Mr. Robert Morton:

Good morning. I thank the committee for the invitation to attend today's meeting to discuss the National Ambulance Service.

I am joined by colleagues today. I will not repeat their names as the Chair has done the introductions. The National Ambulance Service, NAS, operates from over 100 locations around the country. At the end of January, we had 2,125 staff. With regard to accountability, we operate under the HSE’s performance accountability framework, which sets out the means by which we are held to account. This operates predominantly through the HSE service plan. Clinical governance is provided by a full-time clinical director, Professor O'Donnell, who is supported in that role by a number of other senior clinicians around the National Ambulance Service.

We submitted a briefing note in advance of this meeting that focuses on the areas of recruitment and retention and performance, which I believe were of interest to committee members. The NAS, through the HSE's national recruitment service, continued to actively recruit new staff throughout 2022. We launched a rolling advertising campaign for qualified paramedics, student paramedics and intermediate care operatives in March 2022. The campaign for student paramedics in particular was highly successful and the NAS College was oversubscribed for the September 2022 intake of student paramedics, which saw 90 students start at our three campuses, which are in Tallaght, Ballinasloe and Tullamore. The second round of the student paramedic campaign for 2022 closed for applications on 5 September 2022 and 85 new student paramedics began training with the NAS on those three campuses on 19 December 2022.

We had 209 new staff start across the National Ambulance Service in 2022 with the majority, 181, starting in patient and client care, that is, as emergency medical technicians, intermediate care operatives and ambulance officers. This area also covers paramedics and advanced paramedics. This compares favourably with an average of ten leavers per month. This figure includes retirements, resignations and people securing promotional opportunities in the wider HSE.

The student paramedic recruitment campaign for 2023 has commenced. It kicked off on 16 January 2023. Remaining panellists from the previous campaigns are being offered opportunities to join the next intake, in September, which we hope will see 128 student paramedic places offered on the BSc programme, although that is subject to the establishment of a fourth educational site in County Cork, which is a work in progress. Estimates planning for 2024 has begun and is already well under way. This includes plans for a fifth educational site, in either Wexford or Sligo, to expand our educational capacity further.

To support staff retention, the NAS has developed a people plan for the three-year period from 2022 to 2025. The overarching purpose of this plan is to enhance employee experience, optimise the working environment and meet the expectations of health policy in Ireland. Working in partnership with our workforce, we have introduced changes to our deployment model that reflect the reality of the current capacity deficit while seeking to address some of the key issues our staff have raised, which include travel times, late finishes and access to rest breaks. Staff feedback on this work to date has been positive. A key issue for many staff is the location of their assignment. Therefore, in 2022, we introduced a policy of assigning staff to a location within 45 km of their home address, which has been very well received and has contributed significantly to our attractiveness when recruiting.

National aggregate response time targets for calls are set out in the HSE’s service plan each year. Calls may be described as purple, the new categorisation, or echo, as it used to be known. These labels refer to life-threatening cardiac or respiratory arrest. Calls may also be categorised as red or delta, referring to life-threatening illness or injury other than cardiac arrest. These calls account for approximately 48% of all 999 calls received. Lower acuity 999 calls, the other 52%, can be further triaged through our clinical hub by clinicians, that is, doctors and nurses, to establish if sending an emergency ambulance is appropriate compared to other options such as self-care or visiting a pharmacy, a GP or a GP out-of-hours service. In 2022, the HSE's national service plan set national aggregate key performance indicator targets for emergency calls. It was targeted that 80% of purple or echo calls would be responded to within 18 minutes and 59 seconds and that 50% or red or delta calls would be responded to in 18 minutes and 59 seconds. Response time targets are national aggregate targets and are therefore reported on nationally. With regard to the NAS's performance against those targets in 2022, 71% of purple or echo calls were met within the target time, as against the targeted 80%, and 43% of red or delta calls were met within the target time, as against the 50% target. As members would imagine, there was considerable variation across the year. Further details on performance in respect of echo and delta calls over the previous three years have been supplied in the briefing note.

The HSE recognises that both the HSE and Dublin City Council have statutory powers to provide ambulance services in Dublin. The Department of Health and the Department of Housing, Local Government and Heritage have established a task and finish group on behalf of both Ministers to look at any outstanding issues or areas of concern. This group had its first meeting yesterday. Despite the challenges of recent years, the continued investment by Government and the HSE in the National Ambulance Service is contributing to progress on the shift to reorient healthcare away from a hospital-centric model, as envisaged under Sláintecare. In November 2022, the HSE board approved a new ten-year NAS strategy that provides a roadmap for the continued development and enhancement of the National Ambulance Service in Ireland. The strategy has been submitted to the Department of Health and is currently being considered with a view to informing a memo for Cabinet. That concludes my opening statement.