Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank Deputy Cullinane for tabling the motion. It is a good motion and we will not be opposing it.

I acknowledge the extraordinary work that is being done by the women and men in the National Ambulance Service. Before Covid arrived, they were doing an extraordinary job. They did not have the resources they needed. The investment was not going in; that is the truth. A very good and credible strategy was launched in 2016 that did not get the resources that it needed. That was the situation before Covid arrived. Since it arrived, those working in the National Ambulance Service have been under extraordinary pressure. They have been among the most impressive people I have met as I have met health workers and others all over the country who have been involved in the fight against Covid.

All present remember the pop-up testing and tracing tents that were deployed. That was the National Ambulance Service. As Deputy Conway-Walsh stated, we remember the housebound and the urgency to get to them; a lot of that was the National Ambulance Service. We remember the urgency of getting vaccines out to various parts of the country; that was the National Ambulance Service. It has done an extraordinary job. While it was supporting the Covid efforts in testing and tracing, getting to the housebound and in vaccines more broadly, its staff were continuing to do their day job in respect of emergency response. They have done and continue to do an absolutely extraordinary job and I think every Deputy in this House will acknowledge and thank them for their amazing work through Covid.

I welcome the opportunity to address the motion with colleagues. The National Ambulance Service is a statutory pre-hospital emergency care provider. It operates as part of an integrated health system in which care begins immediately at the time of an emergency call and continues through appropriate treatment, transportation and handover of the patient to the clinical team at the appropriate emergency department or alternative facility.

It is fair to say the National Ambulance Service has undergone a significant amount of change and reform in recent years. It has changed from a service that traditionally transported patients to hospital for treatment to a service that is clinically led. That is an incredibly important and fundamental change. For example, it is now treating patients over the telephone, at the scene, at the patient's own home much of the time and on the way to a medical facility.

Right now, we are investing more than €200 million in the National Ambulance Service. The budget for next year will be in excess of €200 million. This means that NAS annual funding will have increased by approximately €30 million since 2019, which really is important because I agree with the Deputies who are calling for investment. Importantly, in the budgets for this year and next year we have matched that with action. Deputies have rightly stated that we need to see action and the money. I am delighted to be able to share with them that since 2019, the last year of the previous Government, funding has increased by 18%, which is very important. Since the 2016 plan entitled Vision 2020 was published, the NAS has increased staff numbers by 16% and there is far more change on the way. Building clinical capacity in the state-of-the-art national emergency operations centre, NEOC, in Tallaght has facilitated the introduction of alternative care pathways such as “see and treat” and “hear and treat”, which are really important and allow the NAS to assess and treat many patients at the lowest appropriate level of acuity, resulting in better outcomes for the patient and more effective use of healthcare resources.

I and the Government are committed to supporting the NAS as we continue with its development and transformation. Significant achievements have been made. Those working in the service deserve great credit for that. In addition to the funding for the budgets for this year and next year, I am very happy to share with colleagues - some of them will already be aware of this - that the National Ambulance Service has been allocated €5.7 million in targeted funding under the winter plan. This is important targeted funding in response to rising demand for access and it focuses on the “see and treat” measures, which will reduce the number of patients who have to be brought to an emergency department.

As set out in the national service plan for this year, there are specific targets in place that the NAS must meet in responding to life-threatening calls. The service works to achieve these targets by prioritising the allocation of resources to higher acuity calls and patients. I am aware that, as Deputies have noted, the wait times for lower acuity, non-life-threatening calls have presented a particular challenge recently as the NAS has been experiencing unusually high demand. While this is in line with the current experience of many parts of the hospital system, I know it is a concern for all present and certainly for all those working in the NAS. I have been advised that several particular factors are currently impacting on its ability to meet response times. These include a significant increase in demand for ambulance services. In fact, since February of this year, the NAS has seen an increase of 20% in emergency calls. That is a very steep increase. In addition, as all present will be aware, emergency departments have been extremely busy, which has negatively impact on turnaround times, that is, the time required to release an ambulance from an emergency department following patient transport. We are also dealing with a depletion of resources due to increased levels of sick leave, such as due to staff being a Covid-19 close contact, for example, which is impacting on the availability of front-line staff. There is also the ongoing need for enhanced infection prevention and control measures. I am fully committed to supporting the National Ambulance Service in responding to all these challenges, as it is doing. The unprecedented level of funding allocated in the past two budgets is evidence of that. The funding will help the service to address capacity shortfalls and build on the staffing levels increases and continue with that, which is important.

Successive reports on emergency ambulance capacity have highlighted that there is a shortage of qualified paramedics in Ireland, regardless of funding allocated. What are we doing about this? We are training more paramedics. There are more than 200 student paramedics at different stages of the paramedic degree programme right now. Of course, colleagues will be aware and, I am sure, fully supportive of the amazing advanced paramedic role. We are seeking to have more of those as well. They are doing an incredible job. It has been a really positive innovation in the ambulance service.

The stated target of the HSE is that 80% of ambulances will be released and available for tasking within 30 minutes of arrival at an emergency department. I am aware this target is not being met and that the pressures in emergency departments are a significant contributing factor to the release of the ambulances. The HSE has commissioned a review into this issue with a view to identifying what can be done in the short term to assist with it. I am advised that the initial findings of this review are currently being assessed by the HSE. I look forward to sharing and discussing those findings with colleagues.

I note for the information of the House the progression of delivery of acute bed capacity projects that is happening across the country in line with the requirements set out in the 2018 capacity report. This is relevant to the debate on the National Ambulance Service because to achieve the desired turnaround time, one of the many things we need in the acute hospitals is a significant increase in beds. The progress in this regard includes an increase in permanent acute bed capacity of 795 beds compared with the number available on 1 Jan 2020, with a target of 938 to year end. We also have €52 million in funding provided for critical care this year to allow for an additional 66 beds and to be followed by an additional €10.5 million for next year, with the stated aim of bringing the number of critical care beds from 255 at the start of Covid to 340 by early 2023. That will be an increase of one third, or 33%, in ICU capacity, which is significant. As we have discussed previously in the House, we are not stopping there; we are driving on with a very significant increase. In fact, the target we have set and on which we have Government agreement is in excess of the number identified in the previous capacity report.

The past few months have been challenging for the National Ambulance Service, as all present will be aware. Our clear focus now must be on continuing to support the capacity building and reform to ensure the service offers the right care at the right time and in the right place. We are acutely aware that the past two years have been incredibly challenging for the healthcare services. The experience of the National Ambulance Service and the women and men who work in it has been no different in that regard. While continuing to provide front-line services, it has done an enormous job in the Covid response, including carrying out more than 2 million Covid-19 tests. I thank the Deputies for tabling the motion. The Government will not oppose it. It contains very good ideas and I look forward to continued discussion.

See this speech in context