Michael Kitt (Galway East, Fianna Fail)
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I thank the Minister for Health for attending. There has been a long campaign for an ambulance service in north Galway and I was one of several representatives who organised a campaign petitioning to have an ambulance base located in Tuam to serve north Galway-south Mayo. We expected a 24-hour service but what we received is a day service that is not fully operational. There is not even a timetable available for the ambulance base. On the one hand, we are told there is an embargo on recruitment and on the other, we are told that there are staff willing to transfer to Tuam to provide the service and we are still waiting.

There is a new building in place and people are very anxious to have a service there. Great work is being done by the Order of Malta but the Minister probably understands that traffic to and from Galway city where the ambulances come from is a huge issue. We do not have adequate staffing or vehicles, there are over 30,000 people in the catchment area and €2 million has already been spent on the building. I know other centres are looking for funding but I make the point that trade unions have been fighting the cause of the people and there are very well-qualified personnel. Many of the staff trained in St. Brigid's Hospital in Ballinasloe. We are still using Galway city as a base even though we have bases in Loughrea and Carraroe in west Galway. Traffic is a huge issue. We are waiting for work on the new Gort-Tuam motorway to start. There seems to be some delay in getting it started. Given that work has not started, traffic will be a huge issue and there will be delays in Tuam and south Mayo, which we hope will be served by the base. I hope the Minister can give us some indication as to how the base in Tuam will proceed.

Éamon Ó Cuív (Galway West, Fianna Fail)
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When I was a Minister, we recognised that the more isolated rural areas were unlikely to ever get an ambulance service adjacent to them. The Minister would appreciate far more than me the rule about the golden hour. As a result, we decided to grant aid through the Order of Malta and the Red Cross the purchase of voluntary ambulances. Local people did all the necessary training up to the standards laid down to become voluntary ambulance workers. We had a very good ambulance service in places like Carna, Leenane and Clonbur in my own area but also around the country. We had ambulances in place anywhere a local community was willing to commit to this service. They were available on call-out. It meant that times getting to incidents were vastly reduced.

It was with great shock that I found out recently that the ambulance service of the HSE has claimed that these people who are trained to the national standard and have the qualifications laid down by the Pre-Hospital Emergency Care Council are not considered sufficiently trained to continue to provide this service. My understanding is that there are four levels of qualified staff - emergency first responder, emergency medical technician, paramedics and advanced paramedics. I understand that the HSE's argument is that these people are not trained paramedics. It is strange that they are allowed to attend football matches gratis and any other event and that if a person has a heart attack there, there is no problem with putting them in the ambulance. However, they cannot do a call-out in our area and we must wait for an hour, an hour and a half or two hours for a first call. An ambulance could be sitting within ten to 15 minutes of the person affected but according to some bizarre rule, they cannot get that ambulance to provide the service.

I presume the Minister was not aware of this. I would not expect him to know every detail of every decision made by the HSE. However, this issue is worthy of an investigation. Perhaps in his reply, the Minister could commit to coming back having investigated the basis for this decision.

Denis Naughten (Roscommon-South Leitrim, Independent)
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I compliment Una Smith and the "Prime Time" team for exposing the reality of what is happening at the coalface in our ambulance service. We have wonderful staff working in appalling conditions. I want to bring the Minister back to something he said in the House on 30 June 2011 when he stood up and promised the people of Roscommon that they would have additional ambulances. He stated:

The service was to be supplemented by an additional ambulance so there would be four ambulances covering Roscommon during the day and three at night. I can guarantee that. There will be extra paramedics available with a car to provide cover if all the ambulances are out of Roscommon at any given time. These are services that I can control and which I will deliver.

Instead of addressing this issue, the intention is to spread these limited resources over an even wider area with one of the Roscommon town ambulances now to be relocated to Loughglynn to provide a badly needed service to the people of west Roscommon and east Mayo. We have already seen the loss of one of our ambulances servicing the county in Ballinasloe which has been re-located to Tuam for three days a week. Yes, we have a great air ambulance service, which is to be welcomed, but people get heart attacks and strokes at night and the only way the ambulance can be called in is if the paramedic calls it.

