo, does not have a base which is open 24 hours. It has more than 30,000 people in the catchment area, €2 million has been spent on the building and the trade unions have been fighting a very strong case on behalf of their staff. The personnel are very well qualified and provide high-quality care in the region. They are very dedicated to their work, and they work under very great pressure. Some of the staff are trained at St. Brigid's Hospital in Ballinasloe. At present Galway city is being used as a base with all of the congestion which goes with it and the traffic on the Tuam to Galway road. We are waiting for work on the motorway from Gort to Tuam to begin but the contract has not been signed on it yet. I hope it will soon open. There are other bases in Loughrea and Carraroe but Galway seems to be the base for our area.

I commend in particular the great work done by the Order of Malta and the Red Cross. I understand in the past grant aid was given to these organisations to purchase voluntary ambulances but the staff are not regarded as qualified. I cannot understand this. I raised this as a Topical Issues matter recently and it seems even though they are very fine organisations their staff are not considered qualified.

"Prime Time" brought this matter to our attention with the fine programme on the reality of what is happening to the ambulance service. It highlighted the large number of people in rural areas and the fact staff are not being transferred to areas such as Tuam where they are needed. When the Minister replied to the Topical Issues matter I raised he stated the 2014 national service plan includes a reform programme with additional funding of €3.6 million and 43 staff. I do not see the results of this investment in the western region. The fact the Tuam base is not fully operational shows it is not apparent. There is a particular challenge in rural areas so let us see some of this funding. I hope the Government will consider the north Galway and south Mayo area, which is one of the biggest catchment areas without an ambulance service.

The health correspondent of the Irish Independent, Eilish O Regan, recently wrote that HIQA is conducting a six-month review of the ambulance services. I hope this review will be done very soon. The situation is urgent and needs action. I had representations from the National Ambulance Service Representative Association, NASRA, which raised the issue of the worrying rise in the number of serious delays in response times. The NASRA stated it does not have the personnel or vehicles to meet the targets and it is time for the service to accept these targets are unrealistic unless cutbacks are reversed. This clearly states the situation. A national control centre is to be put in place and steps are being taken in this regard. I certainly hope this happens. I am sure the Minister of State agrees that where a building is available, such as that in Tuam, it should be staffed, training should be provided and the ambulances should be put in place. I hope this can happen quickly in the case of Tuam.

Charlie McConalogue (Donegal North East, Fianna Fail)
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I join my colleagues in commending our health spokesperson, Deputy Kelleher, for tabling this motion and allowing two evenings of debate on what is a critical issue of exceptional importance and concern throughout the country. I am sure the Minister of State will acknowledge this, particularly as a result of the very effective investigative work done by "Prime Time", which highlighted real deficiencies and the stretched resources our ambulance service must deal with on a daily and nightly basis in various parts of the country.

I commend the Trojan work done by the highly trained staff in the ambulance service throughout the country. I am sure the Minister of State will join me in commending them for the work they do. It is not something everybody has the ability or strength to do because it is a very difficult job and requires an ability to deal with very stressful situations. Those who work in it must have a vocational spirit to be able to take on the role and carry it out as they do day in and night out. Unfortunately, we have not supported them sufficiently, or in the way we should, to enable them to carry out the role. They try to do it as best they can with the resources allocated to them but they are human and can only manage a certain amount of work. They cannot be in two places at the same time.

The Minister of State is aware that my county of Donegal has had very unfortunate situations where target ambulance response times have not been met. I will reference one very unfortunate case which has been dealt with in the House before.

The family of Maura Porter, who unfortunately lost her life on 30 December 2013 as a result of a road traffic accident in Carndonagh, County Donegal, has been very strong in putting across their experience and in trying to ensure no other family has to experience a similar situation again. It took up to 50 minutes for an ambulance to attend the scene of the accident, in which Maura was a pedestrian, even though there is an ambulance station approximately half a mile from there. Unfortunately, Maura passed away some time after she reached the hospital. Members of her family who live right beside the scene of the accident spent an excruciating 40 or 50 minutes at her side as they waited for the ambulance to come. They will never know whether it might have made a difference and she might have survived if she had been treated earlier, but they want to ensure - at a minimum - that no other family has to experience this type of situation in the future.

