Mr. Ted Kenny:

I thank the Chairman and committee members for the invitation to discuss the challenges faced by our members working in the HSE National Ambulance Service, NAS, and the Dublin Fire Brigade, DFB, fire-based emergency medical services. SIPTU represents more than 1,600 members in the National Ambulance Service, all of whom are critical to the delivery of care in emergency services in our communities. The HSE National Ambulance Service provides the following supports to the public throughout the State: emergency ambulance service; immediate care transport; mobile intensive care ambulance; and neonatal intensive care ambulance.

In Dublin, a dual system is operated by the NAS and the DFB, which has served its residents well over many years. Dublin Fire Brigade ambulance service employs 110 personnel in all grades of ambulance professionals, inclusive of more than 80 advanced paramedics. Dublin Fire Brigade ambulance service requires back-up support from 840 paramedic first-response firefighters, backed up by 21 paramedic first-response fire appliances and two emergency fire appliances, offering a rapid first response deployment to any pre-hospital emergency.

Ambulance capacity in Ireland has been at a low level historically, with demand increasing over the years. For example, monthly demand in the second half of this year is at levels normally experienced in December pre-Covid. Covid has, obviously, affected all aspects of the health system, from primary care to hospital care. There are very high levels of hourly use of emergency ambulances and pressures on these areas of the system have had a knock-on effect on ambulance services. Hospital offload delays have increased in number and duration. Call volume to emergency control centres has increased, and the time duration of each call has extended due to the additional personal protective equipment, PPE, and effective prevention control measures that are required when managing Covid. Ambulance crews are experiencing the effects of lengthening response times, which in turn have an effect on the welfare of staff working in such a busy system, both in the control centres and operationally.

SIPTU representatives have expressed deep concerns over the high level of pressure on the ambulance service, with paramedics frequently having to be diverted from other parts of the country, under a system that has been widely criticised by staff and has resulted in many members suffering from burnout. Staff recruitment and retention in the service has become a serious issue. In Dublin Fire Brigade's fire-based emergency medical service, ongoing manning shortages have meant that, at times, up to 20% of front-line DFB fire appliances have been taken out of service, resulting in a corresponding reduction in the number of available paramedics.

In representing members in these vital services, we want to share our concerns about the effect this is having on the morale of our members who provide front-line ambulance services throughout the Republic of Ireland and the concerns our members have about the perceived lack of public confidence in an essential, life-saving service. As the Chairman and committee members will be aware, from both their work on the committee and their work in their constituencies, public concern has grown throughout the country as a consequence of several high-profile cases in which ambulance responses to a specific incident or event have been flagged in the media as a matter of concern. We are here to assist the Oireachtas Joint Committee on Health to examine all factors involved in the delivery of the ambulance services, to do what we can to establish the growing challenges confronting this essential front-line service and to assist the professional ambulance personnel committed to providing these services.

Ambulance professionals, in both the HSE National Ambulance Service and Dublin Fire Brigade, have a proven tradition of putting the care of the patient first, and this ethos has been well demonstrated by their commitment to developing the service from being a patient-transport service to a sophisticated first-point-of-control medical intervention. This has required the strategic educational development of personnel, whereby ambulance professionals are trained to the level of medical technician, paramedic and advanced paramedic, all of whom are equipped to deliver the earliest possible medical intervention, thereby giving the patient the best possible medical outcome. This also provides the added benefit of taking pressure off accident and emergency departments through earlier interventions. Our members are also committed to the bachelor of science degree programme in pre-hospital emergency medicine supported by University College Dublin and University College Cork. Those who deliver front-line emergency ambulance services are deeply affected when a failure to deliver the best medical intervention or to meet the recommended response times is linked to an adverse outcome for a patient, given many of our members who work for the ambulance services live in the communities they are deployed to serve.

Despite restrictions on resources in these difficult times, ambulance professionals continue to develop their skill set to serve in the interests of the public. SIPTU has been at the forefront of the development of the professionalisation of the ambulance services, which has evolved since 2001 and has been overseen and regulated by the Pre-Hospital Emergency Care Council, PHECC, which is also the licensing authority for all qualified ambulance personnel. In order for a proper discussion to take place on the resources required for the State's ambulance services, it is imperative the recommendations of the NAS capacity review be implemented.

SIPTU members are committed to working with any and all processes, including future capacity reviews, that will advance the ambulance service. The huge advances made by our members from the ground up are testament to our credibility in improving the ambulance service through the development of ambulance personnel and services.

I thank the Chairman and the committee for their consideration on this submission.