Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I will come to that next. A number of elements need to be there. There is a different hierarchy within the EMTs, the paramedics, the advanced medical practitioners, and a broader advance of other groups like the community first responders, CFRs. We have 275 CFRs. They were stood down during the Covid period, but 125 of them are working again. I hope that will come to bear when there is an Echo or a Delta response, because they are closest to the person and give the support at the start while he or she is waiting on an ambulance. There is no excuse for a person having to wait four or five hours. I have heard the stories.

Deputy Lowry made a valuable contribution when he said that 57% of all ambulance workers do not finish on time. He asked about the deployment of front-line paramedics for Covid testing. It is something I will bring back to and discuss with the Minister, Deputy Stephen Donnelly. Deputy Lowry suggested that interns and apprenticeships should be left closer to home because they are not paid an inordinate sum of money. There are numerous reasons, for example with regard to housing, we should leave them closer to home. We do not want to burn them out or turn them off. We would like to give them a reasonable experience in order that they might stay on board. We need them in the profession. We do not want to lose them at their point of entry after working.

I cannot comment on the matter raised by Deputy Joan Collins with regard to the unions because I do not have enough knowledge on it. I will bring it up with the Minister, Deputy Stephen Donnelly. Two or three Members raised that point before Deputy Collins did so.

Deputy Cairns talked about the triple lock. I do not have enough information to answer that question, but I know I have addressed it.

I asked for a clear breakdown on budget 2020. In budget 2022, €8.3 million was allocated to the NAS for the continued implementation of the strategic initiatives aligned with the NAS plan. The training and recruitment of additional paramedics to support baseline capacity needs 49 whole-time equivalents. The strength and clinical capacity in the National Emergency Operations Centre needs eight whole-time equivalents. Addressing tactical and operational management deficits needs 42 whole-time equivalents. Enhanced governance arrangements within the NAS need 29 whole-time equivalents. From what I can see, there is an action plan in relation to recruitment across a number of levels to address it. It does not speak to the point that Deputy Pringle raised about ambulances. That is what we need, and Deputy McNamara also said it. We need ambulances. That was the difference in Connemara. We got the ambulance and the people came around it. It takes the guts of 11 people to man an ambulance so that it can run 24-7. One can work out from that how many ambulances would need to be recruited into those areas. This is absolutely essential. I have heard the horrific stories from front-line workers who have found being out on the ground extremely difficult and very challenging. I have heard about how exhausted they are and the burnout they have felt. What is wrong in the NAS did not just happen over Covid. It was wrong before Covid ever arrived and it has to be acknowledged. I acknowledge that the Minister has sought funding. It is provided for within the budget. There is a plan for the spending within the budget. My experience and engagement with the NAS within my ministerial role has been very positive. They engaged, they found the funding and the staff and they had the will to implement it.

Queries have to be made about the suggestion that temporary amendments could be made to the current deployment model. What are the proposed amendments being considered? When will a final decision be made on whether they will be introduced? Deputy Pringle spoke about the deployment of an ambulance from Donegal to Tipperary. The current deployment model is aligned to best international practice and was put in place following HIQA recommendations regarding safety concerns with former health board level control centres. In the context of current service pressure and capacity issues, the NAS and trade unions have a working group in place that is jointly looking at what work practice changes are possible. This will improve staff experiences without affecting or compromising patient safety. While a timeline for the conclusion of these discussions is not yet available, the NAS has emphasised that there is no intention to move away from the HIQA-recommended model and return to a geographical limited model, which would reintroduce inherent patient safety risks that were eliminated when the local control centres were closed. They should, and I hope they will, look at the piece of equipment - the ambulance or car itself - and at the rapid response between the various areas, and whether that could help in formulating any support that could work. When they did this piece of work in the past, they looked at the UK model and found that the rural capacity response rate there was 12%, whereas our rate was 40%. The geographical spread and the diversification within our need for more local or regional ambulance depots is essential, as is the quality of those depots.

It is sad to hear that when ambulances are left outside hospitals, paramedics are failing to have access to toilet facilities or to eat. It is wrong that they are left having their lunch in the ambulance, which is their place of work all day. I ask the hospital groups to take that on board following tonight's debate. It is wrong that the families and friends of patients are going to the local service station to buy ambulance personnel a cup of coffee or a bun. That is not how we should treat any front-line worker. Most importantly, it is not how we should treat people who are under an inordinate amount of pressure, and are in fact under severe pressure. That is my one ask of the hospital groups. It does not require money. It does not require legislation. It requires a willingness to acknowledge the role played by our paramedics and front-line NAS personnel in delivering patient care.

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