Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following: "notes:

— the vital role played by the National Ambulance Service (NAS) in Ireland's public health service;

— the vital role played by the NAS throughout Ireland's response to the Covid-19 pandemic;

— that ambulance services have been experiencing a significant increase in demand in recent years with a record 389,764 emergency ambulance calls received from the public in 2022, a 6 per cent increase on the number received in 2021;

— that the Government invested a record amount of over €200 million in the NAS as part of Budget 2022, and this represented an overall increase in NAS annual funding of approximately €30 million since 2019, with a further record investment for the NAS being allocated as part of the 2023 Health Service Executive (HSE) National Service Plan;

— that NAS staffing levels have increased from 1,933 whole-time equivalent (WTE) in 2019 to 2,125 in 2023, a 10 per cent overall increase in WTE, with further expansion of this workforce expected in 2023;

— the significant progress made under the previous NAS strategy 'Vision2020', to commence the transformation of the NAS from a conventional emergency medical service to an agile and responsive mobile medical service, and to enable patients to be treated at the lowest appropriate level of acuity;

— the significant modernisation and development of the NAS operational fleet of vehicles, including critical care ambulances, emergency ambulances, intermediate care vehicles, rapid response vehicles and a range of specialised support vehicles;

— the establishment of a number of alternative care pathways, designed to treat patients at the most appropriate level of clinical need, in the right care setting, while avoiding the unnecessary use of emergency resources where there is no medical requirement;

— the development of the NAS clinical hub 'hear and treat' service at the National Emergency Operations Centre, the pathfinder 'see and treat' model of care, and the establishment of the NAS Intermediate Care Service, which undertakes low acuity inter-hospital transfers to help free up frontline emergency capacity;

— the expansion of the successful Medical Assessment Unit (MAU) pathway pilot project, first trialled in North Cork and Mallow General Hospital in 2022, to the MAUs in Ennis, Nenagh and Roscommon;

— that the MAU pathway results in patients receiving medical treatment in a hospital closer to their home, reduces patient presentations to emergency departments and releases ambulances more quickly to respond to other emergency calls;

— that the NAS has developed a Human Resources People Plan 2022 – 2025, to further support staff retention, and the overarching purpose of this plan is to enhance employee experience, optimise the NAS working environment and meet expectations of health policy in Ireland;

— the Department of Health and the HSE are working to finalise a new NAS strategic plan to 2031, and this plan will facilitate a strategic organisational redesign and continued focus on key priorities including alternative care pathways, specialist paramedic roles and progress towards meeting capacity requirements and performance targets; and

commends the NAS for recent improvements in response times, noting:

— the key performance indicator is for 80 per cent of all ECHO (life-threatening cardiac or respiratory arrest) emergency responses and 50 per cent of all DELTA (other life-threatening incidents) to be responded to within 18 minutes and 59 seconds; and

— the latest figures for January 2023 from NAS show that 77 per cent ECHO and 48 per cent DELTA were responded to within the target time; and acknowledges that certain parts of the country are not yet seeing the improvements in response times that are required, and commits to on-going support for the HSE and NAS in investment and reform, to ensure targets are met both nationally and regionally."

I welcome the opportunity to address the House on the delivery of emergency care by the NAS. Deputies will be aware that in parts of Dublin, ambulance services are provided by Dublin Fire Brigade and my comments this evening apply to both groups of healthcare professionals, both Dublin Fire Brigade and the NAS. I meet with ambulance staff throughout the country. I am always impressed by their professionalism, their passion and dedication to providing the best possible care to their patients and by their fierce pride in the NAS. The women and men of our NAS and Dublin Fire Brigade were some of the heroes of Ireland’s Covid-19 response. They were regularly first on the scene with teams for testing, patient isolation, treatment, transport, vaccines and much more. In recognition of this and in response to it the Government recently sanctioned an additional rapid response force for the NAS of 200 healthcare professionals.

Our healthcare professionals in the ambulance service also deserve great credit for the improvements being seen throughout the country in regard to response times and new services. The Sinn Féin motion would have you believe that our NAS professionals are failing in their jobs, that they are failing to improve services for patients, to get to patients quicker, when nothing could be further from the truth. Our ambulance teams are responding quicker. They are arriving with highly trained emergency medical technicians, paramedics and advanced paramedics. They are providing new services including access to nurses, doctors and health and social care professionals. Last year the average response time was 25 minutes. In January this year they had that down to 22 minutes. Last January, out of 30,000 calls, 35 people waited more than 2 hours. That is 35 people too many, but it has fallen from last January to this January from 35 people to 30 people. Last January 114 people waited more than 1 hour. Again, that is too many. However, this year the ambulance services brought that down from 114 people to 81 people. They are absolutely committed to bringing those numbers further and further down.

