Pat Breen (Clare, Fine Gael)

I welcome the opportunity to raise the urgent need to review the provision of an ambulance service in County Clare 24 hours a day, seven days a week. There needs to be a specific emphasis on the provision of such a service to areas like west Clare. Three special deliveries in recent weeks, when three women gave birth in separate incidents, brought this issue to the fore. The common denominator in the three cases was that no ambulance was available to transfer the expectant mother to hospital. All three mothers and their families live in west Clare — two in Kilrush and one in Kilbaha, which is approximately 100 km from Limerick. Coincidentally, the women went into labour within hours of one another on 4 and 5 February last. One woman waited for an ambulance for over an hour before her father drove her to hospital. Another woman had to wait three hours before she arrived at the maternity hospital in Limerick. The third woman gave birth on the side of the road. All three mothers and babies are well in spite of their ordeal, thank God.

Since the withdrawal of maternity services from County Clare, it is common for expectant mothers in west Clare to have to make a pilgrimage of this nature. It is of concern that in all three cases, no ambulance service was available when telephone calls were made to the 999 service. The organisation of the ambulance service in the outlying areas of County Clare is putting the lives of people at risk. Ambulance service personnel in the county are to be commended for the excellent service they provide in trying circumstances. However, their work needs to be complemented by a review of the organisation of the entire service. We need to eliminate the dependence on "on-call" services. Rather than all ambulance personnel being in the ambulance centre, some of them are on call from their homes, which can add a minimum of 20 minutes to the call-out time. Such a delay in the start of the ambulance's journey to the person in need can be vital.

The ambulance service in County Clare is clearly under-resourced and under-staffed. In this case, no staff were available in Kilrush to work on the ambulance due to sick leave, etc., and an ambulance had to be dispatched from the Ennis centre. This is not an isolated case, sadly. It is common practice for ambulance crews in Ennis, Ennistymon, Kilrush and Scarriff to be dispatched to the four corners of the county. They also have to provide a back-up service for the regional hospital in Limerick. As staffing numbers are at a minimum — some workers are on sick leave etc. — there is extreme pressure on the delivery of the service. For example, there was a 25-minute delay in responding to a recent incident in Ennis town centre because the ambulances at the Ennis station were out on other calls. A private ambulance had to be called in to assist in that case.

The Labour Court recently recommended that an additional 180 emergency medical technicians be recruited to the service throughout the country. That recruitment and training should not be delayed or postponed. A review of the ambulance service should also consider the provision of advanced paramedics as part of a special response unit, which could be made available throughout the county for emergencies. Kilrush would be an ideal location for a permanent advanced paramedic posting because it is 44 km from the nearest hospital. Such highly trained personnel are currently under-utilised. They should not be seen as additional staff in their centres, but as part of the centres' crewing numbers.

Despite the Minister's commitment to provide a 24-hour accident and emergency service at Ennis General Hospital, there is huge apprehension in west Clare that the situation will get significantly worse for those who have the misfortune to get sick. Recent incidents do little to dispel this fear. The people of west Clare do not have access to a first-class ambulance service, never mind a first-class health service. They deserve better.

The HSE recently launched a hospital hygiene campaign, Wash Your Hands. If the executive is serious about hygiene, it should immediately address the scenario in Ennis ambulance station. It is an absolute disgrace that staff are expected to clean out ambulances with nothing more than a mop and bucket. I recently visited the ambulance centre and I was appalled to witness at first hand how the ambulance personnel clean their vehicles. They must clean out coagulated blood in a public car park, which is a hygiene scandal. These are Third World conditions in a first world economy. Staff have been waiting more than three years for a new wash unit. How long more must they wait? I appeal to the Minister of State to bring the matter to the attention of the HSE immediately. Perhaps he will get back to me in regard to same because it is a total disgrace.

Our excellent medical personnel are continuously fighting to give their patients the best medical help in a system in which penny pinching practices are increasing. I urge the Minister of State to request the HSE to undertake immediately a review of the ambulance service in County Clare. The review should focus on the provision of a 24-7 service in isolated rural areas, particularly in west Clare, to extend the operation of the Scarriff station to 24 hours and to revisit the provision of an ambulance centre in Shannon, the second largest town in the county.

If efforts are not made to address and reorganise the ambulance service in County Clare, more incidents will happen and people's lives will be lost. Having visited the ambulance centre a few days ago, I ask the Minister of State to contact the HSE regarding the primitive working conditions of staff cleaning out their ambulances and to come back to me about it.

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