David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I move:

That Dáil Éireann:

notes that:

— the National Ambulance Service (NAS) and emergency services are at crisis point, with health care professionals expecting a very challenging winter with insufficient ambulance capacity;

— response time standards state that life-threatening callouts should be responded to within 19 minutes in 81.5 per cent of cases;

— State-wide response times for life-threatening callouts (Clinical Status 1 – ECHO: Patients who are in cardiac or respiratory arrest) within this timeframe have decreased from 80 per cent in December 2017 to 76 per cent in December 2019, in particular outside of Dublin; and

— State-wide response times for potentially life-threatening callouts (Clinical Status 1 –DELTA: Patients with life-threatening conditions other than cardiac or respiratory arrest) within this timeframe have fallen from 54 per cent in December 2017 to 49 percent in December 2019, and that rates in the summers of 2020 and 2021 were down on previous years;

further notes that:

— the annual spend on private ambulance services has risen from €2.1 million in 2011 to €10.1 million in 2019;

— in 2019, the three top spenders on private ambulance services were Letterkenny University Hospital (€1.6 million), Mayo University Hospital (€1 million), and Cavan General Hospital (€682,973);

— ambulances are too often travelling in excess of 150 kilometres to reach a destination,with instances in excess of 200 kilometres, and there are extreme geographical disparities in ambulance coverage;

— ambulances are often left idling outside of hospitals due to a lack of bed capacity and an inability to transfer patients, particularly Covid-19 patients, as accident and emergency services are not operating in an efficient and effective manner, resulting in cancellations of scheduled care and contributing further to the waiting list crisis;

— an unacceptably high proportion of shifts, possibly as many as half or more, already run overtime, with 12-hour shifts often lasting 15 hours or more, leading NAS staff to have low morale with widespread burn out and occupation-related mental health difficulties;and

— the attractiveness of a career in the NAS is damaged by the terms and conditions of work under the current system, which is a reputational issue also affecting medical scientists and other underappreciated professions in the health service; and

calls on the Government to:

— urgently complete and fund the recommendations of the capacity review on the adequacy of the NAS, to identify additional budgetary needs to phase out the use of private services, reduce reliance on overtime, fill vacancies, and expand staffing and the ambulance fleet to meet need;

— urgently review the adequacy of the spatial distribution and coverage of the ambulance fleet, ambulance stations and rapid deployment points, to ensure an equitable distribution of services across regions and to reach response time standard targets;

— avoid call centres directing long-distance callouts to teams which are nearing the end of their shift and ensure adequate coverage to support this;

— advance legislation relating to specialist paramedic grades and rapidly advance funded expansions to primary and community services, in particular those relating to community paramedicine and chronic disease management, to provide alternatives to hospitalisation and reduce the strain on emergency services;

— establish a clinical framework to provide for ‘hear and treat’ and ‘see and treat’ alternative care pathways, to further reduce hospitalisations;

— provide more appropriate hospital beds to avoid patients being left in ambulances and admit them to hospital in a timely manner;

— expand mental health supports for the NAS workforce, including access to counselling and psychiatric services where appropriate; and

— ensure redeployment opportunities within the health service, particularly to non-emergency community roles, for frontline paramedics who are fit to work but cannot return to frontline emergency roles for health reasons.

I will be sharing time with some of my colleagues. I have tabled this motion because, as is the case in many areas of healthcare at the moment, we have a lot of burnout and fatigue in the National Ambulance Service. I have met many ambulance paramedics and members of the National Ambulance Service in recent weeks and months. I am sure the Minister is aware of many of the pressures the National Ambulance Service is under. We often hear the words "burnout", "low morale" and "fatigue" in relation to our front-line healthcare services. It is no different in the National Ambulance Service.

I met yesterday with the SIPTU representatives and many ambulance paramedics on a Zoom call. I again heard at first hand the consequences of what is happening as a result of the lack of capacity in our National Ambulance Service. There are no breaks for many of those who are on long shifts. Ambulance paramedics often work for 12 hours. They cannot get a break, even a lunch break, and many of them talk about a desktop lunch because they simply cannot get time to eat properly. That has a consequence for them. Even after the long hours they work, if there are 15 or 20 minutes left at the end of their shift, they can be given a call-out to somewhere 100, 200 or 300 miles away from their destination, adding lengthy hours to an already long shift. There are many more consequences for the ambulance paramedics. There is real fatigue and burn-out in that community.

There are also consequences for patients. We hear more and more anecdotal evidence from patients and families that people are waiting too long for an ambulance to arrive. I put that directly to ambulance paramedics I met, including those from SIPTU last night, and they say that is precisely what is happening. They say they cannot stand over a service where the response times are not what they should be. One ambulance paramedic remarked to me that he came onto his shift last week, starting at 7.30 p.m. His first call was to respond to a call that came in from a patient at 11.38 a.m. He had to respond to that call, arriving six or seven hours later, and had to deal with that challenge, through no fault of his own. An awful lot of moral injury applies here with regard to the impact that has on front-line staff. Ambulance paramedics have to do their best. They want to make sure they take whatever call comes in. A child could be sick. An older person may have fallen. Yet, at the same time, those ambulance staff know they need a break or are coming towards the end of their shift. They have to deal with all of that, day in and day out. I am hearing more about that kind of moral injury, not just from members of the National Ambulance Service but right across our healthcare system. It all comes back to a lack of capacity.

I can pre-empt some of what is in the Minister's response. A number of working groups have been established by the National Ambulance Service to look at some of these issues around breaks, late call-outs at the end of shifts and many of those sorts of areas. However, they have not been actioned. We need to see even those small steps implemented as quickly as possible. I also know a capacity review is being conducted. When I talk to ambulance paramedics, they relay to me that the nearest comparable country is Scotland, where there is a staff complement of 5,000 while we, in this State, have a staff complement of just over 2,000. We are far behind. Our fleet needs to be greater than it is, as does the number of paramedics. We need more emergency medical technicians and more staff generally in our ambulance services. The consequence of that not happening is that ambulances will not arrive on time. More burnout and fatigue will be the result.

I have also been told by managers in some hospitals throughout the State that ambulances can be parked up for hours on end because the hospitals do not have the beds to transfer or decamp patients from the ambulances into the hospital. It can happen for hours on end. Those hospital managers told me they have had ambulances, sometimes a fleet of ambulances, parked up for hours outside their hospitals because they do not have the beds for those patients. In those scenarios, the ambulances are acting almost as hospital trolleys. How mad is that? How frustrating is it for ambulance paramedics and people who use the service?

This motion is a sincere attempt to say to the Minister that we need action. I hope the Minister will support this motion and I think he should be able to. We are calling for the completion of the national capacity review and for its publication when it is complete. We are also calling for the proper resourcing of the service. Let us put in place a strategy for the National Ambulance Service that properly resources it, increases the fleet and personnel and ensures we can provide a fair service. We must ensure ambulance paramedics are fairly treated. Let us address the issues of burnout, low morale and fatigue and put in place a plan in which ambulance staff can have confidence. I know there are new personnel at the head of the National Ambulance Service and I wish them well and want them to succeed. I ask the Minister to support the motion and, more than that, I ask that he actions the requests in the motion.

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