The target for echo calls, that is cardiac and respiratory emergency responses, is that 80% of those calls be responded to within 19 minutes. Last year they were at 71%. This January they are up to 77%. That is very close to their 80% target. The delta call target, which is the other emergency calls, is that 50% be responded to within 19 minutes. Last year they were at 43%. This January they were up at 48%. As people working in the ambulance service will confirm, January is often the most difficult month of the year.

Sinn Féin acknowledges none of this in its motion. It says nothing of the improvements that our healthcare professionals are making to response times. It says nothing of the upskilling and advanced training of ambulance crews and nothing of the new services being rolled out. It gives no credit to our ambulance workers for the invaluable progress those healthcare professionals are making.

The Government has a different view. The Government acknowledges and supports the progress being made. We are investing in our National Ambulance Service at record levels and we salute those working in our ambulance service for using the funding with which they have been provided to improve response times, to expand the workforce, to modernise the fleet, to upgrade the bases and to provide new services for patients.

There is more progress to be made. Some parts of the country are not seeing the national response times that are needed. Many bases throughout the country need to be upgraded. We need to expand further the workforce. Deputy Kerrane quite rightly pointed to a workforce recruitment challenge in the midlands. I have discussed this in recent days with the director of the NAS and the service is aware of those recruitment challenges. It is aware that there is regional disparity. It is focused on bringing standards up across the country. In light of these various challenges, some time ago I asked the director of the NAS to develop a new strategy. The HSE board reviewed the draft plan in the past two weeks and it is now with my Department. The plan provides a path for ongoing investment, growth and modernisation with patients always front and centre.

Years ago, as we all know, the ambulance service was concerned mainly with getting patients to hospital. We now have a service that is clinically led, deploying highly trained crews onsite.

The new plan seeks to continue this journey and evolve from a emergency response service to a mobile medical response service. The ambulance service is now treating more patients over the phone, at the scene and in their homes. These are patients they would have had to bring into the emergency department in previous years.

Last year, the Government invested €200 million in the National Ambulance Service, an increase in funding of around €30 million since 2019, with additional funding being allocated on top of that this year. Staffing has increased by nearly a fifth since 2016. Is more needed? Yes it is. Do we need to train more paramedics, advanced paramedics and emergency medical technicians, EMTs? Yes we do. Do we need to address some of the regional recruitment challenges? Absolutely we do.

Additional clinical capacity in the national emergency operation centre, NEOC, in Tallaght has introduced new care pathways which are very good to see. These "hear and treat" and "see and treat" pathways allow the ambulance service to assess and treat many patients at the lowest appropriate level of care. Additional investment in the NEOC clinical hub means that a growing number of callers who are clinically triaged do not require transfer to hospital. Since October 2020, nearly 50,000 patients have been treated through this new pathway, 19,000 of whom did not need to go to an emergency department.

The pathfinder model has been rolled out in Tallaght, Limerick and Waterford. Additional sites are currently being identified for this year. The service aims to ensure individuals aged over 65 can avoid a visit to a busy emergency department, where clinically appropriate. The National Ambulance Service is assessing over the phone whether it is appropriate to send out a team that might include an occupational therapist or physiotherapist. It is engaging with the patient in his or her home and is able to tell a patient it does not need to bring him or her in, but instead needs to provide supports in the home. People are being made stable and treated at home, and are linked into the new specialist teams in the community.

Another recent initiative developed by the ambulance service, in collaboration with hospital groups, has been the medical assessment unit pathway. This was trialled in Mallow General Hospital in Cork last year. It has been rolled out in Ennis, Roscommon and Nenagh and we are considering more sites to roll it out in later this year.

Substantial funding has been allocated to increase the number of student paramedics training at the National Ambulance Service College. The recruitment programme last year was successful, with an intake of 135 students on the BSc programme in paramedic studies.

Colleagues will be aware that we are in the middle of a fundamental shift in how healthcare is delivered in Ireland. Over the past three years, we have built a new enhanced community care service comprising 96 primary care teams, 94 which are now in place. There are 60 specialist teams supporting older people and those with chronic diseases. There is a new modern network of primary care centres with enhanced supports for GPs, including direct access to diagnostics. I, and, critically, the National Ambulance Service believe they are well positioned to play a major role in this fundamental shift in how we deliver care. Its proposed plan, which we are reviewing at the moment, has a vision for the ambulance service playing an ever greater role in treating patients in the community and in their homes, in particular focusing on the elderly population where it will be able to add more and more care and treat people at home and in the community.

The Government is committed to supporting the National Ambulance Service as it grows and innovates. I want to acknowledge again that there is work to do. It is by no means all perfect. We and those working in our service are acutely aware that people are still waiting too long for an ambulance and that there are recruitment issues in some parts of the country. Some of the ambulance bases are, quite frankly, not fit for purpose and we investing in rebuilding them. Progress is being made at pace. Response times are getting better. The workforce is expanding.

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