Mr. Robert Morton:

As regards trends, we are seeing a big shift in how people access unscheduled care generally. We are seeing far more people access episodic illness and injury care through 999 and 112 and self-presenting at accident and emergency departments rather than the traditional model of attending their GP followed by an onward referral. There has certainly been a change in health-seeking behaviour and we are seeing this across all aspects of healthcare. Our response to that is about diversifying the model of care we provide, and that is very much with Sláintecare in mind.

Much of our energy is focused on alternative care pathways, as Mr. Keeley mentioned. We are developing new services that focus on particular groups. For example, we are developing a clinical hub that is staffed by doctors and nurses, and we will introduce paramedics into that model this year. It is a secondary clinical triage where a clinician has a conversation with a patient to determine whether there is a more appropriate mechanism or referral option for that patient other than sending a traditional ambulance. We have developed a frailty response model, which has been rolled out in a number of locations and will be further rolled out in 2023. That focuses on older people over 65 years of age and particularly those over 75 years of age. It is about supporting those people to stay at home and connecting them with other services in the community, such as community intervention teams, home support services and frailty services in hospitals, where we are deploying occupational therapists, physiotherapists and advanced paramedics. We are also mobilising community paramedics who work very closely with general practitioners. Much of what we are trying to do is to bring care closer to patients, in their locality or their home. That is how we are responding to the trend.

We are very clear on what we need in terms of capacity. I came into this post at the end of May 2021. I commissioned a capacity review in July 2021 that identified an immediate requirement, which is on the record of the House in a meeting of the Committee of Public Accounts in December 2021. We need 1,080 staff pretty much straight away. It is just not possible to get 1,080 staff but that is what we need. It would provide 90 ambulances throughout the country. Over a period of ten years, we have identified a workplace requirement of 4,385 staff who would be required to deliver all services, not just ambulance services, over a ten-year period.

We have a very clear workforce plan, which is very challenging to deliver in the current context. On retention, one of the key issues we hear from our staff when they do exit interviews is about the nature of the job. Shift work is the number one issue that people find most difficult to cope with. It has the greatest impact on their work-life balance. What we have tried to do, in partnership with our trade union colleagues, is focus on those issues that staff tell us create the greatest impact. That is about trying to prevent late finishes, trying to make sure they have access to breaks and trying to make sure they are not travelling great distances. That is one of the dysfunctionalities that occur when there is a capacity deficit. You get an inbred issue of dysfunctionality which happens by virtue of the fact that there are not enough resources to respond. Those are the sorts of local issues we are focusing on, pretty much guided and informed by our staff.