Dáil debates
Thursday, 13 October 2016
Topical Issue Debate
Ambulance Service
5:10 pm
Michael Harty (Clare, Independent)
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I wish to speak about the review of the national ambulance service in the mid-west. This will include a review of our rapid response units. We in the mid-west are very concerned that these rapid response units will be withdrawn. Six or seven years ago, the services in the mid-west were reconfigured and acute casualties services were withdrawn from the hospitals in Ennis and Nenagh and transferred to the regional hospital in Limerick. In response to this, it was decided to introduce a rapid response unit staffed by advanced paramedics.
They look after patients in their homes or at the roadside and provide urgent casualty services prior to transferring them to hospital. They were intended to make up for the lack of casualty services in Ennis and Nenagh hospitals. Unfortunately, in the reconfiguration of hospital services in the mid-west, additional services and beds were not provided in University Hospital Limerick. Consequently, there is a huge trolley crisis at the hospital which is experiencing a huge bed shortage. If the acute paramedic rapid response units are withdrawn, it will be a further blow to medical services in the mid-west. It will be a breach of trust and faith with patients and the population of the mid-west, which is approximately 440,000. Following the review of the ambulance service and the rapid response units, in particular, they need to be maintained or increased but certainly not decreased.
The services the rapid response vehicles provide are essential. Paramedics provide a triage service at the site of accidents or for someone with a serious illness; they can call in the helicopter service and stream patients to the most appropriate location, either by ambulance or helicopter to Galway, Limerick or Cork, depending on the illness or injury the person has suffered. This is an important service which is much valued by the community. It has become embedded in the acute services provided in the mid-west.
The out-of-hours services provided by Shannondoc co-operative will be reduced in the near future because there is a lack of GPs in rural Ireland. This is a major problem facing the health service. The Committee on the Future of Healthcare and the Joint Committee on Health have discussed how staff can be recruited and retained, but how can doctors be expected to work and live in a rural community which has no services? No doctor, no village means no medical service. If the Government continues to erode community services which has been happening for the past few years, we will end up with an unsustainable service. Community services need to be bolstered, which means more GPs are required. Urgent response units also need to be added.
The National Ambulance Service is creaking at the seams. A huge geographical area needs to be covered. I mean no disrespect to ambulance staff because they cannot cope because of the area they have to cover. There are significant delays in ambulances arriving. The rapid response unit is an intermediary which supplies essential services in the mid-west. If the review recommends the removal of, or a reduction in, that service, it will be extremely detrimental to the health of people living in counties Clare and Tipperary.
5:20 pm
Catherine Byrne (Dublin South Central, Fine Gael)
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I thank the Deputy for raising this issue. Unfortunately, the Minster for Health cannot be present and he has asked me to take this matter on his behalf.
I welcome the opportunity to address the House on a matter which has been the subject of speculation recently. The National Ambulance Service has undergone a significant process of modernisation in recent years and a number of key reform targets have been reached. They include the establishment of the national emergency operations centre; the delivery of improved technology to improve response times; the development of the intermediate care service to provide lower acuity hospital transfers, thereby freeing up more emergency ambulances to respond to more urgent calls; and the establishment of a permanent emergency aero-medical support service to provide rapid access to appropriate treatment for high acuity patients in remote rural areas where access by land ambulances may be difficult.
In the context of the ongoing process of reform and modernisation, the National Ambulance Service continually reviews its operations to ensure the most efficient service can be delivered to the public. To this end, a local review is under way in the mid-west which is focusing on the use of a specific rapid response vehicle in the region. The available data suggest more efficient use could be made of this vehicle in the context of available resources.
Contrary to recent media speculation, there is no question but that the service in the area will not be diminished. In fact, the purpose of the review is to ensure the people of the mid-west will receive the best service possible within available resources. The Minister has been advised that the outcome of the review will be subject to full discussion at national level and that service delivery and enhancement will be an integral part of the discussions.
The reform programme is taking place against the backdrop of the HIQA review of ambulance services which was published in late 2014 and the National Ambulance Service capacity review which was published earlier this year. The capacity review which was undertaken by Lightfoot Solutions, a UK-based consultancy firm, examined overall ambulance resource levels and distribution against demand and activity levels. The review found that the National Ambulance Service was presented with a major challenge compared to ambulance services elsewhere, as population density in Ireland is significantly different from that in many other countries. Outside the greater Dublin area, the population is widely dispersed, with a relatively large population living in rural areas. This means that response time targets are much more difficult to achieve because of longer driving distances. The report endorses the existing policy of dynamic deployment, whereby vehicles are strategically located where they are most likely to be required, rather than statically deployed, that is, located at a particular station. It is in this context that the review in the mid-west is taking place. The review is fully in line with the National Ambulance Service's key priority to ensure the deployment of the most appropriate resource quickly and efficiently. By optimising operational performance, we are seeking to ensure better outcomes for patients.
Michael Harty (Clare, Independent)
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Nobody understands better population density in rural areas which is not the same as in Dublin. Therefore, ambulance response times cannot be the same as they are expected to be in Dublin, but that aspect does not concern us; what concerns us is the rapid response vehicles dispatched to the site of seriously ill patients. Many patients who require an ambulance do not require a blue light service and can wait for a reasonable period. I am referring to the rapid response units that attend seriously ill, traumatised patients involved in road traffic accidents and coastal fall incidents who require urgent medical attention. Such a service is needed because of population density and the size of the area covered in west Clare and County Tipperary. Casualty services were removed from Ennis and Nenagh hospitals. While a helicopter service is available to transfer seriously ill patients, it can only be called by an advanced paramedic. It is essential that the rapid response service be maintained and bolstered because those living in rural Ireland should be entitled to the same services as those living in urban areas. We pay the same taxes and should have the same service. We understand we cannot have a casualty department at every crossroads, but the rapid response unit was intended to make up for the withdrawal of casualty services, with services now being provided 60 miles away. I ask the Minister of State to ensure there will be no reduction in the number of rapid response units.
Catherine Byrne (Dublin South Central, Fine Gael)
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I do not question the Deputy's knowledge of rural Ireland and the distance between locations and hope he did not take offence at some of my remarks. I understand his concerns, particularly as we live in a country with many roads and access is not what it should be for ambulances in rural areas. The rapid response service plays a huge part in attending to ill patients throughout the country. The diminution of the service would be a major disadvantage to people living in rural areas. I will convey the Deputy's concerns to the Minister and assure him that the Minister is very much aware of them. I will reiterate them when I meet him during the week.