Jennifer Whitmore (Wicklow, Social Democrats) | Oireachtas source

I thank the Regional Group for the opportunity to discuss this important issue. The Social Democrats are fully supportive of all the calls being made today. It is telling that there are two motions on the NAS this week. Related issues were also discussed at the Joint Committee on Health. Pre-hospital emergency care is a vital cog in our healthcare services. Paramedics and other workers in the NAS provide life-saving care every day, often in incredibly challenging contexts. However, this crucial service is under-resourced, with insufficient staff and vehicles to meet current needs. Health emergency 999 calls have increased by 14% since 2019. Life-threatening cases relating to illness, injury, cardiac or respiratory arrest account for almost half of all emergency calls. By the standards set by the NAS, nationally it responds to 71% of calls relating to life-threatening cardiac or respiratory arrest in under 19 minutes. This figure is 43% for life-threatening cases due to illness or injury. This gives an indication of the scale of the current situation. However, with our growing and ageing population we will need even more emergency service personnel. Not only must the Government ensure the retention of as many staff as possible, but it must also engage in a massive recruitment campaign in order to meet current and future needs. Ordinary people, especially older people, need to have the confidence that an ambulance will be available to respond rapidly to their calls.

The glaring point on this matter is the recruitment and retention of staff. Entry into the profession is not easy. At a time when we should be facilitating people to enter the profession, barriers are being put up. For example, students in the BSc in Paramedic Studies cannot get placements in the NAS. Instead they go to the UK to learn on the job. Many of them are then snapped up by the NHS which recognises their skills and qualifications. Those who choose to return to Ireland face barriers in becoming paramedics due to a convoluted entry process for the rolling recruitment. There are young people who want to become emergency healthcare professionals and serve their communities. Instead of being enabled to do so, they are faced with obstacles. This is not good enough.

Their working conditions are challenging and often dangerous. Reports from paramedics reveal how overstretched they are. It is common for shifts to run over time with 12-hour shifts extending to 15 hours and more. This is unsustainable and unsafe, both for patients and staff. Staff are being burnt out. It impacts their health and family life. It leads to low morale in the service and ultimately makes recruitment and retention more difficult. It must also be recognised that paramedics and others operate in stressful and sometimes dangerous circumstances. They attend sites of accidents, violence and domestic violence and, unfortunately, face situations where people assault them or attack their vehicles. The NAS had more than 330 reported incidents of assault on active staff between 2020 and December 2022.

The NAS currently has 1,900 emergency medical staff such as paramedics, critical care nurses and doctors. The workforce plans lays out a need for over 1,300 more of them by the end of 2024. Given the current conditions, it is unclear how this target can be met.

It is also important to remember that this is not a stand-alone matter. Challenges in the NAS inevitably impact other areas of healthcare. The proposed ban on people seeking home births when based more than 30 minutes away from a maternity hospital was inherently linked to the availability of ambulance services. The slim rationale in the HSE report last year was that in emergency situations pregnant people needed to be less than 30 minutes from a maternity hospital. Such a decision would impact all of Wicklow, west Cork, Kerry, Clare, Roscommon, Donegal and Monaghan. This was a significant proposal by the HSE. The move was strongly opposed by many families as well as the Midwives Association of Ireland. They knew it was a thinly veiled attempt to drastically restrict home births. One of the major concerns was that due to a lack of availability of ambulances, the arbitrary 30-minute distance could become 20 minutes or 15 minutes, thereby restricting the service even more. Home births are essentially an opt-in system with women and pregnant people encountering many soft barriers. We need a fully functioning ambulance service to enable people’s choice to have a home birth.

When I tabled a number of parliamentary questions in relation to home births, I received some interesting replies. When the Minister spoke about this matter in the Chamber, I found it interesting that he referred to a blue light distance. When I asked paramedics what a blue light distance is, they did not know. When I asked the Minister about the matter in a parliamentary question, he referred back to the HSE to find out what the definition of a blue light distance is. It seems that this policy is being made up on the hoof. This is not acceptable when it comes to such a fundamental right as a woman’s right to have a baby at home and have the supports with her.

Another issue is the interface between ambulances and acute hospitals. We have cases of much-needed ambulances and staff being kept for long periods at hospitals due to constraints in emergency departments. As I stated, 50% of calls are classified as non-life-threatening, which means that people with breaks, falls and other issues can be left in ambulances until space is found for them. This ties up ambulances for hours, adding further strain to the system.

Out-of-hours GP services are also relevant to this discussion. Edoc, Caredoc, Kdoc and Kildare and West Wicklow Doctors On Call provide fantastic care at night and at weekends, but they are overstretched. Insufficient staffing levels mean these vital services cannot provide the cover needed for the people of Wicklow and many other counties. Families struggle to get appointments and have to go even further away. This in turn puts additional stress on the NAS and emergency departments as parents with sick children and others have nowhere else to go. The Government and the HSE must address the need for more GPs and locum staff in this area as well as the provision of more paramedics.

Today’s discussion has been a timely reminder of the importance of our ambulance service and the dedicated people who staff it. Too often we assume that due to its importance, the ambulance service is a Government and HSE priority. However, the debates this morning and last night highlight the systemic issues in the service, particularly the problems with recruitment and working conditions. They are beyond alarming. They put lives at risk. This motion calls for much-needed support for staff, including improving the working environment, facilitating more people to enter and progress as emergency service professionals, and improvements in our community emergency infrastructure. All of these measures are important. Individually and collectively, they will help to save lives and improve health outcomes. I urge the Government to act now.

I also urge the Government and the Minister to talk to paramedics, ask them for an honest assessment and listen to their lived experiences. I have spoken to paramedics. I have paramedics in my family. I know first-hand the stresses they are under. They want to do their best, to provide the service and to care for people. That is why they went into the job. What they find is that because of the systemic problems, they cannot provide that level of care not only to their patients but also to themselves. They are finding it very difficult. Those I have spoken to are looking at the exit door. They cannot wait to get out because they know they cannot continue in the system as it is at the moment. I urge the Minister to have a truthful and honest conversation with paramedics and to ask them to explain exactly what their lived experiences are.

That in itself would be very informative.

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