Michael Healy-Rae (Kerry South, Independent)
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I thank the Ceann Comhairle's office for allowing me to raise this important matter as a Topical Issue. I wish the Minister of State, Deputy Donohoe, well in his new position. I understand why the Minister for Health and the Minister of State at the Department of Health, Deputy Kathleen Lynch, are not here today. I would like to send the Minister of State my best wishes. I understand perfectly why nobody from the Department of Health is able to be here today. I am not giving out about it. I am saying I understand it.

Paschal Donohoe (Dublin Central, Fine Gael)
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Sure.

Michael Healy-Rae (Kerry South, Independent)
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This is a very important issue. The great town of Killarney has been served by two ambulances for 36 years. Unfortunately, it has been decided as part of a reconfiguration - a wonderful word that is used by the HSE - to take away one of the ambulances that serve the town. This ridiculous decision will have a detrimental knock-on effect on the ambulance service in places like Kenmare. While I am grateful that the town will retain its 24 hour, seven day emergency ambulance service, it is obvious that the Kenmare ambulance will be called on when a second ambulance is required in Killarney. That, in turn, will mean that Kenmare and its massive hinterland, which includes places like Cuhig, Lauragh, Sneem, Bunane and Kilgarvan, will have no ambulance service.

It is wrong that this measure is being taken. It was highlighted recently by people like Councillor Niall 'Botty' O'Callaghan and my brother, Councillor Danny Healy-Rae, when we met HSE officials at a controversial briefing. While we have been fighting vigorously against what the HSE is doing, we have to be realistic at this stage and accept it is going ahead. We need to decide what this situation will mean for us. I have resigned myself to having to make certain requests. Confidence in the ambulance service in Kerry has been lost because of this move. At the very least, the HSE should make provision for busy times. Everybody knows the population of Killarney explodes during the summer, at Christmas and when Munster finals take place. Provision should be made for a second emergency ambulance service to be provided at those times. That is a reasonable request. It is also reasonable to ask for the situation to be reviewed in three months time. There should be an examination of how the new system that has been put in place by the HSE is working. It should involve all of the stakeholders, including the local GPs in Killarney, who provide an excellent service, and the local town councillors, who are unfortunately about to be abolished. While they are still in place, there should be another meeting involving people like Councillor O'Callaghan at which the manner in which the service has unfolded - how it is working out on the ground - could be discussed.

I would like to mention another aspect of this issue before I conclude. As the Minister of State knows, the emergency call-out centre has been taken from County Kerry and centralised up here in Townsend Street. I was totally and absolutely against this move because I did not think the Townsend Street facility was fit for purpose.

No external safety audit of it was carried out while an internal safety audit was carried out by the HSE itself, which was totally inadequate. Situations have arisen since that has happened and I will give one example. Rock Street in Tralee is five minutes from Kerry General Hospital. A man suffered a serious stroke recently. It was 45 minutes before the ambulance arrived for him and that was a direct result of taking our call-out centre away from County Kerry where we had local knowledge and centralising it in Townsend Street.

Paschal Donohoe (Dublin Central, Fine Gael)
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I thank the Deputy for raising the issue and for acknowledging why I am taking this on behalf of the Department of Health. During the summer, I had opportunity to spend a wonderful week in many of the areas to which the Deputy referred. I have some small appreciation of some of the difficulties to which he has referred.

I would make the point to the Deputy that he is very strong in opposing so much of the work the Government is doing when a tax increase is put forward or a spending cut put in place. All the Government is trying to do is put in place reforms to ensure that out of the many billions of euro of taxpayers' money that are still being spent, it can provide a level of service to the Deputy's constituents that he wants to see them provided with and the Government wants to see maintained. If I have a look at what has happened here in respect of the national ambulance service and the measures being proposed there, I hope that despite the Deputy's caution, it will be seen as a way in which our front-line professionals can make the best possible use of what they have at their disposal.

