Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Last week, there was a special "Prime Time" programme on the ambulance service. It monitored various counties and also looked at ambulance response times in Dublin. The programme was shocking as it showed interviews of staff and family members who made 999 calls, some of whom received appalling responses.

For example, one man explained how he rang 999 as his father had chest pain. Even though they could see the Wexford hospital from their own home, the ambulance took more than 50 minutes to arrive and unfortunately his father passed away. This man could not understand why ambulance control did not explain that there would be a delay, as he would have been able to drive his father to the hospital within a few minutes. When he queried this afterwards, he was told that people were not normally told there would be delays unless they asked.

A whistleblower from the mid-west was interviewed. She said that ambulance crews from the mid-west were run ragged and "going without food for hours" trying to respond to patients because of a lack of ambulances. She is an emergency medical technician. She said: "There are still not enough vehicles to cover an emergency. If a plane crashed, there are definitely not enough ambulances for it." She also said: "The situation of late response times for ambulance call-outs in Limerick is serious. There wouldn't be a day that would go past that you wouldn't be stuck somewhere for an ambulance going 'Oh, God, we've no ambulances to send there'."

The Health Information and Quality Authority report published last week confirmed that ambulance calls continue to rise by about 10% per year.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

A question, please.

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Worryingly, it also found that staffing in some control centres fell below the required safe levels.

Does the Taoiseach accept that ambulance response times are far from acceptable? What does he intend to do to address this situation? Does he accept that it is time for a fundamental review of how the ambulance system in the country is organised to ensure proper and effective ambulance response times in all areas of the country, particularly in rural areas?

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

The ambulance service over the years has always been one where controversy has raised its head on many occasions. I recall being on a health board many years ago and the clapped-out ambulance vehicles in many cases were a source of constant engagement at the meetings.

Since 2011, there has been a major programme of change to reconfigure how pre-hospital emergency care services are managed and delivered. Last year, there were 280,776 calls, 14,000 more than in 2012, which is a significant number. In 2011, there were no targets set for ambulance response times. When the Minister, Deputy Reilly, was in charge he raised the bar for response times. For 2014, a new target has been set for 80% of life-threatening calls to be responded to in under 19 minutes. The 2013 target was for between 68% and 70%. For the first time now hospital turnaround data are being collated on a national basis, which is important. That will allow an assessment of performance in the handover of critically ill patients in the system as a whole, in the response times and in the collection times. That will obviously allow for determination as to how the system can be improved. I accept it is not perfect by any means.

The HSE has acknowledged that at times of high demand with the emergency care system there is clearly a potential for delays in the transfer of patients from ambulance to emergency department and this results in delays in the release of ambulances from emergency departments and reduces the availability of ambulances elsewhere. That is why a national collation system has now been put in place.

There has also been a whole new further set of details on the ambulance emergency department framework. That clarifies the process of clinical handover, establishing where are the lines of responsibility . There is a €5.4 million increase in the ambulance budget for next year, which I think everyone will welcome. There will be 50 replacement ambulances next year, which I think everyone will also welcome. The DELTA and ECHO response times are improving, but the HIQA report recognises that patient outcome is actually more important than response times. The clinical audit will begin next year for the first time.

It is an evolution to a point where national data are now being collated. We have increased investment in the provision of new ambulances and in the collation of the data. Most important of all is the health of the patient.

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Taoiseach needs to stop referring to things happening "for the first time" because that is the classical political response to very serious issues. The HIQA report was quite clear that over a ten-year period, there was very significant progress in the training of emergency medical technicians. The whole pre-ambulance care council and so forth which was established more than ten years ago changed dramatically what had been happening prior to then.

The key point is that the lack of any strategic planning is now evident. Something has gone fundamentally wrong with the reconfiguration. What is the response to that person in Wexford who was within eyesight of the hospital and yet it took 50 minutes for the ambulance to get there? There are probably Deputies in all parts of the House who can instance cases where the response times were simply too long. The money that has been allocated for replacement vehicles had to be allocated because the HIQA report revealed-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

A question, please.

