John Lyons (Dublin North West, Labour)
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In the short time available to me I wish to speak about the valuable service provided by Dublin Fire Brigade in our capital city and the ongoing review of ambulance services. Dublin Fire Brigade and Ambulance Service has operated since 1898. Dublin Fire Brigade performs a dual role, which means that either an ambulance or a crew on a fire appliance will arrive at a scene and stabilise a patient until an ambulance arrives. As a result of this dual role and the brave work of fire fighters, Dublin has one of the best survival rates for out-of-hospital cardiac arrest cases in the world. Dublin Fire Brigade is a first class example of a fire service based emergency medical service, which is recognised internationally as best practice.

This model is used in many cities throughout Europe, such as Paris, Dusseldorf and Frankfurt, and also in cities such as New York and Detroit in the United States of America.

At present, the HSE pays about €9 million for the Dublin Fire Brigade to deliver this vital service for the capital city. This amounts to less than 7% of the total national budget for ambulance services, even though Dublin Fire Brigade responds to almost 40% of ambulance calls nationally.

As a Dublin TD, I have been contacted by many fellow citizens from all sides and staff of the fire services, including those I know personally, about the HSE plan from March 2013 and the current joint review of Dublin ambulance services by Dublin City Council and the HSE. This HSE plan from last year, details of which were revealed in The Irish Timesrecently, includes plans to take control of the Dublin ambulance service from Dublin Fire Brigade by the end of 2015. There are concerns among firefighters that the review that is currently under way will recommend this plan and not consider the exemplary service provide by the Dublin Fire Brigade, which I mentioned already.

I am out of time. I value the Dublin Fire Brigade service and the ambulance service that it offers, and anybody who lives in Dublin or receives its services will be aware that it is the best service in the country. The level of ambulance service that the Dublin Fire Brigade provides is where the bar should be set for all ambulance services throughout the country.

As a citizen, I am fearful of any changes to the way the ambulance service is run nationally and fearful of the prospect of its being taken into the control of the HSE. I note that Swords is covered by the Dublin Fire Brigade as well. I am merely concerned that the bar set by Dublin Fire Brigade in running the ambulance service in Dublin will be jeopardised and I ask that this be acknowledged in any review that is carried out. It is the only ambulance service, I believe, that almost reaches the HIQA standards even though it is not obliged to abide by them. I am aware that another Member is speaking on this, so I will leave it at that.

Billy Kelleher (Cork North Central, Fianna Fail)
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I welcome the opportunity to speak on this issue.

When one looks at the leaked report that broke over St. Patrick's weekend regarding the HSE's plans to take control of Dublin's ambulance service from the fire brigade, it prompts two questions: the key question of why, and whether it is the right direction to take.

According to the report, the HSE is seeking to remove the emergency ambulance provision from the Dublin Fire Brigade because of two key points - a lack of HIQA oversight, and cost. The difficulty my party has with this is that the report was carried out by the HSE itself. That the HSE is the one drawing up the report would indicate that it may at least be partisan or biased on this issue. I would suggest that there be an independent assessment of whether this is the right action.

As Deputy Lyons pointed out, nobody complains to us - and I am quite sure nobody complains to the Minister - about the ambulance service being provided through the Dublin Fire Brigade. It is one of the most efficient in the country. If one looks at the basic cost analysis and breakdown, they seem to be cost-efficient.

I am concerned that a service that is working reasonably well is being taken over by an organisation whose ambulance service nationally is not working well. There have been the most catastrophic incidents throughout the country, with wheels falling off ambulances, children being locked in ambulances, delays, ambulances being dispatched to the wrong county, and an incident in which a person was taken from county to county after breaking their leg at a football match in Carlow, so that by the time they ended up in hospital they had been throughout the south east.

There are inherent difficulties. I note the Minister has acknowledged that and requested that HIQA carry out a full audit, but in the meantime the least the Dublin Fire Brigade deserves is an independent assessment of the service it provides. By and large, as Deputy Lyons highlighted, the vast majority of the people of Dublin are satisfied with the service provided by the fire brigade. I would ask that the Minister request independent audit and verification as opposed to relying on the HSE to carry out a cost analysis.

Regarding oversight, I am quite definite that this could be addressed with regard to HIQA through legislation or even a statutory instrument.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputies for raising this matter, which has been the subject of some speculation recently, and I welcome this opportunity to clarify the matter for the House.

Dublin Fire Brigade provides emergency ambulance services in Dublin city and county by arrangement between Dublin City Council and the HSE. The HSE National Ambulance Service also provides some emergency capacity in the greater Dublin area, as well as non-emergency patient transport.

