Peadar Tóibín (Meath West, Sinn Fein)
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I am raising the issue of ambulance services in County Meath again. I believe the problems in the county are replicated in other parts of the country. A number of years ago, County Meath was served by four ambulances. This number had decreased to three by 2010. It was decided earlier this year that just two ambulances would be provided on two days of the week, Tuesday and Friday. I understand that just one ambulance is now available in the entire county due to significant rostering problems and a lack of overtime provision. This is happening at a time when there is significant pressure on ambulance services. Ambulances cannot always go to local hospitals because service reductions mean those hospitals usually have to be bypassed. It is significant that the call centre for ambulances in the north east is now based in Dublin, rather than being based locally.

When a woman who lives five minutes from the hospital in Navan had a serious stroke two weeks ago, it took 40 minutes for an ambulance to come from Drogheda, arrive at her house and bring her to the hospital in Navan. When an infant tragically died at the start of this year, the family had to wait an extended period of time for an ambulance to arrive. I will mention some other incidents that took place recently. An ambulance had to come from Ardee, County Louth to deal with a fatal road traffic accident in the south of County Meath. A serious non-fatal accident on the bad roads of the south west of the county was dealt with by an ambulance from Ardee. A person in the south of the county who suffered a cardiac arrest had to wait 45 minutes for an ambulance to arrive. When an eight year old girl in Navan was pinned down by an industrial-sized gate two weeks ago, it took 50 minutes for an ambulance to arrive. Ambulances are coming from towns like Mullingar and Portlaoise to serve County Meath. Ambulances occasionally have to travel from County Down into County Louth because the nearest available ambulance to deal with an incident in Dundalk is in Navan. Recently, a garda had to be asked to drive an ambulance in County Meath because just one member of the ambulance staff was available. This information has been provided to me by ambulance personnel, fire service personnel and patients. These people are living in a culture of fear and silence. They feel afraid to discuss such service breakdowns with local Deputies. In my view, every citizen should have the constitutional right to consult their Member of Parliament.

Some months ago, I tabled a parliamentary question asking the Minister to investigate these issues before any further changes were made in the region. I asked for the key performance indicators from County Meath and the rest of the north-east region to be made available. The response I received from the Minister referred me on to HIQA and the HSE. HIQA did not provide me with the key performance indicators because - believe it or not - it does not maintain key performance indicators for the ambulance service on a regional basis. Anybody who knows anything about management will understand that one cannot manage if one cannot measure. If the HSE, HIQA, the Minister or the Department of Health do not have the key performance indicators needed to measure the performance of the ambulance service in County Meath or the north east as a whole following these cuts, how is the Minister able to manage the manner in which this critical, front-line emergency service is provided to the people of the county? I sent an e-mail to the National Ambulance Service 12 days ago to look for the key performance indicators for the region and the county. When I contacted the service today because it had not acknowledged my letter, I learned that it has not started to look for the information I am seeking. Will the Minister provide the key performance indicators for the region to the House?

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy for raising this issue. A significant reform programme has been under way in pre-hospital emergency services in recent years. This is to ensure the best clinical care is provided for the people in each region served by the National Ambulance Service, through the provision of a clinically driven and nationally co-ordinated system that is supported by improved technology. The programme includes a performance improvement action plan and the development of the intermediate care service, the emergency aeromedical support service and the National Ambulance Service control centre reconfiguration project. Following discussions between the service and unions, changes are being implemented in rosters in a large number of ambulance stations around the country, including all stations in the former north east area, where the Deputy comes from. As a consequence of these new rostering arrangements, additional cover will be provided in a number of ambulance stations based on discussions with staff and activity and demand analysis.

The introduction of new rostering arrangements will progress a number of efficiencies arising from a Labour Court recommendation. It will address excessive overtime in rostering arrangements and will require the full co-operation of all staff.

The National Ambulance Service has completed an individual and collective consultation process with staff at each station in Louth, Meath, Cavan and Monaghan. Staff, through their trade union SIPTU have agreed to implement the new rosters. Although staff and public representatives have raised concerns over claims of reduced cover, the National Ambulance Service has advised this is not the case - in Louth, Meath, Cavan and Monaghan, the new rosters introduced earlier this year will see an increase in cover of 188 rostered hours a week, or approximately 9,800 extra rostered hours a year.

As well as the additional hours, the National Ambulance Service has introduced two rapid response vehicles in Ardee and Trim to augment services further. Also, as services are provided regionally rather than from single stations, ambulances from adjacent stations provide cover in a dynamic manner, by moving to areas as and where cover is required.

The National Ambulance Service has introduced more resources in tandem with the reorganisation of acute services in the Louth and Meath area. Extended analysis has identified that demand is in inter-hospital transfers, which have traditionally used emergency ambulances. In the former north east, this service is operating from Cavan, Castleblayney and Dundalk ambulance stations. The National Ambulance Service has also implemented additional intermediate care capacity in Louth. The ongoing introduction of intermediate care services allows the release of existing emergency ambulance resources back to emergency uses. These and other changes being implemented at local, regional and national levels will continue to move the ambulance service in the right direction - a national service, providing the best clinical care for the needs of the people in each region it serves. Emergency resources and staff are available 24 hours a day, seven days a week, ensuring the people of the north east have timely access to highly skilled paramedic and advanced paramedic staff day or night.

Peadar Tóibín (Meath West, Sinn Fein)
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Ours is, to a certain extent, a disjointed conversation, Minister. There is no doubt that resource efficiencies are needed. I support efficiencies in any manner they can be procured as long as they do not have a negative effect on patients. I have requested from the Minister for Health, HIQA, the Health Information and Quality Authority, and the National Ambulance Service on previous occasions and again from the Minister today, key performance indicators to show the ambulance service's response time for life and death emergency situations in the north east. I ask again that the Minister provide those to the House as soon as possible.

It is important to note that I provide the Minister for Health with key performance indicators of patients and citizens who have come to me and shown me that the performance of the service falls outside the HIQA guidelines. The Minister mentioned there is a rapid response unit in Trim. HIQA guidelines say that treatment should be available to echo or delta patients in eight minutes but there needs to be an ambulance to transport the patients to a hospital in the 18-minute target. The ambulance service is not achieving those performance indicators in the north east.

The views of the National Ambulance Service and its staff are at polar opposites - one could not find two more divergent analyses of the situation in the region. We can talk about who said this and who said that, but the only way to cut through the issue and to enable the Minister to manage the funding of the region better is for local key performance indictors to be provided. Will the Minister provide such indictors?

James Reilly (Dublin North, Fine Gael)
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I emphasise that the new rostering arrangements have resulted in increased hours of 188 hours each work, which is 9,800 hours a year. There are - as there always have been - problems in the ambulance service. According to my briefing note, the relatively high absenteeism rate rather than a lack of vehicle resources is an issue. Although the absenteeism is being addressed by the National Ambulance Service's management, unforeseen and short-notice absence presents challenges for emergency provisions, which are dealt with through regional resource utilisation, deployment and call prioritisation.

It was recently reported that a garda was driving an ambulance. That might occur for a number of reasons, including a clinical situation in which both attending crew are providing patient care. Gardaí are authorised to drive any vehicle deemed necessary in the performance of their duties. I think we all agree such collaborative arrangements are necessary when all our agencies at the scene of an incident are focused on a common goal and mission - to preserve life. Although no one wishes to hear of situations such as the ones that Deputy Tóibín has described, I assure the House that the new arrangements have increased the number of hours available to give the life saving service. There will always be room for improvement and we shall strive to make that improvement.

I will discuss the key performance indicators with SIQA and I will get back to Deputy Tóibín in due course.