Barry Cowen (Laois-Offaly, Fianna Fail)
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103. To ask the Minister for Health his plans for a safer ambulance service; and if he will make a statement on the matter. [14875/14]

Clare Daly (Dublin North, Socialist Party)
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104. To ask the Minister for Health if he will order a fully independent national capacity review of the ambulance service throughout the country [14912/14]

Barry Cowen (Laois-Offaly, Fianna Fail)
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My question predates last week's "Prime Time" programme on the ambulance service. It was timely and reiterated many of the feelings which have been expressed on both sides of the House on the efforts of those at the coalface to deal with the lack of resources and equipment. How does the Minister intend to improve the service and make it safer? It is not safe currently notwithstanding the fantastic efforts of those at the coalface.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy for his question and, in particular, for acknowledging the great work done by front-line staff in our ambulance service. Every day across the State, our paramedics attend to an average of 769 patients. The workforce includes approximately 1,700 people, including national ambulance service paramedics and the Dublin Fire Brigade ambulance service. The Government is committed to improving our ambulance service and ambulance response times. I am prioritising the ambulance service despite shrinking budgets. I will not go back into why we have shrinking budgets, Deputy Kelleher. We all know why.

Billy Kelleher (Cork North Central, Fianna Fail)
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Could the Minister elaborate? He might as well.

Barry Cowen (Laois-Offaly, Fianna Fail)
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He might as well press the mantra button again.

James Reilly (Dublin North, Fine Gael)
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It was the little fiscal fiasco the Deputies' Government left us to deal with. We had to get our financial sovereignty back. Those little issues are important to the ordinary man and woman in the street as they seek to get re-employed having been put out of work by the Deputies' Government.

Barry Cowen (Laois-Offaly, Fianna Fail)
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Paddy likes to know, is it?

James Reilly (Dublin North, Fine Gael)
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This year, we are spending €146.9 million on the ambulance service, which is 6% more than two years ago. This year, the ambulance fleet stands at 534 vehicles, including national ambulance service emergency ambulances, rapid response and intermediate care vehicles, motorbikes and Dublin Fire Brigade ambulances. That is 77 more than four years ago when the Deputies opposite were in Government.

Billy Kelleher (Cork North Central, Fianna Fail)
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On your bike, Minister.

Dara Calleary (Mayo, Fianna Fail)
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That is great if they are parked up at the manager's house.

James Reilly (Dublin North, Fine Gael)
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It is 77 more, Dara.

Dara Calleary (Mayo, Fianna Fail)
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They are all parked up at managers' houses.

Finian McGrath (Dublin North Central, Independent)
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There are 15,000 waiting for speech and language assessment. Answer that one.

James Reilly (Dublin North, Fine Gael)
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The Deputies are all welcome to Question Time.

Last year, our ambulance service responded to 280,776 emergency calls, which was almost 14,000 more calls than in the previous year.

Barry Cowen (Laois-Offaly, Fianna Fail)
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Everything is grand.

James Reilly (Dublin North, Fine Gael)
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Despite the steepest health cutbacks in the history of the State, we are spending more money and attending to more patients and, crucially, more life threatening emergency calls in under 19 minutes than in previous years.

While we are making progress, I acknowledge that we have more work to do. Nobody should wait on the side of the road with a loved one in their hour of need, fearful of whether an ambulance will arrive in time. I am determined to make further progress in order that all our citizens have access to the efficient, modern ambulance service that they deserve, regardless of where they live.

This year, to drive improvements in response times, the national service plan sets a new target of having 80% of life threatening calls responded to within 19 minutes. Last year's target was between 68% and 70%. It should come as no surprise to learn that a target was not in place when the Government took office. To achieve this year's target I am continuing to prioritise ambulance services, despite shrinking budgets. Additional funding of €3.6 million and an additional 43 staff have been provided.

We are also making better use of our ambulance fleet. We are increasing non-emergency vehicles to transport patients between hospitals, thus allowing our ambulances to focus on life threatening emergencies. Last year, 25 intermediate care vehicles were added to the fleet and this year the intermediate care service will take on more work and more staff will join the service. On-call working is also being eliminated to improve response times. This means paramedics no longer respond from their homes during a shift but are based in their vehicles or bases, ready to be dispatched on emergency calls. We are rationalising control rooms in one resilient national system in line with best practice. This process will be completed next year.

