James Reilly (Dublin North, Fine Gael) | Oireachtas source

I should, however, caution that while response times are helpful for performance measurement, they give a very narrow view of service performance and should not be used in isolation. Accordingly, when we are assessing performance, we should also have regard to patient outcome indicators. I am pleased that the first outcome key performance indicator, which is for the return of spontaneous circulation in the emergency department for heart attacks under certain defined circumstances, is being introduced by the National Ambulance Service this year.

The National Ambulance Service is proactively seeking to improve response times and has put in place a performance improvement action plan. The plan has 57 action points including improving call-taking allocation and dispatch and crew mobilisation times; appropriate targeting of emergency and intermediate care vehicles; and improving emergency department turnaround times.

A key measure of the reform programme is the national control centre reconfiguration project. The National Ambulance Service has operated in eight ambulance regions with no interconnection of radio and computer systems. This has delayed improvements in emergency response times, particularly at regional boundaries, where the nearest ambulance may be in the neighbouring region. A reconfiguration project is under way to establish a single national ambulance control centre on two sites, with significant investment in new voice, data and mapping technologies. This is in line with best international practice and will allow the National Ambulance Service to deploy emergency resources more effectively and efficiently, regionally and nationally, rather than within small geographic areas. The national control centre will be located in Tallaght and Ballyshannon, with the project expected to be completed next year.

In 2013, under the control centre migration plan, Cork, Tralee and Navan control centre functions moved to the national ambulance service control centre at Townsend Street, which has operated a computer-aided dispatch platform since November 2013. National digital radio, TETRA, is now online in the former east region - that is, Dublin, Kildare and Wicklow - Cork and Kerry, and the former north east - that is, Louth, Meath, Cavan and Monaghan. It will roll out to other areas during 2014, starting with the former west area.

In co-operation with staff, the National Ambulance Service, NAS, is successfully moving from on-call rostering where staff are off-site waiting to be summoned to on-duty rostering where paramedic crews are in their stations or vehicles during shifts. This leads to faster deployment as the crew is in position to respond immediately to calls rather than the average on-call deployment of over 20 minutes.

A key performance issue has been the use of emergency ambulances for routine inter-hospital patient transfers. NAS is developing dedicated non-emergency patient transport through the intermediate care service for routine transfers. This frees up emergency resources for emergency tasks improving response times and performance. The intermediate care service with over 73 intermediate care staff and 36 vehicles now operates in Cork, Galway, Sligo, Letterkenny, south Dublin, Mayo, Limerick, Louth, Monaghan, Cavan, Kerry, Waterford, Sligo and Roscommon. Further staff will be assigned in 2014. This obviously frees up more emergency vehicles to deal with emergencies.

As I indicated, improving turnaround times in emergency departments is addressed in the performance improvement action plan. Ambulance turnaround times at hospitals are now monitored on a continuous basis via the command and control centres. When an issue regarding turnaround time arises, NAS operates an escalation policy. This escalation policy involves contact via the command and control centre to the hospital emergency department and the dispatch of an ambulance resource manager to the emergency department to assist in the mitigation of the delay. I should also mention that NAS is currently developing a national emergency department turnaround framework to ensure consistent and rapid intervention to any delay in ambulance turnaround times. In response to Deputy Browne's allegation that there are regular hour-long delays, the turnaround time is not reported in the performance monitoring report but NAS is now gathering this data. However, the average time turnaround in Wexford General Hospital in March was 22 minutes and 42 seconds and times of one to two hours occurred in under 5% of cases. In response to Deputy Calleary, I will check out the delays in responses to parliamentary questions. That is not in anyone's interests and should be addressed.

I noted earlier that one of the factors affecting response times is geographic and demographic challenges, particularly in isolated rural areas such as in the west of Ireland. One of the ways in which we have met this challenge is through the establishment of the emergency aeromedical support service. This is a pilot project between NAS and the Air Corps which provides dedicated aeromedical support in the west and other areas, specifically where land transit times would not be clinically appropriate. The emergency aeromedical support service completed 368 missions in 2013, one third involving STEMI-type heart attack patients who need time-critical transfers to primary percutaneous coronary intervention, PCI, units for treatment. In other words, they need a stent within 90 minutes of the onset of the heart attack. A review of the pilot project found a clinical need for the service and that it should be established on a permanent basis. An inter-service group is examining how best to do this. Agreement has been reached with my colleague, the Minister for Defence, to extend aeromedical support by the Air Corps until June 2014, pending decisions on how best to establish a permanent service. With 14 years in government and more money than one could count, Fianna Fáil could never put an air ambulance service in place. Another vital service provided by NAS is the neo-natal retrieval care service, which was expanded in December 2013 to a 24-hour, seven-day-a week service. This service transports critically ill infants with their clinical care teams to high acuity care. It has now completed over 100 transfers.

