Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I thank the Ceann Comhairle for selecting this important matter for discussion during Topical Issue time.

Last week the Kilkenny Peoplerevealed that Kilkenny has just two emergency ambulances on duty each night for its population of 100,000 people, or one ambulance to every 50,000 people. The figures, obtained through a freedom of information request, also revealed the total number of emergency ambulances available to Kilkenny on day-shift duty from Monday to Friday is four for each day. However, this falls to just two on Saturdays and Sundays, a time when there would be more demands on the service.

This particular point of the strategy needs to be urgently re-examined as we have a vibrant nightlife in Kilkenny city at weekends. The bars, clubs, hotels and restaurants are always busy with visitors from outside the county who come for a weekend city break or otherwise. The streets of the city are a busy place at night. There is always an increased risk of incident or injury occurring which, in turn, will increase the demand for ambulances. The majority of people are out to enjoy themselves and will be well behaved. There is always a risk of incident, however, when people are out late and perhaps drink is taken. The same can be said for any city.

If there is a valid reason as to why the National Ambulance Service deems it appropriate to reduce ambulance availability at the weekend when demand for a service could increase dramatically in a short space of time, I would be glad to hear it. However, if it is down to an oversight in strategy or planning, then it requires urgent re-examination. Will the Minister of State take a close look at this?

One ambulance cannot cater for 50,000 people on a nightly basis over a long-term period and a daily basis on weekends. It is simply not sustainable. We could potentially be sleepwalking into a scenario where on a bad night someone in an emergency situation in south Kilkenny cannot be reached in a reasonable timeframe because the other two ambulances are otherwise engaged in the north of the county. That person must then rely on what the HSE likes to call "dynamic deployment" from Carlow, Waterford, New Ross and Clonmel, provided the ambulances in those areas are not otherwise engaged or under pressure.

Kilkenny is a focal point of Ireland's Ancient East and has large numbers of tourists flocking to the county for day trips, particularly at weekends. We are lucky to have several stunning attractions around the county as a result of our rich medieval heritage. The tourism industry is important in sustaining our bars, traditional pubs, restaurants and other small and medium-sized enterprises. It is a high-risk strategy, to say the least, that only two ambulances are available in Kilkenny during busy weekends. There is a glaring risk of serious damage to our good reputation if a regrettable incident or incidents were to occur.

In respect of the day shift on weekdays, we have four ambulances available on Monday to Friday. How does this figure compare to the national average for ambulances deployed per capitain the various regions? If the Minister of State has any figures in this respect, I would be glad to hear them.

We have four ambulances on a weekday but only two at the weekend. That is not good enough for a population of 100,000 people. We need more ambulances. Relying on ambulances in other areas is not positive as they may not be available. I know of one incident where an ambulance available in Kilkenny was called to Wexford to bring a patient to Wexford General Hospital. It turned out the patient was 500 m from the hospital but no ambulance was available there. That was not viable or practical. The Department should re-examine the whole area of ambulance service provision in the area again.

Catherine Byrne (Dublin South Central, Fine Gael)
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I am taking this matter on behalf of the Minister, Deputy Harris, who regrets he cannot be here this afternoon.

The National Ambulance Service is committed to providing a quality ambulance service in Kilkenny, and across the country, both during daytime and night-time hours. The National Ambulance Service has advised the Minister for Health that the allocation of night-time ambulance resources is based on activity and demand. It is important to note the National Ambulance Service operates on a national and area basis as opposed to a local basis. While resources are dispatched to calls in the Kilkenny area from the ambulance station in Kilkenny in the first instance, resources are also deployed from stations in surrounding areas. In this regard, ambulance resources from Carlow, Waterford, New Ross and Clonmel can provide cover in Kilkenny as required and respond to incidents as they arise on a nearest to the incident basis.

In recent years, the National Ambulance Service has embarked on a strategic reform programme to reconfigure the management and delivery of pre-hospital emergency care services. The programme aims to deliver a service that is safe, responsive and fit for purpose through the development of a modern, clinically driven, nationally co-ordinated system, supported by technology and data. The reform programme mirrors many of the strategic changes under way in ambulance services internationally as they strive for high performance and efficiency while coping with increasing demands for services.

