Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I extend my deepest sympathy to the family of Vakaris Martinaitis, who died on Wednesday last after a tragic accident in Midleton. It was an indescribable tragedy for his family. It almost beggars belief that no ambulance was available to take this seriously injured young child to hospital immediately, as was required. Despite the HSE's contradicting this, the reality is that those who called the emergency services were told there was no ambulance and no ambulance arrived. The inadequacy of the provision of emergency services in east Cork is not a new concern. It has been raised repeatedly by the local community, by my colleague Deputy Sandra McLellan, by Midleton town councillor Pat Buckley and by other elected representatives for the area, including Deputy David Stanton with whom we share this Topical Issue matter.

Last March in the Dáil, the Minister for Health, Deputy James Reilly, claimed "improved training and better deployment through more efficient rostering ... will drive the improvement of response times in every region". It is very clear that response times in every region have not improved and that in areas such as east Cork there are major gaps in services. The Minister needs to intervene directly with those responsible for emergency services in east Cork to identify what now needs to be done. Throughout the State he must ensure that ambulance and other emergency services are of the standard required. I call on him to carry out an urgent review of the actual effect on the ground of the reconfiguration of recent years. The news - and often tragic news - coming back to us is that there are huge gaps and it is not confined to east Cork.

Sandra McLellan (Cork East, Sinn Fein)
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The death of young Vakaris Martinaitis and the trauma and profound sense of loss his family must now endure is almost beyond belief. I extend my deepest sympathy to his family at this time. As a mother it must be absolutely shocking to find your child has fallen out of a window and that he is seriously injured, but I can only imagine the initial shock must then be magnified many times over by the realisation that no ambulance is available to take your child to hospital. Despite the line by the HSE on this, the fact remains that when an ambulance was requested, the caller was informed none was available, and no ambulance arrived to take little Vakaris to hospital.

Unfortunately, the unreliable nature of the emergency services in my constituency of Cork East is now having profound consequences for children and adults who have serious injuries or illness. Only six weeks ago another child, James Casey Butler, needed emergency care and again the circumstances surrounding this particular incident are causing concern in the area. Questions about the failures and inadequacy of the emergency services in east Cork are not new. I have repeatedly raised the issue in the House, as has my colleague Deputy Ó Caoláin. The situation has now reached a crisis point and, simply put, lives are now at risk as a result.

In March of this year the Minister, Deputy Reilly, gave an undertaking that response times would improve as a result of more effective rostering and improved training. However, recent incidents prove this is simply not the case. The people of Midleton are entitled to better. They deserve to know that if they or their children have an accident or become ill an ambulance is available to take them to hospital. Not only in east Cork but throughout the country people are entitled to an emergency service which is both reliable and dependable. I therefore call on the Minister to conduct as a matter of urgency a review of how the restructuring or reconfiguration of the ambulance and emergency services actually works for people and communities. The evidence to date suggests serious problems exist with the service and people are suffering or dying as a result.

David Stanton (Cork East, Fine Gael)
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Yesterday I attended the funeral and extended sympathy to the family of the little boy who passed away so tragically. I am pleased the Minister of State is in the Chamber, but I am disappointed neither the Minister for Health nor a Minister of State from the Department is present to debate such an important issue. I have faith in the Minister of State who is present.

Many serious questions must be answered. What happened? I want the preliminary report to be made available as soon as possible. For two hours yesterday I engaged with approximately 70 or 80 very angry, distressed and worried people who were outside my office. The anger and concern about this and other such incidents is palpable. We need answers and we need them quickly. I hope the Minister of State will have some answers for us. What about other first responders whom I understand are normally alerted when such an incident occurs? Why were they not alerted? We have since been told other ambulances were available. Why was one of them not dispatched to the scene? What about the other rapid response vehicle in the area?

The role of SouthDoc needs to be examined. The reconfiguration of the ambulance service needs to be examined and I call on HIQA to be involved in this. Why is it when ambulances go to Cork University Hospital they are often held there for quite an amount of time before they can leave because their stretchers and trolleys are kept in the hospital until the patients are taken off them? How many calls are responded to and what is the average time of response? How many frivolous calls are made to the ambulance service? Very serious questions are raised and it is a life-and-death situation. A family has buried a little two-year-old boy. Nobody knows whether he would have survived if an ambulance had arrived, but one was not available at midday on a bank holiday Monday, which one would imagine to be a very quiet time with not much demand for an ambulance service. We need answers quickly.

Jan O'Sullivan (Limerick City, Labour)
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I thank the Deputies for raising this issue, to which I am responding on behalf of the Minister for Health. I join with the Deputies in extending my sympathies to the bereaved family and all those involved. The death of a child in any circumstances is a tragedy for all concerned and, in speaking about this matter, I am conscious of their terrible loss. Nothing we can say can make it any easier for them.

To establish an accurate account of this incident, the HSE has asked the national ambulance service to examine the details of what occurred. The ambulance service, in line with the HSE incident review methodology, has commissioned an incident review into the management of a 999 call received at 2 p.m. on 6 May 2013. The review team will provide a preliminary report as a matter of urgency, to be followed by a full report. The ambulance service has also appointed a liaison officer to the family to ensure they are informed of the progress and outcome of the review.