We have three nationally recognised ambulance black spots, all of which happen to be in the west of Ireland - Mulranny in Mayo, Tuam in Galway and west Roscommon-east Mayo. The Government is spending €1.2 million on the Tuam base, €470,000 on the Mulranny base and €70,000 on the Loughglynn base with no ambulances and no additional staffing being made available to service those stations.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputies opposite. We covered this area last week in the Chamber and again yesterday at Question Time. I understand that in different parts of the country, different concerns are raised but I welcome the opportunity to outline again the current position relating to our pre-hospital emergency care services.

The National Ambulance Service, NAS, is working to ensure the provision of high quality and timely emergency pre-hospital care services using all available resources as effectively and as efficiently as possible. As with any pre-hospital service, development and modernisation is an ongoing process as technology and clinical standards change. A significant reform programme is under way and additional funding of €3.6 million and 43 staff have been provided in the 2014 national service plan. I believe it is important that we acknowledge that progress is being made.

New governance arrangements are being put in place to ensure the timely assessment, diagnosis, initial management and transport of acutely ill patients to appropriate care. A joint review of Dublin ambulance services, commissioned by Dublin City Council and the HSE, will determine the best model of ambulance services for the city, although I know this does not concern any of the Deputies here. In addition, an independent review of the NAS capacity nationwide will determine the level and use of resources required in terms of staff, vehicles, skills and distribution, for a safe and effective service now and into the future. I am confident that the reports of these reviews will inform the development of a modem, clinically-driven system, properly resourced, for appropriate and timely services to the benefit of patients.

Deputy Kitt raises the issue of services in north Galway and south Mayo. The national capacity review, as well as the HIQA review, will be of importance in the context of the development of services outside the main urban areas and, in particular, the western area which, because of its rural nature and road network, provides a particular challenge for response time targets. The counties in question benefit from the Emergency Aeromedical Support, EAS, service. This service provides rapid air transport of seriously ill or injured patients to an acute facility, where the land transit time would not be clinically advisable. The EAS has completed 556 missions since its inception in June 2012 to February 2014. The Irish Coast Guard also performed over 300 helicopter missions in support of the NAS in 2013 and will continue to do so in 2014.

I would like to assure the House that the NAS will continue to modernise and reconfigure its services to deliver timely and appropriate emergency pre-hospital care. The ongoing reform programme will provide a clinically driven, nationally co-ordinated system, supported by improved technology.

Deputy Ó Cuív's commented on the golden hour but things have moved on in that regard. The critical period now is 90 minutes for somebody with an acute myocardial infarction or a heart attack which requires a bypass, which is now done through stenting. All patients going to the relevant centres can avail of this and the outcomes have been hugely improved for people who suffer heart attacks. There have also been huge improvements in the numbers of stroke patients who receive thrombolysis, the blood clot busting agent, which relieves their symptoms, saving at least a life a week and preventing three people per week from going into long-term care. We have gone from the bottom of the list in Europe for such procedures to the very top in a very short timeframe of 18 months.

Michael Kitt (Galway East, Fianna Fail)
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As the Minister said with regard to Tuam, the traffic situation on the Galway Road is very serious and presents a huge challenge when ambulances have to be called from outside the town. In reference to HIQA, the health correspondent of the Irish Independent, Ms Eilish O'Regan, wrote recently about HIQA conducting a six-month review of the ambulance service. I would hope that the review could be done very quickly because the situation is urgent. I was hoping a start would be made on the new road from Gort to Tuam but there seems to be some delay in that. The contracts were to be signed last week. We have very good staff who I know get good training and I have no issue with the equipment or the ambulances themselves. That said, there is a worrying rise in the number of incidents of serious delays in terms of response times. This has been highlighted by the National Ambulance Service Representative Association. I hope the situation can be improved. I believe a national control centre is to be put in place and steps are being taken in that regard. Above all, however, where a building is available, it should be staffed, training should be provided and the ambulances should be put in place. I hope that can be done quickly in the case of Tuam.

