Dáil debates

Thursday, 25 October 2012

Topical Issue Debate

Ambulance Service

4:25 pm

Photo of Colm KeaveneyColm Keaveney (Galway East, Labour)
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The issue of staffing arrangements in the new ambulance base in Tuam is of concern to me and to many people in north county Galway who, for many decades, have been aware that they live outside the optimum response time zone for ambulance bases in the county. This issue was thrown into sharp relief by the recent tragedy in Tuam. I take this opportunity to sympathise with the families affected by that tragedy on Sunday.

Through discussions with paramedic staff working in Galway, I understand that only two paramedics will be assigned to the new base. This would provide for seven 12 hour shifts in a 14 day working cycle, offering three and four day blocks, with gaps of three and four over a seven day working cycle. The plan appears to fill some of the significant blocks in the roster on an ad hoc basis. Will the Minister of State acknowledge that this is entirely unsatisfactory? Anything less than a 24 hour, seven day week staffing of the base would be equivalent to gambling with the lives of people in my community.

Some months ago there was a near tragedy in Tuam. An emergency call was placed but no ambulance was free to attend from Galway so one was despatched from Loughrea. The response time from Galway is 25 minutes, as the Minister of State may be aware, but the time from Loughrea is 45 to 60 minutes. An ambulance coming from Loughrea which brings a patient back to Galway poses significant risk for the patient concerned. In the case I mentioned, as was also the case in the recent tragedy, off-duty paramedics living in the Tuam community attended the call after receiving an emergency call from the Garda asking them to attend the scene. It is not an unusual occurrence for off-duty emergency medical technicians to be called in, unpaid, to attend after a road traffic accident or a crisis in Tuam, comparable to that of last Sunday. I acknowledge the dedication, commitment and the action of the paramedics and the gardaí. That is important. However, the people of north Galway cannot be asked to be dependent on the goodwill of public servants in terms of their security and circumstances.

From my discussions with the paramedics in Galway, I understand the Tuam base would require 11 shifts in order to provide both 24-7 cover and relief cover to avoid overtime. A new rota for paramedics was introduced in early September. Rotas since then that were shown to me show that shifts in the county are surplus to the staffing requirements of the existing network of ambulance bases. I understand there is a particular emphasis by management to ensure that overtime is not paid in order to maintain what one might argue is a "phantom" shift. In the week ending 14 October there were 14.5 so-called phantom shifts in County Galway and in the week ending 21 October there were 15 such shifts. On the week ending 28 October there were ten shifts that might be described as available, though not in action, in the county.

Some minor amendments to the rota could allow for 24-7 cover in the new Tuam base. I understand that Galway has significant surplus capacity in shifts and that there is significant surplus capacity in the midlands and in County Mayo. Emergency medical technicians travel from Tuam to service Athlone and Mayo where there are surplus shifts in the midlands and in Castlebar.

I have no wish to make a political point using last Sunday's tragedies but the regret I would feel returning home tonight not having spoken in the Dáil, not having reported what I believe are unavoidable situations that occur because of a lack of personnel in my community outweighs the risk of raising this issue.

When is the Minister of State prepared to convene discussions with the head of the ambulance service nationally in order to resolve the situation? Solutions are available.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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I thank Deputy Keaveney for raising this issue. Before I reply I join him in offering my personal sympathy, that of the House and of the entire country, to the family in question on the tragic loss of their children. It was a traumatic and awful event and we deeply sympathise with the family.

The National Ambulance Service, NAS, provides pre-hospital emergency care and intermediate care services, by stretcher-based inter-facility transfers, to the people. Pre-hospital emergency care is the emergency care provided to a patient before transfer to a hospital or appropriate healthcare facility. In line with commitments to a better and more efficient health service made in the programme for Government, the NAS is progressively improving and modernising emergency ambulance services. Supported by the Department of Health, the Pre-Hospital Emergency Care Council and HIQA, the NAS is providing national management and leadership, particularly in the development of two national control centres, the deployment of advanced paramedics, the move to on-duty rostering and the dynamic deployment of resources within regions.

