Mr. Pat Healy:

Good morning. I thank the committee for the invitation to meet today. I am joined by my colleagues, Mr. Robert Morton, director of NAS, Professor Cathal O’Donnell, clinical director, Mr. Willie Merriman, director of operations, and Mr. Eamon Hunt, assistant national director of employee relations in the HSE. I am supported by Ms Abbie McCarthy from my office and Mr. Niall Noonan from NAS.

The National Ambulance Service plays a critical role in Ireland's healthcare system, responding to over 430,000 emergency calls in 2024, up 10% on 2023, and with further projected growth to more than 450,000 emergency calls in 2025. Despite this increase in demand, NAS has continued to improve performance against HSE target times, with 74% of purple calls and 46% of red calls responded to within 18 minutes and 59 seconds in 2024 against a target of 75% and 45% respectively. This improvement in performance continues to be maintained.

Responding to increasing demand has required a twin-track approach of both continued investment and reform in NAS. In recent days, the committee will have received a detailed briefing on the progress made the over recent years, the current areas of focus to improve services and our plans for the future. NAS is undertaking significant transformation to enhance service delivery, optimise resources and play a greater role in delivering care and community-based care. Additional investment since 2022 has seen the base budget increase by 41%, or €83 million, to €285 million this year while headcount WTE increased by 28%, or 588, to 2,655 WTE in the same period. Capital expenditure on fleet replacement and expansion amounted to €126 million.

The current HSE NAS strategy set out a roadmap to 2031. The HSE has commenced work on a new development plan for the next three to five years. This will support effective service planning for the required capacity, service improvement and reform required. The plan will address as a priority improvement in waiting times, the education and training programme to ensure availability of the required professional work force, organisational culture improvement initiatives, expansion of alternative care pathways, and consolidation and expansion of the intermediate care services. We will also have to address in a fundamental way the future development of aeromedical services, including critical care and retrieval.

The recent rejection of the Labour Court recommendation, the product of two years' intensive engagement at WRC, and subsequent referral of phasing of pay by the Labour Court, is disappointing and a significant challenge to the timely implementation of the NAS transformation programme. The deal offered pay increases of between 3% and 14% for approximately 1,500 staff in exchange for service reform and change, including improved rosters, professionalisation of the workforce and a simplified pay system. NAS will continue to engage with the respective trade unions through the recognised industrial relations processes, with a view to finding a solution.

Approximately 20% of patients seeking access to emergency care do so through NAS emergency calls. NAS continues to develop and expand alternative care pathways for these patients, allowing them to be treated out of hospital, closer to or at home. These initiatives include the clinical hub at NEOC, pathfinder, community paramedics and the alternative pre-hospital pathway, APP, cars in CUH and UL hospital.

I want to address the recent concerns raised by the trade unions and members of this committee with regard to the non-urgent patient transport pilot in the Dublin area. It has been acknowledged by the HSE and NAS that this specific initiative was not handled in accordance with the provisions of the public service agreement. The matter is being rectified and engagement is under way with the trade unions through the conciliation process. I want to take this opportunity to restate that the HSE remains fully committed to maintaining and expanding these directly employed intermediate care services in the coming years.

Separately, the acute services through the HSE regions publicly procure private ambulance companies where NAS is unable to meet the demand in a timely fashion. Having reviewed the position with the CEO and in the context of the establishment of the national services and schemes, NSS, directorate, the intention is to provide a more integrated and co-ordinated intermediate care service by consolidating the service under the governance of NSS and NAS. This initiative will be implemented on a phased basis, involving consultation and engagement with trade union partners, REOs, national and regional procurement and other stakeholders.

The need to recruit, train and retain a skilled workforce is critical to the success of the next phase of NAS development. We have a total of 442 students currently progressing through the paramedic training programme. In 2026, we intend to expand the student numbers through the commencement of a new college in Cork, providing for 24 new paramedic training places.

I wish to address specifically the issue of advanced paramedics. There are over 400 HSE staff working in NAS who are currently registered as an advanced paramedic, with the pre-hospital emergency care council, PHECC, and a growing number who are direct-entry staff already holding the PHECC registration. These trained staff are a valuable resource, but NAS data shows that half of calls that advanced paramedics are dispatched to do not require the skill set of an advanced paramedic. In this context, the HSE has informed the representative trade unions that there is a need to strengthen the deployment of existing staff with the specialist advanced paramedic skills to match patient requirements before we consider further increasing the staff with such training. This issue is encompassed within the broader pay dispute around roles and responsibilities, which I referred to earlier. Once this dispute is resolved, NAS will progress with the training programme for specialist advanced paramedics in 2026. In the meantime, NAS has prioritised investment in an MSc in community medics, with more than 20 students currently undertaking the course in 2025, with an additional 13 students commencing the course this year.

As we embark on the next phase of development of NAS, we do so within the context of wider health service reorganisation and reform. The HSE's CEO and board have placed great emphasis on addressing organisational culture as part of this reorganisation. Much work has already been done or undertaken in NAS to create an environment where we treat our patients, service users, families, carers, colleagues and others with compassion, dignity and respect. However, we recognise that there is more work to be done in this area through commitment and leadership at all levels of the service. NAS is committed to implementing the recently completed HSE enabling framework for organisational culture, which will form a core part of the development plan for the next three to five years.

I also want to take the opportunity, in light of recent media coverage of our service relating to protected disclosures and complaints, to reiterate the NAS commitment to the dignity at work policy for the public service, which sets out how the HSE and other public service organisations aim to create and maintain an environment where staff are treated with dignity and respect. The HSE takes such matters very seriously and following investigation, can and will implement appropriate sanction up to and including dismissal. Creating a culture of dignity, inclusion and accountability is everyone’s responsibility, that is, every staff member, supervisor and manager, and NAS is committed to continuing the work required to ensure that standard is met.

In conclusion, I wish to publicly acknowledge the dedication and professionalism of our all of staff, supervisors and managers across NAS and their commitment to delivering quality services in challenging times. As we look to the next five years, I am confident we can build on the strong foundations of our transformation to date and continue to deliver for our staff and the public the professional, agile and responsive urgent and emergency care service they deserve.

I am happy to take questions.