The ongoing development of pre-hospital emergency care involves a range of initiatives, including the development of a single national control and dispatch system. The new national system will deploy all emergency ambulance resources in the State, including emergency ambulances, rapid response and intermediate care vehicles, first responders and aeromedical services, as well as ambulances in Dublin. This move to a single dispatch system will represent a significant change in clinical governance, as Dublin Fire Brigade currently dispatches its own ambulances. The Dublin city manager and the HSE's chief operating officer have, therefore, commissioned a joint review of Dublin Fire Brigade ambulance services in Dublin city and county. I hope Deputy Kelleher heard that bit.

Billy Kelleher (Cork North Central, Fianna Fail)
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I did.

James Reilly (Dublin North, Fine Gael)
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It is not merely a HSE review.

Billy Kelleher (Cork North Central, Fianna Fail)
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I note that.

James Reilly (Dublin North, Fine Gael)
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The review will consider all aspects of ambulance operations provided by the Dublin Fire Brigade in Dublin, including the capacity and capability of ambulance services. This will inform consideration of the optimal and best-value model for provision of emergency medical services in Dublin. It is part of the process of ensuring a clinically driven, nationally co-ordinated system supported by improved technology so that emergency pre-hospital care can continue to be modernised and services can be delivered in an appropriate and timely manner to the benefit of patients.

I am aware that concerns have been raised about this review, with suggestions being made that it should be suspended or cancelled entirely, and that there is no necessity for a review as the Dublin Fire Brigade ambulance service is operating in a fully satisfactory fashion. I want to assure the House that I am fully aware and appreciative of the excellent historical tradition of service provided to the citizens of Dublin by the Dublin Fire Brigade and, in fact, due to my previous life as a GP in north Dublin, I myself can attest to that. This review should not in any way be interpreted as a criticism of that service. We are obliged, however, to ensure that pre-hospital emergency care across the entire country is ready to meet the challenges of the future. This review is being carried out with that in mind, and I look forward to the outcome of the process.

John Lyons (Dublin North West, Labour)
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I appreciate the Minister's comments.

Unlike a lot of Deputies, I do not go running around the House shouting concern too often, but on this matter I genuinely feel concerned. I am concerned that we are going to throw the baby out with the bathwater here. Dublin Fire Brigade, as I stated already, is the most impressive and exemplary fire service in the country, operating a fantastic, efficient and cost-effective ambulance service for Dublin city - the one that every other citizen in this country should have. I am just a little concerned, to say the least, that any plans for the HSE to be involved in running this service will throw the baby out with the bathwater. I ask that all that can be done is done and that the voices of the Dublin Fire Brigade officers and ambulance officers, who are joint officers, are heard properly, but, most importantly, that the baby not be thrown out with the bathwater. I really do have concerns. As somebody who may need that service in the future, I have complete confidence in Dublin Fire Brigade's delivery of it. Unfortunately, the stories I hear from other places - I have a brother who is in the National Ambulance Service - are a little daunting. I want everybody to have the best service, and Dublin Fire Brigade offers the best service.

Billy Kelleher (Cork North Central, Fianna Fail)
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I concur with Deputy Lyons.

I accept the veracity of the Minister's statement that the review is not a criticism of the service provided by Dublin Fire Brigade. I also note that it is the Dublin city manager, in conjunction with the HSE, who is carrying out this report. It is not that I would question anybody's integrity in this issue, but there should at least be an independent evaluation. Who is to say that the Dublin city manager or Dublin City Council would not encourage a hiving off of the service to some other organisation? The least it deserves is an independent assessment.

The cost breakdown suggests that the Dublin Fire Brigade provides an exceptionally efficient service. When one looks at the difficulties and the complaints nationally, one can see that most of the complaints derive from outside of Dublin. Maybe the Minister should look at that as well. All I ask is that there be an independent assessment of whether moving the Dublin Fire Brigade ambulance service to the HSE would make any difference or would compromise or enhance the service. That would be useful. In general, people have not expressed any complaints about the service.

The issue of HIQA oversight is a red herring. The Dublin Fire Brigade already subscribes to that in its commitment to providing a service.

With a tweaking of legislative proposals or statutory instruments, Dublin Fire Brigade could be brought within HIQA oversight in meeting HIQA guidelines.

James Reilly (Dublin North, Fine Gael)
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I understand the concern of the Deputy about what is an excellent service and anything he construes as impairing it. Far from it; this is designed to improve the service. It may transpire that the report will make unexpected findings which Deputies in this House are presupposing. It is not fair to compare an urban service like the one in Dublin with rural services in the light of the distances that must be travelled, the number of hospitals available and the density of population. A review is taking place and let us await its outcome. We will revisit the issue at that point and give everyone in the House the opportunity to engage. The ambulance service in Dublin is a critical part of infrastructural services within the city and has a long and proud tradition. I do not want to see anything interfering with this. I am a believer in not accepting the status quo if something can be improved and there is no service that cannot be improved. There is unanimity on this point. It is an excellent service which has nothing to fear from a review other than seeing how we can improve it further. Therefore, let us not prejudge the outcome.