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

-----that up to 47 vehicles were way beyond the seven years and 500,000 km criteria for emergency ambulances in the State.

They had long passed those criteria and still had not been replaced and will not be until next year. We welcome that fact, but it is too late and shows a lack of proactivity. The report, which backs up the "Prime Time" programme, says that EMPs are not being adequately trained, there is a lack of strategic planning, and quality assurance of clinical care is limited.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

We are over time. The Deputy should put his question.

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

It also strongly criticises the issue of ambulance capacity being lost due to the delay in handing over to accident and emergency departments. It is not just a question of saying that it is far from perfect. There are serious issues which are crying out to be addressed-----

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Yes, I know.

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

-----in terms of the reconfiguration and the move to centralisation. Would the Taoiseach accept that something has gone wrong concerning people's access to ambulances and the response times.

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Yes. I accept that it is not perfect and that there are serious issues, but they are being addressed by the Minister. I think the Deputy accepts that a €5.4 million increase in the ambulance budget next year is important. That is recognised by the Minister and it is now in place. Some 50 replacement ambulances will be provided. These are brand new ambulances. I had an opportunity quite recently to deal with a private company on the issue of a number of new ambulances and their facilities are absolutely first class.

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

But it is the public sector that should have them.

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Yes, I understand. The former Minister for Health, Deputy Reilly, brought in targets for the national ambulance service whereby, when a life-threatening condition occurs, a patient-carrying vehicle should be on the scene within 19 minutes for 80% of those calls. That does not actually deal with the problem, however.

Timmy Dooley (Clare, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Like most of the things he brought in.

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I will tell the Deputy why. Target times are only one element of an ambulance service. At present, if an ambulance responds in under 19 minutes to a call in respect of a life-threatening situation and the patient unfortunately passes away, that is recorded as an ambulance meeting its target. On the other hand, if an ambulance responds in 20 minutes to a call in respect of a life-threatening situation and the patient makes a full recovery, it is recorded as an ambulance missing its target. The determination of times, therefore, does not give a comprehensive response, although it is one element of it.

Timmy Dooley (Clare, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Whose fault is that?

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

The emergency aeromedical service support was a 12-month pilot project between the NAS and the Air Corps providing dedicated aeromedical support for the NAS in the west, specifically where roads were poor and land ambulance transit times were more severe. A review of that project found that a clinical need exists for the service.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

Thank you, Taoiseach. We are over time.

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

It recommended that it be established on a permanent basis. The 2015 HSE plan includes a specific target for turnover at hospitals for the first time, so that is an improvement. We also have an air ambulance for the midlands and the west, which is important. It is not perfect but the air ambulance for the midlands and west is now in situ, which is a big improvement in terms of access and travel times for hospitals.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Must our voiceless in care depend on whistleblowers, unannounced HIQA inspections and RTE's "Prime Time" programme to expose the wholly unacceptable behaviour of some who work in our care homes and facilities? I know at first hand the great work that so many employed in these settings perform. I have a brother with an intellectual disability in a HSE care home. This drip, drip exposé of dreadful behaviour by some must also deeply hurt those who are true carers in these settings.

For all concerned, but especially for those who cannot speak for themselves, like my brother, this behaviour must be rooted out once and for all. In the case of Áras Attracta, HIQA had inspected, made recommendations, returned and felt that all had been addressed. These inspections are not enough and we cannot depend on them alone. A special RTE documentary to be broadcast tonight showing the RTE investigations unit's examination of the standards of care in an Irish residential care facility for adults with intellectual disabilities will once again raise this issue. The focus of tonight's programme is bungalow 3 at the Áras Attracta care home in Swinford, County Mayo. It is now the subject of investigations by the HSE, HIQA and An Garda Síochána following this exposé. A litany of 19 issues have been raised by the RTE investigations unit.

That home is geographically close to the Taoiseach, but the issues being raised are always close to me and my family, and to all families of loved ones with intellectual challenges in such placements. It is imperative that these matters are addressed. Accordingly, what real steps are the Taoiseach, his Government colleagues and the HSE going to take to ensure that this particular problem that presents time after time, in one incident after another is substantively addressed once and for all?

