Pat Breen (Clare, Fine Gael)
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I welcome the opportunity to raise the urgent need to review the provision of an ambulance service in County Clare 24 hours a day, seven days a week. There needs to be a specific emphasis on the provision of such a service to areas like west Clare. Three special deliveries in recent weeks, when three women gave birth in separate incidents, brought this issue to the fore. The common denominator in the three cases was that no ambulance was available to transfer the expectant mother to hospital. All three mothers and their families live in west Clare — two in Kilrush and one in Kilbaha, which is approximately 100 km from Limerick. Coincidentally, the women went into labour within hours of one another on 4 and 5 February last. One woman waited for an ambulance for over an hour before her father drove her to hospital. Another woman had to wait three hours before she arrived at the maternity hospital in Limerick. The third woman gave birth on the side of the road. All three mothers and babies are well in spite of their ordeal, thank God.

Since the withdrawal of maternity services from County Clare, it is common for expectant mothers in west Clare to have to make a pilgrimage of this nature. It is of concern that in all three cases, no ambulance service was available when telephone calls were made to the 999 service. The organisation of the ambulance service in the outlying areas of County Clare is putting the lives of people at risk. Ambulance service personnel in the county are to be commended for the excellent service they provide in trying circumstances. However, their work needs to be complemented by a review of the organisation of the entire service. We need to eliminate the dependence on "on-call" services. Rather than all ambulance personnel being in the ambulance centre, some of them are on call from their homes, which can add a minimum of 20 minutes to the call-out time. Such a delay in the start of the ambulance's journey to the person in need can be vital.

The ambulance service in County Clare is clearly under-resourced and under-staffed. In this case, no staff were available in Kilrush to work on the ambulance due to sick leave, etc., and an ambulance had to be dispatched from the Ennis centre. This is not an isolated case, sadly. It is common practice for ambulance crews in Ennis, Ennistymon, Kilrush and Scarriff to be dispatched to the four corners of the county. They also have to provide a back-up service for the regional hospital in Limerick. As staffing numbers are at a minimum — some workers are on sick leave etc. — there is extreme pressure on the delivery of the service. For example, there was a 25-minute delay in responding to a recent incident in Ennis town centre because the ambulances at the Ennis station were out on other calls. A private ambulance had to be called in to assist in that case.

The Labour Court recently recommended that an additional 180 emergency medical technicians be recruited to the service throughout the country. That recruitment and training should not be delayed or postponed. A review of the ambulance service should also consider the provision of advanced paramedics as part of a special response unit, which could be made available throughout the county for emergencies. Kilrush would be an ideal location for a permanent advanced paramedic posting because it is 44 km from the nearest hospital. Such highly trained personnel are currently under-utilised. They should not be seen as additional staff in their centres, but as part of the centres' crewing numbers.

Despite the Minister's commitment to provide a 24-hour accident and emergency service at Ennis General Hospital, there is huge apprehension in west Clare that the situation will get significantly worse for those who have the misfortune to get sick. Recent incidents do little to dispel this fear. The people of west Clare do not have access to a first-class ambulance service, never mind a first-class health service. They deserve better.

The HSE recently launched a hospital hygiene campaign, Wash Your Hands. If the executive is serious about hygiene, it should immediately address the scenario in Ennis ambulance station. It is an absolute disgrace that staff are expected to clean out ambulances with nothing more than a mop and bucket. I recently visited the ambulance centre and I was appalled to witness at first hand how the ambulance personnel clean their vehicles. They must clean out coagulated blood in a public car park, which is a hygiene scandal. These are Third World conditions in a first world economy. Staff have been waiting more than three years for a new wash unit. How long more must they wait? I appeal to the Minister of State to bring the matter to the attention of the HSE immediately. Perhaps he will get back to me in regard to same because it is a total disgrace.

Our excellent medical personnel are continuously fighting to give their patients the best medical help in a system in which penny pinching practices are increasing. I urge the Minister of State to request the HSE to undertake immediately a review of the ambulance service in County Clare. The review should focus on the provision of a 24-7 service in isolated rural areas, particularly in west Clare, to extend the operation of the Scarriff station to 24 hours and to revisit the provision of an ambulance centre in Shannon, the second largest town in the county.

If efforts are not made to address and reorganise the ambulance service in County Clare, more incidents will happen and people's lives will be lost. Having visited the ambulance centre a few days ago, I ask the Minister of State to contact the HSE regarding the primitive working conditions of staff cleaning out their ambulances and to come back to me about it.

Pat Gallagher (Donegal South West, Fianna Fail)
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I thank the Deputy for raising the matter. I am pleased to have the opportunity to respond on behalf of my colleague, the Minister for Health and Children.

It is regrettable that the mothers referred to by the Deputy should have suffered undue distress, particularly as the birth of a child should take place in a safe, secure environment. I have been advised that while, thankfully, such incidents are rare, the HSE will examine the circumstances which culminated in the unfortunate events. The HSE apologises unreservedly to the three mothers. Both the Minister and myself hope that the events leading up to the birth of these babies have not taken from the joy which the birth of a child brings to parents.

A number of objectives were identified in the Strategic Review of the Ambulance Service 2001, which were to lead to an improvement in response times and, ultimately, more effective responses to emergency calls. In recent years, substantial additional funds have been invested to develop the ambulance service along the lines identified in the strategic review and this work will continue into the future. Since the publication of the review, as part of the revised organisational framework developed under the Health Service Executive, a national ambulance service has been established to replace the eight ambulance services that operated under the former health board structure.

The HSE has advised that, within the greater mid-western area, resources are deployed from nine ambulance stations based on the policy to dispatch the nearest available ambulance to respond to emergency calls. While the location of the ambulance station may be important, it is not the only factor, as resources and skill mix can be tactically deployed based on priority and demand. For example, the ambulance may be diverted, while en route to a routine call, to an emergency call.

County Clare is 3438 sq. km. and has a total population of 110,000. The county is serviced by ambulance stations in Ennis, Ennistymon, Kilrush and Scarriff with 24-hour services in all but Scarriff, which provides 19 hours of cover per day. Part of County Clare is also serviced by Limerick ambulance station. Since the inception of the HSE's national ambulance service, there has been significant investment in ambulance services in terms of estate facilities, education, training, fleet and equipment. To ensure optimum use of the Government's investment, one of the critical objectives of the service is to develop models of pre-hospital emergency care that will meet existing and future demands.

In conjunction with the Pre-Hospital Emergency Care Council, PHECC, a statutory agency that has responsibility for clinical education and training standards as well as response time standards, the national ambulance service is researching the demand for emergency services and associated ambulance services in the context of the developing the optimum deployment of resources. This research is being undertaken by way of a national spatial analysis study. The outcome of this study will be used for the development of pre-hospital emergency services and, in particular, for tactical deployment of resources and future planning of services in terms of models of care, skill mix of staff, ambulance response points and fleet configuration. This study will form the bedrock for pre-hospital emergency care development in the future. It will then be possible to ensure that available resources are targeted to the best advantage in terms of response times.

The Deputy raised a number of specific questions and, as requested, I will ask the HSE's parliamentary affairs division to correspond with him in this regard.

Pat Breen (Clare, Fine Gael)
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I thank the Minister of State.