Éamon Ó Cuív (Galway West, Fianna Fail)
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I am delighted to hear about the extended time to an hour and a half but with most of the places to which I refer, an hour and a half would get one there but would not get one back again. I am talking about places where it would take an ambulance well over two hours and up to three hours to get out and get back. The local ambulance, on the other hand, is run on a voluntary basis by people who work to serve their communities and who have huge dedication. They are fully qualified and have received training from organisations like the Red Cross and the Order of Malta, which adhere to very high standards. No explanation has been given as to why they can transport patients who were injured at sports events and so forth but cannot pick people up who need to be brought to hospital. Perhaps the Minister would inquire into this matter because we are always talking about communities helping themselves in this country but it seems that often, when they do, they are rocked back by some rules that come out of the blue and for which there seems to be very little justification.

Denis Naughten (Roscommon-South Leitrim, Independent)
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We were told on the "Prime Time" programme by Martin Dunne, the head of the ambulance service, that we are providing an excellent service to everybody in the west. Along with the north east of the country, we have the worst response times. We have the biggest number of dropped shifts, which means a loss of ambulances. Bizarrely, we also have the biggest underspend on overtime. The only places where there are overtime underspends are the west, the north east and the east, based on the first nine months of last year. That does not include the scheduled overtime cuts that are taking place, with no cover for annual or long-term leave. It is all well and good that we have fabulous uniforms but we do not have ambulances or ambulance staff. I could not care less if the ambulance crews come to us with the knees out of their uniforms if we actually have ambulances and ambulance staff. That has to be the priority. I urge the Minister to directly intervene in this regard. I know the Minister has taken a huge interest in it and has demanded that HIQA comes forward with its report. We need ambulances and staff now. I ask the Minister to direct the National Ambulance Service to put ambulances and staff into the three bases referred to, the only three nationally recognised ambulance black spots of Mulranny, Tuam and west Roscommon. We need those additional services now.

James Reilly (Dublin North, Fine Gael)
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It is important to make it clear, in the short time I have, that nobody who works in the ambulance service believes it cannot be improved - it can be and it will be. The real issue here, which Deputy Ó Cuív alluded to, is the time to care. That is why the early responder and pre-hospital emergency care advance paramedics are so important. That feeds into the Deputy's other concern regarding the Order of Malta and others, who are not trained to deal with people in the same way as the advanced paramedics are trained, which is why they cannot be used in as open a fashion as the Deputy might like. That is not in any way to denigrate the people concerned and we certainly need to look into the issue raised by the Deputy to determine how we can best use the resources available. There must be cases which would be suitable for the Order of Malta to transport - patients who are not acutely ill but who, nonetheless, need to go to hospital. However, I do not think we would want them to be looking after someone who has had an acute heart attack, without the ability to canulate the patient and so forth, or other situations which require the specialist expertise of the advanced paramedic.

In 2013, the HSE target for carrying vehicles to respond within 19 minutes was 70% for echo calls and 68% for delta calls, both of which are life-threatening. For 2014, the target for both call types has been increased to 80%.

There has been in excess of a 1,000% per month increase in ambulance call-outs and this has placed a strain on the service. None the less, they are only 1% and 2% behind those rates this year. The Government has increased spending on the ambulance service both this year and last year. While there was a reduction in the number of ambulance vehicles per sefor carrying patients, there are more of them available to do that job now because we have increased the number of vehicles to transfer patients between hospitals, thus freeing up those as well as the number of cars and motorbikes.

We are making improvements, although I can understand that there is room for more. We plan to make more improvements as time goes by. We want people to be reassured that they are able to obtain acute care when they need it. We fully realise and understand also that there are isolated areas with poor roads that are very difficult to access. We will continue to strive to achieve that, however. Mr. Dunne was alluding to the fact that our vehicles are of the highest specification and that our staff are trained to the highest level. Those matters are important. The crucial thing is that ambulances can get to the patient who needs them on time.

Denis Naughten (Roscommon-South Leitrim, Independent)
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They need to respond at all stages.