Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the presentation by the ambulance services. No one is criticising the staff at the coalface of the ambulance service. We should be clear about that. We are here to try to shed some light on the challenges facing front-line services, to see where there are deficiencies and if we can highlight and throw some light on that, as well as determine where additional resources are required.

We recognise the fact that resources are always an issue in every service. However, at the same time, there seems to be a good deal of disquiet among the public about the ambulance service. Given the reconfiguration of hospitals groups, the small hospital framework and the downgrading of emergency departments and the amalgamation of others, pressure has been put on the services which had not necessarily been anticipated. Moreover, the issues that have been highlighted by other speakers relating to major incidents raise questions about the responsiveness of the ambulance service. This is why we are having these meetings. It is not a criticism of front-line staff.

The deputation stated that HIQA or some other body should have carried out a capacity review in advance of bringing forward the key response indicators of 7 minutes and 59 seconds and 18 minutes and 59 seconds. Does the deputation recognise that HIQA has probably set out best international best practice in terms of the performance indicators and call-out times? Rather than addressing these issues, what we should be addressing are the resources to ensure we can meet the key performance indicators. That is why we are here today.

Some confusion exists. If an ECHO or DELTA call comes in, the first responder is meant to be there in 7 minutes and 59 seconds. That would be either a community responder, emergency vehicle or an ambulance. If the ambulance is the first responder, then it should be there in 7 minutes and 59 seconds. If it is the second responder, then it should be there within 18 minutes and 59 seconds.

When we question the National Ambulance Service and speak to individuals who have complained about response times, we get varying views. I would like to have this clarified once and for all: is the National Ambulance Service obliged under HIQA guidelines to have a community responder, an emergency response vehicle or an ambulance, if it is the first responder, within seven minutes and 59 seconds? If there is a first responder that is not an ambulance, is the ambulance obliged to go as a second responder within 18 minutes and 59 seconds?

We have heard all too often that the emergency response vehicle is being used to supplement, rather than complement, the ambulance. That seems to cause a great deal of confusion. I believe the National Ambulance Service almost has a policy to use emergency response vehicles as the first and only responder. I seek clarity on that issue.

There is no doubt that a cursory look at the resources available to the National Ambulance Service to provide a quality service shows that they are not available, when compared with those available in Northern Ireland or Scotland. Instead of talking about HIQA’s response times, we should be talking about the need to ensure proper resources are in place.

Is the relationship between SIPTU members and management confrontational? Do individuals have issues about how they may relay their concerns? Is the union able to advocate for its members? Are there rostering difficulties and are relief teams being used to supplement, as opposed to complement, the service team on duty? Is there an inherent break-down between members at the coal face and management in addressing the rostering of personnel throughout the country? That is critically important when we are reconfiguring hospitals throughout the country. Is there enough discussion between key front-line personnel who try to deliver the service? They seem to be under inordinate pressure and stress. When I speak to individual members of the service, they say they work excessive hours and travel long distances.

While I understand the pressure on emergency departments in hospitals, from time to time ambulances are lined up outside emergency departments, unable to discharge patients. How can this issue be addressed? I can understand that in traumatic cases the patient is rushed in, but I cannot understand why a scarce resource is simply parked outside an emergency department. Has SIPTU put forward any proposal to deal with this, or discussed the issue with the National Ambulance Service or the Pre-Hospital Emergency Care Council? What is its view on how to address this impediment to ensuring a smooth discharge from the ambulance and its release to do its work?