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

It is evident from the debate this evening that Members across the House share a commitment and motivation to ensure the ambulance service has the requisite support and resourcing to allow for the delivery of the best possible level of care for patients that is appropriate and timely. There is general consensus that this is achievable with an ambulance service that is appropriately resourced and structured to work as part of a wider system to meet national healthcare policy needs. I reiterate that the Government is committed to continuing to support the NAS with the necessary funding throughout this transformative period to allow for an expansion and development of patient care services, as the Minister outlined.

The significance of the role played by the ambulance service in the delivery of care has never been more prominent. Ambulance services are evolving and growing capacity to meet the future service needs. This is most notable in the area of alternative care pathways and mobile medical services. Paramedics are at the forefront of the interface between community care and hospital services and their position offers real opportunity to effect considerable benefits for patients and the wider healthcare system.

Through the development and expansion of its suite of alternative care initiatives, the NAS will play an ever-increasing role in relieving the pressure on hospitals and aiding in the reorientation of healthcare. It is worth reiterating the point raised earlier by my colleague, the Minister, that between October 2020 and October 2022, the NAS treated nearly 50,000 patients through an alternative care pathway. Of those patients treated, over 43%, or nearly 19,000, did not need subsequent conveyance to a hospital emergency department. The NAS estimates that in the region of €3.7 million was saved in the care of these patients as a result. These are very small numbers in the context of the wider healthcare system but the potential for further development and expansion of initiatives like the clinical hub and the pathfinder model of care could yield significant gains in terms of the numbers treated outside of emergency departments and the potential savings that could be accrued. I take on board the point raised by Deputy Harkin regarding Sligo-Leitrim and will bring it back to the Minister.

The continued implementation of Sláintecare reforms means that community-based care options will continue to expand and the NAS will be centrally involved in delivering these patient care options as conveyance to hospital increasingly is no longer considered the most clinically appropriate default solution. I emphasise to the House, therefore, the scale of reform and modernisation that has already been achieved within the NAS in recent years. Such innovations include those aimed at providing alternative pathways of care and helping to improve resource availability and response times. Although current capacity issues in the ambulance service and across the wider hospital system are certainly affecting the level of response provided, I am reassured by the significant funding commitments we have been able to make in recent years to progress initiatives and increase capacity in the medium and long term.

As noted by the Minister, a new strategic plan is currently in development. The new strategy will set out the strategic aims of the service in the coming years to enhance staff experiences, further utilise technology and update organisational structures to ensure the patient care provided is aligned with the Sláintecare goals of the right care in the right place at the right time. I hope that will consider providing that a central ambulance base deployment system would be more on a regional basis than a national one.

I will briefly address other initiatives the NAS has undertaken to improve response times and resource availability. It has established a significant number of voluntary community first responder schemes to provide a high level of initial cardiac response within local communities. A total of 275 schemes had been established prior to the outbreak of Covid, when a temporary stand down of these groups was put in place due to the pandemic response. The majority of the schemes have since returned to full operation. As stated by the Minister, a collaboration between the NAS and a number of hospital groups throughout the country has resulted in the expansion of the successful medical assessment unit, MAU, pathway pilot. This project was first trialled in north Cork at Mallow General Hospital in 2022 to the MAUs in Ennis, Roscommon and Nenagh. This MAU pathway will reduce patient presentations at emergency departments and release ambulances more quickly to respond to other emergency calls.

Following a HIQA review in 2014 into pre-hospital emergency care services, the NAS set out to implement a number of key recommendations for improvements. One of these recommendations was to use a dynamic deployment model. Dynamic deployment allows staff at the HSE national emergency operations centre to see all available resources and prioritise their allocation to higher acuity calls that require immediate emergency response. This model represents international best practice and was highlighted by HIQA as a way to improve response times and NAS performance generally. I assure the House that the NAS has been continuously working with stakeholders to introduce changes to its ambulance deployment model which reflect the reality of current capacity challenges while seeking to reduce demands on ambulance staff. That takes on board what an awful lot of Members have stated this evening.

Ambulance services in Dublin are delivered by the NAS and Dublin Fire Brigade. There is a high level of co-operation between the HSE, NAS and Dublin Fire Brigade on day-to-day operational matters.

This collaborative relationship was further strengthened during the Covid-19 pandemic and efforts are ongoing to build on this co-operation to strengthen arrangements for the delivery of ambulance services in Dublin into the future. I am aware that the first meeting of a task and finish group - formed following agreement between my colleagues, the Minister for Health and the Minister for Housing, Local Government and Heritage, to identify an ambulance service delivery model for Dublin took place in the last fortnight. I look forward to seeing the results of the group’s work in the coming months, which I am sure everyone in the House will agree can only be beneficial for the citizens of our capital.

The well-being of NAS staff is a priority both for the Department of Health and for NAS and HSE management. The NAS has developed its HR People Plan 2022-2025 to enhance employee experience, optimise NAS working environments and meet expectations of health policy in Ireland. In 2020, the NAS launched its holistic model of staff support, WelINAS, which details the range of supports available to support the well-being of staff. In 2022, the NAS was also allocated funding to strengthen 24-7 management and governance arrangements, and plans to further strengthen management, technical and business functions as part of the new service development plans for 2023.

As part of budget 2022, an additional €8.3 million in development funding was invested in the NAS. This funding was used to build upon the significant process of modernisation the NAS has achieved in recent years. Specifically, the funding provided for: increasing paramedic whole-time equivalent, WTE, staffing levels to meet identified capacity requirements in support of improved performance and service delivery goals; adding clinical capacity within the hear and treat service in the National Emergency Operations Centre to advise lower acuity patients of appropriate alternatives to hospital transfer; and implementing an organisational redesign to enhance governance arrangements and improve the NAS's ability to integrate with strategic developments across the health sector.

I would contend that notwithstanding the considerable challenges of record patient demand outlined by my colleague, the Minister, earlier today, our ambulance services have continued to deliver a high-quality, patient-centred service, even against the backdrop of similar record levels of hospital and ED activity. The Covid-19 pandemic forced us to change the way that our health services operate, and the way patients interact with our health services. Our ambulance services continue to adapt to these changes. The transformation outlined will lead to a service that is better able to deliver on the future requirements of the wider healthcare system. Despite the challenges that have been experienced over recent years, the strategic aims for our ambulance services remain clear, as does our firm commitment to delivering on them. A number of Deputies brought up the issue of UL students. I will bring that back to the Minister. I cannot, for the life of me, understand how those students in the masters programmes are not getting the opportunity to practise their profession in an environment where they are trained to do so.

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