The ambulance service is under scrutiny in a way that has never happened before. Three reviews are taking place at present with a view to further improve our ambulance service. First, HIQA is conducting a review of governance arrangements in pre-hospital emergency services to ensure timely assessment, diagnosis, management and transport of acutely ill patients to appropriate health care facilities. This review includes an assessment framework designed against the national standards for safer better health care.

The objective of the review is to seek assurance that NAS has in place a clear strategic direction with implementation plans and control measures for the national service; robust governance and leadership arrangements at all levels within the service; clearly defined schemes of delegation; appropriate controls in place through service-level agreements with third parties delivering services on behalf of the national service; appropriate quality and risk management arrangements; a well-organised, skilled workforce with a culture of continuous improvement; and the use of care pathways, clinical outcomes and other performance indicators that demonstrate that the ambulance service is both safe and effective. It is anticipated that the review will lead to a range of recommendations aimed at ensuring NAS is enabled to develop and benchmark its services using modern outcome indicator data used by similar ambulance services internationally. At my request, HIQA brought forward this planned review of NAS and I am pleased that the review has now commenced. I understand that the review will be completed by the end of the year.

Second, NAS has commissioned an independent national capacity review to determine the level and use of resourcing required for a safe and effective service. The capacity review is a tool used by many emergency medical services around the world in order to identify the volume and location of resources required to achieve optimal effectiveness and efficiencies, improve performance and deliver a better service to the patient. The capacity review will be undertaken by the Association of Ambulance Chief Executives from the UK. The association has wide international experience in operational and strategic reviews of this kind. The review has begun and it is expected to be completed in the third quarter of this year.

Finally, in the context of the development of the national control system, the Dublin City Manager and the HSE's chief operating officer commissioned a joint review of Dublin Fire Brigade's ambulance service. The review will consider all aspects of Dublin Fire Brigade's ambulance operations, including the capacity and capability of ambulance services. The review will inform consideration of the best model for provision of emergency medical services in the greater Dublin area. There has been much speculation about this review and I am aware of the concerns raised by some about the future of the service. I assure those concerned that I fully appreciate the long arid proud tradition of service provided by Dublin Fire Brigade to residents of Dublin. This review is not in any way a negative reflection on that service, rather it is a means to establish the best way forward in light of the move to a single dispatch system.

The three reviews are being conducted in parallel in a concerted effort to examine our pre-hospital emergency care services throughout the country with a view to identifying the best way to enable them to meet the challenges of the future. I look forward to the recommendations of all three reviews, which will be considered in a holistic and coherent manner. I am confident that the recommendations will guide us in the provision of a modern, forward looking service that is capable of delivering the best possible outcomes for the public.

I will touch on a few points that were raised around rapid response vehicles and issues raised by Deputy Ó Cuív about the air service to the islands. There is no discrimination between country and city as he would try to allege. Clearly, rural Ireland presents a greater challenge because of its geography and demographics. I am not aware of any diminishing of service to the islands. In addition, we also have the air ambulance service to support that. Both advanced and ordinary paramedics are very highly trained and can undertake a very high level of medical assessment and treatment - potentially life-saving treatment in many cases. Therefore, NAS has invested significantly in recent years in training ambulance staff to very high standards in both paramedic training, which is two years, and advanced paramedic training, which is an additional ten months, and the purchase of rapid response vehicles. As highlighted on RTE, an internal investigation and review are ongoing as to the use of rapid response vehicles. However, it is important to say that in the first three months of this year, officer vehicles responded to more than 630 incidents and over 250 of these were outside working hours. That is an average of seven responses a day, almost three of which have been outside working hours. It would not make sense to have these vehicles locked up in a station with the officer concerned having to drive a distance to get the vehicle to do the call. In the same way, we do not have people on call at home anymore but have them either in the depot or sitting in the ambulance ready to go.

Clearly, much has been achieved in reconfiguring and remodelling our ambulance service. In this regard, I acknowledge the very significant contribution made by ambulance personnel throughout the country whose commitment and dedication are second to none. As Deputies have acknowledged, they are working day and night to do the best by their fellow citizens. While we are making progress, I accept that we have more to do.

I am determined to make further progress in order that all our citizens have access to the efficient, modern ambulance service they deserve, regardless of where they live in the country. To this end, I assure the House that the National Ambulance Service will continue to modernise and reconfigure its services to ensure emergency pre-hospital care is delivered in an appropriate and timely manner.

I point out to Deputy Kelleher that I stood where he is now when his Government, despite all its resources, did not even measure response times and ambulances queued up regularly outside hospitals, especially in Dublin. We have increased the availability of ambulances through the use of our new intermediary care ambulances for inter-hospital transfer patients. The outcome for the patient is the key here. That is influenced not just by the ambulances but by the presence of our paramedics and advance paramedics who can ensure treatment gets to the patient as quickly as possible.

I do not talk about my achievements-----

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