Michael McCarthy (Cork South West, Labour)
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I thank the Ceann Comhairle for selecting this issue for debate this afternoon. I also thank the Minister for being here in person to take it.

A curtailment of the ambulance service in west Cork is being planned by the HSE. It is introducing plans to remove ambulance cover from both Skibbereen and Castletownbere between 8 p.m. and 8 a.m. and to replace the service with two rapid response cars. Neither car will have patient carrying capability and will be manned by a single paramedic. The effect of this action will be that a population of more than 82,000 people in the wider west Cork area will be serviced by just two ambulances, one in Bantry and one in Clonakilty, from 8 p.m. until 8 a.m. seven days a week. To say this is causing considerable stress is an understatement, not least given the overstretched ambulance service that already exists in the area. There is a strongly held belief that this action will endanger lives.

There is one ambulance for every 37,000 people in the country. The withdrawal of 24 hour cover in Skibbereen and Castletownbere means this figure will rise in west Cork to one ambulance for every 57,000 in County Cork. It is unacceptable in the 21st century that such a situation could prevail. I appeal to the Minister to reverse the decision.

I acknowledge the second phase of the proposal from the HSE will restore the 24 hour ambulance cover in Castletownbere. While I welcome that move, it negates the reason for removing cover from the area in the first place. I question the logic of restoring cover in Castletownbere but not in Skibbereen, which is the second busiest, and occasionally the busiest, 999 ambulance station in west Cork, second only to Clonakilty. If Skibbereen loses its 24 hour cover, it effectively means the vast area from Rosscarbery west to Mizen Head will not have a service after 8 p.m. seven days a week. This will have an adverse impact on people in Leap, Glandore, Union Hall, Castletownsend, Skibbereen, Baltimore, the islands, Ballydehob, Schull, Goleen and Crookhaven.

Another key issue to consider in the context of this proposal is that the SouthDoc service in Skibbereen closes at 11 p.m., meaning that if a GP is needed after hours, a doctor would have to come from Bantry, 30 kilometres away. The HSE has a target time of ten minutes as a maximum time for treating a trauma casualty on-site before transporting him to hospital. The withdrawal of 24 hour cover from Skibbereen will mean that in respect of advance paramedics or ambulance after 8 p.m. or doctors after 11 p.m., this target time will not be met.

Heaping more pressure on the situation are future plans by the HSE to shut the minor injuries assessment unit in Bantry Hospital at night. All trauma patients will have to be taken to Cork city during these hours, leaving a minimum three hour absence of ambulance cover from the west Cork area. In the recent Roscommon case, the closure of the casualty department was offset by the provision of extra ambulance cover. The opposite will happen in west Cork, where ambulances will be taken out of service while the minor injury unit in Bantry is closed. There are honest fears about this and I appeal to the Minister to look at this sympathetically.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy for raising this issue.

The HSE has confirmed to me that no ambulance stations are closing in Cork and Kerry. The opposite is true, as stations move to on-duty status and away from on-call. This means highly trained paramedic crews will be on-site in the stations to respond to calls rather than having to go to the station when called out. It also means that resources can be deployed dynamically, based on need and demand patterns, rather than simply by location, producing more flexibility and responsiveness. This will produce better response times for the people in the Cork and Kerry area and a better service.

Skibbereen will, under the new system, move to full 24 hour on-duty cover. Paramedics will be present at all times, with an on-duty ambulance during the day and an on-duty rapid response vehicle at night. The dynamic delivery model means that an on-duty emergency ambulance will be available from within the region as required.

I note that ambulance staff sought the elimination of on-call working, that it has already been reduced from 44 hours to 16 hours per week and that it will continue to decrease on a phased basis as part of the improvement of services and response times in the region. There are ongoing discussions with staff on implementing the proposals, including Skibbereen. The HSE and unions are committed to this process.

The national ambulance service proposals are phased. In phase 1, stations in east Cork with night time on-call will have crews rostered on-duty 24/7 and 365 days a year. The more rural stations of Castletownbere, Kenmare, Bantry, Skibbereen and Caherciveen will be in later phases. The service will be evaluated after each phase.

Current evidence suggests patient outcomes can be improved by better treatment and stabilisation at the scene, followed by ongoing treatment and transport to the most appropriate centre, even if that means longer transport times. On-duty service will enable a modern emergency response service involving paramedics, advanced paramedics, community first responders and GP out-of-hours services working together to respond to emergency situations. This approach is consistent with international best practice and will ensure compliance with HIQA response times and quality standards.

On-duty rostering is one of several service enhancements. Other developments include improved arrangements for control and dispatch, practitioner deployment and inter-hospital transfers. All of these will allow the national ambulance service to provide a better, safer, more comprehensive and more efficient emergency ambulance service to the people of Skibbereen and to the Cork and Kerry region as a whole.

Michael McCarthy (Cork South West, Labour)
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I thank the Minister for being here in person and I thank him for his reply. However, I refer him to the second paragraph of his reply. He states:

Skibbereen will, under the new system, move to full 24 hour on-duty cover. Paramedics will be present at all times, with an on-duty ambulance during the day and an on-duty rapid response vehicle at night. The dynamic delivery model means that an on-duty emergency ambulance will be available from within the region as required.

That is simply not the case. That information is inaccurate. The official who drafted that response is, at worst, lying and, at best, grossly ignorant. The story is as I outlined in my contribution.

Does the Minister agree that removing an ambulance from a geographic area as expansive as west Cork will endanger lives? Would the Minister, or any other Deputy, if he were suffering a heart attack, prefer to see a car with one individual in it to an ambulance with trained paramedics? We are at least 90 minutes from Cork city. What the HSE is proposing will endanger lives.

I would be interested in meeting the official who drafted the Minister's response. If this is believed, the same individual would believe the tooth fairy.

James Reilly (Dublin North, Fine Gael)
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I will address both points. I stated that an on-duty emergency ambulance will be available within the region as required. I did not say it would be available within the area. Regions cover larger areas. Perhaps that is what the official who drafted the reply means. Nevertheless, I would be happy to arrange a meeting between the Deputy and the individual who drafted the reply. I am not in the business of giving disinformation to the House. If the information is not accurate I would take a serious view of that.

Second, the concept of the golden hour is 40 years old and comes from military field medicine. All international experience and experts, and our own emergency department consultants and specialists, are clear that it is far more important to receive appropriate treatment in a bigger centre than to receive immediate treatment at a smaller centre where the full skill-set may not be present. That we now have paramedics on-site to commence treatment while an ambulance is on its way makes a huge difference to outcomes for patients. Paramedics and advanced paramedics are a great addition to the service and will result in many lives being saved rather than the reverse.