Response times around the country vary significantly, based on the nature of the area covered and the rural-urban mix. As might be expected, response times are longer in remote areas of the country. In this context, the NAS has developed a performance improvement action plan, focused on achieving an improvement in response time performance. The NAS continues to deliver the best possible performance with the resources available. One of the key elements within this plan outlines that the service provided is not a static service but deploys its resources in a dynamic manner. The NAS therefore works on an area and national basis, rather than a local basis. The dynamic deployment of ambulance resources ensures that the nearest appropriate resource is mobilised to the location of any incident.

The Emergency Aeromedical Service, EAS, which was initiated in June 2012, is focused on the western seaboard in order to provide aeromedical support to emergency ambulances in regard to transit times from a serious or life-threatening incident to an appropriate facility. The EAS involves the Irish Air Corps helicopter, supported by the Irish Coast Guard. Based in Custume Barracks, Athlone, the service has a dedicated helicopter with medical staff, and personnel to fly and maintain the craft. The NAS is responsible for patient care, which is provided by advanced paramedics. The Irish Coast Guard provides additional support to the EAS aircraft, using its new SAR helicopter based in Shannon. This helicopter is crewed by Coast Guard paramedics, accompanied by an NAS advanced paramedic where necessary. Accordingly, there is coverage of the entire western seaboard if required.

In regard to Tuam, emergency activity in the Galway area is reasonably static. Consequently, when Tuam ambulance station is finally commissioned, the NAS intends to use existing resources more efficiently to improve response time performance to the existing call volume. The NAS has been in continuing discussions with staff representative bodies about the introduction of tactical deployment of existing resources from existing ambulance stations to new locations such as Tuam. While such practices have been in place in other parts of the country for some time, Galway is one of a number of areas where this plan had not been progressed. However, this issue is now being progressed under the Croke Park agreement.

The NAS is committed to better utilisation of existing resources in a tactical deployment model so that Tuam ambulance station can service the north Galway area. It is hoped that this ambulance station will be commissioned and operational in the coming weeks.

Photo of Colm KeaveneyColm Keaveney (Galway East, Labour)
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I thank the Minister of State for his response.

I am cautious about using the desperate circumstances in which there was no ambulance available to bring two bodies from Tuam to Galway on Sunday last in order to highlight this matter. I am disappointed that the Minister for Health is not present to respond to my observations. I do not accept that progress is being made by management in respect of available resources in the context of ensuring a new ambulance base could be opened immediately and on a cost-neutral basis. There is categoric evidence - this is based on rosters which came into effect on 1 September - which proves that there is capacity in the system to provide for a 24 hour service in Tuam with immediate effect.

The Minister of State's reply suggests work is in progress on the possible establishment of a 24 hour ambulance station in Tuam. I welcome this, particularly as it is the first I have heard of it. I am sure this is the first time the staff have become aware that there is space within the mechanisms of the Croke Park agreement to make provision in this regard. I ask the Minister of State to take personal responsibility for this matter and invite the head of the national ambulance service to attend a round-table discussion with the elected representatives from my constituency as a matter of urgency in order that they might put forward comprehensive proof based on existing rosters that there are sufficient staff available across the ambulance service network between counties Roscommon, Mayo and Galway to put in place a 24-7 service as soon as possible.

I am not prepared to look forward to the next crisis and ask what would happen if the ambulance was not available. It is unacceptable to be obliged to pose such questions in circumstances where the requisite resources are available. I categorically state there are existing resources in the Galway area which would allow for the immediate provision of a 24 hour service. Such a service should be put in place for a community that is grieving.

4:35 pm

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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I again thank the Deputy for raising this matter. I will ensure his comments which will be published in the Official Report are brought to the attention of the Minister and his Department. I will ask the Minister to take on board the issues he has raised. My duty is to provide the Deputy with a response, but it is the duty of the Minister and his Department to ensure the wishes the Deputy has expressed are met. The proposition the Deputy has put forward is eminently practicable.

I reiterate that the national ambulance service has been in continuing discussions with staff representative bodies on the introduction of the tactical deployment of existing resources, from existing ambulance stations to new locations such as Tuam. While such practices have been in place in other parts of the country for some time, Galway is one of a number of areas where this issue had not been progressed. However, it is now being progressed under the Croke Park agreement. The matter is under consideration and I hope a conclusion to the satisfaction of the citizens who live in the area in question will be reached.