Mr. Stephen Mulvany:

I thank the Chair and members for the invitation to attend today’s meeting to discuss expenditure on emergency services, particularly ambulance services, in the context of the HSE's financial statements 2021. The Chair has identified the colleagues who are here and introduced them so I will not repeat that. As requested by the committee, we submitted in advance of today’s meeting a briefing note that provides information and a detailed breakdown of HSE expenditure on the NAS. At last week’s session, we provided in the opening statement an overview of the annual financial statements for 2021 and the financial outturn. I will therefore confine my opening remarks today to the following matters.

The NAS operates from over 100 locations throughout Ireland and its services are delivered by over 2,000 staff members. The NAS operates under the HSE’s performance accountability framework, which sets out the means by which the service is held to account for its performance in relation to access to services and the quality and safety of those services. The clinical governance of NAS is provided by a full-time clinical director who is supported by a number of other senior clinicians. The NAS received a budget allocation for 2021 of €202.1 million, representing approximately an 8% increase when compared with 2020. The actual expenditure for 2021 was approximately €202.9 million, which included Covid-related services.

This expenditure saw the NAS responding in 2021 to over 366,000 emergency 999 and urgent calls; transporting approximately 24,000 intermediate care patients; more than 1,000 aero-medical and air ambulance calls; 2,047 calls via the NAS critical care retrieval service; and the delivery of mobile swabbing and vaccination services in relation to Covid. Other key activities progressed in 2021 included implementation of the out-of-hours cardiac arrest strategy; continuing development of alternative care pathways - hear and treat or refer and see and treat or refer; a new service commencing in Connemara; supporting implementation of the strategy, a trauma system for Ireland; and improvements to the NAS critical care and retrieval service for adults, children and neonates.

As of August 2022, NAS expenditure is in the order of €131.7 million against a year-to-date budget of €133 million. The full year allocation of budget for the NAS is of the order of €202.6 million.

Based on the outputs of a capacity and demand analysis commissioned in July 2021 and new developments set out in the NAS draft strategic plan, the current NAS workforce plan recommends 2,161 additional staff across a broad spectrum of roles that would be required to meet the future needs of the service. Given the scale of workforce growth required over the coming years, it is expected to take up to ten years to effectively double the workforce.

In 2022, 62 graduate paramedics have commenced work and the NAS expects to recruit up to 180 student paramedics and 90 emergency medical technicians by year end. For 2023 recruitment planning, a submission has been made to recruit up to a further 192 student paramedics across NAS programmes starting in January and September 2023, as well as growing educational capacity by opening a fourth campus in 2023 in the south of the country. In addition, in 2023, recruitment competitions are planned for 50 medical emergency controllers and 25 intermediate care operatives.

Last winter, the NAS put in place a capacity action plan which sought to engage with all of the capacity that is available in Ireland, including remobilising all of the community first responder schemes that had unfortunately been stood down in March 2020 due to the Covid pandemic. The service engaged with voluntary ambulance organisations and the private ambulance sector as part of the contingency plan for winter.

The HSE continues to invest and develop our urgent and emergency care systems. There was significant investment in capacity and people in the past 18 months. We are in the process of preparing the national service plan, which will include the NAS plans for 2023.

Despite the challenges of recent years, the continued investment by Government in the HSE in the National Ambulance Service is contributing to progress on the shift to reorient healthcare away from a hospital-centric model. Recent measures are particularly evident within the NAS in the areas of ehealth, telemedicine, and community-delivered care and service integration, that is, community paramedicine, pathfinder programmes and alternative pre-hospital pathways. The NAS is currently finalising a strategic plan for the service that will provide a roadmap for the continued development and enhancement of the service.