Unfortunately, people in Donegal and other parts of the country have been unable to get the necessary reassurance that the relevant and required resources are in place to ensure calls can be responded to in the shortest time possible; indeed, within the target times that have been set. Deputies have mentioned other cases from across the country which support the contention that the fact that ambulance response times are not being met is evidence that our resources are over-stretched. In June of last year, 45% of Echo calls and 49% of Delta calls in the west were responded to within the target time. The figures in the north west were 75% and 62%, respectively.

I know there have been some changes within the ambulance service. It has been moving from an on-call service at night time to a rostered service. I think that is a constructive move in that one can now be sure that those staff are actually on duty, as opposed to being at their homes, when a call might come in. That should lead to faster response times. Unfortunately, that can only be the case if they are actually at base when the call comes in. It will depend on whether someone has the misfortune to take ill after an ambulance has been called away on a call and has not been replaced, and there is no replacement ambulance within a reasonable distance of that area.

In the Carndonagh example that I mentioned, there is a station beside the location of the unfortunate accident. There used to be two ambulances on call during the day and one ambulance on call at night. As a result of the move away from on-call to rostering, that has moved to a situation where there is one ambulance rostered all day and one rostered at night. In order to try to keep two ambulances per day in the station, there is supposed to be an ambulance sent from Letterkenny every morning to back that up. Unfortunately, that is not happening in reality. If the ambulance is on call at night, no ambulance is sent in to take up its position. This means that if a second call comes in, one has to depend on being lucky enough to have an ambulance in place. Otherwise, an ambulance might have to make a one-way trip of 40 or 50 minutes to reach an emergency case.

Many Government Deputies have spoken about successful outcomes. Is the success of an outcome dictated by the treatment that is provided to the patient when the ambulance actually arrives? Is the success or otherwise of the call-out dictated by how the patient responds or by how quickly the ambulance arrives? When people speak about successful outcomes, I wonder whether they are somehow trying to diminish the importance of getting there on time. There is no doubt that when the ambulance gets there, the treatment that is made available to the patient is crucial. We have ambulance staff who are exceptionally well trained to do the best they can when they arrive on-site. There is no doubt that the time involved in getting there - the speed with which the ambulance gets there - is crucial to outcomes. The sooner the ambulance personnel can get there to provide expert treatment and bring the patient to hospital, the higher the chance of a successful outcome and the higher the chance of the patient making a full recovery, particularly in cases of cardiac arrest and stroke.

We need to see what the type of investment that Deputy Kelleher has outlined in his motion. This investment is necessary to increase the number of personnel, facilities and ambulances to the level necessary to enable ambulance staff to meet the targets that have been set. It is also needed so that people throughout the country can be confident that the service which is in place will be available to them if they ever need to use it.

Timmy Dooley (Clare, Fianna Fail)
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I welcome the opportunity to contribute to this Private Members' debate. Unlike some Deputies on the other side of the House, I have consistently spoken on health matters during my time in this House, as I did when I was in the Seanad. I am glad that my party's health spokesman, Deputy Kelleher, has given us an opportunity to discuss this issue as part of the business of the House. Deputy O'Donovan and others have failed to recognise that those of us who were elected for Fianna Fáil - there might be fewer of us than we might like - have a mandate to raise issues of national importance. There is a legitimacy to the existence of the Opposition. It is not all about doing the political thing by saying "they are all bad and we are all good". Notwithstanding where we have come from, I think we are in a position to contribute to debates of this nature by virtue of our understanding of the issue and the interaction we have with our constituents.

