Noel Harrington (Cork South West, Fine Gael)
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I thank the Minister for Health for his work to date trying to maintain health services after inheriting a funding debacle from the previous Administration. I am sure every local health service across the country will be deemed as urgent and a priority. However, ambulance provision in west Cork and the services provided at Bantry hospital are pressing issues for my constituents in Cork South-West. It is proposed to reduce ambulance cover in south-west Cork from four ambulance stations to two on a rotating basis and stop night cover. While it may appear as a cost-saving exercise on a spreadsheet, anyone familiar with the geography of Cork South-West will realise the proposed cover is not adequate and will jeopardise the health of many.

In the western side of this constituency, the general hospital at Bantry is up to 50 miles away from some people in its catchment area, not including those on the offshore islands. A journey for some of these people to the accident and emergency department at Cork University Hospital can be far as a 110 miles. To that end, a good ambulance service is critical and is in effect our accident and emergency department. If this service is reduced, lives will be put at risk particularly those in the peripheral areas of south-west Cork.

The existing service is commendable with the dedicated teams of medical technicians working long hours, sometimes travelling from Castletownbere to Cork all in an evening. Emergency services in the area are complemented by the Royal National Lifeboat Institution, retained fire services and the Coast Guard. A fundamental link to these and Cork University Hospital is the ambulance service. The Health Service Executive claimed there is a safety issue involved in the provision of ambulance cover, quoting the HIQA seven-minute response to a call threshold. In fact, the HSE is quite prepared to replace the ambulance service with a first-responder service to appease HIQA. Unfortunately, such a service is not adequate for a road traffic, cardiac or stroke victim who needs to be taken to a hospital for further treatment within an hour. There is not a snowball's chance in hell an ambulance will leave Clonakilty, or even Bantry, to pick up a cardiac arrest patient in Castletownbere and get back to Cork University Hospital in less than three hours. That is assuming the ambulance will be available in the first instance.

This reduction in ambulance cover in south-west Cork seems to be a spreadsheet exercise. Taking into account the geographical layout of the area, I would warn any decision-maker not to interfere with the area's ambulance service. As already stated, it is our accident and emergency service and we are more dependent on it than is the case in any other region. Those involved with the ambulance service work extraordinarily hard and I am of the view that the service deserves to be enhanced rather than diminished.

I am also concerned with regard to the doubts surrounding the emergency services provided at Bantry Hospital. Again, the management, clinicians and staff at this hospital work extremely hard. All the services provided there have been enhanced. Obviously, cancer care and other specialist services are not on offer at the hospital and local people are quite prepared to travel the 100 or 110 miles to Cork University Hospital in order to access such services. All we are seeking is that emergency services continue to be provided at Bantry. We are not asking that they be provided at a location two or three miles away. Some of us are only seeking that the ambulance service be provided within a 50-mile radius. However, we cannot countenance a situation where we will have a reduced ambulance service and where people will be obliged to present at Cork University Hospital some 110 miles away. I strongly urge the Minister for Health to reconsider any proposals to reduce the services on offer at Bantry Hospital or to downgrade the ambulance service in the Cork South-West constituency.

Jimmy Deenihan (Kerry North-West Limerick, Fine Gael)
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I am replying on behalf of the Minister for Health. The Minister sends his apologies that he cannot be present.

The Minister is happy the Deputy has raised these important and interrelated issues. As a general principle, the Government has made it clear that it wants a health system which is safe, high quality and affordable. The Minister for Health does not wish to see a diminution in any level of service. However, the country is facing into an unprecedented economic crisis and the HSE must live within its budget and prioritise its services.

The Minister for Health has made clear on many occasions that local hospitals can and should be a vibrant element of local health services, providing treatment and care at the appropriate level of complexity to the patients in their areas. However, the care provided must be safe and must not put patients at risk. The Health Information and Quality Authority, HIQA, has set a framework for the type of services that can safely be provided in smaller hospitals and in respect of the structures required for good governance and accountability within our hospitals. This has been set out in the reports on Ennis and, subsequently, Mallow hospitals.

Pre-hospital emergency care is critical to the successful implementation of the HIQA recommendations. The national ambulance service, NAS, is working to develop the management and integration of its services. This includes a reduction to two ambulance control centres nationally, with appropriate technology, a clinical lead for pre-hospital care, performance indicators for pre-hospital care and standard national criteria for non-emergency patient transport. In particular, since January 2011, the NAS has been working towards improvements in emergency response times, as measured against HIQA's response times and quality standards.

There are 18 ambulance stations in Cork and Kerry and these have approximately 200 staff. It is one of only two regions still operating on-call arrangements for out-of-hours ambulance services where staff are at home and are summoned to answer calls. On-call arrangements are gradually being replaced with proper on-duty rostering to ensure that vehicles are dispatched as quickly as possible. This clearly improves efficiency and means that a quicker and safer service can be provided to patients.

The HSE has already been able to greatly increase the level of on duty rostering in Cork city and Killarney. There is now no on-call in any station at weekends, the period of highest activity. The changes involve altering work practices and these must be negotiated. The on-call service is now only provided from Monday to Thursday and has been reduced from 44 hours to less than 16 hours per week per individual. The remaining on-call commitment is under discussion at the Labour Relations Commission, LRC. However, it is important that staff work with management to deliver the changes that are required and to overcome any blockages in implementing these changes, which are for the benefits of both patients and taxpayers.

The NAS is, under the auspices of the LRC, developing a plan that includes rapid response cars, staffed by advanced paramedics and emergency paramedic ambulances. Rapid response cars are already in place in west Cork and are to be deployed at various times in Youghal, Millstreet, Skibbereen, Cahirciveen and Castletownbere. Rapid response vehicles staffed by ambulance staff on duty, rather than on call, will improve the immediate response time compared to on-call arrangements. In June, the HSE and NAS agreed that the new cars and ambulances model will be implemented on a phased basis - the first phase will not affect the west Cork service; the NAS will set out the priority for stations to move to the new model; following implementation, reviews will be held under the LRC; and implementation in west Cork and south Kerry will not proceed until this review is completed.

The national ambulance service has made a major investment in the education and training of approximately 200 advanced paramedics. It is essential that these personnel be deployed in an effective manner. The HSE south's plan to develop an integrated university hospital network in Cork and Kerry, which was published in 2010, recognises the vital service that Bantry Hospital provides to the people of west Cork. The hospital will continue to provide consultant-delivered, selected acute medicine, geriatric medicine and day surgery. It will also provide outreach specialist services for initial assessment and post-treatment follow up care in areas such as gynaecology, rheumatology, orthopaedics, urology and gastroenterology.

There will be at least five consultant physicians based at Bantry for a viable consultant duty roster as part in the regional hospital network. Its location, activity and integration with local primary and community care services will make it an important teaching site for medical and other health profession students from University College Cork, UCC. The Minister and the HSE recognise the importance of Bantry General Hospital and the contribution it has made, and will continue to make, to the provision of hospital services in the region.