Mattie McGrath (Tipperary South, Independent)
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I thank the Ceann Comhairle for affording me the opportunity to raise this issue. I am glad the Minister, Deputy James Reilly, is in the Chamber to take it. As he will know, in south Tipperary an ambulance service operates out of Cashel, Clonmel and Tipperary town. There has been a concentrated effort by the national ambulance service to downgrade the service in south Tipperary by reducing the number of ambulances and ambulance personnel. It is bad enough having people waiting on trolleys in our hospital in south Tipperary on a daily basis and staff operating under enormous pressures. Now we will not have enough ambulances to collect sick people in any type of reasonable response time. The service covers a huge area from the hills of Araglin right up to the hills of Hollyford. It includes a national primary road and a motorway, as well as significant industry. This issue is of huge concern to people in the area who are wondering what will happen if they have an accident or become ill.

I have called on the national ambulance service to engage immediately, on respectful and conciliatory terms, with ambulance personnel in south Tipperary. I salute those staff on behalf of my constituents in south Tipperary and beyond for their dedication in getting to people as fast as they can and using their paramedic training to stabilise patients and transport them safely to hospital. The personnel in Cashel have come up with a very reasonable proposal that will improve the situation from the perspective of the HSE and the national ambulance service management. They have offered an additional four hours of cover per day and other changes to the roster, which is currently very damaging to their own family life. This proposal has been rejected, however, by the national ambulance service, which seems determined to downgrade the service in Cashel and possibly also in Clonmel.

The Minister is aware that we have lost the psychiatric hospital in Clonmel. Patients are now transferred to Kilkenny, which makes the ambulance service even more important. I do not have time to list all the pressures under which the service is operating. Will the Minister take a common sense approach and engage directly on this issue? He promised when he took office that he would get rid of the HSE and take a hands-on approach, instead of having these agencies in the middle engaging in bullyboy tactics and telling people they must do X or Y or else. We have a High Court agreement signed by the then Minister for Health and now Minister for Finance, Deputy Michael Noonan, under which guarantees were given that two ambulances would be based in Clonmel, with sufficient staff and an adequate roster. Those guarantees were reiterated last year.

I was present on the day the agreement was reinforced or reinstated by a Supreme Court judge.

The Minister has to sit up and listen. He must get involved here. These very dedicated staff are covered under the Haddington Road agreement. The Minister is using reviews, mar dhea examinations and more reviews to wait until the Haddington Road agreement runs out. At that stage, he will do the dirty work and remove the ambulance. The people of Tipperary will not stand for this. They are entitled to a modicum of service. The personnel who are in place are doing a good job. I want the Minister to live up to the commitment he gave the people of Tipperary and the rest of Ireland, which was that he would take a hands-on approach to prevent the HSE from issuing diktats without any communication or engagement with local politicians or the personnel involved. He should ask the HSE to acknowledge that what is currently in place is not broken and therefore does not need to be fixed. The people of Tipperary should have some bit of ease and relaxation in the knowledge that an ambulance will come if it is needed.

James Reilly (Dublin North, Fine Gael)
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A significant development programme has been under way in recent years across all areas of the National Ambulance Service. The service continues to modernise and reconfigure its services to ensure emergency pre-hospital care is delivered in an appropriate and timely manner. Since 2012, in particular, there have been significant changes in rostering and work organisation arrangements for paramedic and control staff, following Labour Court recommendations. These changes have included addressing arrangements which are obsolete in the provision of a modern pre-hospital emergency service, such as moving from rostering with built-in overtime to arrangements which reflect a standard 39 hour week. The move from on-call rostering, where staff are off-site waiting to be summoned, to on-duty rostering, where paramedic crews are in their stations or vehicles during shifts, is ongoing. This is leading to faster deployment because the crew is in position to respond immediately to calls, rather than having to wait for the average on-call deployment period of over 20 minutes. On-duty rostering is now in place across much of the State. As part of the modernisation programme, an ongoing review of service provision is taking place in the former south-east area. This includes consideration of rostering arrangements and resource allocation. I am aware the Deputy has concerns regarding Cashel ambulance station. I am informed by the National Ambulance Service there have been no changes in respect of cover or rostering arrangements at that station.

The reform programme that is under way will ensure we have a clinically driven and nationally co-ordinated system that is supported by improved technology. Development funding of €3.6 million and 43 additional staff have been provided for in the 2014 national service plan. The national control centre reconfiguration project is a key measure in this programme. The National Ambulance Service has traditionally operated in eight ambulance regions, with no inter-connection of radio and computer systems. This has delayed improvements in emergency response times, particularly at regional boundaries where the nearest ambulance may have been in the neighbouring region. The control centre project is moving to one national control system, on two sites, with significant investment in new voice, data and mapping technologies. This will allow the National Ambulance Service to deploy emergency resources more effectively and efficiently, regionally and nationally rather than within small geographic areas. The national centre will be located in Tallaght and Ballyshannon, with the project expected to be completed next year. I assure the House that the National Ambulance Service will continue to modernise and reconfigure its services to ensure emergency pre-hospital care is delivered in an appropriate and timely manner.