I am certainly not here to knock the ambulance service or say that it is all wrong. I am sure the same thing applies to Deputy Kelleher - he will speak for himself - and to other Deputies. The ambulance service does an exceptionally good job. It delivers very well for many people most of the time. If we have learned anything from recent history, particularly in relation to the way our economy was run, it is that we should not be afraid to look beneath the bonnet, question the norms that have existed heretofore or challenge the current thinking. We must be able to engage in a critical and dispassionate analysis of the issues in the best interests of the people who put us here and who we are here to represent. We should be able to do that in a collective way. I appreciate that the business of the House requires Opposition parties to use Private Members' time to propose motions. I accept that the Government will usually try to amend those motions and win the vote at the end of the debate. We all know that is what ultimately happens. Everybody has a capacity to bring forward ideas and identify problems in a way that improves services in the long run.

There have been significant advances in the quality of the vehicles used by the ambulance service. The move towards single ambulances that carry just one patient has required an increase in the number of ambulances. There was a time when an ambulance was little better than a meat truck. We have moved beyond the era when injured people were thrown in, piled up and taken to the closest hospital. The quality of the service is much better now. We now have a high-quality air ambulance service. Without seeking to applaud previous Governments, I should mention that many of these improvements were put in train under the reconfiguration process that was initiated by Mary Harney when she was Minister for Health and Children. There are some people who are taking credit today for what has been achieved without referring to when these things happened. It is understandable that there might be some confusion as there were many changes in health service delivery during that time.

As well as being critical of us, Deputy O'Donovan complimented the great service in Limerick. While I agree to some extent with what he said, he failed to recognise that the manager of the ambulance service participated in a recent "Prime Time" programme that was very critical of the service. She was identified as a whistleblower. One cannot have it both ways. We must look to the people who have identified the weaknesses and the flaws.

We have had some progress in terms of the provision of advanced paramedics, which certainly has been effective. However, the whole reconfiguration process has put a greater burden on the ambulance service. It is a pity that Deputy Patrick O'Donovan clearly did not prepare for this debate and instead decided simply to come in and throw a few political balls about the place. He did himself a disservice in so doing because it showed a fundamental weakness in his understanding of the way in which the health service has changed. Reconfiguration was never about saving money. It was about improving the outcome for the patient and ensuring a greater level of patient safety. I supported the proposal, as did others who are now in opposition, against the bleating of the then Opposition, both Labour Party and Fine Gael Members, that patients would die. Deputy O'Donovan's colleagues in my county erected posters, developed a campaign and frightened people by claiming that reconfiguration of the health service would lead to the deaths of 20 people in Clare every year. I have challenged all of them on that claim but none has come forward with any sound statistics to back it up.

Of course, what they predicted has not come to pass. However, reconfiguration has put a greater burden on the hospital in Limerick, on accident and emergency services and on bed capacity. It also has imposed a greater burden on the ambulance service. The increased investment which took place when the reconfiguration was initiated was not enough and will not be enough to reach the targets set down by the Health Information and Quality Authority. It would be nice if colleagues on the Government benches who have the benefit of following in the wake of those of us who had to take the bullets to get reconfiguration through would at least accept their role in taking it to the next stage, which is building on the foundations that were created and continuing to roll out an enhanced ambulance service. That is the job in which the advanced paramedics and first responders are engaged. They provide a wonderful service, but there are not enough of them.

None of us here is blinded by delusions of there being some endless pot of money at the end of the rainbow. There is no expectation on this side of the House that the Government can simply click its fingers and deliver everything that is needed. There must, however, be a planned approach. If we saw a coherent plan coming forward from the Government or the Health Service Executive which showed a capacity to build towards acceptable norms as set down by HIQA over a defined period, everyone would accept we were on the right track. What we have instead, however, is some members of the Government parties, Fine Gael in particular, proclaiming at every opportunity that a little growth in the economy will allow the Government to offer tax breaks at the next budget. That is being done because we happen to be in an election environment.

