Colm Keaveney (Galway East, Fianna Fail)
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I thank the Minister of State, Deputy Kathleen Lynch, for coming to the House to listen to my concerns. I am sure she will appreciate the considerable level of concern and disquiet at national and, in particular, regional level about ambulance response times and follow-up capital investment for ambulance services in the west. She should be concerned because a recent HSE report clearly outlines that the ambulance service in the west is not performing well and that its response times are considerably out of kilter with those in other regions and international norms.

I ask the Minister of State to accept that there is a need to accelerate investment in the ambulance service in the western region which is quite large in geographical terms. The population of the region is entitled to expect adequate ambulance response times. The Minister of State will recall that the closure of the accident and emergency unit at Roscommon County Hospital was sold to us on the basis of significant investment in the ambulance service and the emergency medical technicians who provide it. I take the opportunity to acknowledge the dedication, commitment and, above all, actions of these staff. However, I request that the Minister of State consider the state of the vehicles they are obliged to use for their work. In the context of the HSE's recent figures for response times relating to clinical status 1 - echo - I also request her to investigate their capacity to operate properly. I do not wish to bamboozle people by using terms such as "echo", "bravo", etc. Suffice it to say that when someone suffers a heart attack, he or she wants to know that staff driving the vehicle with the blue lights on top will be able to get there, assist and transport him or her to hospital. The response times in Tuam and Roscommon are a source of great concern and significantly out of step with those which obtain elsewhere.

One of the underlying aspects of the support requested from the House in accepting the need to close the accident and emergency unit at Roscommon was that a world-class standard would come into being in the case of ambulance response times.

The situation is even worse for clinical status 1, which is when the service is in life-saving mode for cardiac arrest, respiratory emergencies and so on. The trip from Galway to Tuam on a blue light can take up to one hour. There is a brand new facility lying idle in Tuam but there has never been the required investment in human resources to cover what they now call in Tuam and Roscommon the Bermuda Triangle. We have no idea where the ambulance is.

I call on the Minister of State to cast her mind back to the "Prime Time" programme that investigated the matter. The Minister of State might remember the National Ambulance Service representative who said that the service did not have the people or the vehicles to meet the targets and that it was time for the National Ambulance Service to accept that the targets were unrealistic unless the cuts were reversed. Will the Minister of State make a statement with respect to my observations? Then in my two-minute slot subsequently I will introduce some of the statistical details of the report of the Minister of State on response times.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising the matter and I am pleased to be able to outline some of the current developments in pre-hospital service in the region. The National Ambulance Service is working to ensure the provision of high quality and timely emergency pre-hospital care services, using all available resources as efficiently and effectively 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. It is important to acknowledge that progress is being made. The single national control system due for completion in 2015 will improve our control and dispatch performance. We are continuing to develop the intermediate care service, ICS, which transports patients between facilities, allowing emergency vehicles to focus on emergency calls. The ICS now carries three quarters of the non-emergency workload. We are also moving to more efficient on-duty rostering and to develop a national rostering system. I gather this is what the Deputy was referring to in respect of the "Prime Time" programme.

The emergency aeromedical service is operated from Athlone by the Air Corps and staffed by National Ambulance Service advanced paramedics. The EAS provides swift transfers of seriously ill or injured patients to appropriate hospitals. I fully accept that we need to drive further improvement; no one is denying that. Two national reviews are under way for a better service for patients. This country is difficult to compare with other areas because our geographic spread is different.

The Health Information and Quality Authority's governance review is examining how the NAS can develop and benchmark its services with modern outcome and indicator data. The NAS has commissioned an independent capacity review to determine current and future service needs. Among the areas being examined are staff numbers and skill mix as well as resource locations. Given its rural nature and road network, the western area provides a challenge for targeted response times for pre-hospital emergency care. The NAS recognises this and has undertaken specific measures to meet this challenge. The ICS has been rolled out in the west, including at Castlebar, Sligo and Galway. Almost 50 intermediate care operatives are now in place in the west.

There have been over 700 EAS completed missions since June 2012. One third of these have been ST-segment elevation myocardial infarction heart attacks, allowing these patients to be treated in a specialist setting within 90 minutes of diagnosis. Most of these occurred in west and northwest. I know this to be true because it happened to a friend of mine recently. This development allows ambulance crews to remain in their areas in the west, ready to respond to any other emergency calls. Additional advanced paramedics have been trained throughout the west, with the objective that each station will have an AP and to ensure the spread of APs throughout the region. Castlebar control will be integrated into Ballyshannon in order that crews can be dispatched throughout the region more efficiently and deployed across regional boundaries, as required.

The NAS is moving towards a more dynamic and tactical model of service delivery. The current model, where ambulances remain at a single station, will change to a model in which they are deployed from a central location and move to several sites during a shift rather than remaining at a single point until required. This will ensure greater geographical cover as well as improved response times and patient outcomes. I am confident that these reforms and reviews will lead to improvements in pre-hospital emergency care services to the benefit of people living in the west. Having said that, I agree with the Deputy that there is more to be done.

Colm Keaveney (Galway East, Fianna Fail)
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I am pleased the Minister of State acknowledges that there is more to be done. I imagine the Minister of State is aware that there are over 84 vehicles in the National Ambulance Service that have approximately 350,000 km clocked up on their odometers. When making comparisons we should not suggest that the geography presents a unique challenge. Let us compare the region to Scotland, which has a comparable challenge in terms of population, rural isolation and connectivity. Given its geographic area Scotland is approximately as challenging as the region I live in. For example, Scotland has a comparable volume of call-outs. However, it spends twice the budget. It has a significant cohort of staff, far in excess of our National Ambulance Service. I call on the Minister of State to come back to us in future and to be prepared to examine where we are going to go in this budget in respect of the recruitment of emergency medical technicians. I call on the Minister of State to follow through with the strategic plan that, we understood, was to be rolled out in what is called the Bermuda Triangle, comprising the area from Tuam to Boyle to Castlerea. I call on the Minister of State to map out a specific element of understanding of what is required to follow through with the commitments given by the Government. There was one broken promise when the Roscommon accident and emergency unit closed, but the second broken promise was that the Government did not follow up and invest in response times, emergency medical technician staffing, ambulance bases and a modern fleet worthy of the citizens in the area. The people there have a high expectation and believe the vehicles should be up to standard.

I intend to come back to discuss the matter with the Minister of State again. It is something that we must work on together. We are entitled to the best of public service investment and we want to see an emergency response unit as part of our ambulance service that is fit-for-purpose.

Kathleen Lynch (Cork North Central, Labour)
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The recent referendum in Scotland highlighted many things, one of which was that the investment in individual citizens in Scotland is approximately five times more than the corresponding figure in either Wales or certain parts of England. We are not comparing like with like. We do not have the luxury of allocating funds to a greater degree to one area over another.

The NAS has sought funding for 2015 to facilitate an improvement in the ambulance service in the west and to meet capacity and HIQA review recommendations. Funding to the value of approximately €1.2 million is required to staff ambulance stations in Tuam and Mulranny on a 24 hour, seven day basis. In addition, approximately €1.7 million is required to eliminate on-call in the west. Conversion of the vacated Garda station to an ambulance station in Loughglinn, County Roscommon, has commenced and will be completed in a few weeks time. That should answer some of the Deputy's concerns.