Pat Deering (Carlow-Kilkenny, Fine Gael)
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I thank the Ceann Comhairle's office for selecting this very important issue which relates to the ambulance base in Carlow town. Carlow town has a population of approximately 23,500. The total population of the county is around 55,000. The ambulance base has been located in the grounds of the former mental hospital in Carlow, St. Dympna's, for the past few years. It has 15 rostered paramedics, five advanced and ten ordinary. The base is one of the busiest in the south east. The structure itself is a prefabricated building which has been in place for the past 15 years. In the past while, however, the structure has become totally outdated. There are issues with sewage and vermin, there is no running hot water and there is no place for the paramedics to make a cup of tea. The base is used 24 hours a day, seven days a week, but is totally unsuitable. Paramedics who are on a shift from 7 a.m to 7 p.m., for example, and who are back at the base in Carlow, cannot even make a cup of tea. If they get soiled while on duty, there is nowhere for them to have a shower or change their clothes.

Last October, I was given a written guarantee by the authorities regarding the base. In a letter from the HSE, I was assured that a logistics and estates manager was involved in ongoing discussions with the HSE's estates section with the aim of identifying a suitable alternative site or suitable accommodation within the St. Dympna's campus as a matter of priority. The campus at St. Dympna's is huge with a lot of available space. However, as and from Monday morning next, the paramedics who work out the Carlow base are being moved to Kilkenny. It is totally unacceptable to expect paramedics in a town the size of Carlow to work out of Kilkenny. There should be an alternative site in Carlow made available to them. I was also told that work was ongoing to provide an alternative and upgrade the existing structure.

If this work is going to be done, why not move the personnel to another part of the Carlow base?

I have two questions for the Minister of State, whom I thank for being here. Can she assure me that the base in Carlow will be maintained after this work has been completed? It is essential that the Carlow base is maintained and I want an assurance to that effect. There are serious concerns about the effect the decision to move these paramedics to the base at St. Luke's hospital in Kilkenny, which is at least 40 minutes from Carlow town and the north Carlow area, will have on patient care and welfare in the Carlow ambulance service area. Can the Minister of State to give me an assurance that this move will not have a knock-on effect on the care and welfare of patients in County Carlow? I will repeat my two questions. Can the Minister of State tell me whether the base in Carlow town will be maintained indefinitely? Can she comment on the effect this move will have on the welfare and care of patients in the Carlow area?

Catherine Byrne (Dublin South Central, Fine Gael)
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I thank Deputy Deering. I am responding to this matter on behalf of the Minister.

The National Ambulance Service, NAS, has confirmed that following a health and safety audit, an issue was identified in the shower and changing facilities used by staff at the Carlow ambulance station. Works are planned to take place to rectify the issue concerned and this is being treated as a priority by the NAS. Discussions are under way with staff with a view to addressing how services in the Carlow area can best be provided while the planned works are under way. Patient safety will be the overriding priority in these discussions. The director of the NAS has assured me that services in the Carlow area will not be compromised during this period.

The NAS has undergone a significant process of modernisation in recent years. A number of significant service innovations and developments have taken place, including: the establishment of the national emergency operations centre; the delivery of enhanced technology to improve response times; the development of an intermediate care service to provide lower-acuity hospital transfers, thereby freeing up more emergency ambulances for more urgent calls; and the establishment of a permanent emergency aeromedical support service. We are looking at alternatives to the current care model, which requires every patient to be brought to an emergency department. These alternatives include providing clinical advice over the phone to callers and referring them to other care pathways as appropriate.

This reform programme is taking place against the backdrop of the HIQA review of ambulance services, which was published in late 2014, and the NAS capacity review, which was published earlier this year. The capacity review, which was undertaken by a UK-based consultancy firm, Lightfoot Solutions, examined overall ambulance resource levels and distribution against demand and activity. The review found that the NAS faces a major challenge compared to ambulance services elsewhere because population density in Ireland differs significantly from that in many other countries. The population outside the greater Dublin area is widely dispersed, with a relatively large number of people living in rural areas. This means 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 and located at a particular station.

The implementation of the recommendations of the capacity review will require a multi-annual programme of phased investment in ambulance manpower, vehicles and technology. In that regard, the Deputy can be assured that increased funding will be available to the NAS for 2017. The detail of the improvements to be funded will be provided in the HSE's national service plan for 2017. Officials in the Department of Health will work closely with their counterparts in the HSE and the NAS in the coming weeks to agree priorities for the 2017 allocations.

Pat Deering (Carlow-Kilkenny, Fine Gael)
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I thank the Minister of State for her reply. I appreciate her point that this is a priority issue. It was a priority issue last October but 12 months have passed. When does a priority issue become a genuine priority? I am very disappointed that this issue has not been addressed over the past 12 months. We are not talking about huge sums of money.

The members of these ambulance crews, who could be out on a call for a large part of the day, have nowhere to make cups of tea or wash their hands. They are based in conditions that are at a Third-World level. It is not acceptable in 2016 that there are vermin issues and sewage is building up. This issue needs to be addressed as soon as possible. While I accept that services in Carlow will not be compromised, I am not convinced in other respects. I did not hear much in the Minister of State's reply to suggest that the ambulance base in Carlow will be maintained there in the future. This is the key issue.

There must be an ambulance base to cater for Carlow town's population of 23,000 or 24,000 people. Ambulance personnel have to be able to get to the people of Carlow as soon as issues arise. I appreciate that the demographics of our society are changing. We need to be able to get to incidents within a specific period of time. The ambulance staff in Carlow want a base in the town to serve the local population of 23,000 or 24,000 people. They need a place where they can make cups of tea, wash their hands and change their clothes when the situation arises. I ask the Minister of State for confirmation that this will become a priority issue as we move forward. The ambulance base in Carlow must be maintained. The alternative accommodation that the local ambulance personnel want must be provided for them as soon as possible.

Catherine Byrne (Dublin South Central, Fine Gael)
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I understand where Deputy Deering is coming from. It is unacceptable that the staff of a service that helps people have to work in conditions in which they cannot do normal things like wash their hands and use the bathroom. All I can give the Deputy is the answer I have in front of me. I cannot specifically say to him where the base will end up. I will raise the matter with the Minister, Deputy Harris. Having spoken to the Minister, I can assure Deputy Deering that the HSE will be prioritising the facility for the people who are part of the emergency service in Carlow. I will continue to pursue this matter with the Minister on behalf of the Deputy over the next day or two.

It is not acceptable that the Deputy has had to raise this matter again after 12 months of promises that something will happen. I will make it my personal business to go back to the Minister and speak to him at length, just as I have done every time I have responded to Topical Issues raised by Government and Opposition Deputies. I will come back to Deputy Deering with some kind of a formulated answer if that is acceptable.

Pat Deering (Carlow-Kilkenny, Fine Gael)
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I thank the Minister of State.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank the Minister of State and Deputy Deering for their co-operation. It is much appreciated.