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

I welcome Ms McGuinness, Mr. Dunne and Dr. O'Donnell. We all welcome the fact this HIQA report has finally been published and we have an opportunity to debate it. In many ways, it makes for sobering reading. This issue has been debated in the Dáil and has been raised by numerous Deputies on many occasions in terms of the concerns they have in regard to response times and resources for the national ambulance service and the need for us to ensure there is confidence among the general public that there will be a timely response in the event of an accident and the ambulance service being called into action.

The report highlights many deficiencies in the national ambulance service. I do not think we can pretend they are not there. If one goes through the report in detail, it quantifies them. In some areas, the review identifies challenges in relation to workforce and leadership, the model of care and fleet and fleet deployment.

I put down numerous parliamentary questions in regard to the age of the fleet and the mileage of same. I think that has been dealt with in the context of the HIQA report. Certainly, there are major concerns about the age of the fleet and the reliability of same and the servicing of it. Incidents have been reported to us and they have been published nationally in regard to some of the fleet just not being up to standard in terms of safety, both for the personnel operating it and the transferring of patients.

As I said, some incidents have been highlighted very publically. I am quite sure there have been others, as identified in the HIQA report.

Deputy Ó Caoláin referred to the national ambulance service and its relationship with the Dublin fire brigade. It defies logic that we have a situation where they do not seem to be talking to each other and that proper structures do not seem to be in place so that they can complement and assist each other in a meaningful way. That has been highlighted in the report. Are there difficulties, in the context of the national ambulance service, the HSE or whoever, in dealing with that?

A delegation from the Dublin fire brigade came before the committee. It seemed to have a fairly efficient system in terms of call out times and responses to emergencies. We do not seem to view the national ambulance service and the Dublin fire brigade as complementing each other and using their resources efficiently and effectively in a compatible way. Perhaps the witnesses could refer to that.

Ambulance services have been debated during Private Members' business in the Dáil on numerous occasions. The report states the national ambulance service serves a very rural population, with 40% of incidents arising in rural locations. In England, for example, 12% of incidents are classified as rural in a typical ambulance service. It goes on to state that this will have significant implications for the ability of the national ambulance service to perform to the same standards as the English ambulance service.

That leads to a number of questions. In terms of response times to echo and delta call outs, we are not meeting the HIQA targets. We do not need a report to identify that problem because it has been highlighted regularly and raised consistently. We are not meeting those times, and we need to ask why we are not meeting the targets in a manner we would consider appropriate.

The resources and personnel of the national ambulance service are being reduced in some areas, in particular in the west and Roscommon, where there seems to be a view among the public, which is supported by HIQA, that there is a deficiency in resources. In rural areas across the country there is major concern that the national ambulance service does not have the necessary capacity. This is no reflection on the personnel who have highlighted on numerous occasions the enormous pressures under which they work. They have to travel large distances to and from emergencies to take patients to hospitals.

Do we now have to accept, as identified in the HIQA report, that we need extra resources? There is no point in pretending otherwise. Mr. Dunne previously stated to the committee that it is one of the finest ambulance services in the world, and I have no doubt it is, in the context of the resources with which it is provided. It is a miracle it is providing its current level of service, and that is a reflection of the professionalism and competence of the people working on the front line. They have to be resourced and assisted, and need extra personnel and vehicles.

Call-out targets are assessed on the basis of a patient-carrying vehicle being the first responder. Are we beginning to massage the figures with regard to call-outs? Very often the first responder is considered the first response. However, as the committee previously discussed, the targets should be based on a vehicle that can transport a patient, rather than on first responders. I ask for some extra clarity on that.

Another key area identified as tying up scarce resources are lines of ambulances outside emergency departments in hospitals throughout the country. Recently, Beaumont Hospital had some 40 patients on trolleys, and had to cancel elective surgeries and send out a message that it did not want people to attend the emergency department. The national ambulance service took patients elsewhere. One of the bizarre things happening is that what are already scarce resources, namely, highly trained personnel, are waiting outside emergency departments. In this day and age there should be some mechanisms to ensure patients can transfer more seamlessly into emergency departments and beyond.

I do not expect the national ambulance service to resolve this issue, but the HSE has an obligation to address what is a glaringly obvious problem, namely the transfer of a patient from an emergency situation to an emergency department, through the acute hospital setting and, eventually, out the other side. The idea that we have had numerous instances of ambulances being tied up for long periods of time is very concerning.

How many minutes do I have?