Mr. Paul P. Bell:

Yes, but that is because their services were structured in such a way as to meet this key performance indicator. However, a debate is taking place in the United Kingdom to the effect that clinical outcomes and patient outcomes should now be examined. That is because of what happened in mid-Staffordshire. That debate is raging on. It comes from a different era. As Mr. Ray said, ambulance professionals now can give much more direct medical intervention, and they will continue to improve that service in rapid deployment.

The issue we have had is that the regulatory authorities, namely, the pre-hospital emergency care council and HIQA, should be discussing what it is possible to meet. In terms of HIQA, we believe there should have been some discussion about having the capacity to review and to say whether we can meet these key performance indicators. The problem is now that members of the public and those waiting for ambulance services have an understanding of two key times and, as my professional colleagues described earlier to the committee, they relate to specific emergency life-threatening calls. The two other main players are the regulatory authority, which is the pre-hospital emergency care council, and HIQA.

Some of the questions being put to us today are being asked well after the fact. We believe the capacity review, which will cover a number of clear, defined areas for public representatives such as the members, professionals such as the representatives, and the general public, will clearly understand what is achievable and what is best.

I put it to the committee that if our colleagues in an ambulance service save a life today but that call was responded to in 21 minutes, that will be deemed a bad call. If they respond and achieve the key performance indicator and the patient has an adverse outcome, because of the way the structure is set that is a good call. We find that unacceptable. Our members are determined to have the best patient outcomes, whether people live in the city or in rural settings. We want to see the development of a capacity review that takes all of that into account as well as, more importantly, quality and patient outcomes. That is what we are about. Key performance indicators have their place but the professional ambulance services across the globe, be they in the United Kingdom, Scandinavia or elsewhere, are now having the discussion about best clinical and patient outcomes. That is the way we want to go.