A significant reform programme of pre-hospital care services has been under way in recent years. This is to ensure a clinically driven, nationally co-ordinated system, supported by improved technology.

The programme involves a number of measures, including the performance improvement action plan, development of the intermediate care service, the trial emergency aeromedical service, EAS, and the NAS control centre reconfiguration project.

The NAS is not a static service. It deploys its emergency resources in a dynamic manner and on an area and national, rather than a local, basis. In line with the need for increased efficiencies in State services under the Croke Park agreement, the NAS has been moving from on-call to on-duty rostering for ambulance services. The change to on-duty rostering means that highly trained paramedic crews are on site in their stations or their vehicles to respond to dispatches immediately, rather than in the average time of over 20 minutes that it takes to summon on-call staff and activate the vehicle.

In 2011, following a Labour Court ruling, the NAS began the phased move to on-duty rostering in the southern region. All of Cork now operates under on-duty rostering. In addition, county boundaries no longer apply - the nearest ambulance responds, regardless of its origin. The changes also mean that resources can be deployed dynamically, based on need and demand patterns, rather than simply by station location. This allows for more flexibility and responsiveness and will result in better response times for the people of Cork and Kerry and a better service. In the new model of service, on-duty ambulances and response vehicles will move to the optimal location at any time based on predicted needs assessments. The NAS in east Cork has been enhanced under these changes. Previously, for four nights a week, paramedics responded to calls after 8 p.m. from their homes. From 2012, the emergency resources in east Cork are in use, on duty in the stations or in their vehicles, 24 hours a day, seven days a week. All of these measures will allow the national ambulance service to provide a better, safer, more comprehensive and more efficient emergency ambulance service to the people of Cork as a whole.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I know this is not the Minister of State's area, which does make it very difficult. She is delivering a written reply, but nowhere in that reply is there any commitment to carry out the type of review we believe is required following the reconfiguration of the ambulance service. It is important that such a review be undertaken to establish an accurate account of the incident in question. The Minister of State indicated that the HSE had asked the national ambulance service to examine the details of what occurred. Has she any idea how quickly that report will be presented? These are important matters to inform us and the many others who will be interested in this exchange. When will the national ambulance service report, through the HSE, to the Minister and to the House? Will the Minister of State tell her colleague, the Minister for Health, Deputy James Reilly, that it has been strongly urged that a review into the configuration of the ambulance service, including emergency ambulance services across the State, be undertaken? This is to establish the adequacy of the service in terms of current and projected needs.

Sandra McLellan (Cork East, Sinn Fein)
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People in the east Cork area are very concerned and do not believe they have an enhanced ambulance service. During the bank holiday weekend, a young man in Youghal suffered serious head injuries in an unprovoked attack and lay in the street in a pool of blood. There were reportedly two rapid response vehicles in the area but they did not attend the scene. Local gardaí had to obtain the assistance of the local fire brigade, whose members were on call but not on duty. The strategically positioned ambulance did arrive 53 minutes later.

Sometimes things might look good on paper but they do not work that well in practice. People in the area have no confidence in the ambulance service. Will the Minister give a commitment to undertake a comprehensive national review of the reconfiguration of the ambulance service?

David Stanton (Cork East, Fine Gael)
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A child is dead and one can imagine the kind of emotional response that has provoked in the area among families and parents when an ambulance was not available and did not arrive. Now, however, we are told that ambulances were available. Deputy McLellan, I and others worked hard when this reconfiguration was going ahead. We supported the national ambulance service in that work. We asked a lot of hard questions and got answers. At the time I felt it was an improvement, but I now have serious reservations.

The Minister must ensure that we have full information. The public must have full information on what happened as well as full information on the reconfiguration. This is an extraordinarily serious issue. How many calls have the ambulances responded to in the last while, and what is the average response time? We want an independent and ongoing review. The feeling in Midleton now is that no ambulance is available in the town. My understanding of the reconfiguration is that the ambulance is not a static service but moves around. If one tries to explain that to people, however, they neither accept it nor understand it.

Because of the incidents outlined by myself, Deputy Ó Caoláin and Deputy McLellan, the public no longer have any confidence in the ambulance service. When confidence disappears people get worried and angry. I am angry also, so I want answers quickly. How soon will this preliminary report be available? If the Minister of State cannot tell me that now, I would appreciate if she could do so before the evening is out. We also need to know how soon the full report will be available and what kind of information will be in it. I am quite angry about this, so I want a comprehensive response.

Jan O'Sullivan (Limerick City, Labour)
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I will ensure that the Minister of Health, Deputy Reilly, is made aware of all the Deputies' questions and concerns. I did indicate that the preliminary report would be produced as a matter of urgency and would then be followed by a full report. I note that the Deputies have also requested a review of the whole service and not just this specific incident.

Sandra McLellan (Cork East, Sinn Fein)
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Yes.

Jan O'Sullivan (Limerick City, Labour)
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Deputy Stanton asked a number of questions about average response times and the number of calls. I will convey those queries to the Minister. I agree with all the Deputies that it is important that people have confidence in the ambulance service. I have no doubt that I speak for the Minister, Deputy Reilly, when I say that it is a major concern. I will ask that the information sought by the Deputies be supplied by the Minister as soon as possible.