Mattie McGrath (Tipperary South, Independent)
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I shudder when I hear the word "reconfiguration". We have reconfigured. We lost our hospital in Cashel. We have a High Court agreement. The paramedics and staff are not resisting change. All they want is to be able to operate in the knowledge that they will not be blamed for any embarrassing or sad situations that might arise. I do not want to predict doom and gloom. When I hear all the lovely talk about "reconfiguration" - the Minister was prepared to read a statement about what might or will happen to the National Ambulance Service - I wonder what will happen when ambulances cannot get away from hospitals because there are no beds or trolleys to put people on, which is what happened at Our Lady of Lourdes Hospital in Drogheda. Does the Minister know what will happen to all the predictions regarding delivery, call-out and response times when an ambulance is held up for hours because the trolley the last patient was brought in on is being used in the hospital to accommodate that person due to a lack of trolleys? This is all poppycock. It is lovely in writing. It is lovely jargon for the Minister to read out and quote from. It is nice that it is dressed up in flowery language like "reconfiguration".

The bottom line is that we need a safe service. The people of Tipperary and elsewhere are entitled to such a service. They should not have to wait for periods of time that one might expect to have to wait for in a Third World country. We have to maintain this. Does the Minister have any respect for the High Court or Supreme Court judges? Does he have any respect for the agreements that were signed and organised by his colleague, the Minister, Deputy Noonan, when he served as Minister for Health? I ask the Minister to intervene in this matter by asking the National Ambulance Service to come up with proper management structures. He has mentioned figures for new ambulances and new recruits, but what about natural wastage? What about vehicles that are off the road because they have reached the end of their days? Is the Minister expecting the Civil Defence or the Red Cross to fall in here? Is he expecting people to use their own vehicles?

During a recent edition of "Prime Time", we heard about many cases of people who were beside hospitals in built-up areas but nevertheless had to wait nearly an hour for ambulances to arrive. This is not the fault of the paramedics. We do not have enough of them because they are being cut back, moved and downgraded. Blame is being placed on honourable people who are trained and abide by the hippocratic oath. They want to look after those who are in need, but they do not have the personnel or the ambulances to enable them to do so. The Minister spoke about new radios and everything else. That will not be much good to people when they are in the hills of Hollyford or Araglin, with an hour and a half of driving in between. I ask the Minister to sit up and see what is happening here. He needs to stop this situation from arising. He should not wait for the review, as it will be too late for people's lives.

James Reilly (Dublin North, Fine Gael)
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The Deputy is not too bad at the old flowery language himself. We need to stick to the facts. There has been a great deal of investment in the National Ambulance Service in recent years. We have not diminished the number of ambulances. In fact, we have added to that number by providing intermediate care vehicles and using different vehicles for inter-hospital transfers, which were mentioned by the Deputy. As a result of these measures, more ambulances are available for acute emergency care. I remind the House that despite this country's financial difficulty, this Government was the first to bring in an air ambulance service, which serves the area alluded to by Deputy McGrath. I know there were some reports and claims in local media earlier this year that ambulance services in Cashel were being downgraded. There is no downgrading of the ambulance service in Cashel.

Mattie McGrath (Tipperary South, Independent)
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So it is all imaginary.

James Reilly (Dublin North, Fine Gael)
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I did not interrupt the Deputy.

Mattie McGrath (Tipperary South, Independent)
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Are the staff imagining it?

Michael Kitt (Galway East, Fianna Fail)
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The Minister, without interruption.

Mattie McGrath (Tipperary South, Independent)
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What the Minister is saying is not true.

James Reilly (Dublin North, Fine Gael)
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The National Ambulance Service has advised that there was no removal of an ambulance at Cashel over the Christmas period in 2013. However, short-note absences such as sick leave resulted in reduced cover at the station on a couple of occasions.

Mattie McGrath (Tipperary South, Independent)
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The staff are being blamed again.

James Reilly (Dublin North, Fine Gael)
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I am setting out the facts. Some €129 million has been invested in our ambulance services. The service employs approximately 1,550 staff and uses more than 480 vehicles. The volume of calls has increased significantly in recent years. Some 229,703 calls, equating to an average of 19,142 a month, were made in 2012. That figure has increased to 296,730, which equates to a monthly average of almost 27,000 calls. When there is such a volume of calls, sadly there will occasionally be times when the targets cannot be met. It is a very serious situation for those people. The ambulance service is striving to ensure ambulances are available for the most serious calls to deal with those who are most in need. That remains the goal. As the Deputy knows, we have limited resources. We have invested in the ambulance service and we will continue to do so. I congratulate the men and women who work in our ambulance services on the great work they do.

Mattie McGrath (Tipperary South, Independent)
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I thank the Minister for that.

James Reilly (Dublin North, Fine Gael)
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I refer in particular to paramedics.

Mattie McGrath (Tipperary South, Independent)
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The Minister was blaming them a minute ago.

James Reilly (Dublin North, Fine Gael)
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This is not just about ambulances being available to people. It is more important that people are treated as quickly as possible. That is where the paramedics in the vehicles I mentioned, and the riders on the bikes, come in.