Dara Calleary (Mayo, Fianna Fail) | Oireachtas source

I thank Deputy Kelleher for the opportunity to debate this motion.

At the end of February, Ms Laverne McGuinness, the deputy director-general of the HSE, addressed the Joint Committee on Health and Children along with the managers of the ambulance service. At that meeting, she stated:

The primary role of the ambulance service is to deliver a responsive emergency service to the public in pre-hospital emergency care situations, with patient care at the heart of this service. Care begins immediately at the time the call is received right through to the safe transportation and hand-over of the patient to the receiving hospital.

She also stated: "Responding to emergency calls within the target response time is a key objective of the ambulance service". Let me outline the reality of how the service operates. On 21 October, the service received a call from a patient in Ballina at 10.40 p.m. Apparently the ambulance was mobile three minutes later, which is fantastic and a tribute to the staff on board. It got to the scene at 12.10 a.m. It left the scene at 12.29 a.m. and was at the hospital at 1.02 a.m. and clear at 2.09 a.m. The reason for the delay was that the ambulance came from Boyle in County Roscommon because the ambulance crew based in Ballina was responding to a call in Rooskey in County Roscommon. Earlier that evening, an ambulance crew from Clifden had to be called to Ballina to address a call in that region. That is the reality on the ground and the HSE makes no apology for it. Minister of State Deputy Kathleen Lynch had to intervene for me to obtain an answer to a parliamentary question on the ambulance service. The HSE stated the national ambulance service operates on a national basis as opposed to a local basis. This contradicts directly the notion of having patient care at the heart of a service.

In County Mayo tonight there are two ambulances based in the Castlebar region, one in Ballina and, since it is Tuesday, one on call in Belmullet. If they get called out of the county, as they do given the approach of operating on a regional basis, there will be no ambulance. The Minister will know Belmullet as his roots are there. Erris is the size of County Louth. We are saying that but one ambulance on call there tonight is good enough for the people there. Anybody taken seriously ill in Belmullet tonight will immediately be brought to Mayo General Hospital so the ambulance will be gone from the region for at least two hours. That is for a basic call. We saw the consequences of this recently. Former Deputy Dr. Jerry Cowley had to deliver a baby because the ambulance that was to bring a pregnant lady from Achill to Castlebar was late arriving.

Deputy Jerry Buttimer chaired the meeting at which Ms McGuinness was present. She and the managerial staff were genuine in their belief that the original model is the way to go. However, the practical consequences in large rural areas are such that the model does not work as desired. We are not scare-mongering in that there have been deaths, including in Donegal and Louth. The case in Louth was particularly tragic because it was in a large urban setting that the response did not happen. It is not fair to lay the blame completely at the Minister's door. Deputy Brown stated the Minister is not being given the full picture. He has a reputation for carrying out on-the-spot checks and calls. I encourage him to make an on-the-spot call some night to the national ambulance call centre to determine the cause of what is happening

When one examines the HIQA target and the reality pertaining to calls, one realises fewer than one third of calls are within the target time. Perhaps HIQA in its upcoming review will revise the appropriate target time so people will have a realistic expectation as to when an ambulance called will respond to their need. They just might need to find another way of getting their loved one or other sick person the care they need straightaway.

It very much boils down to resources. As my colleagues have pointed out, resources have been made available, including jeeps and rapid vehicles. On the "Prime Time" programme, we saw how they are being used. It is now three weeks since the "Prime Time" programme but there has been no adequate explanation given for the use of the vehicles in the meantime. If the resources the Minister has provided are not being managed in such a way as to put patient care at the centre, it is another issue that either the Minister or HIQA will have to consider in the context of the review.

It has been incredibly difficult to obtain answers to parliamentary questions on the national ambulance service. The reason Minister of State Deputy Kathleen Lynch became involved is that she replied on behalf of the Minister to a topical issue. I raised with her the difficulty in obtaining a response to a question. On one occasion, it took three months to get basic information back. On another occasion, I asked how many ambulances had left County Mayo to answer calls in other counties, and vice versa. I was told that information on response times on a county basis, in addition to the number of occasions on which ambulances from outside County Mayo are deployed to answer calls in the county, is not available. The ambulance service does not record these data. The location of one's vehicle, or any company asset, and the service it is providing at any given time is basic management information, yet it cannot be provided. In order to measure how the regional policy is working, surely the ambulance service should have at its fingertips the location of the four ambulances on call in County Mayo tonight.

It should be able to tell this tomorrow, if someone goes looking for it for any reason. The same applies to any county in terms of where the ambulances were tonight or this time last year, if they have any basic management information system in place to record ambulances. I presume they have tracker systems and GPS. This strikes me as a very strange and unco-operative system in terms of trying to get basic information on how such an important service works.

When we think outside the box in terms of the ambulance service, it can work. The emergency aeronautical service has been a huge success and has directly saved lives, and the Minister might clarify if there are any plans to expand that. However, there is also enormous frustration among the staff of the service. As with all public service workers, they are subject to all of the cuts of recent years. Ambulance personnel in particular have to cope with extra pressure and trauma due to their place at the front line of our emergency services. There is also the question of the definition of, for example, those within the service who have trained and qualified as paramedics and who do the duty of a paramedic but who only get paid as an EMT, which is a grade below paramedic. There are quite a number of such people within the service.

I put that question to Mr. Dunne on the night of the committee meeting and he avoided answering it. To be honest, putting down another PQ to the ambulance service and waiting a few months for a response is a waste of my time. I would like the Minister to look into this and to explain what are the divisions within the service which mean very qualified and dedicated people feel alienated from their colleagues because of some sort of grade issue. These people are doing the same job as those working with them, but those working with them are getting paid more.

In the view of Mr. Dunne, we apparently have the best ambulance service in the world. We do not. The notion that he thinks that is actually quite frightening, as is the notion that he was able to go on "Morning Ireland" and express this in the context of the programme he had viewed the day before, and in the context of the fact some of his workers bravely co-operated in the making of that programme and gave their version of events inside Leinster House. We have the best ambulance workers in the world, of that I have no doubt, and all of us know of examples where they have responded to calls. All of us will stand with them when they face God knows what or when they get a call at any stage. I have seen this personally. However, have we the best service in the world? Have we a service that actually treats the best ambulance workers in the world with respect? Clearly, we do not. Have we a service that is run and managed with what it aspires to have, namely, to have patients and patient care at the heart of the service? There is no way we can say that, under this alignment and this way of running things, patient care is at the heart of the service. I say we must give the people who work in the service the service they deserve, give the people who need the service the service they deserve and give the country the ambulance service it needs based on its geographical make-up.

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