Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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I thank the Minister of State for coming to the House. I wish to raise the matter of the ambulance response times in my constituency of Cavan-Monaghan. I must highlight a very harrowing case that actually happened to a family in County Monaghan.

Last July, a young man of 44 years of age, who was a son, a father and a husband, suffered a cardiac arrest in Castleblayney, County Monaghan. Luckily he was in company at the time and the 999 call was made. People who were on the scene at the time carried out CPR on this man and the locals who made the 999 call stayed in constant contact with the ambulance service while they waited for an ambulance to arrive. These people had the time both to get the defibrillator to perform the CPR and to make contact with the ambulance service and they waited and waited. The ambulance had to come from Navan. It was redirected to Dunshaughlin - this is all in County Meath as the Minister of State is aware - before it reached Ballybay, which is just outside Castleblayney, County Monaghan. I understand there is an ambulance and an ambulance service based in Castleblayney, which is literally ten minutes from where the incident was happening. In the end this gentleman was waiting for the ambulance to arrive for one hour and 15 minutes. He was still alive and had a good strong pulse when the ambulance did arrive. Unfortunately, when the gentleman was taken into the ambulance, he lost his life. His mum and his family maintain to this day that had the ambulance response time been much quicker or had the doctor on call arrived on the scene, the outcome quite clearly could have been very different. This man has left behind young children and a wife, his mum, dad, sisters and brothers, who are absolutely traumatised and heartbroken at this outcome.

I put it to the Minister of State that it is just not good enough in this day and age for anybody in such a critical condition to be obliged to wait that length of time for an ambulance. Not only was the incident happening within ten minutes of Castleblayney, where there is an ambulance service to respond to such calls, they were another ten or 15 minutes away from Monaghan Hospital. The ambulance that was dispatched was directed to Cavan General Hospital, which has an accident and emergency unit. This response time is just not good enough. In December we met representatives of the National Ambulance Service, NAS, to address these issues but I have a couple of questions to put to the Minister of State today.

For this family, unfortunately, that is not where this issue finishes. Another family member, who had been ill for many years, became critically ill just ten days after he had lost his son. The ambulance was called again. This man's wife, who is in her 70s and had just suffered the trauma of losing her son, had to call on the ambulance service again. To not put a tooth in it, the ambulance got lost. When the family rang the 999 number, they were told the ambulance was in Shercock, County Cavan, which is literally ten miles away or a ten-minute journey at most. The ambulance got lost and when it did show up the family was told that it had no satnav and had been given no contact details as to where the 999 call had come from. This gentleman had to wait one hour and 25 minutes, ten days after they had lost their son, having waited one hour and 15 minutes. Thankfully, the outcome for this gentleman was much better and his life was saved. He was brought to Cavan General Hospital. That family are absolutely traumatised. I put it to the Minister of State that this family are not the only ones in the constituency of Cavan-Monaghan who are bewildered by the ambulance response times.

Jim Daly (Cork South West, Fine Gael)
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I thank Deputy Smyth for the sincerity and appropriateness with which she has brought this issue to the House. I extend my sincere sympathies to the family of that young gentleman and for the harrowing story and circumstances they endured. I am very conscious that no mealy-mouthed words I will issue today with statistics or figures will go any way towards answering the what-ifs, the maybes and the buts the family has to live with every day of their lives. Listening to me speak about the global macro picture, the response times in the Cavan-Monaghan area and what percentages of calls have been achieved satisfactorily and within an appropriate response time, will go nowhere towards solving the anguish of those people. When we talk about ambulance response times, the reality is that we are talking about life and death. We cannot afford to get them wrong. I absolutely accept this from the outset.

I ask the Deputy to not assume this response is a defence; it is by way of background and explanation from the Department. Ambulance response times are helpful for performance measurement, however, it should be recognised that sole reliance on response times does not provide a comprehensive picture of modern ambulance service performance. Response times tell us how fast the service was provided rather than how well the patient was cared for. Response time performance is being globally reviewed as to whether it is the only appropriate measure of pre-hospital patient care. While rapid deployment and timely arrival is accepted as being necessary, patient outcome indicators are now being viewed as a more appropriate measure of patient care and experience. The National Ambulance Service has developed a suite of key performance indicators to measure patient outcomes and experiences and these are currently being piloted to be included in the national service plan.