Let us ensure that we are not looking at people starting to believe that we have a culture of abuse of our most vulnerable in such care settings. As a sibling of one who is so placed, I do not accept that there is such a culture. We run the risk of people believing that, however, if we fail to take appropriate action. What action do the Taoiseach and his Government intend taking?

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank Deputy Ó Caoláin for his question. I know that from his personal family circumstances he can empathise in a situation like this so much more deeply than others who may not have those particular family circumstances.

I was called about this last week by the Minister of State, Deputy Kathleen Lynch, and I took her call with a sense of dread and anger. I have since been briefed on it by the Minister for Health. I believe I speak for the whole country when I say that the idea that men and women with intellectual disabilities would be slapped or sat on - as I understand is shown in the footage of this programme - is utterly intolerable and unacceptable to us as a Government and as a people. Every person who uses our disability services is entitled to receive supports of the highest standards and to live in an atmosphere and environment of safety and care. There is no excuse - none whatever - for abuse or conduct in the circumstances that I understand have been outlined. I have not seen footage of the programme but I intend to watch it later on this evening or tomorrow morning.

The HSE alerted the Garda Síochána and HIQA immediately. In the interests of protecting residents and staff themselves, it put a number of staff off duty while the allegations are being investigated. I support the HSE's immediate initiation of an expert investigation into these serious allegations, which is chaired by Mr. Christy Lynch who is the CEO of KARE, whom the Deputy may know. He independently chaired the review of services provided at this facility, led by Dr. Kevin McCoy who is a former chief inspector of the Northern Ireland Social Services Inspectorate.

The director general of the HSE wrote to all the staff emphasising the serious responsibilities on them personally to ensure that individuals supported by the HSE in any setting are treated with respect and dignity. He also reminded them of their absolute duty to report incidents of maltreatment or poor practice concerning any person. As the Minister has said, the HSE is also planning to initiate its own undercover investigations into operations in HSE facilities to supplement the programme of inspections already in place. We had this before with Deputy O'Dowd a number of years ago in the Leas Cross situation.

The Minister has been fully briefed and has assured me that instructions have been given to the HSE to keep both himself and the Minister of State fully informed. I have also been assured that the HSE's priority is to protect the valued services that people residing in Áras Attracta receive as a critical support for them and their families.

I recall when this place was opened. As the Deputy rightly points out, there are many people who work in the health service who do an excellent job and provide a first-class service. This kind of activity does them down, ruins the reputation of health care workers and is an insult to the wider family of the persons involved. Let me assure the Deputy, the House and the families of those in Áras Attracta and elsewhere that the law will follow its course. HIQA, the HSE and the relevant Minister are fully involved in following through this, as are the Garda. It may well be that criminal charges may arise from this. That is a matter for the authorities involved.

There were 59 recommendations made in respect of the HIQA investigation into the facility and they have all been implemented. Two practice co-ordinators have been assigned to Áras Attracta, effective from 2 December 2014, reporting directly to the director of services and liaising with the national head of operations and service. I have provided the names of the investigators there and the assurance review team.

I know the facility, which is close to me. Unfortunately, this is another incident in a long line of incidents over the years. As the Minister indicated, the HSE will have its own undercover investigation team. RTE should be commended for the service it has carried out in this regard and I hope the investigations, when complete, will be followed through. There is no place in our society for this kind of conduct.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The Taoiseach has made the point about Áras Attracta and other settings. It is important as that is at the core of the issue and this is not only about Áras Attracta. This is not an isolated incident and there has been a range of other settings exposed for malpractice over these years. The critical matter is not just the address of the individual care home setting, there is a need for a root-and-branch re-examination of the level of training, management and oversight right across the board. That is what is required. As I have stated, I do not accept that everything is being done and steps must be taken.