The national emergency operations centre has been established where emergency calls are received and emergency resources are dispatched. The National Ambulance Service utilises an advanced medical priority dispatch system which uses international standards in triaging and prioritising emergency calls. This system ensures life-threatening calls receive an immediate and appropriate response, while lower acuity calls may have to wait until an emergency resource becomes available. In addition, the National Ambulance Service has developed the intermediate care service to provide lower acuity hospital transfers, which frees up emergency ambulances for more urgent calls. A permanent emergency aeromedical support service has also been established to provide a more timely response to persons in rural areas.

The ambulance reform programme is taking place against the backdrop of the HIQA review of ambulance services, published in late 2014, and the National Ambulance Service capacity review, published last year. The capacity 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. Additional funding of €7.2 million was provided in 2016 for the National Ambulance Service, including €2 million in development funding. In 2017, an additional sum of €3.6 million was made available which included €1 million to fund new developments. Additional finding will be made available for the continued development of the National Ambulance Service in 2018. This will be set out in the national service plan 2018. The allocation of the additional funding by the HSE to specific service developments around the country must await the finalisation of the national service plan, a process which is under way.

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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We can use all the HSE buzzwords we like. We can say that resources are dynamically deployed or that ambulances are dispatched on a nearest available to incident basis and not a county boundary basis. When one peels back the spin, however, the ratio of ambulances to population size is concerning. The idea of roaming ambulances and resources can only work if there is a sufficient complement of ambulances to begin with. We cannot subject people to a lottery of roaming resources as if the ambulances are constantly static and can be at the scene of an incident anywhere in the county at a moment's notice. That is what the HSE's dynamic language suggests but the reality is the current strategy is simply not sustainable.

If we were unfortunate enough to have a high number of emergency situations occurring, either simultaneously or in a close timeframe to one another, this strategy would unravel faster than one could dial 911. I raise this public safety issue against the backdrop of our continuous fight for 24-7 cardiac care for a population in excess of 500,000 people across the south east. The idea that we expect critically ill patients who present to University Hospital Waterford outside of Monday to Friday, 9 a.m. to 5 p.m., to travel to Cork University Hospital is not workable.

It is not possible to do that fast enough to maintain patient safety. It can take close to two hours to travel from south Kilkenny to Cork University Hospital. The journey takes far too long and puts the lives of patients at risk.

There is a mobile cath lab, which is a welcome assistance, but I am concerned it could increase pressure on existing cardiac services for people in the south east. More people will be diagnosed more quickly but the existing laboratory will have limited extra capacity to carry out follow-up procedures that result from the additional angiograms. It is projected that 30% of patients would require additional procedures and 1,500 diagnostic procedures could be carried out annually in the mobile lab. That indicates 450 people would be added to waiting lists for cardiac procedures at the existing cath lab at Waterford Hospital each year. However, only €500,000 additional funding has been allocated. Will the Minister increase that funding allocation?

There is currently no emergency cardiac care service at the weekend in Kilkenny. One ambulance cannot care for 50,000 people. It is an emergency waiting to happen. There should be a reconsideration of more ambulances being made available on a county basis.

Catherine Byrne (Dublin South Central, Fine Gael)
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I assure the Deputy that I have noted his concerns regarding the ambulance service for the 100,000 people living in Kilkenny. Nobody can predict how many emergencies will occur in an area at a particular time. The emergency services must do the best they can in the time permitted and with the number of ambulances provided in Kilkenny. I do not know who decided on the number of ambulances allocated to Kilkenny but I assume it was the National Ambulance Service. I will bring the concerns of the Deputy to the Minister's attention.

More than 90% of non-emergency patients are seen to by intermediate care services during daytime and night time, which frees up ambulances for real emergencies. However, I will bring the Deputy's concerns to the Minister and I will outline, as I have done in the House, the number of ambulances available Monday to Friday and on Saturdays and Sundays. I do not know why there are fewer ambulances available at night time. I will ask the Minister to revert to the Deputy.