Séamus Kirk (Louth, Fianna Fail)
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I thank the office of the Ceann Comhairle for selecting this most important topical issue. Yesterday, the Health Information and Quality Authority, HIQA, review of pre-hospital care emergency services was published. While there have been many positive developments in our ambulance services in the past ten years, the HIQA review of pre-hospital care emergency services is a cause for great concern. It found that the National Ambulance Service, and many hospitals, struggle to routinely meet their targets. Additionally, it found a lack of effective leadership, clear strategic planning and ongoing constructive co-operation between management and staff in the National Ambulance Service. This must be acted on with the greatest urgency.

Alarmingly, the report tells us that a number of staff reported that they did not have appropriate technical knowledge for their positions. HIQA also says it is unacceptable that, owing to the lack of clinical audit in the National Ambulance Service, quality assurance of clinical care is very limited, especially for staff who have completed training.

The review also highlights the deficiencies in dispatch and response. Three different computer-aided dispatch systems were in use at the time of HIQA's review. Those systems are not integrated, which means the National Ambulance Service continues to operate as six different services within defined geographical areas rather than as one national entity. That means there appears to be limited visibility of ambulance resources outside the geographically defined areas.

The most disquieting finding is that there is a lack of effective leadership, clear strategic planning and ongoing constructive co-operation between the management and staff of the National Ambulance Service.

This must be acted on with the greatest urgency. It is alarming that a number of staff reported that they did not have the appropriate training knowledge.

The disjointed relationship between the National Ambulance Service and the Dublin Fire Brigade is also highlighted in the review. Both bodies should move swiftly to publish the joint action plans that HIQA is recommending.

It is clear there is a need for more resources in our ambulance services, just as it is clear that there is a need to better manage those resources. The Government must act on the former and the National Ambulance Service must act on the latter. It seems from the reports today that the HSE has admitted that urgently needed improvements to the ambulance service will have to be delayed because of a lack of resources. The HSE is indicating now that longer target response times may be introduced for ambulances in rural areas compared to those operating in cities.

With regard to first responders, the National Ambulance Service seeks to have one on the scene of an emergency call within seven minutes and 59 seconds in at least 75% of cases. The best monthly results for ECHO calls involving immediately life-threatening cardiac and respiratory arrest was 58%. The best result for DELTA calls involving other life-threatening situations was 34%, just over one in three.

HIQA says that the National Ambulance Service demonstrated consistent underperformance in the efficiency of call taking and the processing of emergency calls. That has contributed to poor response times to ECHO and DELTA calls.

I am glad the Minister for Health is in the House to take this important item. What action does the Government plan to take in light of this report?

Leo Varadkar (Dublin West, Fine Gael)
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I very much welcome the HIQA report on the ambulance service, which was requested by my predecessor, the former Minister, Deputy Reilly, some time ago. The report provides us with an opportunity to reflect on the progress made in pre-hospital emergency services and to acknowledge the challenges and opportunities ahead.

I am aware there are shortcomings in the current service provision. However, I assure the House that I am committed to improving services and performance.

The National Ambulance Service is modernising and reconfiguring its services so they are delivered in an appropriate and timely manner. A significant reform programme is under way for a clinically driven, nationally co-ordinated system supported by improved technology.

The emergency services have come a long way in recent years, from providing basic care and transport to advanced and sophisticated treatment for people in crisis. While the report confirms that we are on the right path in terms of service reform, it also sets out much of what remains to be done. Many issues identified in the report have been dealt with or are prioritised to be dealt with in 2015. A key component of reform of the ambulance service is the single national control centre in Tallaght, with backup in Ballyshannon. This will be completed in 2015 and, with the single computer aided dispatch system, provide the opportunity to further improve call taking and dispatching.

With the recent transfer of the Limerick control centre to the national platform, call taking and dispatch functions are now separated in all National Ambulance Service control rooms. The ambulance turnaround framework, to address ambulance delays at hospitals, is being implemented. The national service plan provides for 47 new ambulances next year. In addition, the 50 plus intermediate care vehicles are doing a lot of the work that previously fell to be done by the emergency fleet.

The HIQA report highlights a lack of clinical audit in the National Ambulance Service and this is of great concern. However, I am pleased that funding is provided in the 2015 service plan to initiate effective clinical auditing for the first time. Funding is also provided to expand the number of community first responders and to go a long way towards ending on call in the west.

While an extra €5.4 million has been provided for the National Ambulance Service in 2015, it is not all about resources. One of the most valuable matters identified in the HIQA report is how much more could be done with current resources. An example is dynamic dispatch. Too many ambulances spend too much time waiting in fire stations, ambulance control centres or at hospitals when they could be dynamically dispatched like so many other fleets. From where ambulance calls are going to come is predictable; they rarely come from next door to the ambulance station. We must examine alternative models of care, given that every patient who calls an ambulance does not need one and certainly does not need to go to an accident and emergency unit. In many countries, as little as 60% of the people who call an ambulance are taken to an accident and emergency unit.

The report is particularly critical of the relationship between the National Ambulance Service and Dublin Fire Brigade. This is a long-standing issue which has not been addressed to date. The HIQA report, with the awaited capacity and Dublin ambulance review, will give us a clear evidence base to finally establish a fully integrated service in the Dublin area. When we have the reports, I will consider them and request the HSE to prepare an action plan which I will bring to the Government. Taking the findings of the three reviews together, we will develop a comprehensive and coherent response. My Department will work with the HSE to ensure the development of an action plan, with timelines, to realise a new vision for ambulance services in Ireland.

Séamus Kirk (Louth, Fianna Fail)
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Every month the HSE management data report provides figures for the percentages of incidents responded to by a patient-carrying vehicle in 18 minutes and 59 seconds or less. It does not supply figures for first responders. Can we see the figures published on a monthly basis?

Leo Varadkar (Dublin West, Fine Gael)
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I am not sure if the figures are calculated or available, but I will look into the matter. I am not sure if the Deputy has had a chance to read the report from cover to cover, but, for anyone who has, it is abundantly clear that an overemphasis on crude response times is not a good idea. In other parts of the world overemphasis on response times has caused ambulance services to pull out of rural areas because the times set were not achievable. This effectively handed services over to helicopters, which is not the right or the best thing to do. We must be careful, therefore, about how we address the issue of response times. The Deputy knows rural Ireland well and that a call time of less than eight minutes would be very difficult to achieve in many parts of the country, short of having an ambulance in every parish or firm. We want to move towards a clinical audit to actually find out what happens to patients. Where someone is not reached by an ambulance in eight minutes and 30 seconds, he or she may be defibrillated, intubated and recover in hospital. That is considered to be a failure, yet someone could be reached within three or four minutes and die in the ambulance, but it is considered a success, which is absurd. That is why we must move towards having a proper clinical audit to find out exactly what happens to patients from the time they call a ambulance to the time they reach the hospital. I am glad that we are moving towards a clinical audit for the first time in 2015. The Dublin Fire Service does some of this work already.