I noted the commentary of Mr. Tony O'Brien, the director general of the HSE, with regard to wider use of undercover surveillance but that is such a reactive step under the assumption that things are wrong. We must take the required steps to ensure the highest standards are understood in the first instance and implemented by those we trust to look after those defenceless loved ones in our respective families. My brother is non-verbal and I can understand what was said by the sibling of one of those who will be most particularly focused upon in tonight's programme. These people are incapable of voicing or giving expression to whatever treatment they are being subjected to, and it is a terrible position and great fear for families, parents and siblings. They must know the truth of each day of their lives.

Mr. O'Brien's point is well taken but that is not the full answer. We must examine care settings right across the board and instill through retraining and uptraining the highest standards in the first instance of management and oversight in every care setting in the land. Will the Taoiseach take that on board?

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I will take it on board and the Deputy can rest assured that the Government will support the Minister, Deputy Varadkar, the Minister of State, Deputy Lynch, and the HSE in carrying out a proper evaluation of the entire process. The HIQA inspectorate and the HSE complaints are clearly inadequate in the case that has arisen in Áras Attracta. The first response was to the families directly affected by those persons with intellectual disability in the particular unit. All of the others were written to on 1 December and meetings were initiated with 56 other family groupings. They have all been offered meetings but some did not require a meeting, having been assured by telephone that the relevant family member was not in this specific unit.

I take the Deputy's point that there is no argument against this. It can be trying in many of these circumstances. The Deputy speaks from a fraternal perspective but I cannot speak in the same depth of understanding of what it means 24 hours a day. I assure the Deputy that having raised the matter, this is not acceptable under any circumstances. The analysis being carried out by the HSE, HIQA, the Minister and the Minister of State will have the support of the Government. The authorities are involved and the Garda are investigating the matter. It is one of a number of investigations which I expect to be carried through by the authorities.

The point made by the Deputy is a central issue, as this is probably not an individual or isolated case. We have seen similar cases in the past, and it is now a case of attempting to deal with the entirety of the issue in a way that stands up to the utmost scrutiny and standards. These particular and very special people and their families should be guaranteed to live in an environment of comfort, care and consideration, with those who serve them living up to the highest standards set by the principles of the HSE. I thank the Deputy for his question.

Mick Wallace (Wexford, Independent)
Link to this: Individually | In context | Oireachtas source

The Minister for Justice and Equality, Deputy Frances Fitzgerald, recently signed into law Part 3 of the Criminal Justice (Mutual Assistance) Act 2008. This refers to targeted surveillance, meaning the person or persons whose information is intercepted would be the subject of a particular criminal investigation, that the request shall be detailed and make a reasonable case for the necessity of the interception of information. The reality is very different. As was exposed by Mr. Edward Snowden recently, billions of Irish communications are being actively recorded and stored by the British GCHQ and shared with other intelligence agencies. They have tapped into a cable under the Irish Sea and it appears that Vodafone has been paid tens of millions of euro for facilitating the activity. This is nothing short of mass surveillance and the indiscriminate targeting of all citizens of this country, regardless of whether people are innocent or guilty. It seems people are now guilty until proven innocent.

It seems that in a world where everything is collected and monitored, anyone who challenges unjust laws will be silenced. This undermines democracy. There is no system of judicial oversight instituted by this legislation signed into law by the Minister. The Minister has given extraordinary powers that are not subject to scrutiny and there is a proposal to set up secret courts to deal with third party companies that do not comply with the Minister's orders, which is completely at odds with any notion of transparency and judicial oversight practices that would be regarded as essential for any country adhering to the UN convention on human rights.

Why does the Government feel it necessary to violate all notions of transparency with regard to this legislation? Will the Taoiseach indicate if the Government authorised the British monitoring of the undersea cables? If so, under what legislation was this done?

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank Deputy Wallace for his question. The Criminal Justice (Mutual Assistance) Act 2008 implements the EU Convention on Mutual Assistance in Criminal Matters between member states of the European Union of 2000. Part 3 of the 2008 Act deals with mutual assistance regarding requests to or from EU member states for assistance in the interception of telecommunications. The recent decision by the Minister to commence Part 3 of the 2008 Act arises from an obligation under the Treaty of Lisbon whereby the State would be in breach of its obligations to fully implement the provisions of the EU Convention on Mutual Assistance in criminal matters by 1 December this year. An EU convention is at issue, and this mirrors arrangements in other EU countries. Accordingly, it is open to the Garda in Ireland to request similar assistance from other EU member states if it is deemed appropriate.