In fairness to the Minister of State, Deputy Kathleen Lynch, and other members of her party, they have not engaged in that type of auction politics. The Minister of State knows full well, in the brief she holds, that there are very significant gaps in service delivery. Those gaps can be seen in the ambulance service, in elder care, and in services for people with disabilities and mental illness. The Minister of State is struggling to find the cash to do what she wants to do. In fairness to her, she has rightly indicated her view that if moneys become available as a result of an upturn in the economy, they should be used to fill those gaps. That is the correct approach, not a return to the auction politics of the past, at which, I acknowledge, my party was as good as Fine Gael is showing itself to be. I assure the House that we have learned our lesson, but from what I saw of the antics of the Deputy from Limerick tonight, who really should know better, I can have no confidence that the other party in government has taken that lesson on board. However, fair play to the Labour Party for challenging Fine Gael in its auction approach to politics. We saw it again today, with Members briefing journalists and then denying they had done so. It is all about courting popular opinion on the cusp of an election when all the opinion polls are showing that Fine Gael is taking almost as hard a battering as the Labour Party. At least the Minister of State's party has been upfront in accepting the responsibility that befell it upon coming to power.

I appeal to Fine Gael Members to approach this issue with an open mind. I ask that they at least be prepared to accept that while a great deal has been done, there remains a significant amount of work to do, and that when funds become available, as they will with the pick-up in the economy, those moneys should be used to improve and enhance services, including the ambulance service, in a manner that meets the needs of diversely populated rural areas and benefits all.

Denis Naughten (Roscommon-South Leitrim, Independent)
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There are three official ambulance blackspots designated by the National Ambulance Service, namely, Tuam in County Galway, Mulranny in Mayo, and the west Roscommon-east Mayo area. The National Ambulance Service has spent €1.74 million putting in new ambulance stations at each of those locations, including at Loughglynn in County Roscommon in the case of the west Roscommon-east Mayo area. The new policy of the ambulance service of dynamic deployment means there no longer needs to be an ambulance station but only a parking bay and toilet facilities for ambulance crews. We have a situation now where the facilities are there but there are no ambulances.

Based on a comparison with Northern Ireland, we have approximately one third of the ambulances needed to provide an adequate emergency service across the country. As I said, bases have been installed in the three nationally recognised ambulance blackspots, yet we have no money to provide ambulances or crews to serve those bases. As a result, the National Ambulance Service is obliged to borrow ambulances from Ballinasloe, Galway, Castlebar and Roscommon town, with those stations left scrambling to find vehicles to respond to emergencies. This is the reason we are failing to meet the HIQA targets for the west, where fewer than one in every two ambulances arrives within the 90 minute target and where, in fewer than one in five cases, a first responder, be that a paramedic, doctor or a person with a defibrillator, arrives on the scene within eight minutes.

People argue that it is all about outcomes. However, if there is no ambulance and no first responder at the scene of an incident, there will not be a positive outcome. It is important to bear in mind that these are HIQA standards. The Government has used standards set by that independent body to justify its reconfiguration of other services. The existing ambulance service needs to be reconfigured to meet the standards that have been set out and the requirements of the public. What is happening at the moment in my part of the country is a case of death by geography, because we do not have the required number of ambulances. We need more ambulances and more ambulance crews, and we need them now.

Kathleen Lynch (Cork North Central, Labour)
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I thank those who made contributions to the debate up to now. I must admit that I did not hear all of the contributions but I will very much take on board what was said during those for which I was present. I wish to express my thanks to the people who crew ambulances throughout the country. I recently had an opportunity to be very thankful for those individuals. As Deputy McConalogue correctly stated, treatment begins when a highly trained paramedic or first responder attends at the scene of an accident. That is why what these people do is so important.

The Minister, Deputy Reilly, outlined the significant reform programme currently under way within our ambulance services. Everyone acknowledges that this programme has been put in place. We are making progress and additional resources have been provided to the national ambulance service, NAS, to facilitate further developments. Additional funding of €3.6 million and 43 extra staff were provided in 2014. The NAS is working to ensure the provision of high-quality and timely emergency pre-hospital care services, using all available resources as effectively and as efficiently as possible. However, as with any pre-hospital service, the process of development and modernisation is ongoing, particularly as technology and clinical standards change.

