Ms Laverne McGuinness:

I thank the Chairman and members for the invitation to attend the committee meeting today. I am joined by my colleagues Mr. Martin Dunne, who is director of the National Ambulance Service, and Dr. Cathal O’Donnell, who is the medical director of the National Ambulance Service and a consultant in emergency medicine. Before beginning the statement, I wish to acknowledge the presence of the McQuillan family and to extend the HSE's sympathy to the family on the loss of their son.

The joint committee requested information regarding the National Ambulance Service and response times and the HSE already has provided a detailed briefing. In my opening remarks, therefore, I will focus on the key areas of investment in 2013 and 2014 and on improvements in emergency response times. 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. Each year, the National Ambulance Service receives between 275,000 and 280,000 emergency calls, which amounts to approximately 23,000 emergency calls each month. During 2013 the National Ambulance Service experienced an increase of approximately 1,000 emergency calls each month over the year, and in December the total number of emergency calls exceeded 25,000. Analysis of the overall data indicates that there has been an increase of approximately 10% in all emergency calls from January 2013 to December 2013.

The National Ambulance Service has a budget of €137.7 million in 2014. There has been significant investment in the ambulance service in recent years with the aim of developing a modern, high-quality National Ambulance Service that is safe, responsive and fit for purpose. Responding to emergency calls within the target response time is a key objective of the ambulance service, and the target set for 2013 was that 70% of clinical status 1 ECHO incidents - that is, those incidents in which patients are suffering from a life-threatening emergency such as cardiac or respiratory arrest - should be responded to by a patient-carrying vehicle in 18 minutes and 59 seconds or less. National performance for 2013 was 69.5%, while some regions achieved rates as high as 79%. As for clinical status 1 DELTA incidents - that is, those dealing with other non-cardiac life-threatening emergencies - the target set in 2013 was that 68% of incidents should be responded to by a patient-carrying vehicle in 18 minutes and 59 seconds or less. The performance for 2013 was 64.1%, with some regions achieving 67.87%. In 2013 a total of 88,644 category 1 calls, both ECHO and DELTA, were received, which amounted to between 7,300 and 7,500 each month. During 2013, the volume of ECHO and DELTA calls alone increased by an average of 1,000 per month. Despite this increase in volume of 1,000 per month, the ambulance service responded to a higher number of these calls within the 18 minute and 59 seconds target. Had the volume of calls remained the same, we would have seen an even more significant improvement in response times.

A performance improvement action plan has been put in place to improve our response times and patient outcomes, and we have increased our target for ECHO and DELTA response times in 2014 from 70% to 80%. These actions include monitoring and improving processes in respect of call taking, allocation and dispatch, monitoring and improving crew mobilisation times, appropriate targeting of emergency vehicles, appropriate targeting of intermediate care resources and monitoring and improving emergency department turnaround times. The delivery of these improvements will be facilitated greatly by the new financial investments made in 2013 and 2014. To ensure successful implementation of these items, a three-year national ambulance strategy is currently being finalised.

I will turn to some of the significant areas of investment. The development of a single national ambulance control centre operating over two sites, namely, Tallaght and Ballyshannon, is a key priority for the health service. Between 2013 and 2014, the health service invested €26.2 million in the development of a single national control centre which will operate over the aforementioned two sites. Of this €26.2 million, capital funding amounts to €14.2 million, which includes €7.6 million invested in ICT, for example, for the digital, voice recognition and call-aided dispatch technology system and an integrated command and control system. This €26.2 million also includes €8 million in revenue funding.

The process of rationalising the number of ambulance control rooms across the country is in line with international best practice. The single control centre will contribute to the provision of optimal pre-hospital emergency services to the public by ensuring that all emergency call-taking and despatch is carried out on one system in order that the nearest available emergency resource is despatched to each incident, regardless of any former geographic boundaries. It is expected that the new national control centre will open in 2015.

Cork, Tralee and Navan control centres' functions have already migrated to the National Ambulance Service Control Centre at Townsend Street during 2013 and control operations for the former east, which is, Dublin, Wicklow and Kildare, migrated onto the same computer system as Townsend Street and went live for both voice and data on the national digital radio system.

One of the other investment is in intermediate care vehicles and services. In 2013, capital funding of €3.25 million was used to purchase an additional 25 intermediate care vehicles to allow us further optimise the deployment of resources. The intermediate care service is specifically focused on the delivery of inter-hospital transfers and low acuity work to ensure emergency ambulances are available to respond to emergencies as they arise. To date, 73.4 operatives have been appointed across the country in Cork, Galway, Sligo, Letterkenny, south Dublin, Waterford, Kilkenny and Castlebar.

In 2013, in order to support the implementation of additional intermediate care services, the National Ambulance Service procured 25 additional vehicles at a capital cost of €3 million. Preliminary analysis of the data for 2013 shows that the investment made in respect of our intermediate care services is already showing some positive results. This preliminary data, especially for December, indicates that intermediate care vehicles are taking over much of the non-emergency work that would normally have been managed by our emergency ambulance vehicles. This investment allows emergency vehicles to be freed up, thereby enabling improvements in emergency response times, to deal with the increased volume of emergency calls being received.

The emergency aeromedical service was established as a pilot service in June 2012. The service involves the Air Corps providing aeromedical support to the HSE National Ambulance Service. Based in Custume Barracks, Athlone, the Air Corps is providing a dedicated helicopter and personnel to fly and maintain the aircraft.

The emergency aeromedical service has completed 458 missions since its inception to year end 2013. The Irish Coast Guard supplies services to the National Ambulance Service as a primary responder for search and rescue missions and as a secondary responder for aeromedical services. In 2013, the Irish Coast Guard completed 276 missions.

These are just some of the key investments that have taken place within the National Ambulance Service over the past two years. As part of the three-year national ambulance strategy, the health service will be conducting a national capacity review setting out the requirements of the ambulance service over the next number of years.

This concludes my opening statement and together with my colleagues, I am happy to answer any questions that the committee may have.