Hildegarde Naughton (Galway West, Fine Gael) | Oireachtas source

I welcome the opportunity to address the House on the future of regional pre-hospital emergency care on behalf of the Minister for Health. I join colleagues from across the House in paying tribute to our fantastic healthcare staff, working in pre-hospital emergency care and across the wider system.

The landscape of pre-hospital emergency care is changing, in Ireland and across the world. We have a growing and ageing population and our health service needs to adapt to accommodate this and provide high-quality care. The NAS has a pivotal role to play in meeting this challenge. In recent years, it has undertaken a significant programme of reform that began in 2016 with the vision 2020 strategy, which has laid the building blocks for the transformation of the service. This vision aims to transition the NAS from being a conventional emergency medical service to an agile and responsive mobile medical service. More patients than ever are being treated over the phone, at the scene or preferably in their own homes, in line with the vision of the Sláintecare programme.

This change is backed by funding. As part of budget 2022, the Government invested a record amount in excess of €200 million in the NAS. This represented an overall increase in annual funding of around €30 million since 2019. A further increase in the budget for NAS in 2023 is envisaged once final allocations are confirmed. The service has also seen staffing levels increasing by almost a fifth since vision 2020 was published. Along with the unprecedented funding allocations provided by the Government, this has allowed the NAS to make significant progress in delivering a new model of care.

For example, we have been able to add additional clinical capacity in the National Emergency Operations Centre, NEOC, in Tallaght. This has enabled the NAS to introduce alternative care pathways, such as see and treat and hear and treat. This allows the NAS to assess and treat many patients with the most appropriate level of care, resulting in better patient experiences and a more efficient use of resources. We are continuing to invest in the NEOC clinical hub, which means a growing number of callers clinically triaged to the hub do not require unnecessary conveyance by ambulance to a hospital accident and emergency department where there is no clinical need. In fact, since October 2020, the NAS has treated nearly 50,000 patients through this alternative care pathway. Of those patients treated, more than 43%, or nearly 19,000 people, did not need to be taken to a hospital accident and emergency department. This is a great example of Sláintecare in action and we will continue to develop and grow this crucial service to meet the growing demands of our population.

The Government is committed to supporting the NAS in its development and transformation of patient care. In addition to funding for budgets 2021 and 2022, the NAS has been allocated €6.8 million in targeted funding under the HSE winter plan. This funding is assisting the NAS in responding to an ever-increasing demand for access to emergency services. It is also assisting the NAS in further developing and expanding coverage of its see and treat initiative, including the pathfinder model of care, which involves the service collaborating with healthcare professionals to see and treat older persons in the comfort of their own homes, where clinically appropriate. As with other areas of the health service, our ambulance services are also seeing a sustained demand for emergency resources. This is impacting the NAS’s ability to meet response targets. Included among the reasons for this are significant general increases in the demand for ambulance services. Last year saw a record number of nearly 390,000 emergency calls for an ambulance, exceeding the previous record number of more than 366,000 such calls in 2021, a rise of between 6% and 7%. There has been an even more significant rise in the number of activated emergency calls involving the despatch of an emergency resource, up from 157,285 in 2021 to 178,224 in 2022, which is a increase of nearly 21,000 or more than 13% in a single year. Equally, there is ongoing pressure on hospital accident and emergency departments, which significantly impacts ambulance turnaround times, particularly on the time required to release an ambulance from a hospital accident and emergency department following patient transport, as well as the ongoing need for Covid-19-related enhanced infection prevention and control, ICP, measures.

Regarding ambulance turnaround times, the HSE’s stated target is that 80% of ambulances will be released and available for retasking within 30 minutes of arrival at an accident and emergency department with a patient. I acknowledge this target is not always met. Through dedicated funding provided by the Government under this year’s winter plan, however, the NAS has been able to improve ambulance turnaround times at busy accident and emergency departments. The NAS was also allocated funding for private ambulance companies to deliver a total of 27,000 hours of inter-hospital transfer and discharge services. This crucial investment has helped to preserve emergency ambulance resources for front-line demands. The Government remains committed to investing and growing the NAS to meet the demand for pre-hospital emergency care services as well as developing and expanding its suite of alternative care pathways so that growing numbers of patients receive primary, person-centred care in line with the aims of Sláintecare.

To develop and grow the NAS, we need to ensure an adequate supply of qualified paramedics is coming through. That is why substantial funding has been allocated to increase the number of student paramedics training at the NAS college. The NAS recruitment programme in 2022 was highly successful, with an intake of 175 students into its BSc in paramedic studies programme.

Our fantastic healthcare workers are the heartbeat of the healthcare system, and we need to support them to deliver the best possible care for patients day in and day out. That is why the NAS has developed a HR people plan 2022-25 to enhance employee experience, optimise working environments and meet expectations of health policy in Ireland. The NAS in 2020 launched its holistic model of staff support, called wellness NAS, which details the range of supports available to support the well-being of staff.

In 2022 the NAS was also allocated funding to strengthen management and governance arrangements, and it plans to further strengthen management, technical and business functions as part of the new service development plans for 2023.

Looking forward, a draft new National Ambulance Service strategic plan to 2031 is with the Department for review. This strategy builds on the vision and objectives of the previous strategy and will further develop innovative alternative care pathways for patients. Planning for the new strategy has been informed by demand and capacity analysis to project patient demand into the future. Of course, additional funding will be required to meet the expected rise in service demand.

Since Vision 2020 was launched in 2016, the population has grown by 8% to an estimated 5.12 million. The population of those over 65 years of age has grown by 20% to 768,900 in 2022. These demographic changes informed the work carried out in preparation for the new strategy in terms of the required capacity and in further developing alternative care pathways.

In this context it is clear the National Ambulance Service has a central role in the transition of the healthcare system to a community care model. A key strand of the NAS's strategic reform will be to play an ever-increasing role in delivering patient care in the community and in treating our older population where most clinically appropriate.

One fantastic example of this is the pathfinder model. This innovative service was first trialled in Beaumont and has been rolled out to Tallaght, Limerick and Waterford. The service aims to avoid bringing people over 65 years of age to hospital emergency departments, where clinically appropriate. This approach increases the availability of ambulance resources for front-line emergency response. Sites are being identified for further service expansion this year.

Another recent initiative developed by the NAS, in collaboration with a number of hospital groups, has been the medical assessment unit pathway pilot project. This project was trialled in north Cork and Mallow General Hospital in 2022 and has been rolled out to additional medical assessment units, MAUs, in Ennis, Roscommon and Nenagh. This approach aims to reduce patient presentations at emergency departments and will release ambulances more quickly to respond to other emergency calls. It also allows patients to access an appropriate level of care closer to the home. I expect this service to be expanded later this year to other locations.

It is important we harness the learnings from this and other initiatives as we explore new and innovative ways of working. It is clear that the pandemic fundamentally changed the way in which healthcare services are safely accessed and delivered. The role of pre-hospital emergency care practitioners has changed and will continue to do so as they increasingly become providers of primary as well as emergency care services. The Department of Health is examining the regulatory framework governing the delivery of pre-hospital care in Ireland to ensure that it meets the growing and changing needs of the sector.

I reiterate that the Minister for Health, Deputy Stephen Donnelly, and the Government are committed to supporting the NAS through this transformative period.

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