Catherine Byrne (Dublin South Central, Fine Gael) | Oireachtas source

I welcome the men and women from Dublin Fire Brigade who are in the Visitors' Gallery. I am taking this motion on behalf of the Minister for Health, Deputy Harris, who, unfortunately, cannot be here this evening. It is not any criticism of the Minister because I have a detailed reply to the Deputies and we may be able to settle some of the problems we face.

On behalf of the Minister, I accept the motion. I join Deputies across the House to commend the DFB for the excellent ambulance service it provides to the people of Dublin. The Dublin fire brigade has a long and very proud tradition of emergency medical service provision, which the Government is pleased to acknowledge. I assure the House that there are no plans afoot to remove responsibility for the delivery of Dublin's ambulance services from the fire brigade. I fully agree that any such move would have a negative impact on service delivery. Services would likely grind to a halt because the NAS does not have the capacity to take over the provision of emergency ambulance services in Dublin. Even if we wanted all such ambulance services to be provided by the NAS, that would not be achievable.

We are dependent on the approximately 800 men and women, dual qualified paramedic firefighters, who comprise the DFB workforce. I am happy that the fire brigade's Pre-Hospital Emergency Care Council, PHECC, registered paramedics are available to the HSE through a service arrangement. That workforce is a wonderful resource for all of us. They have been trained at the expense of the State and there is no reason whatsoever to think that the State might decide that we no longer require their expertise and their services. It is difficult to recruit trained paramedics; as in other medical disciplines we struggle to retain paramedic staff. Over recent years we have provided increased funding to the NAS to recruit and train additional paramedics and we will need to do so for many years to come. Even if we had unlimited funding, we would be unable to recruit at the level we require and, therefore, we need to do so on a phased basis. With the best will in the world, the NAS could not recruit at the level necessary to displace the DFB paramedic workforce and so cannot, and will not, take ownership of Dublin emergency ambulance service provision.

The Government is mindful of the great service that has been provided down through the years by the fire brigade and long may that service continue. As a former Lord Mayor of this city, it was a privilege to work with DFB. Its members were the escorts of the Lord Mayor and continue to do their duty on a daily basis to support the Lord Mayor in his or her role. The fire brigade provides emergency ambulance services in Dublin city and county by arrangement between DCC and the HSE.

The NAS also provides some emergency capacity in the greater Dublin area, as well as non-emergency patient transport. Over the years, funding issues have arisen between the HSE and DCC. It is timely to look again at how the funding arrangements between the two organisations work in an effort to ensure the service is put on a sound financial footing. The city council should be appropriately reimbursed for ambulance services provided on behalf of the HSE. In recent times there has been much improved co-ordination between the NAS and the fire brigade, particularly in respect of operations and clinical governance. I want both organisations to continue to work together to develop and improve ambulance service provision.

In that regard, we must address the current patient safety risk that prevails because of the existence of two separate call and dispatch centres in Dublin. Emergency 999 or 112 ambulance calls made in Dublin are transferred by the emergency call answering service to either the Dublin Fire Brigade east region communication centre or to the NAS's national emergency operations centre, NEOC, depending on where in Dublin the call originated. The NEOC in Tallaght is a state-of-the-art ambulance call centre which uses up to date digital telephony technology and bespoke computers to aid dispatch. The technology allows staff to have visibility of all NAS ambulance resources and, therefore, it can be guaranteed that the nearest available resource will always be dispatched by the service. The NEOC takes calls for the entire country apart from the Dublin area, and it also has a resilience site in Ballyshannon. If there are any difficulties in Tallaght for example, a power outage, the Ballyshannon centre will take over all call taking and dispatch operations.

A clinical hub went live in the NEOC in March 2018 and provides an alternative model of care for some patients. Certain low acuity calls are now transferred to the hub and the caller receives medical advice from nurses over the phone, and this may remove the need to dispatch an ambulance. Emergency calls for ambulances in the Dublin area are managed from the Dublin Fire Brigade control room in Townsend Street, Dublin. Fire brigade personnel take calls and dispatch resources for both ambulance and fire services. However, the analogue telephony system in Townsend Street is outdated and in need of replacement; calls are dispatched over the radio.

DFB has 12 ambulances and 21 fire appliances are available to be dispatched as first responders. In cases where the fire brigade does not have a resource available or where the resources are deemed to be too far away the call may be stacked to await a resource or telephone contact is made with the NEOC with a request that the NAS responds to the call. While mechanisms to transfer calls between the call centres exist this, by its nature, carries inherent risks and can give rise to delays, with potentially adverse implications for patients. In addition, each provider only has visibility of its own resources and, therefore, it is not possible to ensure the nearest available resource is dispatched to emergency calls in the Dublin area. Data from the NAS indicates that DFB requests for its assistance can be in the region of 1,000 per week. Sometimes the fire brigade passes calls in batches which presents challenges to the NAS in prioritising batched calls. This highlights that change is required in ambulance call taking and dispatch arrangements in Dublin.

Since the 1990s a number of reports have raised concerns about the existence of two call and dispatch centres in Dublin. The 1993 report of the review on ambulance services proposed that the two organisations should function as a single entity using a single command and control facility. A subsequent review was conducted in 2001 and that also promoted a single command and control centre and no duplication of services. In 2007, the city council and the HSE conducted a comprehensive review which identified 15 key recommendations. These were underpinned by the principle that any member of the public or health professional should have a single point of contact with the emergency ambulance services serving Dublin city and county and that they receive a response from the nearest appropriate emergency care resource in the shortest time.

Once again, an integrated command and control unit was advocated. In 2014, a review of the pre-hospital emergency care services was undertaken by the Health Information and Quality Authority. The report found that the NAS and DFB were not integrated, and identified poor levels of co-operation between both entities which was not always in the best interests of the patient.

I am pleased to note that in the following review in 2017, HIQA found evidence of a much better relationship between the NAS and the fire brigade. However, HIQA identified a high risk in respect of Dublin ambulance services stemming from overall capacity deficit and arrangements for call-handling and dispatch. HIQA warned that the current arrangements in place can result in high numbers of potential life-threatening calls being queued by DFB rather than receiving an immediate response. I imagine the House will agree that these successive independent reports over the decades highlight the urgent need for change in the call and dispatch function for ambulance services in the Dublin region.

The NAS has undergone a significant process of reform and modernisation in recent years. Several important service initiatives and developments have taken place. The significant reform programme aims to reconfigure the management and delivery of pre-hospital emergency care services, and includes plans to develop alternative pathways of care such as hear-and-treat clinical hubs and see-and-treat models as well as transferring patients to alternative destinations for treatment.

I want the people of Dublin to reap the benefits of these developments and innovations. However, as things currently stand, they do not. Dublin is the only area in the country where we cannot guarantee that the nearest available resources will be dispatched. Callers from certain parts of Dublin do not have access to clinical hubs.

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