John Browne (Wexford, Fianna Fail) | Oireachtas source

I compliment Deputy Kelleher on tabling this motion. It gives us an opportunity to express our concern and to highlight the difficulties faced by people in our constituencies waiting on the ambulance service. There is nationwide concern and disquiet about the provision of ambulance services, with delays in ambulance response times far exceeding national and international recommended norms. Large areas of the population throughout the country are regularly left without any local ambulance cover. While dedicated and professional staff do all they can, it is obvious that more resources will be required to address the deficit in service provision.

Several incidents and many recent media reports have brought the quality of our ambulance service to the fore over recent months. The "Prime Time" television programme gave a very comprehensive and revealing insight into the problems on the ground. Alarmingly, it also seemed to indicate a management culture that is effectively in denial about the scale of the difficulties. While watching the programme, I was amazed that the person in charge of the ambulance service would not accept there was a problem and that there will be a problem down the road unless extra resources are made available. He seemed to be programmed to give the one stock reply that everything was fine, when we all know the ambulance service is not what it should be. The ambulance service management should spell out clearly to the Minister the difficulties involved, instead of saying that everything is rosy when it is not. It is clear the service is underfunded and understaffed and, while it remains this way, it will be impossible for the ambulance service to meet the recommended response times.

As the National Ambulance Service Representative Association pointed out after the "Prime Time" broadcast, "we do not have the personnel or the vehicles to meet these targets and it is time for the National Ambulance Service to accept that these targets are unrealistic unless cutbacks are reversed". That is not a political charge from this side of the House, but is coming from the National Ambulance Service Representative Association.

My county of Wexford is certainly under-resourced, especially at night. There are only three ambulances operating during the night in Wexford, which has a population of 140,000. That population increases to 190,000 people in the summer, when Dubliners and many other visitors come to their holiday homes in the county. Wexford General Hospital and the ambulance service are expected to provide an adequate service, despite no increase in funding from the Department of Health. This is causing major problems because, on many occasions, there are only two ambulances operating because the third ambulance has gone to Waterford Regional Hospital with a patient who requires orthopaedic attention. As a result we have only two ambulances at night for a population of more than 140,000. There were more ambulances at night in Wexford in the 1970s and they had a carrying capacity of two, yet now we only have a carrying capacity of one. This highlights the reduction in service that has taken place and which does not in any way meet the need of the population.

There is much disquiet that the closure of the Wexford control centre will occur when the new national control centre is in operation, and there is certainly a lot of disquiet about that because people feel that while it is diverted to Dublin, they will not have the local knowledge or the expertise on the townlands and communities involved. This is not a move in the right direction.

There are only four advanced paramedics in Wexford. I understand more will be trained and allocated to different counties in future. The advanced paramedics do a great job. They are essential before the ambulance arrives and it is important there is more training of advanced paramedics sooner rather than letter.

With a population of 4.6 million, Ireland has 1,600 ambulance service staff. With a population of 1.7 million, Northern Ireland has 1,200 staff, while Scotland employs 4,500 staff and has a population of 5.3 million. That proves without doubt that the National Ambulance Service in this country is underfunded and understaffed. Perhaps the Minister can comment on how he expects the services to be provided in this country with a lot fewer staff than our counterparts in Northern Ireland or in Scotland.

Deputy Kelleher spoke about the delays in the accident and emergency departments, and certainly we have had huge delays at the accident and emergency department in Wexford General Hospital, and I am sure it is the same in every other hospital in the region. Overcrowding at accident and emergency departments causes difficulties for ambulances when they arrive with new patients as they cannot deal with any new calls until they transfer their patients to the care of the hospital. Information released under the Freedom of Information Act to The Irish Timesshows that many ambulances are regularly being held up for an hour or more at emergency departments when the HSE's target turnaround time for these ambulances is 20 minutes. We can see the farcical situation that exists there. Throughout the country in 2012 and 2013, these targets were being missed.

In the east, ambulances were regularly delayed by at least an hour in approximately 40% - and up to 48% - of cases in the first eight months of 2013. In the north west, almost one in five ambulances had a turnaround time of more than an hour last December. That cannot be said to meet the times designated by HIQA in any way. In the midlands, ambulances were held up for at least an hour in more than 80% of cases in January, March, May and July of last year before they were able to transfer patients to accident and emergency departments and depart on new calls.

The difficulties that are being faced by the ambulance service and its staff will continue as long as the Department of Health is not making funds available to the HSE. I do not think the Minister is being told the truth or being given the facts. If one were to listen to what the head of the ambulance service had to say on "Prime Time", one would think everything was grand. The reality on the ground is that things are not working out fine. Things are not what they should be. The Minister should spend some time visiting hospital services. He should go to accident and emergency departments to see the situation where ambulances are operating.

The episode of "Prime Time" to which I refer suggested that many rapid response vehicles are being used as company cars, in effect, by some staff of the National Ambulance Service. I hope that is not the case. According to "Prime Time", this is what is happening. The use and apparent abuse of these vehicles raises serious issues that must be confronted by the management of the National Ambulance Service. The National Ambulance Service Representative Association has valued each of these high-specification vehicles at approximately €100,000. Ambulance people have pointed out to me that the €6 million which was spent on such vehicles would buy 24 much-needed ambulances.

Perhaps the Minister will explain in his reply what he is doing in response to the recent "Prime Time" investigation. I am aware that HIQA is now involved. The practices that were depicted on "Prime Time" are not desirable and should not be tolerated in this House. As the head of this country's health service, the Minister should not be tolerating them. It seems from the evidence that was outlined on "Prime Time" that rapid response vehicles are being put to significant personal use and are making little if any contribution to the provision of emergency care. As I have said, this is intolerable.

It seems that many vehicles are not being used at night or at weekends to attend emergency call-outs. This calls into question the efficiency of the system. Why are we spending huge amounts of money purchasing such vehicles if we are not using them to provide services in the intended manner? It was highlighted clearly on "Prime Time" that we did not get value for money in the case of the recent purchase of vehicles at a cost of €100,000 each. I ask the Minister to clarify in his response if he has found out whether the "Prime Time" allegations are true. If so, what has he done to ensure ambulance personnel and management do not continue to use these vehicles in this manner? Will they now be used to provide the important emergency services that are required by people who are suffering from heart attacks or other ailments and need to get to hospital as quickly as possible?

See this speech in context