Michael McNamara (Clare, Independent) | Oireachtas source

I thank the Regional Group for tabling this timely and important motion. Paramedics and the ambulance service have become a crucial aspect - if not one of the most important aspects - of our healthcare system. There was a time when they were not even considered part of the health system; they were merely considered to have a role in conveying somebody to the health system. Now, they are one of the most crucial parts of the health system. What happens in the immediate aftermath of an accident and their arrival will, more than almost anything else, determine the outcome. It is therefore crucial they are adequately resourced.

I spoke to last night's motion on the inadequate resourcing of the ambulance service. The figures about meeting the desired outcome, which is to respond within 19 minutes of a call, unfortunately speak for themselves. The percentage of cases of respiratory or cardiac arrest in which paramedics reached the patient within 19 minutes, which is the target, dropped from 69% in December 2019 to 59% in December 2022. In all other cases of call-outs, it has dropped to 43%. That is a great concern. We can only assume it is a result of resourcing, or else it is a matter of the centralisation of services and the fact that ambulances are being sent right across the country. I mentioned a case in which an ambulance was sent from Ennis to Enniskillen and, as a result, there was a delay in getting a case in north Clare.

Centralisation generally has not worked terribly well in the health service. Certainly in the HSE, there was a move away from the health boards to the HSE. There may have been a degree of political interference under the old health board structure, but at least there was a degree of accountability. The former Mid-Western Health Board, like all health boards across the country, was accountable to its members and to the elected representatives from the local councils. It seems that the HSE is theoretically accountable to nobody, other than perhaps the Minister. Sometimes one wonders who is accountable to whom with the regard to the relationship between the Department of Health and the HSE. The HSE answers parliamentary questions, which I appreciate, and I suppose it is at the Minister's behest that they are referred on. However, it was very much established not to be accountable. Regardless of whether we are talking about the HSE or any other aspect of the public service, it is damaging when there is a move towards taking it away from public accountability. I think there was such a move with the establishment of the HSE.

Returning to the ambulance service, the issue of paramedic training has been raised. There is a master's programme in the University of Limerick, but almost all the graduates coming out of it have to go abroad to seek work. There seems to be a bit of protectionism, frankly, going on in the NAS. It is a tribute to the University of Limerick that it has set up this course. It is greatly desirable because we need more paramedics in the country. Yet, in order to get practical experience and to get employment, almost all the graduates - although I know there were some recent exceptions that almost proved the rule - have had to go to England to get work experience and to get employment thereafter. I ask the Minister to intervene to look at this problem, which was also raised with the Minister of State, Deputy Rabbitte. I do not expect him to have an answer right now on the floor of the Dáil, but I ask him to look at the issue, to see what it is and to make sure there is not a degree of protectionism going on. Anything like that at a time of such dire need would be damaging to public confidence and to the public service that people rightly demand.

I tabled a parliamentary question to the Minister on the percentage and number of call-outs to the NAS in which the patient in respect of whom the call-out was made had already died by the time the ambulance arrived. Obviously, there is no fault to be given in every case in which a case the patient has already died. While there could be fault, none should automatically be given. When the Minister referred to the matter to the HSE for an answer, as is the normal course, I was surprised to learn that it does not maintain or record these statistics. I would have thought it would be a useful statistic to maintain and one that should be maintained in the future. I ask that it be maintained in future. There is an important balance to be struck. Some useful information could be gleaned from those statistics, just as information has been gleaned from the statistics around the percentage of call-outs that arrive within the target time, which is unfortunately dropping.

I again thank the Regional Group for putting forward the motion. It is important and I will be happy to support it. I am not sure whether the Government tabled a countermotion but, regardless of whether it did, I hope the spirit of the motion will be heeded, that the crucial role played by the NAS and paramedics will be acknowledged by the Government and that they will be adequately resourced to fulfil that role. They are a crucial, if not the most crucial, part of our healthcare system in determining outcomes.

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