Ms Laverne McGuinness:

Deputy Kelleher asked a number of questions too. I have dealt with his questions on the fleet and the relationship with the Dublin fire brigade and will now deal with his questions on response times. I referred to the capacity review which will address some of the concerns around response times. We are improving our response times for both ECHO and DELTA calls. The times given relate to the patient-carrying vehicle getting to the scene. In other words, the 17 minutes, 59 seconds response time relates to ambulances arriving on scene. That has improved from 63.4% to 69% with regard to DELTA calls and from 65.7% to 78.5% for ECHO calls but we still have some way to go. Some additional improvements can be made in call activation within our resources but additional resources will be required to bring about further improvements.

The issue of delays at emergency departments is very significant and one on which we are focusing. It is not something that can be dealt with solely by the ambulance service itself. We are working with the acute hospital services in order to improve turnaround times at emergency departments. In January 2014 we introduced what we call an "escalation framework" in the emergency departments whereby if ambulances are blocked up for a period of time, that escalates right up through to the highest level in the organisations and telephone calls are made and we say, "This is unacceptable; we are nearing a point where ambulances will have to be locked". That has significantly improved the situation for us although it is still not where we would like it to be. At this point, 94% of ambulances are released in less than an hour and 67% are released within 30 minutes or less. We have a pilot programme in place in Cork University Hospital whereby the minute an ambulance arrives at the back of the emergency department staff in the department see it on their screens and know they must be on their toes and carry out the clinical transfer as quickly as possible. There is more work to be done in this area but it is being done collaboratively between the hospitals and the ambulance service. This must be seen in the context of the fact that our emergency departments have been particularly busy this year. There were an extra 6,000 admissions in the year to October. They are busy indoors in the hospitals and then the ambulance service has also experienced an increase in calls of 1,000 per month. There is congestion at both ends in that regard.

Deputy Kelleher asked who will be monitoring or overseeing the implementation plan. The plan will be developed jointly between Dublin fire brigade and the national ambulance service. It will take account of the various reviews which are coming on stream, namely the capacity review, management review and the review of the Dublin fire brigade service.

It will be overseen nationally by the HSE, Health Service Executive, while the Department of Health will have a significant role in it, as well as HIQA, the Health Information and Quality Authority, requiring regular updates.

Regarding the closure of accident and emergency departments and the ambulance service, significant ambulance resources were put into Roscommon to ensure a safety net. Bypass protocols are in place but that means an ambulance would have to travel a further distance to bring the patient to the appropriate hospital.