Ms Mary Dunnion:

What it means for the public is that although they may experience good care, there is no system in place to assure those who manage the service that there is good care, there is no assurance for those who deliver the care that it is being monitored and that lessons can be learnt where there may not be good care, and there is no way to assure members of the public formally that there is care in respect of their individual experience. Of course, the big loss is that if there is not good care, it cannot be detected and it is not possible to manage, change it and learn from it. That is probably the most important example.

There is a difference between those whom the committee met from the Dublin Fire Brigade and those whom it met from the National Ambulance Service. Dublin Fire Brigade is a uniform service and by its nature it has the constituents of that. It is well organised, there are clear communication pathways and the staff are responsive to any issues, or to recommendations or direction given through their management line. In the National Ambulance Service, there are a lot of legacy issues, which we saw. In the groups that we met - as I stated, we met quite a large number of staff - there was dissatisfaction. It permeated through. Probably the biggest manifestation was the poor communication processes that they perceived to be in place. They would, for example, have cited areas where information was passed down by memo as opposed to somebody talking to them. What we saw is that although staff were complaining, it was in a desire to improve the service. That was tangible through all the groups that we met and is noted in the report. We recognise the need for good communication processes and the dissatisfaction that happens when those are not in place, which is what we witnessed. As a consequence, we have a recommendation related to that within the report. They were two different groups of staff. They are structured differently. One is a fire service and emergency service, and it is in existence a long time and has probably the cohesiveness which arises from that length of time.

On staffing, the review would recognise that there are not enough advanced paramedics. Also, we would have seen that in the attrition rate within the ambulance services, particularly the National Ambulance Service, for paramedics more than advanced paramedics, the replacement factor does not match the attrition. When paramedics are recruited, it takes two years before they are able to function on their own. If one does not have a good replacement practice then there will be shortages. That is why we made the recommendation regarding workforce planning because we would not have seen that such was in place. As Mr. Quinn stated, we have been informed by the HSE that the capacity review which, because it was happening in tandem with our review, looks specifically at resources and what is required in the service moving forward, will be ready for publication at the latter end of December. That review should give a more comprehensive view of what is required but we saw deficits in the numbers that would be required for the service.