Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I welcome this motion on the perilous state of our ambulance services, which was tabled in the name of the Fianna Fáil Deputies.

This Government has deliberately ignored, tried to gloss over or even dismiss many issues during its term of office, including the impact of its austerity policies on the most vulnerable, and the deepening housing crisis. I have not seen the Government completely ignoring any crucial issue as it has done with the ambulance situation.

In two recent engagements with the Minister for Health, Deputy James Reilly, I raised the ambulance crisis. At the Committee on Health and Children, and during ministerial questions, I prioritised this key matter of public health and safety. I can only describe the Minister's responses to me as dismissive in the extreme. He levelled the disgraceful accusation of "shroud-waving" at me and, by extension, at all who are raising concerns about our ambulance services.

There was not a syllable of acknowledgement from the Minister of the concerns raised in recent weeks. There was no hint of recognition of the deep hurt caused to many families who have seen loved ones suffering and, in some tragic cases, losing their lives in circumstances where ambulances arrived on the scene of accidents or medical emergencies far outside the HSE's target time. From a Minister for Health that is not good enough, to say the least.

The recent "Prime Time" investigation exposed the extent of what we know exists in this State - a crisis in our ambulance services as a direct result of cuts. There is huge public concern at the total inadequacy of emergency ambulance cover across huge swathes of the country. It is unacceptable that ambulances are often arriving too late and that people are dying as a result.

It is unacceptable that target times set by HIQA are not being met and, in fact, have been increased by the HSE. It is unacceptable that only one in every three people with life-threatening conditions was responded to by the ambulance service within the target time last year. I have said that again purposely because the Minister refutes it.

The Minister for Health needs to significantly increase the number of trained personnel and the number of ambulances as a matter of urgency. The Minister must also tackle HSE mismanagement of the service. For example, there is a scandalous misuse of rapid response vehicles as personal cars for managers, sitting outside their homes for long periods or parked in fleets at national HSE meetings, instead of serving the regions they are supposed to serve.

We cannot improve the ambulance service without significantly increasing personnel and infrastructure. Has the Minister compared the service in this State with the Six Counties and Scotland? The facts speak for themselves. With a population of 1.7 million the ambulance service in the Six Counties employs just under 1,200 staff, with 300 vehicles deployed from 57 bases and an annual budget of €78 million. Scotland, with a population of 5.3 million has 4,500 staff and 450 vehicles, including a full time air-ambulance, 100 bases and an annual budget of €258 million. Yet this State, with a population of 4.6 million, employs less than 1,600 staff, deployed from 87 bases, of which at least 10% are not 24-7, and has an annual budget of €137.4 million.

These figures speak for themselves. More importantly, however, survivors and families of victims of traumatic accidents and medical emergencies have spoken out and must be listened to. This ambulance service is one of the key pillars of our health services, literally a life support system. I want to pay special tribute to all who work in our ambulance services, and all the emergency services. We need to make very clear that when we express concern over response times, lack of coverage of large parts of the country with ambulance services and other problems facing the system, we are in no way criticising the dedicated work of ambulance crews. They are providing a modern, highly skilled and efficient service, but within the severe limits of the resources made available to them by Government.

Paramedics have yet to receive the proper recognition that their work deserves. The inadequate resources allocated to the service by successive governments, including the present Government, place them under enormous pressure on a personal and professional basis.

Of course, it is not all about resources. I acknowledge that ways of working have been improved and improvements are continuing but there is a limit. It is clear to me that there is a crisis in terms of the inadequate Government allocation to this vital service.

I agree with National Ambulance Service Representative Association, NASRA, which stated that targets are not being met because of shortages of personnel, infrastructure and funding. No amount of re-arranging or playing with figures can disguise that. Both NASRA and SIPTU point to the unfavourable comparison of this State with the Six Counties and Scotland, as I have mentioned.

My own region, comprising counties Cavan, Monaghan, Louth and Meath, is expected to survive with 12 ambulances available at any one time. I know from direct personal experience, and from the experience of my constituents, that the cover is totally inadequate. That is replicated across the State.

Another important aspect of this issue, though not mentioned in the motion, is the situation regarding Dublin. The Dublin Fire Brigade responds to 40% of the total number of emergency calls in the 26 Counties, yet it receives only 7% of the HSE's total ambulance budget.

There is a huge concern in Dublin that the HSE is now attempting to take control of the Dublin Fire Brigade ambulance service and that this will result in a worse service given HSE management's obvious incompetence and mismanagement. Hundreds of firefighters of the Dublin Fire Brigade, who provide an excellent service, including an excellent ambulance service, in our capital city, protested recently at Dublin City Hall with their friends, families and supporters.

The level of concern in Dublin and the lack of trust in the HSE was clear at a recent meeting of Dublin City Council's strategic policy committee at which it was noted that the Dublin Fire Brigade provided a professional and efficient ambulance service, that the veracity of data included in a recently disclosed internal review of the ambulance service was poor and questionable, that the committee supported one national review of the ambulance service as recently discussed at the Joint Committee on Health and Children and that the full cost of the ambulance service provided on behalf of the HSE by Dublin City Council was not being recouped. Calls were made for a national capacity review of the ambulance service and establishment of a national ambulance authority. The lack of confidence expressed by some committee members in the ability of the HSE to run the ambulance service was clearly representative of a wider view.

Sinn Féin fully supports the retention of the Dublin Fire Brigade ambulance service and opposes a HSE takeover. While we support the motion before us, we would go further and urge real reform as well as proper resourcing of ambulance services. HSE management cannot be trusted to run the ambulance service. We call for a State-wide audit of ambulance services with a view to increasing the number of front-line personnel and improving the infrastructure in order to bring the service across the State up to a safe and efficient level. Government cutbacks have meant that services across the State are insufficient and lives throughout the length and breadth of the jurisdiction are being put in jeopardy as a result. It is critical to remember the requirement to have cross-Border co-operation in responding to certain situations. That will be impacted unfavourably on foot of the cutbacks. Sinn Féin calls for a truly national ambulance service, including cross-Border co-operation and integration, outside the remit of the HSE and under a new national ambulance authority for the island of Ireland.

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