Mr. Damien McCallion:

As Mr. Mulvany said, the ambulance turnaround at the back of hospitals at emergency departments is a symptom of a wider challenge. We have to try to address that through a whole range of measures that we discussed at a previous meeting with the committee. Separately, we are seeing an increase in ambulance calls of 14% since 2019. There is an investment in the ambulance service and a plan around capacity so we can respond to that while addressing the core issue. In the short term, we have set up a group involving the ambulance service and the hospitals to examine the immediate issues. Some actions have already been taken. Emergency departments now have a screen showing what ambulances are en route, where they are and the nature of the patients coming in. To try to manage the situation better, this technology has been installed. This winter we have put liaison officers from the ambulance service in key EDs to improve the flow within hospitals. That is not to say there are not still challenges from day to day. There are a number of short-term measures. The group is also looking in the longer term at what we can do to address the congestion, as Mr. Mulvany said, and to invest in the ambulance service to deal with increasing demand.

On the demand side of the ambulance service, work is also being done to look at alternative pathways for patients who do not need to go to emergency departments but do need an ambulance. There is a pathfinder initiative which is being rolled out in a number of parts of the country. This is a multidisciplinary approach within the ambulance service that can be used. We have what is called a clinical hub in our emergency operations centre, which allows certain calls, perhaps from people who are in distress with mental health issues or other such issues that can be dealt with over the phone, to be bought to another pathway. We have also rolled out community paramedics who are licensed to work with GPs and other providers to have patients discharged or referred to other services.

There is a range of initiatives to try to deal with the increased demand on the ambulance service. There is an increased capacity to support, recognising that demand is growing, but the third piece, which is to work to improve the flow through emergency departments to minimise wait times, is fundamental as Mr. Mulvany said. In the short term we are trying to manage that as best we can with some of the measures I mentioned.