Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

On behalf of the Social Democrats, I welcome this timely motion from Sinn Féin, which we support strongly. I pay tribute to the staff of the NAS and Dublin Fire Brigade for the essential work they do, which is a matter of life and death. That work is made significantly more difficult, however, due to the severe shortage of staff, vehicles and infrastructure generally.

At last week's meeting of the Joint Committee on Health, the scale of the crisis in ambulance services was laid bare. The gap between demand and capacity is widening and this requires an urgent response from the Government because lives will, undoubtedly, be lost. The newly published response time figures should act as a catalyst for change because they simply cannot be defended. Last year, only 72% of life-threatening cardiac or respiratory arrest cases were reached within the agreed time of 19 minutes, which was eight percentage points off target. For other life-threatening illness or injury, only 41% of cases were reached within that key 19-minute period, representing nine percentage points off the target figure. As outlined in the motion, the average ambulance response time has lengthened by 50% since 2019. That is a shocking figure. As for hospital turnaround times, the figures supplied by DFB are just as worrying. The average turnaround time for Dublin hospitals was 39 minutes, up ten minutes from 2020, while 16% of incidents took more than one hour to turn around, again a ten-minute increase on 2020.

This steep dip in performance must be reversed urgently. The situation is especially bad in some parts of the country, including the west, parts of the south east and Dublin city and county. In Dublin, for instance, serious questions hang over the governance structure of ambulance services and, unfortunately, that is borne out by the figures. Last year, Dublin Fire Brigade sought assistance from the NAS more than 63,000 times, only to be told no ambulance was available on 76% of the occasions. That is a truly shocking statistic. No ambulance was available 76% of the times DFB requested one.

Earlier this month, Paul Cullen of The Irish Timesexamined this issue in great detail, and his work has been helpful in this regard. He had to jump through hoops to get his hands on the 2016 Brady-Flaherty report, almost seven years after its completion. It still has not been published. What is the delay for that? Just today, I requested it. It has been known for a long time that there are serious problems here, and two people with expertise in the area were recruited to carry out a study on that. The study was completed in 2016 and its publication was blocked. Why was that the case? There is no point in doing these things unless we are going to learn from the expertise that has been brought in. It is unforgivable that the report has not been published. I hope it will be made available now, given it was finally released under freedom of information, FOI. It required an appeal to the Information Commissioner for Paul Cullen to get his hands on it. It should be published now.

I tried to get to the bottom of this at last week's committee meeting but none of the representatives of NAS or DFB could say when the report would be made publicly available. All they could say was they understood it was jointly owned by the HSE and Dublin City Council. That, frankly, is not good enough. We need more than piecemeal information. Will the Minister enlighten the House about this? Why has the report not been published and when does he intend it will be? We should not have to chase this. The people of Dublin and their elected representatives deserve to know the full scale of this problem. After all, it is their lives that are being put at risk by suboptimal ambulance provision.

We need to find out where the logjam exists. Is it in the HSE or the local authorities or, more likely, is it in the two parent Departments, namely, the Departments of Health and Housing, Local Government and Heritage, given they are the bodies that hold the purse strings? Those Departments must take ownership of this problem and take responsibility for guaranteeing people that there will be a properly functioning ambulance service. As I said, it is a matter of life and death and we cannot afford not to fund those services properly.

I appreciate that a task and finish group has been established and met for the first time only last week, but we have been told it will be another six months before it finishes its work. In the interim, we need to know what steps the Government is going to take to increase service provision and improve governance. We need answers to that now and we cannot wait any longer. These problems have been highlighted for more than 20 years. The Government has had the report since 2016. We need answers now. The problems have existed for two decades. They are not new; they have just worsened under successive Governments.

It is clear the vision of healthcare outlined in Sláintecare should be the guiding principle for reform, but political will is needed to get that up and running at a proper pace. Alongside scaling up the capacity of the ambulance service, alternative models of care, located in the community outside overburdened emergency departments, are an essential part of that reform. While I recognise progress has been made on putting in place alternatives to acute hospitals, it is terribly slow. There are significant problems with the recruitment of staff and with alternative services being available, not least out of hours. A reference was made earlier to Blanchardstown and the urgent care arrangements there, which are getting worse. Now, appointments have to be made. It was supposed to be an alternative to the overcrowded children's hospitals but now there are problems there.

This needs to be dealt with on a whole lot of different fronts. Both the NAS and DFB detailed a number of initiatives that they are keen would be fully implemented but there appears to be a lack of joined-up thinking. A case in point is the ridiculous situation surrounding UL paramedic graduates. Last month, I raised this with the Minister for Further and Higher Education, Research, Innovation and Science and I raised it again at last week’s meeting of the Joint Committee on Health. However, I am still at a loss to understand why this has not been resolved to date. Every year the UL students are sent abroad to complete their one-year internship because the NAS does not have the capacity to take them on. That is a crazy situation. There is a dire shortage of staff and students are in UL doing the course, yet they cannot get clinical placements in the NAS. That is just nonsense. It does not make any sense whatever.

To make matters worse, once these students have completed their internships, most of the graduates find it difficult, if not impossible, to secure employment with the NAS. I have received a number of emails from UL graduates since January. They are justifiably frustrated with the current application process. I understand work is underway to resolve the internship issue, albeit late in the day, but I see no evidence that the NAS or the Department of Health is dealing with the application issue. We are told that 3,000 additional staff are needed, yet we are freezing out a whole swathe of graduates who would be very well qualified to take up employment. The central issue seems to be with the application process and in particular, phase 1, which is a multi-choice questionnaire. According to a submission to the health committee, in the past seven years 405 Pre-Hospital Emergency Care Council, PHECC, registered paramedics completed the multiple-choice questionnaire but only 75 passed. That is a mere 18%. Of those, 56 got onto the employment panel to await a job offer for which the average time was a staggering 300 days. As of last November, only 37 had been offered a post. That is a no-brainer. That needs to be dealt with urgently.

I ask the Minister to please prioritise the whole question of resources, deal with the issue in UL and ensure that there is an adequate supply of ambulances. We cannot afford to let this go on any longer.

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