Peter Fitzpatrick (Louth, Independent) | Oireachtas source

New figures from the HSE reveal that the National Ambulance Service is not meeting the response time targets for emergencies throughout the country. While it is outrageous that 62 ambulances dispatched in County Louth to deal with life-threatening emergencies in 2022 took more than an hour to arrive at the scene, I commend the tireless work of front-line paramedics and operational staff for dealing with increased demand and limited resources. These timelines are not a reflection of the work put in by NAS staff but of a service that is under-resourced and under-appreciated.

The longest waiting time for a non-cardiac life-threatening incident in Louth in 2022 was four hours and 50 minutes, with the volume of work given as the reason for the lengthy delay. On the back of such figures, the HSE has confirmed there is a significant gap between demand and capacity.

Recruitment and retention issues related to recognition, pay, resources, working hours and poor working conditions, which I have raised numerous times regarding service providers such as gardaí and military staff, now apply to our National Ambulance Service providers. NASRA warns that the service is under significant strain, with pay and conditions so poor that it losing in the region of ten staff per month. Is it any wonder that under the Health and Social Care Professionals Act 2005, the paramedic profession is not even recognised as a profession? On top of this, paramedics do not even get recognition from the largest employer of paramedics within the State, the HSE. This lack of recognition limits career progression, negatively affects retention, restricts alternative pathways of care and, in the case of HSE employees, limits access to health and social care professional education opportunities within the HSE. As a result, the retention of employees within the field of paramedicine generally and within the NAS specifically is an area that needs to be addressed. Since 2019, the National Ambulance Service College brought in 472 staff who commenced training under the three-year paramedic studies programme. Of these, 55 dropped out. That amounts to fewer than 160 recruits a year. With the NAS estimating a requirement of more than 3,000 paramedics within the next four years to meet its workforce plan targets, these numbers of recruits are abysmal. Yet, this is a familiar tale.

Concurringly, emergency service demand is significantly increasing. For example, the number of emergency calls in 2022 was up 15% on 2021. As the "twindemic" hit in December, 2,000 people a day were looking for an ambulance. At one stage in December, 11 ambulances were parked outside the emergency department of Our Lady of Lourdes Hospital, Drogheda, and could not leave because there were no beds or trolleys inside for their patients. Some paramedics were left waiting for five hours before their patients had a place in the hospital due to an extreme lack of planning. Ambulance crews treated patients in the ambulances; however, because they could not offload, none of the ambulances could leave and respond to other 999 calls.

The reality is that if recruitment targets are not met and demand continues to rise, performance will continue to decline and people will die. Patients have unquestionably suffered harm due to ambulance delays. Clinical outcomes are being put in jeopardy as a result of these delays, and this is the real way that this needs to be evaluated. The appropriate measures and steps need to be taken to protect lives.

We need to implement solutions within our entire healthcare system rather than put a plaster over one issue only for another to explode. For example, Cork University Hospital has dramatically improved ambulance turnaround times due to a strategy whereby, if the acute phase of care – initial diagnosis and management, stabilisation and referral to an inpatient specialty – is complete, the patient is moved to a corridor inside the hospital rather than being left in a corridor in a crowded emergency department. This has reduced the ambulance turnaround time from half a day to 20 minutes. However, it has drastically increased the workload of already-overburdened inpatient ward teams and nurses, in particular.

Another potential solution would be to treat stable medical patients who meet the agreed clinical criteria in hospitals closer to their homes, such as model 2 hospitals. This pathway would reduce patient presentations to emergency departments and release ambulances more quickly. I would push for the reopening of Louth County Hospital. There is infrastructure and capacity available immediately that would alleviate the pressures on our other hospitals and ambulance services. The Report of the National Acute Medicine Programme 2010 outlined the need for smaller and larger hospitals to operate as a single local hospital group, resulting in the downgrading of Louth County Hospital and the advised closure of the Navan hospital emergency department. However, 13 years later, it is evident that our ambulance and emergency department services are struggling.

Overall, we need to overhaul the delivery of the pre-hospital emergency care services, having better training for staff in schools and childcare facilities and an expanded role for paramedics, helping to reduce the numbers of patients attending emergency departments in the first instance. However, to succeed we need to consider the career recognition of paramedics, the recruitment and retention issues, and the training issues of paramedics and the community. We need to act now before patients die.

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