The convention applies only to criminal matters. It does not apply to intelligence gathering. Essentially, where a lawful interception order is in place in one EU in relation to the investigation of serious crime, it can be given effect in another country upon request in accordance with the domestic law implementing the convention. In Ireland, the arrangements in place will reflect the provision of the Interception of Postal Packets and Telecommunications Messages (Regulation) Act 1993. That includes oversight by a designated High Court judge. The provision relating to in camerahearings arises because it would not be appropriate in open court to disclose who might be the subject of an interception order in the investigation of serious crime.

I cannot comment on the allegation of wholesale interception of Irish telephone calls by Britain. That is a matter on which I will come back to the Deputy in the context of the Department of Foreign Affairs and Trade and the Department of Justice and Equality. I do not have the answer here.

Mick Wallace (Wexford, Independent)
Link to this: Individually | In context | Oireachtas source

I am disappointed the Taoiseach does not know whether we have illegally authorised the monitoring of the sea cable. I am sure the Taoiseach is aware that in April of this year, the European Court of Justice ruled in favour of Digital Rights Ireland and declared the European directive on data retention invalid owing to its serious interference with private life and freedom of expression, thus violating the European Charter of Fundamental Rights. The Taoiseach said we are signing up to a commitment made under the Lisbon treaty but Part 3 is part of an Act introduced in 2008 and things have moved on since then. The fact that Digital Rights Ireland won that case this year changes the goalposts a good bit. It is now possible that we may be breaking different rules in Europe by signing up to this. What assessment of the 2008 law was done following the judgment in Digital Rights Ireland's European Court of Justice case to ensure that the law is in compliance with the European Charter of Fundamental Rights?

We have a serious problem with mass surveillance. Recently, the US was found guilty of spying on Petrobras, the Brazilian oil company, an economic summit, the IMF, the World Bank and the international credit card system, all to gain economic advantage in international competitiveness.

I refer to the type of industries around information which have set up in Ireland. The idea that GCHQ is tapping into cables and getting all the information it wants and sharing it with whoever it wants around the planet should worry the Government.

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I saw the media reports that GCHQ in the UK was tapping into undersea communications cables. The media reports actually suggest that if such surveillance is being carried out, it is being carried out within the UK's own jurisdiction. Each country makes its own arrangements to have a capacity to intercept communications but I would expect that any such surveillance by any country would have to have a proper legal basis and that the interference is proportionate to the aim for which it is intended. As the Deputy pointed out, there would be understandable concern if the general principle of the privacy of communications was not being respected.

The need for the protection of people from terrorists and other criminal threats is acknowledged but the point must be made that it is necessary to ensure that the information is properly obtained and subject to appropriate safeguards, in particular in those cases. I would expect that the UK would follow these principles as well.

This matter is being investigated by the European Commission. As I said, these matters are governed by legislation in this jurisdiction and there is no question of any form of mass surveillance here. Furthermore, the relevant legislation is overseen by a designated judge of the High Court and the reports are laid before both Houses of the Oireachtas. Ireland will reiterate its belief at international fora and elsewhere that the principles I just mentioned are adhered to.

The story was based primarily on the grounds that if there had been any tapping or interception of these undersea cables, it occurred outside our jurisdiction. While the article did not specifically address that issue, any tapping or interception of these communications would likely have occurred within the jurisdiction of the UK and would presumably be covered by EU law.

As the Deputy knows, these communications cables are owed by commercial companies. Irish companies, such as Eircom, have an interest in some of the cables. The report goes on to say that the Irish owned cables in question, including those which link Ireland with the US and Canada, are routed through the UK. The matter is being investigated by the Commission. There is no question of mass surveillance here and the collection of any such data would have to be in accordance with the legislation laid down, which, in our case, is overseen by a High Court judge. The reports are laid before both Houses of the Oireachtas.