Dáil debates
Wednesday, 24 May 2017
Topical Issue Debate
Ambulance Service
4:20 pm
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Is the Minister of State taking this matter?
Helen McEntee (Meath East, Fine Gael)
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Yes.
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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She is the Minister for the Topical Issue debate today.
Carol Nolan (Offaly, Sinn Fein)
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Go raibh maith ag a Cheann Comhairle as ucht an deis chun labhairt ar an topaic fíor-thábhachtach seo. I wish to raise the issue of the cost of private ambulances being used to transport public patients in the midlands area. This is an issue of serious concern. I will outline why I believe it should be investigated.
When we look at our health service, we can see clearly that it is failing miserably. Are we wasting resources in some areas? That is the overarching point I want to make. This issue has been brought to my attention and I am seeking clarity from the Minister of State. Recently, I submitted several parliamentary questions to the Minister. I have them before me. I was shocked by the figures, which are most concerning. They show that €4 million was spent by the Dublin Midlands hospital group for transportation by private ambulance operators in 2016 alone. The cost relating to the Midland Regional Hospital, Tullamore, at €1.91 million, accounts for almost half of the total amount paid in 2016.
According to correspondence from the HSE, the requirement for private ambulance use arises from the transfer of non-urgent public patients for various clinical reasons. The examples given include transfers between hospitals, transfers between residential and acute settings and transfers for diagnostic tests at other hospitals. The figures show that over €25 million has been spent on private ambulances to transport HSE patents since 2012. That is a matter of concern. For some reason, this figure increased dramatically during the period in question. In 2012, the figure was under €4 million, but it jumped to almost €6.5 million in 2015 and 2016. At a time when our health service is bursting at the seams, we need to question whether this is the best use of resources. We need to challenge the options being used and deployed.
Those of us who live in Offaly know only too well the impact of cuts to the health budget. The full capacity protocol was implemented 230 times last year at the Midland Regional Hospital, Tullamore. It is meant to be used only in cases of emergency. This was the third highest figure in the State. We continue to have ongoing problems with patients on trolleys and the cancellation of elective surgery as a result of the crisis in the accident and emergency department. One patient on a trolley is one too many.
Can the Minister of State explain why the figures for private ambulance operators have increased so significantly during the past four years? Can she explain in particular why the hospital in Tullamore accounts for such a high proportion of the spend? The figure is €1.91 million for Tullamore, the highest in the Dublin Midlands hospital group. Can the Minister of State outline any plans there are to reduce this spend and invest in the capacity of the public ambulance service?
Helen McEntee (Meath East, Fine Gael)
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I wish to pass on the apologies of the Minister for Health, Deputy Harris, who cannot be here. I thank Deputy Nolan for raising this matter and for giving me the opportunity to inform the House of the position relating to it.
The main role of the National Ambulance Service is to respond to emergency 999 or 112 calls, as the Deputy knows. On average, the National Ambulance Service responds to 21,500 emergency calls per month. There is, of course, a significant requirement for transfers of non-urgent patients for various clinical reasons outlined, including transfers between hospitals, transfers between residential and acute settings and transfers for diagnostic tests at other hospitals. The National Ambulance Service provides such inter-hospital transfers through the intermediate care service. By providing this service for lower acuity hospital transfers, emergency ambulances are freed up for the more urgent calls. On average, the National Ambulance Service undertakes 3,800 inter-hospital transfers per month.
In the context of the continued increase in demand for emergency ambulance services in recent years, there is a need to avail of private ambulance services to secure additional capacity for such patient transfers where required. To this end, the HSE has put in place arrangements under a framework agreement that provides for the utilisation of private ambulance providers. In circumstances where providers included in the agreement are not in a position to provide the service required hospitals are permitted to seek patient transport services from other providers recognised by the Pre-Hospital Emergency Care Council. The reality is that there is ongoing need for hospitals to have the flexibility to be able to access private ambulance services where necessary and appropriate. However, the Deputy may be interested to note that the HSE has commissioned a review of public and private ambulance service provision. The purpose is to assess the costs of both services, ascertain the appropriate use of those services and clearly define the parameters for use of public and private providers.
Intermediate care services for the north Leinster area, which encompasses the former midlands area, operate from the Mullingar, Cavan, Cherry Orchard, Castleblayney and Ardee bases. On average, the service based at Mullingar undertakes 41 routine inter-hospital calls per month. Emergency ambulances in the midlands area undertake a similar number of journeys monthly. Where additional services are required, hospitals may directly request private ambulance services.
The National Ambulance Service has undergone a significant process of modernisation in recent years. This ambulance reform programme is taking place against the backdrop of the HIQA review of ambulance services and the National Ambulance Service capacity review, which was published last year. The review examined overall ambulance resource levels and distribution against demand and activity. Implementation of the recommendations of the capacity review will require a multi-annual programme of phased investment in ambulance manpower, vehicles and technology.
In 2017, an additional sum of €3.6 million has been made available to the National Ambulance Service. This includes €1 million for new fund developments. Development funding will be used to increase the number of paramedics and intermediate care operatives in line with the capacity review recommendations.
There is always a need for the public and private sectors to work together to be able to cater for gaps in the system and improvements we are trying to make. Again, the increased number of people accessing and in need of our services will automatically result in increased demand in the public and private sectors. That is possibly another reason why the numbers are increasing.
Carol Nolan (Offaly, Sinn Fein)
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I thank the Minister of State for her response. I have a serious concern that the increased use of private ambulances for HSE patients is an outworking of the policy of dynamic deployment. That policy is failing miserably and is putting ambulance staff under pressure and patients at risk. Given the reduced availability of public ambulances, we are now in a position where we need to rely on the services of private ambulance operators. There are serious concerns in respect of the dynamic deployment policy. Ambulance drivers have outlined these clearly to me. They are concerned that patients are being put at risk. This is putting them in an awkward position and placing them under considerable stress.
Is the use of private ambulances an outworking of this policy? I believe it is. The Minister of State referenced a review of the system. When will this review of ambulance operations take place? As someone who is concerned about my constituency, I am calling for the review to take place as soon as possible. Will the Minister of State outline the procedure for tendering and procurement? What measures are in place to ensure value for money when private ambulances are used? That is the crucial point. We could have a situation whereby money is being wasted and whereby it could be put into another sector of the health service where it is badly needed.
Helen McEntee (Meath East, Fine Gael)
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I agree. The Deputy has raised some valid points. Patient safety should be first and foremost in everything we are doing. It is important to note the fact that the HSE has commissioned a review. I am afraid I do not have the exact details of when it will begin but I can certainly get them for the Deputy. It will look at the service provision, assess the costs of the services, examine the appropriate use of the services and clearly define the parameters for the use of public and private providers. It will look at all the areas of concern raised by Deputy Nolan. I will ask the Minister to come back to Deputy Nolan with the timeframe, an outline of when this will take place and how people can be part of it.