Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I move:

That Dáil Éireann:acknowledging the:

— selfless dedication to their work, of the paramedics in our ambulance service;

— high quality of care that they provide; and

— uniquely pressurised nature of the work they undertake;

recognises that:

— there is nationwide concern and disquiet about the provision of ambulance services;

— this situation can be exacerbated by delays in accident and emergency wards;

— in 2013 only one in every three people with life-threatening conditions were responded to within the target time;

— delays in ambulance response times far exceed both national and international accepted norms;

— large areas of the population right across the country are regularly left without any local ambulance cover;

— the Health Service Executive lowered the ambulance response time targets to 80 per cent in 2012 and 70 per cent in 2013; and

— the centralisation of control and dispatch has led to concerns about a lack of local knowledge and the impact that can have;

notes that:

— the Republic of Ireland, with a population of 4.6 million, has an ambulance service that employs less than 1,600 staff and an annual budget of €137.4 million;

— Northern Ireland, with a population of 1.7 million, has an ambulance service that employs just fewer than 1,200 staff with an annual budget of £62 million (€78 million); and

— Scotland, with a population of 5.3 million, has an ambulance service that employs over 4,500 staff with an annual budget of £203.5 million (€258 million);

believes that:

— while paramedics do their utmost to provide a service to the highest international standards, this is impossible with current budgets;

— it is essential that paramedics be properly resourced to carry out their work; and

— such resources are not currently forthcoming from the Government; and

calls for the ambulance service to be appropriately resourced so as to ensure a safe and efficient service nationwide.

I am sharing time with Deputies Brown, Calleary and Ó Cuív.

At the outset I must put on record the selfless dedication to their work of the staff of the national ambulance service and their diligence in providing an extremely valuable service at the most difficult times. It is important when discussing these issues that we do not try to deflate morale, that we are conscious of the pressures the staff are under and the fact that they are working in extremely difficult circumstances and that they have their arms tied, in a way, due to lack of resources.

We tabled this motion because we have had serious concerns for some time about the national ambulance service. This has been highlighted time and again. I have tabled numerous parliamentary questions over recent times to elicit information from the Department, the Health Service Executive and from the Minister about the national ambulance service and the views they hold on it. There appears to be a disparity between the views of officialdom, what is happening with the ambulance service on the ground and the type of service it provides to the citizens of this country. This was brought to a head in the "Prime Time" programme, which was very damning of the management of the national ambulance service, the Department, the HSE and the lack of resources available to the men and women who provide emergency cover throughout the State.

We have heard a great deal recently about Health Information and Quality Authority, HIQA, reports and HIQA carrying out a due diligence analysis of the national ambulance service. Any investigation or critique of the ambulance service will show that it is under-resourced, not only with regard to vehicles but also in terms of staff. Until there is an acknowledgement by the Minister and the HSE that this is a key problem in the delivery of safe emergency care, we are all wasting our time. The reason we tabled this motion was to highlight the inadequacies and deficiencies in the service and, hopefully, to get a positive response from the Minister and others who, to date, have been denying there is a problem in the national ambulance service. I do not believe the Minister is not aware of the problem, but there appears to be a reluctance to admit the difficulties and challenges the people in the service face daily in trying to deliver safe care.

Many individual incidents have been highlighted. There have been many tragic cases and I do not wish to add to the families' grief by naming them in this House and consistently keeping them in the public domain, but they have been identified and catalogued on numerous occasions. They were repeated again in the "Prime Time" programme. If people are to have confidence in the transition to hospital groups or trusts and the downgrading of some accident and emergency departments, they must know definitively that an ambulance service will be available to them when they require it.

A look at the statistics and data that have been compiled will show the service is simply not meeting the guidelines laid down by HIQA regarding first responder and an ambulance arriving on time, which is within 18 minutes and 59 seconds. These are specific times and they are provided for a reason. They represent international best practice and if these targets are reached, lives will be saved. Unfortunately, the service only reaches the targets 63% or 64% of the time. That is simply unacceptable.

