Wednesday, 2 May 2012
Topical Issue Debate
I am afraid that is not possible with Topical Issues. Time may only be shared where two people apply for the same topic. I would like to facilitate the Deputies but unfortunately, it is not provided for.
I thank the Ceann Comhairle for selecting this very important issue. Although I do not purport to speak on behalf of Deputy Doyle, I know he is aware of and supportive of this issue, as he has been over a number of years. I have not spoken on any issue that is more important than this in my time in the Dáil, and I have grave concerns about this project.
I acknowledge and recognise the excellent work done by Wicklow community first responders, a voluntary group set up almost ten years ago that went active in spring 2005. As recently as a week or two ago, the Greystones cardiac first responders were presented with a special recognition award at Greystones town council. It is a group that has worked hand in glove with the ambulance service, engendering a positive and progressive relationship over the past seven or eight years. Where the scheme is in operation, if somebody rings "999", an ambulance is dispatched and the person in the ambulance centre would also ring a local volunteer who would have a defibrillator, oxygen and other first aid equipment. That person would also be trained and tested to an acceptable standard to carry out work.
In County Wicklow we are very lucky to have approximately 500 individuals at 33 locations around the county who have been called out on 1,500 occasions in the past seven years. They have saved lives, and a newspaper article detailed how a young girl in Tinahely was saved in a doctor's surgery by the community first responders. The scheme is recommended by the Irish Heart Foundation and heart authorities in Britain. It has competed in many competitions around the country.
Over the past number of years the group would have been called out for problems in five categories, including chest pain, heart attack, cardiac and respiratory arrest, breathing difficulties, stroke and choking. The Pre-hospital Emergency Care Council, PHECC, in its wisdom, has in the past year changed the call-out criteria, which are now limited to chest pain and choking. There is grave concern among volunteers that if the proposals are implemented - it looks like they will be - the scheme will collapse. This will happen because it will not be utilised to the extent that it could be, as the lifeblood of the scheme is getting called out to assist in the community. In addition, volunteers have come under pressure in the past few weeks within the local communities; in one case where they were not called out in Blessington, there was a backlash.
This scheme costs the HSE nothing aside from the initial training. When Deputy Doyle was involved with the HSE, he was instrumental in getting funding for that training. The volunteers now self-train, with two or three groups in Wicklow waiting to join; approximately twice every year 50 new members are trained on a voluntary basis. It is one of the most positive and progressive groups of people that I have met in my time, and it is frustrating that the scheme is in danger. This is not about cutting back or lack of resources. I listened to a HSE official talk about smarter use of our resources but this resource will not continue unless the Minister takes direct action and we have a little common sense.
I am responding on behalf of the Minister for Health. I thank the Deputy for raising this important issue and for the opportunity to discuss the recent policy developments associated with it. Community response in various forms has long been an important support in the delivery of health care in Ireland and, in particular, in pre-hospital care for people who have been unfortunate enough to suffer serious illness or injury. I take this opportunity to acknowledge the enormous voluntary contribution, commitment and assistance offered by various schemes in responding to emergency calls over the years.
There are two types of priority emergency call-out in Ireland for the national ambulance service. ECHO calls are for situations involving life-threatening cardiac or respiratory arrest and DELTA calls involve life-threatening situations other than cardiac or respiratory arrest. The national standard for addressing ECHO and DELTA calls is the EMS priority dispatch standard, which is issued by the Pre-Hospital Emergency Care Council, PHECC. Under this standard, ECHO calls may be responded to by cardiac first responders, but DELTA calls require a minimum response of a trained emergency first responder. The new policy was approved on 27 March 2012. It will ensure that the integration of cardiac first responder schemes into priority 999 call responses has a robust governance framework in place. As a consequence, however, neither HIQA nor PHECC standards support the dispatch of community first responders to DELTA calls any longer. There is, therefore, a significant clinical and governance risk in using community first responders for DELTA calls and this practice will have to stop.
I would like to emphasise that the use of community first responder schemes is still important and will remain so. These volunteers are found in workplaces, sports clubs, at public events and within local communities, as the Deputy said. They are often first on the scene at an incident and they are in an ideal position to use their training to provide care and treatment until further assistance arrives. However, the use of community first responders as a dispatched first response to 999 calls was developed before the introduction of national clinical standards for emergency responses and cannot be sustained, other than for ECHO cardiac and respiratory call-outs. Should a community group wish to be able to respond to DELTA priority emergency call-outs, then the responders would need to be certified at emergency first responder level. Standard national training courses are available from approved bodies and the national ambulance service, through local liaison managers, would welcome approaches from groups and individuals who wish to contribute in this way to the provision of emergency services in their communities.
When Fine Gael was in opposition, we moved a good samaritan Bill on two occasions. The previous Government followed a recommendation from the Law Reform Commission integrated into a Civil Law (Miscellaneous Provisions) Bill which was passed by this Dáil. Its purpose is to give a defence to an action for an individual who assists someone else in good faith and who, whether through omission or commission, adds to the injury. If something is not broken, one should not fix it. The Minister of State's reply sounded nice. I spoke to the Minister of Health about this issue earlier but the reply contained a lot of bureaucratic waffle and I say that with deference to the Minister of State, whom I do not blame personally. However, she should go back to the Minister to examine this issue. Of the 1,500 calls responded to last year, I am not aware of one complaint by a member of the public. I regret that I can almost assure the Minister of State that if the current policy remains in place, the scheme will collapse. A total of 500 people work on a voluntary basis, mostly in isolated areas with little immediate access to the national ambulance service within a certain timeframe. These areas, which are represented by Deputy Doyle, myself and others, will suffer. The previous Minister for Health set about replicating the scheme throughout the country.
The standard of the people trained as community first responders is excellent. They have won awards and they are of the highest calibre. They are hugely committed but they are seething and frustrated at the bureaucratic nature of the HSE over the recent period. They had an excellent relationship with the ambulance service of the old health board, which was progressive and took this issue on board when other ambulance services did not. There was resistance in other areas because people working in the ambulance service felt they would be replaced by volunteers. This is an invaluable resource to an area and if we let it slip, I will hang my head in shame. The Minister of State should go back to the bureaucrats. When we were on the Opposition benches, we spoke about them consistently. It would be a poor day if we allowed this scheme to collapse based on a load of waffle, with no tangible evidence that the current scheme has caused trouble or that the new standards will bring about improvement.
In this instance, we cannot blame the HSE. Its officials are not recommending that the procedure and the clinical standards be changed. It is important that we recognise that community first responders did significant good work in the past and, hopefully, they will continue to do so. There are times when there are unintended consequences following the introduction of particular standards and I will speak to the Minister again about this. Perhaps additional training needs to be provided to satisfy HIQA and the other groups involved. It would be a sorry day if this group of volunteers were lost to any community.