Mr. Tony O'Brien:

Persons whose individual circumstances may not have materially changed may none the less find, when a standardised set of rules are applied, that they no are no longer entitled to a medical card. I can categorically stated that there is no targeting of any particular group. Medical cards are reviewed on a batched or random basis, except where on the basis of information which is now available to us through linkages with the Department of Social Protection, there are specific reasons to believe that an individual's circumstances have radically changed. There is no targeting based on medical condition or otherwise. As stated by the Minister of State, Deputy White, even if we were bizarre enough to want to do that, we do not have the capacity to do it. I can categorically assure members of the committee that is not happening.

In regard to the National Ambulance Service, NAS, the Health Information and Quality Authority, HIQA, introduced guidance targets in January 2011. At that time, the service was not organised in such a way as to be able to meet those targets and since that time continuous investment and reorganisation has been producing a steady improvement of performance against target times. I resent the suggestion that there is any pretence about the performance of the National Ambulance Service. This data is published monthly in the HSE's performance reports. The fact that we are engaged, at a time of extraction of significant investment in health care from almost every other sector, in very substantial increases in investment in the ambulance service, resources, training and personnel, is a signal that we do not believe that without that investment or reorganisation the ambulance service can meet the demands that are placed upon it. There is no suggestion anywhere, either at this level in the HSE or in the leadership of the NAS, that the service is currently organised to do everything that is required of it. There is no definitely no sense of pretence.

Some of the changes that we have introduced include, the introduction of immediate care vehicles which now carry 74% of those on into hospital transfer. In the past, emergency ambulances were used for this purpose. The incremental centralisation of the control system to enable the resources to be used dynamically where ever they may be is important. The intention is that as this rolls forward the national control centre, which is being developed with input and guidance from then National Association of Chief Officers of Ambulance Services in the UK - we have been done this path before - will bring about a significant improvement in deployment.

On the Dublin Fire Brigade ambulance service, with no pun intended, there is an awful lot more heat than there is light in the discussion on this issue thus far. The Dublin Fire Brigade, which we fund for this purpose, operates 11 emergency ambulances in Dublin. The NAS operates 28 emergency ambulances in Dublin and, in total, 50 in the former eastern health board area. The Dublin Fire Brigade ambulance is an important contributor but it is by no means capable of description as Dublin's ambulance service. The NAS out-classes it in terms of scope and scale in almost every respect. I wish also to ensure that members are aware that the NAS response time in the most recent monthly data for Clinical Status 1 ECHO calls, for which the target is 70% the response rate was 75.27%. The Dublin Fire Brigade, DFB, supplies the NAS with activity statistics in respect of on-call, volume and response times on a monthly basis, one month in arrears. The most recent data, in terms of the same standard of Clinical Status 1 ECHO calls, in respect of which the target is also 70%, shows that the response was 58.4%. There has been much inaccurate information in this regard. The Dublin Fire Brigade is an important contributor but it is no means the exemplar that some people suggest it is.

I am also concerned by the notion being put about that there is some kind of agenda for a HSE take-over. I remind the committee that I was appointed as final head of the HSE. I am winding up the HSE for the Minister. There is no land grab going on. What we want to do is ensure that one of the legacies is an appropriately structured National Ambulance Service. It will not be a HSE ambulance service but a National Ambulance Service. I agree with Deputy Ó Caoláin on the need for a national ambulance authority. I am sure that following this exercise we will have a National Ambulance Service appropriately governed as hospital groups and so on. There is no selfish organisational corporate agenda. We are happy that the city manager for Dublin City Council has initiated the review. We are working with him in that regard. It does not make sense to have a control centre in the centre of Dublin, with the NAS resources being managed by controllers on one side of the room and the Dublin Fire Brigade resources being managed by the controllers on the other side of the room, with little interaction between them. That is not a good use of resources. I am sure that if we could find a way through this review to manage those resources in a more co-ordinated manner the people of Dublin would have a combined ambulance service, which would be much better. Let us retain a sense of proportion.

That having been said, I in no way diminish the impact of ambulance service delays, such as that outlined earlier or by other citizens. The purpose of the ambulance reforms under way is to ensure a better service.