I am putting the ambulance service under the spotlight as never before, with three separate reviews under way. The aim of these reviews is clear - to improve our ambulance service. The Health Information and Quality Authority has brought forward a planned review of the national ambulance service, which has now begun. The review will examine how we assess the performance of our service and it is anticipated that it will recommend taking response times and patient outcomes into account. The review will be completed by the end of the year.

Dara Calleary (Mayo, Fianna Fail)
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That is approximately as long as it takes some ambulances to arrive.

James Reilly (Dublin North, Fine Gael)
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The outcome for the patient is more important than the time required for the ambulance to arrive.

Billy Kelleher (Cork North Central, Fianna Fail)
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There is a correlation between the ambulance response time and the patient's outcome.

James Reilly (Dublin North, Fine Gael)
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Deputy Calleary appears to hold the view that the operation can be a success, even if the patient dies.

Additional information not given on the floor of the House

An independent capacity analysis of the national ambulance service conducted by the UK Association of Ambulance Chief Executives will be completed this autumn. This will compare resources to demand and activity levels nationwide.

The Health Service Executive and Dublin City Council commissioned a joint review of the Dublin Fire Brigade emergency service to determine the best model for emergency care provision in Dublin. The final report of the review is expected this summer. It would be premature to speculate on what effect the outcome of the review may have on any future arrangements between the HSE and Dublin Fire Brigade.

Barry Cowen (Laois-Offaly, Fianna Fail)
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Having listened to the Minister, I am fearful that the position may be graver than I had thought. Is the Minister prepared to acknowledge that one third of those in life threatening circumstances waited too long for an ambulance to arrive last year? Is the gravity of the situation such that he is prepared to wait until the end of the year for a review on foot of which he will decide what action to take? Will he give a commitment to expedite matters by having an independent review and assessment carried out and a report presented to the House within one month? Will he acknowledge that he must make the ambulance service safer, resource it properly and facilitate those on the coalface who are doing a job in difficult circumstances?

People will not listen when the Minister cites statistics to show he is addressing the problem. He has not done anything to make the job of ambulance service staff easier. Despite many Deputies on all sides and ambulance service staff and their representatives highlighting problems in the service, it took RTE to broadcast a programme on the issue last week before the Minister acknowledged the difficulties in the ambulance service. I have not seen the Government take any action to address the issue. Perhaps the Minister will acknowledge the severity of the problem by strengthening the position of those who have been given the authority to carry out the review. The report should be furnished sooner than the end of the year.

Clare Daly (Dublin North, Socialist Party)
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The Minister's denial of the problem is frightening and runs counter to the direct experience of citizens and the facts unearthed by the "Prime Time" programme broadcast last week. The issue I raise predates the "Prime Time" programme and must be viewed in the context of the leaked document on the future of the Dublin ambulance service as well as rumours that responsibility for the service is to be removed from the fire brigade. Before any decision is taken on the Dublin ambulance service, an examination of the national ambulance service must be undertaken. Despite response times in Dublin being much better than elsewhere in the country, it is proposed to replace the current model operating in Dublin with the dysfunctional model being operated elsewhere. I support the call made by SIPTU and others to scrap the review being carried out by the Health Service Executive and Dublin City Council and replace it with a full independent national capacity review of the ambulance service. Such a review is critical.

James Reilly (Dublin North, Fine Gael)
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To respond to Deputy Cowen, who clearly does not want to listen, I believe people will listen. As I stated, nobody denies that the ambulance service needs to improve and that reviews are required to inform such improvement. I look forward to the Health Information and Quality Authority report. All Deputies will acknowledge that HIQA is an independent regulator and has always acted independently. I have no reason to believe it will act differently in this instance.

To respond to Deputy Daly's comments on the ambulance service provided by Dublin Fire Brigade, I ask her and others not to prejudge the outcome of the review. Let us await the report and have the debate at that point.