Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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58. To ask the Minister for Health the steps he is taking to address the seriously inadequate ambulance provision, on standby and in service, in County Monaghan and in counties Cavan, Louth and Meath generally; if he accepts that, despite this Deputy highlighting to him in advance the serious lack of ambulance cover across these counties over the Christmas-new year period, there was a total failure on his part and on the part of the ambulance service to act; and if he will make a statement on the matter. [4081/16]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I seek to establish the steps the Minister has taken and intends taking to address the inadequate ambulance provision covering my home county of Monaghan and the neighbouring counties of Cavan, Louth and Meath and to highlight to him once again the questionable practice of extending significant leave to important emergency care providers over the Christmas-new year period with inadequate cover to cater to the population of these counties.

Leo Varadkar (Dublin West, Fine Gael)
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Over the past few years, the national ambulance service, NAS, has undertaken significant reconfiguration and modernisation of its services. It now operates on a national and regional rather than a local basis. Ambulance resources, including rapid response vehicles with advanced paramedics, are dynamically deployed over an area from individual stations within, and surrounding, that area. This helps to ensure optimum cover is provided and that the NAS is best placed to respond to calls as they arise. I understand that the capacity review has been completed and will inform how NAS deploys resources across specific areas.

Across the north Leinster area, dynamic cover is currently provided from stations in Monaghan, Castleblayney, Cavan, Virginia, Dundalk, Ardee, Drogheda, Navan, Trim and Dunshaughlin. In the event of a high volume of emergency ambulance calls in the north east area, the NAS may seek assistance, if necessary, from colleagues in the Northern Ireland ambulance service. There has been considerable investment in new technology which ensures the nearest available and appropriate resource is dispatched to an incident.

I am aware that concerns were raised prior to the Christmas and new year period regarding the level of cover which would be available in the area, given the number of staff who had announced annual leave around the holiday period. However, the NAS has advised that leave arrangements for the period were finalised in the normal fashion and that an appropriate level of cover was provided during that period.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I will rely on the facts relating to a case to demonstrate the problem. A constituent has outlined his experience having become ill at home with severe chest pains during Christmas week. Having suffering a previous attack, he called the ambulance service at approximately 8.45 p.m. and was answered promptly by a call attender. The call attender took details and advised that an ambulance was en routefrom the Castleblayney area. However, the ambulance was subsequently diverted to another urgent call in the Castleblayney area. The call attender attempted to contact doctor-on-call but to no avail and there was no ambulance available in the Monaghan town, Cavan Louth or Meath areas. Despite the call attender's best efforts, including requesting an ambulance from Northern Ireland, his efforts had no success. He continued to stay on the phone for almost two hours with the gentleman who had had the cardiac experience giving advice, keeping him calm and providing updates on ambulance availability.

Eventually, an ambulance arrived from Manorhamilton, County Leitrim, at 11.15 p.m. and brought the patient to Cavan for treatment.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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He wishes to record, in the strongest possible terms, his complaint about the non-availability of an ambulance for two-and-a-half hours on that night. He also wishes to record that there were two ambulances parked at the Monaghan ambulance station base - which is located less than three miles from his home - during the period in question. Those are the consequences of the situation that I highlighted prior to Christmas. That is a factual case on which I can share the details with the Minister. I ask the Minister, in these closing hours of the current Dáil, to highlight this situation to the National Ambulance Office. What happened is absolutely unacceptable. I ask that the Minister do as I have requested and that he and his colleague, in whatever elected roles they hold after the upcoming general election, use their voices to lobby the next Government - regardless of its configuration - for change. Communities depend on the ambulance service and there is an inadequate level of cover at present.

Leo Varadkar (Dublin West, Fine Gael)
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The Deputy will know that I cannot comment on individual cases. I was not given prior notification that the Deputy would raise this individual case but, certainly, if he wants to give me the details, I will have the position checked by the National Ambulance Service. It is important to point out that there has been a significant increase in investment in the ambulance service in recent years. The budget will increase by €7 million this year and it increased by €5 million last year. We now have the emergency air ambulance service, which did not exist until this Government came to office. We have the rapid response vehicles which take paramedics to people's homes. We are moving away from an ambulance service that is just about transporting people to hospital to one which ensures that they are given emergency treatment by paramedics both in their homes and at the roadside. That is a major improvement. We have also opened the new national emergency operation centre, NEOC, in Tallaght and we are increasing investment in community first response teams. Therefore, there is a big programme of reform, investment, change and improvement under way in our ambulance service. That will continue. No matter what role, if any, I hold in the next Dáil, the Deputy may rest assured that I will continue to take an interest in ambulance services. If I ever get time off, one thing I would love to do is retrain in advanced cardiac life support, ACLS, and advanced trauma life support, ATLS, and perhaps I can actually become a community first responder myself.

Leo Varadkar (Dublin West, Fine Gael)
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It is the case that a great deal more must be done. I accept that we need to improve our ambulance response times. As individuals who could potentially be the next Minister for Health, I say to Deputies Ó Caoláin and Kelleher that they should be careful about what they promise. It will never be possible to have an ambulance, a squad car and a fire engine at every crossroads in every village in every small town. There will always be instances when these emergency vehicles do not arrive as soon as we would wish.

Leo Varadkar (Dublin West, Fine Gael)
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We need to be honest with people about that.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Absolutely. Honesty is critically important. The very fact that the Minister is indicating a commitment to ensure that the current provision is significantly enhanced is a statement of recognition that there has been inadequate cover during this considerable period of years. Communities such as mine that have lost all of their acute hospital services with the transfer of same from Monaghan Hospital to Cavan General Hospital. Other hospital facilities across the region are totally dependent on the ambulance service in terms of emergency situations relating to road traffic accidents, RTAs, cardiac arrests, stroke victims or whatever is the case. We were promised that there would be significant ambulance cover - that is, appropriate ambulance cover - but that has not been the case. For whatever short period after the advent of the construction of the new station, there was a presence. However, this has been watered down significantly over the period and shared, I understand, with the north Louth area in the context of Castleblayney. It is hugely important to ensure that - not only in the area I know best but throughout the length and breadth of this State - the requisite number of ambulances and staff are provided in order to guarantee full cover at all times. That matter must be a priority and it is one I will be happy to pursue, regardless of whether I am in government or in opposition, after the election.

Leo Varadkar (Dublin West, Fine Gael)
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I reiterate that an additional €7.2 million - this is an increase on outturn - is being provided in the budget for the ambulance services in 2016.

That includes €2 million to recruit and train extra staff and also to expand the community first responder scheme. The National Ambulance Service has recently completed a national recruitment campaign and is commencing an international recruitment campaign for qualified paramedics. The number of paramedics in training more than trebled in 2015 and the additional funding provided in 2016 should provide for further increases. It is important to note the latter on the Dáil record. Last year, 63 ambulances were replaced or refurbished and one new rapid response vehicle was provided at a cost of over €9 million. The investment in this regard will be doubled to €18 million in the current year.