A number of Deputies referred to the use of officer response vehicles. While usage of these vehicles is currently under examination by the NAS, I should clarify that officers use official vehicles in line with NAS policy on the authorised use of official vehicles. Use of a vehicle out of hours may be approved by a senior manager where it is necessary for an officer to be on call. Deputy McConalogue explained the difference between rostering and being on call very well. Use of a vehicle out of hours could include parking it overnight at an officer's home in order to facilitate on-call availability. Officers using vehicles out of hours are qualified to respond to life-threatening calls. These vehicles can be tracked by control centres and are available for dispatch. It is important to note that the vehicles in question are a valuable additional resource, particularly as officers provide an emergency service in their communities outside normal working hours. Officers are not paid an on-call allowance and respond to these calls on a pro-bonobasis. In the first quarter of this year, officer vehicles responded to over 630 incidents. More than 250 of these occurred outside working hours and the officers involved received no payment for their attendance in respect of them.

A number of Deputies also raised issues relating to ambulance coverage in specific areas. They may wish to note that an independent review of NAS capacity nationwide is currently under way. This review will provide greater clarity while also determining the level and use of resourcing required in terms of staff, vehicles, skills and distribution for the provision of a safe and effective service now and into the future. It is accepted that we need to further improve the service. The single national control system, which is due for completion in 2015, will improve our control and dispatch performance. We are also continuing to develop the intermediate care service, which is specifically focused on non-emergency clinical transport, such as inter-hospital transfers and low acuity work. This frees up emergency resources - which traditionally provided such services - to focus on more urgent calls. In order to drive improvement, performance response time targets for 2014 in respect of high acuity emergency calls have been increased in the service plan.

Further areas for improvement will be identified by the three separate reviews of pre-hospital care which are currently under way. I have already mentioned the capacity review. In addition, HIQA is examining governance arrangements to ensure the timely assessment, diagnosis, initial management and transport of acutely ill patients to appropriate care. A joint review of Dublin ambulance services, commissioned by Dublin City Council and the HSE, will determine the best model of ambulance services for the city. The reports relating to these reviews will inform the development of a modern, clinically-driven system - properly resourced - which will deliver appropriate and timely services for the benefit of patients. I assure the House that the NAS will continue to modernise and reconfigure services in order to deliver the best possible level of pre-hospital emergency care.

Michael Moynihan (Cork North West, Fianna Fail)
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I welcome the opportunity to contribute to this timely and important debate. We have witnessed the fanfare relating to the reforms of the ambulance service and we have been informed that the latter has been hugely improved. I have grave concerns with regard to the service, particularly in the context of how it operates in rural communities. The Duhallow area where I reside is now served by an ambulance shared between Millstreet and Killarney. Anyone who is familiar with the geography of the region will be aware that the distances involved are quite large. Prior to the introduction of the shared service, another ambulance had already been removed from the Duhallow area and replaced with a rapid response vehicle. Individuals and families unfortunate enough to have been obliged to depend on the service were frustrated by the amount of time they were obliged to wait for the ambulance or rapid response vehicle to arrive. This matter was recently the subject of a debate on the local radio station.

One of the people administering or working within the service texted in. Obviously, he could not give his name because of the position he held. He stated categorically that he was seriously frustrated, that morale was decidedly low and that they were challenged in every which way. Let us consider the geography of it. Let us suppose an ambulance picks up a patient in the Duhallow region, Millstreet, Kanturk or Newmarket and then travels to Cork, which is approximately one hour away. The paramedics must stay with the patient until he is admitted or whatever and they are there all day. This means the entire western Duhallow region and east Kerry is without an ambulance for the duration. There is a major need to address this.

