Sandra McLellan (Cork East, Sinn Fein)
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I thank the Ceann Comhairle for selecting this matter. It is, without doubt, a very important issue that has an impact on the lives of many thousands of people, not only in the town of Skibbereen but also in its catchment area. The provision of pre-emergency care is essential to the delivery of an acute hospital service. Communities right across Cork, including Bantry and my home town of Youghal, have been threatened with the removal of vital ambulance cover for more than a year. The communities have cried "Halt".

The Government's plan to reconfigure the ambulance service, coupled with its hospital reconfiguration programme and the recruitment embargo, has the potential to have a devastating effect on health service provision and the lives of many. Before the Minister's plans for ambulance services have even taken effect, we have seen the service in Skibbereen cease. Last Monday, this large population centre was left without an adequate and appropriate ambulance service due to the lack of cover and the HSE's apparent unwillingness to pay overtime.

I stated in the Chamber before that a rapid response vehicle manned by a paramedic is not the same as an ambulance manned by an advanced paramedic. The current approach must end. I would like to know what immediate action will be taken to ensure an adequate and appropriate ambulance service will be provided for the people of Skibbereen and its hinterland. They are just as entitled to cover as anyone else.

Noel Harrington (Cork South West, Fine Gael)
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I thank the Ceann Comhairle for selecting this issue and I welcome the Minister of State, Deputy Shortall, to the Chamber. West Cork does not have what one would call a normal accident and emergency unit. We have a good service in Bantry hospital that covers cardiac and respiratory emergencies but we do not have a dedicated accident and emergency unit. Our ambulance service is our accident and emergency service. This week, the people of Skibbereen and its hinterland have been left without this service. The sick leave of one paramedic has effectively led to the withdrawal of the ambulance service in the area. One quarter of the entire west Cork ambulance service has been taken off the roster.

I do not know whether anybody knows how terrified the people of Skibbereen are over the prospect of not having ambulance cover. In the absence of a new role for the ambulance service in west Cork, such as dynamic dispersal or allocation, as might have been spoken about by the Minister, we have no appropriate service. The existing service is very rigid. Due to the absence of one paramedic, the ambulance service has been withdrawn from the people of Skibbereen. This is hard to take. The public service is used to an embargo on recruitment and overtime, but these embargoes should not apply to emergency services. It is not right that a service cannot cope if one person takes a sick day. There are many HSE managers who are well paid to do what they should be doing, namely, manage. This is a classic case of management that cannot deal with the redeployment necessary to maintain basic emergency services for Skibbereen. This is not because of an overtime issue. I ask sincerely that the Minister of State, through her office, instruct the management to do what it is paid to do, that is, manage the situation.

Róisín Shortall (Dublin North West, Labour)
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I thank the Deputies for giving me the opportunity to address this issue. I am responding on behalf of the Minister for Health, Deputy Reilly.

The HSE's national ambulance service, NAS, has been progressively improving and modernising emergency ambulance services in Cork and Kerry. As part of this process, stations and crews are changing from being on call to having on-duty rostering. Being on duty means our highly trained paramedic crews will be on-site in their stations or in their vehicles to respond to dispatches, rather than being alerted and then having to make their way to the station when called out. This drastically reduces deployment times for emergency vehicles. On-duty status means resources can be deployed dynamically. This means that vehicle location during a shift is based on need and demand patterns such that vehicles will not just be sitting at a station. This produces greater flexibility and responsiveness. Under the dynamic model, on-duty emergency ambulances are available from within a region as required. This will produce better response times for the people in Cork and Kerry and a better service.

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

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

The HSE's NAS is engaged with union representatives, through the Labour Court, regarding on-call arrangements for ambulance services in the south west. All parties have accepted that, in accordance with a Labour Court recommendation, providing ambulance services under on-call arrangements should cease. The National Ambulance Service has begun removing on-call arrangements by focusing on east Cork in the first instance. It has been agreed that the arrangements for the removal of on-call in east Cork will be reviewed after six months with a view to implementing similar arrangements in west Cork by mid-2013.

It is important to note that emergency ambulances are staffed by paramedics working in pairs. Where an individual paramedic does not report for duty, the other paramedic on that shift is available to respond to emergency calls. While an individual paramedic cannot transport patients to hospital, support is provided through strategic deployment of available resources. This ensures a patient transporting vehicle is available. The HSE national ambulance service is committed to implementation of the HSE attendance management policy and continues to manage absenteeism on this basis. I thank the Deputies for raising the matter.

Sandra McLellan (Cork East, Sinn Fein)
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I thank the Minister of State for her response. I had so many calls and e-mails this week from constituents, young mothers and elderly persons from Skibbereen who were terrified because they did not have ambulance cover. Could we get a commitment from the Minister of State that what happened in Skibbereen on Monday last will not happen again and what measures will be put in place to ensure the planned reconfiguration does not produce similar occurrences across rural areas?

Noel Harrington (Cork South West, Fine Gael)
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I thank the Minister of State for her response. I fully understand what the ambulance service is trying to do, both in west Cork and nationally. However, I want to come back to the deficiency in the ambulance service in Skibbereen, currently and possibly for a number of weeks because this particular paramedic is on sick leave. We all have heard in recent public debates how sick leave throughout the HSE and other public bodies is expensive and costs a great deal of money. It should not cost lives and that is what the people of Skibbereen are genuinely afraid of.

Notwithstanding the progress and the future plans of the HSE for the national ambulance service, this pinch-point is a staffing issue, a resource issue and a management issue. We are in the old regime in Skibbereen and there is no reason, in the absence of these plans and dynamic deployment, that this situation should be allowed to continue. Will the Minister of State go back to the HSE national ambulance service so that the people of Skibbereen will not have to live in fear that they will not have an ambulance when called for?

Róisín Shortall (Dublin North West, Labour)
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I very much appreciate the concerns raised by the Deputies. As I stated in my reply, the HSE ambulance service is committed to better management of absenteeism. Quite clearly, there was an issue recently and that level of service is a matter of concern. I am willing to undertake to convey the concerns expressed by both Deputies to the Minister for Health.