Derek Keating (Dublin Mid West, Fine Gael)
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I thank the Ceann Comhairle for giving me the opportunity to raise this issue and I also thank the Minister of State at the Department of Health, Deputy Kathleen Lynch, for her attention.

The Dublin Fire Brigade ambulance service is one of the oldest in the world. In 1899, the service dealt with approximately 520 calls but today it deals with approximately 80,000 incidents annually. The Dublin Fire Brigade ambulance service has an added advantage when attending emergency incidents. Where necessary, a fire tender or other specialist vehicle may also be deployed to an incident. Each fire tender has fully trained paramedics who are often the first on `the scene in the case of ECHO or DELTA calls and act as first responders. In many instances, the fire crews initiate first interventions which aid in reducing time to defibrillation and resuscitation as well as reducing on-scene time and ensuring good patient handling and removal. Fire crews are particularly good at patient handling. They take a full-team approach at road traffic collisions and are vital in the stabilisation, immobilisation and management of spinal injury patients and their removal to hospital.

Dublin Fire Brigade has a duty under section 25 of the Fire Services Act to take charge of major or complex incidents. Its ambulance crews can be deployed in high-risk situations involving chemical, fire or other serious incidents where it may not be possible to deploy other services such as the HSE ambulance service. In the event of an emergency incident at Dublin Airport or at Dublin Port, for example, the local authority is responsible under the emergency framework for providing fire and rescue services. The best resource available to provide this incident cover is the Dublin Fire Brigade integrated fire and ambulance service. Its integrated control room has a pivotal role to play in providing the cover needed for such events. An added bonus of the combined fire and emergency medical service is the extra equipment available to crews to ensure scene safety and to extract entrapped patients.

If Dublin Fire Brigade becomes just a fire and non-medical emergency service, vital life-saving services will be lost. If it loses its ability to dispatch integrated emergency medical services, lives will be put at risk. Fire services in the United Kingdom are moving towards an integrated service, combining or co-locating fire and emergency medical services.

Dublin Fire Brigade is contracted to supply 11 ambulances to the Dublin area and handles approximately 80,000 incidents per annum. The National Ambulance Service is supposed to be the first responder in the Tallaght and Swords areas but it usually does not have an ambulance available for these areas. The National Ambulance Service regularly does not have an ambulance on duty in certain areas because if crew members are unavailable for any reason, they are not replaced, as was highlighted on "Prime Time" recently.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising this issue and giving me the opportunity to update the House on the proposed changes to Dublin ambulance services. Historically, the Dublin emergency ambulance service has been provided by Dublin Fire Brigade, DFB. The National Ambulance Service, NAS, supports the DFB as required. However, HIQA published a report last December which identified serious patient safety concerns with regard to the lack of co-ordination between the NAS and the DFB. The urgent need to address these issues was stressed, particularly for 999 call-taking and ambulance dispatch, as well as overall clinical governance.

Following discussions, the HSE and Dublin City Council have agreed in principle to address the identified weaknesses through the provision of a single point of contact for all emergency calls in Dublin. Under the agreement reached, all 999 and 112 ambulance calls for the Dublin region will be routed through the national emergency operations centre in Tallaght, and all ambulances, regardless of whether they are DFB or NAS, will be dispatched from Tallaght. In addition, clinical governance of Dublin ambulance services will become the responsibility of the NAS medical director.

The new arrangements will mean that people in Dublin will get a better ambulance service that will be safer. Currently, where the DFB does not have an ambulance available, it may or may not pass the call to the NAS. Passing calls between call centres is not without risks. Calls can be delayed or, worse, missed. The people of Dublin can also look forward to a more responsive service, as all ambulances will be dispatched from Tallaght. The dispatcher will be able to see every available ambulance in the region. The nearest available ambulance, regardless of whether it is NAS or DFB, will be sent to the incident. The clinical governance changes will mean that patients will receive exactly the same level of care no matter which ambulance arrives.

I am aware that concerns have been expressed in the media about a takeover by the NAS of Dublin ambulance services. I can assure the House that claims of a takeover are wide of the mark. The proposed changes will not impact on the delivery of services. The DFB will continue to provide ambulance services in Dublin. Only the structures around clinical governance of the service and call management will change.

The DFB has provided very well for the emergency needs of Dublin since 1898, as the Deputy outlined. However, no health service can afford to stand still. A single contact and dispatch point for emergency ambulance calls is needed to address the safety issues raised by HIQA. I am delighted, therefore, to note that agreement in principle has now been reached with the unions on the integration of emergency ambulance call taking and dispatch. It has also been agreed that the DFB will continue to be fully involved in emergency ambulance service delivery and there will be no diminution in such services. I understand that a joint forum within Dublin City Council, which will include management and union representatives, is to be established to address issues regarding the control centre reconfiguration. That is a very welcome development and will ensure that the people of Dublin get the ambulance service they deserve.

Derek Keating (Dublin Mid West, Fine Gael)
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I thank the Minister of State for her reply and take special note of the fact that the new arrangements mean that the people of Dublin will get a better ambulance service. She made reference to delays, which are clearly a resource issue. It is my understanding that the DFB was allocated one additional ambulance during a period of approximately 20 years. I may stand corrected, but that is my understanding. The population has increased and the numbers of calls has increased exponentially without a corresponding increase in required resources. The broader problem is that while these arguments rage, lives can often be put at risk. It is my understanding that both the DFB and the NAS are committed to their respective roles.

I welcome the recent announcement by the Dublin city manager that a forum will be created to discuss these issues. Many welcomed the statement by the Minister for Health recently in which he committed to discussion on this matter. It is important to take into account the views of stakeholders, the workforce, service users and, of course, the citizens of Dublin. These views need to be gauged before any step is taken.

The truth needs to be made clear. We should not throw the baby out with the bathwater. After all, 80% of DFB ambulance responses are within the HIQA standard of seven minutes and 59 seconds. We should not overlook that. It is likely that it is one of the best performers in the country. The response time, supplemented by the ability to dispatch a fire attender fully staffed by paramedics, is not something we can lightly afford to lose.

Kathleen Lynch (Cork North Central, Labour)
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I should have declared an interest when I first stood up. One of my sons-in-law works in the fire service in another part of the country. I know from listening to him and from news reports that there is often a need for both services to attend, depending on the circumstances. In a major accident, it might be necessary to use equipment that paramedics in an ambulance service would not necessarily have.

In respect of ambulance time response, be it the DFB or the NAS, I often wonder whether we are setting the bar too high, because there can be circumstances in which ambulances cannot possibly meet the timeframe set for them. I know that to someone waiting for an ambulance, including someone in a support role, the time taken for the ambulance to arrive can often seem to be an awful lot longer than it is. We would all like ambulances and the services we require to be there instantly, but that is not always possible.

There is a positive outcome to the ongoing discussions within the forum in Dublin City Council. I believe the need for both services cannot be underestimated, but it is important that these services comply in respect of the safety concerns highlighted by HIQA. I am not sure whether anyone who has ever waited for an ambulance or any of the emergency services worries about which one of them gets there first, provided someone does get there and those who get there have the competence and training to deliver what the patient needs. I thank the Deputy for raising the issue.