We met representatives of the HSE when they were discussing taking one ambulance out of the region. They gave us various glowing statistics and figures relating to what would happen in future and suggested that the control unit would know the level of oil in the engines of the ambulances and the pressure of the tyres and so forth. This has proved not to be the case in recent times and ambulances have broken down at various stages. These cases have been well documented in the media, they are in the public domain and I have no wish to go into them because I have no wish to infringe on the families involved or their privacy. Evidence exists to show that the service, as reconfigured, is not working. There is a serious need for a review of the whole situation to prevent any serious incidents arising. Specifically, in the case of my region, it is not acceptable to take an ambulance out of what we would call north Cork but what is now being banded by the HSE as north Cork-east Kerry, a great raft of countryside. It is not acceptable and it will not work. I imagine if this continues many cases will be highlighted in the media in respect of people waiting. In certain cases people have had to wait for one hour, an hour and a half or two hours.

The accident and emergency service has been taken out of Mallow General Hospital and since then Cork has become the port of call. I was in an ambulance after a relative of mine was involved in a road traffic accident. The ambulance leaving the road traffic accident was going to Cork but midway en routehad to divert to Mallow because the patient, an uncle of mine, was in serious danger. Thankfully, he got to Mallow and was able to be resuscitated before he was moved on to Cork. There is a serious issue in this regard. I speak from deep experience in respect of having to wait for ambulances for over one hour. This was the position before the reconfiguration. I shudder to think what it will be like in future. This is relevant not simply because the matter was highlighted on "Prime Time". Many of us are hearing about it daily in our constituency offices. This is one of the most pressing issues that must be dealt with. What is being rolled out is not for the better.

Colm Keaveney (Galway East, Fianna Fail)
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I acknowledge the dedication, commitment and, above all, the actions of Deputy Billy Kelleher, who has achieved a significant public service by providing for this debate. The motion we have placed before the Dáil boils down to the assertion of two simple factual statements. Our ambulance services are under-resourced and, as a consequence, we are placing people's lives at risk. The only appropriate response to these facts is for the Minister of State and her colleagues in Cabinet to consider resourcing the ambulance service appropriately. Instead, we and the public are being presented with a Government counter motion that one could only argue is a work of fiction.

I offer an example from my constituency, Galway East. In 2012, a new ambulance base was built at a cost of €1.7 million and opened in Tuam to service north County Galway. As welcome as this was, the issue of staffing arrangements in the base continued to be a source of great concern to my community. We take the word of paramedics over the word of the HSE senior managers and officials in the Department. I maintain front-line staff provide a great picture of the reality of what is taking place in the service. The base in Tuam is only staffed on an ad hocbasis from Galway City and, sometimes, Ballinasloe. For the most part it is only covered by a two to three days per week, 12 hour roster. On certain weeks there are no rostered staff there. This is relevant since the response time to Tuam from Galway city is 30 minutes on a good day. On a bad day it can be between 40 to 50 minutes before an ambulance arrives. For example, response times to Glenamaddy, an area of north County Galway, can take up to 50 minutes on a good day. Sometimes, Galway city is unable to respond and therefore an ambulance is dispatched from Loughrea. The response time for the Tuam area can be up to one hour, and this is not an acceptable situation. It makes a mockery of the 19 minutes target quoted in the Government counter motion. The Government has referred to the strategic deployment of ambulances. In previous responses, the Government used to refer to dynamic deployment, but the spin seems to have been upgraded and it is simply not working.

There is no talk today of strategic deployment to address the situation in Tuam and north County Galway. One paramedic put it to me that while paramedics were well-trained and capable of delivering high quality care, often patients do not need a paramedic carer but rather to get to hospital as quickly as possible. They need to get towards a centre of excellence at maximum speed.

In the current situation, this Government is riding its luck in rural Ireland. Last year, only one in three people with a life-threatening condition were responded to inside the target times. In my area, this has been evident in several high profile cases. This time last year, I put forward suggestions under a Topical Issues debate to facilitate providing for staffing levels on a 24 hour, seven day basis for the existing ambulance services in County Galway on the basis of providing a full-time 5/7 or 7/7 roster for Tuam. In response, the Minister of State said at the time that the proposition was eminently practical. More than one and a half years has passed since that eminently practical proposition but nothing has happened in respect of the staffing levels in Tuam, and north County Galway continues to be at risk. It is considered a blackspot area with respect to coverage.

