Mr. Liam Woods:

I thank members for the invitation to meet with the committee to discuss the National Ambulance Service, NAS. I am joined by my colleagues, Mr. Morton, Dr. O’Donnell and Ms Mahon.

NAS is the statutory pre-hospital emergency and intermediate care provider for the State. The service has more than 100 locations, in excess of 2,000 staff and a fleet of 630 vehicles. Since 2015, NAS staffing has increased by over 500. Since 2019, the NAS fleet has increased by 21%. The Sláintecare implementation plan acknowledges that there is an ever-increasing need to support healthcare in moving away from a hospital-centric model that results in high emergency department, ED, attendance and high hospital occupancy rates. The NAS strategy to 2020 focused on achieving a shift in the operating model from an emergency medical service to a mobile medical service. The NAS strategy to 2026 will continue to accelerate this shift by developing more services to treat more patients in the right setting, improving patient experience and clinical outcomes and supporting a reduction in pressures on EDs.

Additional funding is required to support this continuing transformation. NAS’s 2021 opening budget was €187.5 million. This represents an increase of €13.6 million, or 7.8%, and is the largest year-on-year budget received by NAS. In 2022, the total budget available to NAS is expected to reach €200 million. NAS will play a continuing role in the public health response to Covid-19 and will receive in excess of €10 million to recruit 160 dedicated posts in 2022 for mobile testing and outbreak teams. In 2020, NAS responded to more than 362,000 ambulance calls. Its intermediate care service transports approximately 40,000 patients per annum, co-ordinates and dispatches more than 800 aeromedical calls and completes 600 paediatric or neonatal transfers. In the Dublin metropolitan area, ambulance services are provided by both NAS and Dublin Fire Brigade, DFB.

NAS resources are dispatched to calls received by the national emergency operations centre, NEOC, which operates across two sites, Dublin and Ballyshannon, and represents a €50 million plus investment by the State. NEOC operates on a nearest available to the incident basis and not on a county boundary basis. NEOC represents international standards and best practice in clinically triaging and prioritising emergency calls. Therefore, life-threatening calls receive an immediate and appropriate response, while lower acuity calls may have to wait until a resource becomes available. Resources are dynamically deployed to areas where cover is required, or to respond to incidents as they arise, to ensure that the nearest available resources respond to emergencies.

The current deployment model is designed around international best practice and has eliminated previous practices where the nearest ambulance was not always dispatched due to former legacy boundaries. For example, an ambulance based in Killarney may be dispatched to a call in Cork, if it has just handed over a patient at Cork University Hospital and is the nearest available ambulance to the incident. In addition, NAS is expanding the hear-and-treat alternative care pathway for low acuity calls operated by doctors and nurses and, in due course, specialist paramedics, in NEOC’s clinical hub for patients not requiring the dispatch of an emergency ambulance.

Response time standards for life-threatening calls were first published by HIQA in 2011 and remain as recommended standards. The HSE adopted these as key performance indicators, KPIs, based on the following targets: 80% of echo calls at a national aggregate level to be responded to within 19 minutes and 70% of delta calls at a national aggregate level to be responded to within 19 minutes. The HSE service plan includes these KPIs on the basis that the expected volume of 112 and 999 calls, and ambulance turnaround times at EDs, will remain within expected tolerances as published in the plan. These calls account for approximately 45% of all emergency calls. All other emergency calls are not encompassed by any response time standard, target or KPI, which reflects their low acuity status.

Since the pandemic began, NAS has experienced longer offload delays at EDs. Infection prevention and control measures have increased the length of time spent dealing with patients resulting in longer call durations. Recruitment of paramedics and intermediate care operatives is an ongoing challenge both to fill existing vacancies and resource new developments. A NAS 2015 baseline capacity review found a significant number of additional staff would be required over the coming years to support NAS. Since 2015, NAS has increased its staff numbers each year. However, each year the level of demand for services is also growing. This year, recruitment to NAS is being outpaced by demand for our services, which has grown by almost 30%. There is no ready supply of paramedics in Ireland and NAS, for the most part, must educate its own workforce in its own college. The paramedic programme is degree level and represents four academic years completed over three calendar years. There are currently more than 200 student paramedics at different stages of the programme. The surge in demand for the service has come at a time when staff are working hard to support Covid-related activities. The level of demand now exceeds levels experienced in 2019. The pressure on everyone working in NAS has been immense. However, both our staff and our trade union partners have stepped up at the time of our greatest challenge. Their contribution has been enormous.

In the period 2017 to 2027, NAS predicts demand through 999 to increase by 107%. Given the rapidly widening gap between capacity and demand, NAS commissioned a new independent capacity demand analysis in July 2021, which is now well under way, to inform future workforce planning. The outcome is expected to represent a significant and sustained increase in NAS staffing each year over the next five years. This month, 80 paramedics will graduate from NAS college. In 2022, and in advance of the outcome of the independent capacity demand analysis, NAS is already planning to recruit 200 additional student paramedics and 200 additional emergency medical technicians.