Emmet Stagg (Kildare North, Labour)
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I thank the Ceann Comhairle for allowing me to raise this topical issue and the Minister of State at the Department of Health, Deputy White, for coming to the House to respond to it.

Above all else, people are concerned about their health, and if they are injured in an accident or suffer a heart attack or a stroke they want to be assured that the system of ambulance cover throughout the State will give them the best chance of survival, with prompt medical attention on site and efficient transfer to hospital. I commend our paramedical staff on the tremendous work they do, in often horrific circumstances.

The State is covered by 86 ambulance stations. Under the Croke Park agreement the issue of inefficiencies in rostering arrangements in ambulance stations was referred to the Labour Court following intensive discussions between the HSE's national ambulance service and trade unions representing paramedical staff. The Labour Court subsequently issued a recommendation directing the national ambulance service and the trade unions to address a number of overtime-generating inefficiencies within rostering arrangements. Discussions have concluded at 30 ambulance stations on changes to rosters and 25 will now operate on a 24-hour basis, 365 days per year. However, the stations in Maynooth, Baltinglass, Swords, Athy and Arklow will not have an ambulance on stand-by for immediate dispatch for 12 hours per week. This means there will be no local cover for the equivalent of 26 days, or almost one month, each year.

Maynooth ambulance station covers a population of 60,369 in the towns of Celbridge, Leixlip, Clane, Kilcock and Straffan, as well as Maynooth. Between 7 a.m. and 7 p.m. every Thursday, no ambulance is available for dispatch directly from Maynooth ambulance station. In the event of an emergency, an ambulance would have to be sourced from Athy, which is 90 minutes distant, Naas, which is one hour distant, Dublin or Cavan. I do not want to scaremonger but it would be inefficient to allow this situation to continue if it puts people's lives at risk. The national ambulance service has pointed out that two new rapid response vehicles operate in south Dublin and Kildare and that a new hospital transfer service has increased ambulance capacity. However, neither I nor the people of north Kildare are satisfied with the current arrangement.

If full cover can be retained in 25 stations throughout the country, why can this not be achieved in Maynooth? What is the cost of reinstating dispatch from Maynooth on a 24-hour basis, 365 days per year? I ask that the matter be reconsidered because I cannot understand how savings can be made through the changes that have been introduced. If the Minister of State does not have specific information I will be satisfied if he passes the information to me subsequently. I have been trying to get information from the ambulance service but it is like pulling teeth from hens.

Alex White (Dublin South, Labour)
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I thank Deputy Stagg for raising this issue, for drawing attention to the improvements made in the HSE national ambulance service, NAS, and for affording me the opportunity to outline the ongoing delivery by the HSE and its workforce and representatives of important changes in the way our emergency ambulances and crews are deployed.

The Deputy is correct that the NAS is progressing a number of efficiencies arising from the Labour Court decision following a referral to it under the public service agreement. These include the issue of overtime built into rosters and a change from on-call to on-duty service. The elimination of on-call rostering was sought by ambulance staff. The referral to the Labour Court was in line with the Croke Park agreement. The court has issued a binding recommendation directing the NAS and the trade unions to address a number of inefficiencies in rostering arrangements. New rosters are in place and are operating successfully in a large number of stations, including Tallaght, Swords, Maynooth, Kildare, Wicklow and Cavan.

Some concerns over perceived levels of cover or lack of cover at certain stations in the north Leinster area have been raised as these changes have progressed. I reassure the Deputy and the population of the areas referred to in this regard that the national ambulance service is not a static service. It deploys its resources in a dynamic manner and works on an area and national basis rather than on a local basis. The dynamic deployment of ambulance resources ensures that the nearest appropriate resource is mobilised to an incident, including incidents in the greater Dublin area. Where necessary, emergency cover is provided by an advanced paramedic motorcycle response unit, supported by resources deployed from adjacent stations on a rolling basis.

In addition to the operational efficiencies being implemented, two new rapid response vehicles, RRVs, now operate in the south Dublin and Kildare areas, to improve services further across the greater Dublin area. The national ambulance service has also introduced a new intermediate care service in south County Dublin to address routine inter hospital transfers. This releases emergency ambulances for emergency service work. The net effect of these changes is improved efficiency and increased availability of emergency ambulances across the area for incidents where hospitalisation is required.

As mentioned, the national ambulance service is a dynamic service. It responds to calls on a prioritised basis, through the advanced medical priority dispatch system, AMPDS, which is in operation in all NAS control centres. The NAS has established that 10% of all 999 calls are inappropriate for an emergency ambulance and a further 50% are neither life-threatening nor serious. This data is in line with international experience.

With regard to the specific stations mentioned by the Deputy, Maynooth, Baltinglass, Swords, Athy and Arklow, these stations particularly benefit from the dynamic and rolling cover improvements due to their proximity to each other and to the road network available in the area they cover. I appreciate the Deputy referred to Maynooth in particular. The question raised with regard to Maynooth and the manner in which these issues are being addressed must be seen in the context of the dynamic service that exists, which comprehends a broader area of cover than a particular town or centre.

Emmet Stagg (Kildare North, Labour)
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The system we use for raising topical issues is very useful for Members like myself, but we appear to be falling back into the old trap, where Ministers or Ministers of State come into the House and read a script that was prepared before hearing what we have to say on the issues. The result is that regularly the issues being raised are not addressed at all. This is what has happened today.

I asked some specific questions and while I did not expect the Minister of State to have the answers, I would have been satisfied if he had said he would get the answers for me. I will put my questions again. How can he justify not having an ambulance service in Maynooth when there is, apparently, no savings whatsoever from abandoning it? The system being put in place is no better and is probably more expensive than the system that existed when Maynooth had a full service. I do not accept the notion that Athy and Maynooth are adjacent, as they are an hour and a half apart. A person could have died from a heart attack ten times in the time it would take for the special ambulance to come. However, perhaps the man on the motorbike would arrive to help.

The man on the motorbike would probably cost more than it would cost to send the ambulance which is lying idle in Maynooth, all because somebody decided that five stations in the country should have 12 hours a week with no ambulance service and that a motorbike service would replace them. I do not understand how this could provide any savings. Will the Minister inquire or find out what exact savings are being made, as all of this was based not on more efficient services, but on cost efficiencies? I fought for years to get an ambulance service for Maynooth and we succeeded in getting it. I am not about to allow it be whittled down or reduced so as it will eventually disappear into some larger centre.

Can the Minister of State tell me what happens in Maynooth on a Thursday when the ambulance and crew are not allowed to leave the station? Does the crew sit in it and wait for the 12 hours to be up before they can go out? What has occurred is nonsense. A group in Maynooth and the north Kildare area is organising a protest on this issue and I understand and appreciate that. If we could get some answers, we could explain why this has occurred.

Alex White (Dublin South, Labour)
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The Deputy has indicated he would like me to ascertain the level of savings associated with the changes in so far as they apply to Maynooth and I will endeavour to ensure that if the information can be ascertained it will be relayed to him.

I cannot explain the broader issue any further than I have done. However, all of us would be concerned if any of the decisions being made in order to achieve efficiencies brought an associated risk with them or if they introduced any kind of public health risk into the system.

Emmet Stagg (Kildare North, Labour)
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Of course there is a risk.

Alex White (Dublin South, Labour)
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Our primary concern is to ensure the health and well-being of the population, including access to emergency care if needed. If it can be demonstrated there is some risk associated with this change, that must be addressed.

Emmet Stagg (Kildare North, Labour)
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If there is no risk, there is no need for an ambulance service at all.