I call on the Cabinet colleagues of the Minister of State to stop playing Russian roulette with my community. This is not fiction and no doubt the counter motion is not based in reality. I call on the Minister of State to consider carefully how she could provide for an adequate level of resources for Tuam and north County Galway. It is inexplicable that we have a situation whereby €1.7 million of capital spend took place in 2010-2011 and yet there is no staffing provision for a roster. It is not acceptable that people have to wait up to one hour or an hour and a half to have the services of an emergency medical technician and access to the general hospital. I call on the Minister of State to act on this. The situation is a source of great concern and I call on the Minister of State to respond to us in that respect.

Billy Kelleher (Cork North Central, Fianna Fail)
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I welcome the contributions from everyone with regard to this motion. The purpose of the motion was not to scaremonger or frighten people. It was simply to highlight the inadequacies of a service that is critical to many people. We have been accused of Punch and Judy politics. I do not mind being accused of being Punch or, for that matter, Judy, but I would be failing in my duty if I did not raise this issue because it is an issue of key concern.

There has been couched language from the Government Deputies in their support for the Government motion. At the same time, they raised legitimate concerns in mild language. Perhaps I am more direct but the bottom line is that there are major problems with our ambulance service. It is not meeting the required targets as laid down by the Health Information and Quality Authority. It is under-resourced and understaffed. By any stretch of the imagination to deny that this is the case leads me to believe that we have a greater problem with regard to the provision of emergency care in the country than I had thought.

We have had members and representatives of the HSE National Ambulance Service before the Oireachtas Joint Committee on Health and Children. They were at pains to say that things are okay. However, we have discussed the matter with front-line personnel, including advanced paramedics, paramedics and the people driving the ambulances. They have informed us that there are major deficiencies in the service. Issues have been outlined by Deputies on this side of the House in respect of some parts of rural Ireland which highlight that we are now playing dice with people's lives. There are inadequate resources and personnel in large tracts of the country when it comes to emergency cover on a 24 hour basis, and the "Prime Time" programme exposed this. I and others have tabled parliamentary questions time and again to try to find out the true extent of the deficiencies in the ambulance service. We now know that this is the case.

Our difficulty is with the denial by the HSE and senior management of the National Ambulance Service, NAS, and at ministerial and departmental levels. We must acknowledge that, by any international standard, the Irish service is under-resourced and understaffed. Compared with Northern Ireland or Scotland, the service we are providing is amazing. This is down to the dedication, determination and commitment above and beyond the call of duty of the service's personnel. The difficulty is not caused by the personnel working in the service, but by the lack thereof. We must tackle that shortage to ensure we have a service in which people can be confident.

We have discussed the reconfiguration of hospital services throughout the country, universal health insurance and the creation of hospital trusts and hospital groups in the context of what the Government calls the White Paper on Universal Health Insurance. A key problem is that, as the Government downgrades emergency departments in hospitals, ambulances must drive longer distances to provide cover. This stretches personnel's ability to reach emergency scenes in a timely fashion, as highlighted in the "Prime Time" programme. Given the response times for delta and echo calls, the service is not meeting the requirements set by the Health Information and Quality Authority, HIQA.

A review is being carried out, but we want a full comparison between the ambulance services of Ireland, Northern Ireland and Scotland. In this way, we could definitively know how under-resourced we are. The former director of the NAS stated that we would need approximately 400 personnel in addition to the current level of 1,600 staff. That is a lot. By publishing HIQA's guidelines but lowering the threshold, we are dropping standards so that they can be met. This is not proper policy. It is disingenuous to claim that the standards are being met. Of course they are if they keep being lowered. They were meant to be 80% as regards first responders, but they are now 70%. HIQA's recommended guidelines are being manipulated.

If one spoke with front-line personnel, they would say that they were at breaking point. More importantly, we know what happens when, from time to time, an ambulance is not available to be dispatched to the scene of an emergency. People's lives are being put at risk.

The Government will reject this motion, but I urge it to keep in mind the opinions expressed by Deputies from all sides of the House and to consider resourcing the NAS.