It is a new region-wide service, as the Deputy is aware, that looks to put in place a better way of working to replace the current local delivery systems. It comes directly from an analysis of the needs of the south Kerry area and the best use of emergency resources, including paramedics and advanced paramedics. This plan was agreed by HSE management, union representatives and staff within the HSE so it is a model that went through consultation with all of the people who will be involved in delivering the service and puts in place a number of benefits for patients and the people on whose behalf the Deputy is raising this issue.

It replaces on-call work practices with on-duty rostering to bring south Kerry into line with most of the region. This means that during a shift, paramedic staff are at their bases or in their vehicles ready to be dispatched immediately to 112 or 999 calls as opposed to waiting for notification to come through to them. It looks to put in place the best possible use of emergency vehicles and personnel. It allows for the introduction of an intermediate care vehicle for routine transfers of patients between acute and community hospitals. It permits the retention of the ambulance stations in Killarney, Cahersiveen and Kenmare as locations for deployment in the south Kerry area.

In a modern emergency service, treatment, as the Deputy is aware, begins at the scene of an incident. The patients are assessed, treated and stabilised before being transported to the most appropriate facility. The national ambulance service has highly trained health professionals in south Kerry at paramedic and advanced paramedic level who can and will perform life-saving interventions and other advanced treatment at the scene of an emergency before moving the patient safely to an acute facility for further treatment. The Minister has been assured that many of the concerns raised by the Deputy will be dealt with in the new arrangements that are being put in place.

Under the new arrangements, an extra 126 resource hours are now in place in the three stations I mentioned earlier and the move to on-duty services also means that the entire region of south Kerry will have a 24-hour day, seven-day week emergency ambulance service. This means that the people have timely access to highly skilled paramedic and advanced paramedic staff day and night.

Michael Healy-Rae (Kerry South, Independent)
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I thank the Minister of State for his reply. He talks about saving money and reconfiguring and reforming the delivery of our services on the ground but all places are not the same. Save Our Ambulance Kenmare under the chairmanship of Michael Hayes was formed to retain our 24-hour, seven-day week ambulance service for the town and did excellent work in highlighting how important it was to have a full ambulance service in the town. It highlighted a situation that could arise as a result of taking the ambulance out of Kenmare to cover Killarney because there will be only one basic ambulance serving that big town. Its work has been successful but when that ambulance goes, situations could arise. The town is a very busy place in the summer. There are road accidents and an elderly population. If a person does not have the service of a proper ambulance and if a first responder or some other vehicle goes back to Kenmare, which is a good two hours from Kerry General Hospital, the delay incurred by first sending a first responder, stabilising the patient and then having to wait for an ambulance to come from God only knows where at that stage - Tralee, Cork or Bantry - would be enormous. One would be talking about many hours before that person would finish up in an acute hospital. That would ultimately lead to the loss of lives, which is why I am grateful to have the opportunity to have this Topical Issues debate today, but the Minister of State's response does not deal with the problem we are facing on the ground.

Paschal Donohoe (Dublin Central, Fine Gael)
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I thank the Deputy for his response. I would emphasise a number of points in response to him while understanding completely the concerns of the people he represents. In no way did I mean to suggest that my small amount of time spent there is equal to the knowledge the Deputy and other representatives would have regarding the concerns people are articulating. That said, I emphasise some points we discussed earlier.

The first is that due to the change that has taken place, an additional 126 hours will be rostered every week. Due to the changes in work practices to which staff and unions have agreed, more work hours will be available. I again confirm that no ambulance stations will be closed as a result of this change and emphasise that due to this, not only will an extra 126 hours be available, there will be 96 more on-duty emergency hours available per week in the region. Due to the changes to which staff have agreed, on-duty and response times will improve. I have been informed that the reason for that is because emergency ambulances will be available straightaway and where necessary, ambulances from adjacent stations will provide dynamic and direct cover.

I understand very well because I have had to deal with these issues in my own constituency in respect of changes in front-line services. Whenever any change is made in a service that is so sensitive, people are obviously deeply concerned. All I can do is conclude by emphasising that more hours will be made available as a result of these changes which have been brokered and delivered by the staff, unions and management who are involved in the very provision of the service about which the Deputy is so understandably concerned.