When one compares the resources and time responses in the Republic with those in Northern Ireland and in Scotland, it is easy to see why the ambulance service is incapable of delivering the service that every citizen in this country expects and deserves. We simply do not have enough personnel or vehicles. There have also been some issues with the transition to a national call centre, but given that this transition might bring about more efficiencies in time, the key issue is personnel and vehicles.

There is a further issue. The Minister has put great emphasis on his successes and achievements in reducing the number of people waiting on trolleys in emergency departments, but there is another cohort of people that will have to be counted as well. It is not just the number of people waiting on trolleys but also the number of people waiting in ambulances to be brought into the emergency department. That is happening. The amount of time that ambulances are tied up outside emergency departments throughout the country is simply unacceptable, for many reasons. There are situations now where emergency vehicles arrive at the emergency department with their patients but they cannot unload the patient into the emergency department because of overcrowding. Cases have been identified to the Oireachtas health committee where ambulances have had to wait three and four hours before they could unload the patient. That is a bizarre waste of the time of personnel, who should be back on the road providing other emergency cover, and of the vehicle, which is tied up for hours, while the patient is in the ambulance when they should be in the emergency department.

There is a major problem in that regard and I hope the Minister will acknowledge it and address it in terms of resourcing. I understand the constraints under which the Department and the Minister are working. However, to deny there is a problem is an issue of major concern.

With regard to the Dublin Fire Brigade and the efforts of the HSE to seize it, I often wonder why we take the route of reconfiguration and reform when the Dublin Fire Brigade has been providing a valuable service in a very efficient manner for many years. It has a dedicated workforce of advanced paramedics and paramedics. The idea is that the HSE would annex it and subsume it into its organisation, which is not, to say the least, a shining example of efficiency in terms of the use of resources.

I only have a short time to speak but there is another area of the use of resources which I will refer to in more detail when replying to the debate tomorrow night. It is the issue of some of the national ambulance service management personnel and the use of emergency vehicles. This is an area which I believe the Committee of Public Accounts should investigate. If the committee does not investigate it, the Minister should.

It is simply unacceptable that we have scarce vehicles traversing this country not on call or in response to emergency calls but parked outside the homes of senior management. This is an unacceptable practice and must be examined, and I hope the Minister has asked for a full audit of it. If he has not asked for an audit, the Comptroller and Auditor General should be brought in to investigate the use of public funds for this purpose. It should also be referred to the Committee of Public Accounts, because this is simply an unacceptable use of scarce assets.

Some of the figures have been supplied to me in a very diluted way. I tabled several parliamentary questions and while I respect that those who reply to them are doing their duty, sometimes I receive couched answers and we should also look at that. The bottom line is that the National Ambulance Service does not have the resources and is overstretched. It is servicing a population of about 4.6 million people. It has not got the capacity to deliver a safe, efficient and effective service. The Minister is putting people's lives at risk by not putting adequate resources into it. He is putting huge stress and pressure on the personnel who provide emergency cover for our citizens every day and night. He needs to do an awful lot more to address this. I know he has asked the Health Information and Quality Authority to investigate, but what is HIQA investigating? Can HIQA subsequently inform the Minister that his resourcing of the National Ambulance Service is inadequate and that, to comply with international best practice, it needs additional personnel and additional vehicles? If the report suggests that, will he increase recruitment and funding?

We tabled this motion to highlight the palpable fear that exists. This is not scaremongering; this is happening every day and night in communities throughout the country. Rural Ireland is a case in point, where people simply do not know, if they are involved in an accident or if they need an emergency response vehicle or an ambulance, whether it will come on time, within a reasonable time, or at all. I believe this motion was tabled for one reason, which is to try to get the Minister, the HSE and the management at the National Ambulance Service to accept that they are not meeting the critical response times necessary to save lives. If they continue, lives will be lost, so I urge that the motion does not fall on deaf ears and a meaningful response is provided.

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