Holly Cairns (Cork South West, Social Democrats) | Oireachtas source

We are all aware of the instances in recent months of unacceptable waiting times for ambulances and paramedics being directed, sometimes hundreds of kilometres, to respond to an emergency. This is obviously deeply distressing for families and communities who should be assured of access to emergency services. These fears are even more acute in rural areas where waiting times can be much more significant. The delays in the ambulance service are a cause of worry in themselves, but coupled with the erosion of health services in areas like Cork South-West, communities are deeply troubled by the implications.

Bantry General Hospital is still awaiting the necessary investments to guarantee its future, while the closure of some services due to staffing in the summer demonstrated its precarity. Furthermore, the rationalisation of SouthDoc has resulted in reduced hours in Castletownbere and the closure of the Kinsale service. Combined, all of these issues greatly impact the rights of people in the area to access appropriate medical care.

The focus on ambulance services is incredibly important. This is always part of a multifaceted and interlocking system. We need greater support for all of these features together.

In discussing this motion, it is important to note that we have very dedicated and professional paramedics and ambulance service staff who are doing everything they can to respond to calls. Anyone who has interacted with them understands the commitment and skill they display in dealing with emergency and difficult situations. Emergency services are an essential public service. There should be no doubt or worry that ambulances, in this case, or the fire brigade or An Garda, will respond immediately to emergency situations. This has to be a bare minimum. This has to be a service the State guarantees. Unfortunately, this is not the case.

Instances highlighted in this House and in the media in recent times reveal considerable waiting times, with several cases in Cork. The response times for both life-threatening and potentially life-threatening call-outs have decreased in recent years. Reports from within the NAS, however, show over-stretched staff and inadequate resources where paramedics and other staff have their 12-hour shifts overrun, putting themselves and others at risk. This is simply unacceptable.

After a recent ambulance crash, the Southern Starreported that members of the ambulance crew have begun to speak out. They say that "enforced overtime", which sees their 12-hour shift extended to 14, 16 and sometimes 18 hours, presents a real danger to them, patient outcomes and the long-term effectiveness of the service.

There are four ambulances in west Cork but they often travel massive distances to attend life-threatening calls in Cork city and Kerry on a daily basis, sometimes resulting in one or no ambulances being in west Cork. People have been in touch with me and it was amazing to hear other Deputies saying that it is a very common occurrence for people to be waiting more than three hours for an ambulance. Can you imagine if that happened to you? I cannot believe how common it is and I thought it was an outlier down where I am from.

Paramedics are reported having to apologise to patients for the length of time it takes them to get there, something that was described by one paramedic as embarrassing. Worse than that, it is dangerous. They have said that this has to be highlighted because people are going to die due to delays. We must have sufficient numbers of ambulances based around the country and have staff who work reasonable hours to be able to respond safely and effectively to emergencies. We must also have a service that reaches all communities in a timely manner.

The NAS has identified issues leading to delays in responding to calls in different areas of the country, including increased arrival-to-hand-over delays at emergency departments and infection prevention measures. Congested emergency departments can leave ambulances waiting at the hospital and tie up paramedics who should be out answering calls. It illustrates the complexity of the circumstances and the interconnection with other shortcomings in the health service.

As we face into the winter season of increased numbers presenting in hospitals, especially through emergency departments, will this situation only get worse? Any efforts to address the delays in ambulance responses have to consider all of the factors involved.

The NAS capacity review from 2015 highlighted the need for increased investment in vehicles and technology, the redeployment of ambulance stations around the country to service communities better and the hiring of additional staff. In cases where seconds can make all the difference, it is essential that the necessary investment is made in the service. For example, the improved locating of ambulance stations would decrease drive times and lead to an improvement in response times.

Ambulance crews also believe the switch to operating the service from a regional to national basis is not as effective as it might appear on paper and this needs to be considered.

The motion rightly calls for the urgent implementation of the review’s recommendations. In addition, the capacity review calls for different clinical options as alternatives to converging all patients into already overcrowded emergency departments.

In England, the development of alternative care pathways has allowed ambulance services to treat up to 50% of patients by means other than transportation to accident and emergency departments. However, this requires the creation of link-in services and availability of out-of-hours GP facilities, social services and emergency dental services. More specialist paramedic grades and the development of community first responder schemes can also play a role here in not only reducing the strain on ambulances and acute hospitals but in providing emergency interventions and care at the point of need.

The role of air ambulances in providing rapid emergency care, especially for island and coastal areas, needs to be acknowledged this evening also. The air ambulance is underutilised and underfunded.

Finally, ambulances are not just about emergencies, they are often key assets in transferring patients or people with additional needs for care in acute settings or even appointments. We need the capacity in the system to ensure these services are available to people.

I have recently been dealing with a case where an older person in west Cork has regular appointments in Cork city but is not guaranteed to make them due to the unavailability of vehicles. This is now a constant source of worry for the family who are struggling to make alternative arrangements and is simply unacceptable.

We need a properly resourced ambulance service that guarantees the numbers of vehicles and supported staff to ensure the best possible response times. It is the least the families, communities and the workers themselves deserve.

It is also necessary to provide other services that assist and improve the function of ambulances from fully resourced emergency departments and rural hospitals to out-of-hours GP cover and empowered paramedics. All of these features are connected and necessitate proper investment and co-ordination and this cannot happen fast enough.

I thank Sinn Féin for bringing forward this motion and I encourage all Deputies to support it. I know that the Minister said that he would not be blocking this motion but the question is when he will bring the measures requested in.

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