That said, I am aware that the Delta response times in the north east have been below target. I note, however, that Echo response times are on or above target in the period September to December 2017. A number of developments have been made by the NAS in order to address the issue of response times. I am also aware that in Border counties the NAS works closely with the Northern Ireland Ambulance Service to provide a more responsive service for patients.

The capacity review published in 2016 identifies particular difficulties serving rural areas such as this region. The capacity review indicated that the only practical way to improve first response times in rural areas is through voluntary community first responders, CFR, schemes. The NAS continues to work with local CFR groups across the north east region to enhance services. There are currently 25 CFR groups in the north-east region.

I have also been advised by the NAS that it is improving regional coverage and deployment across rural areas including Cavan and Monaghan. The National Ambulance Service is moving away from ambulance provision from fixed bases to dynamic deployment. This means that resources can be used across a region so that if demand increases in one area, other resources can provide cover as required. In addition, the National Ambulance Service has developed the intermediate care service to provide lower-acuity hospital transfers, which frees up emergency ambulances for the more urgent calls. A permanent emergency aeromedical support service has also been established to provide a more timely response to persons in rural areas.

Over recent years, year on year, additional investment has been directed towards the National Ambulance Service. This year, an additional sum of €10.7 million has been made available, which includes €2.8 million to fund new developments. New developments include the development of alternative pathways to care, as well as the hear and treat clinical hub that is expected to go live soon in the national emergency operations centre. This will divert some lower-acuity patients to alternative care pathways and will free up some emergency capacity. In time it is hoped that such initiatives will help to improve response times around the country including in the Cavan-Monaghan area. I assure Members that the National Ambulance Service is focused on improving ambulance response times throughout the country.

I reiterate my earlier comments that I do not mean to be insincere by giving those facts and figures. They do not do a service to the individuals involved.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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I thank the Minister of State for his response. As he has said himself, it has been a more general answer and I raise that matter as a Topical Issue because I am trying to get to the crux of the issue for this family. They really deserve answers. I appreciate that this is the portfolio of the Minister for Health, Deputy Harris, and that the Minister of State is stepping in for him today. I ask the Minister of State to bring back these specific questions to the Minister because the family deserves answers. We have met with the National Ambulance Service and that is fine but the family wants answers from the Minister with responsibility. Crucially, the constituency of Cavan-Monaghan is suffering. The family wants to know why they had to wait one hour and 15 minutes for an ambulance service on that particular day for their son who lost his life. They also want to know why, ten days later, they had to wait one hour and 25 minutes for the father.

Why was the advanced paramedic unit not sent to this emergency? Why did the doctor on call not come that night? I just do not think it is good enough for the National Ambulance Service to say, as it did in all sincerity at the meeting I mentioned, that the ambulance got lost, that no satnav was available in the vehicle and that it had no contact number for the family that made the original call. If someone in my office did not take the particulars of a constituent who came in, I would be very upset and it could be a sacking offence. This is a matter of life or death. It is not good enough in this day and age for the National Ambulance Service to answer by saying the ambulance got lost, no satnav was in use and no contact number was available. When an elderly gentlemen was in this scenario for a second time, the ambulance sat outside a local shop while the members of the crew blindly looked for directions to the house the call came from because they had no contact details.

I have written to the Minister for Health, Deputy Harris, and the Taoiseach about this issue. The Minister kindly set up the meeting with the National Ambulance Service. The Minister and the ambulance service gave a commitment that if the family did not feel the answers were good or focused enough, the members of the family would be able to sit down with the Minister, which is the least they deserve. They want to be heard. That is all they are asking for. The Minister has written me to say that due to diary constraints, he cannot commit to a time now. This family deserves to be heard. It is not too much to ask for the Minister to provide 15 minutes out of his diary for a simple meeting. I ask the Minister of State to bring the specific questions I have asked back to the Minister so that I can get specific answers.

Jim Daly (Cork South West, Fine Gael)
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I will certainly go back to the Minister, for whom I am deputising here. I am happy and more than willing to go back to him. I will repeat the Deputy's request with sincerity and I will do justice to how she has presented it on the floor of the House. She is right when she says that the answer I have read is not acceptable to the family in question. Ifs, whats and buts are no comfort for the members of the family. I agree that such families need a voice in this Chamber and with the ambulance service. As such a representative, Deputy Niamh Smyth is right to demand accountability. It is not just a choice on our part - as public representatives we have a responsibility to ensure we get accountability for these failures in the systems. There is a management structure in place within the National Ambulance Service at a macro level and at a local level. There are operatives carrying out various duties. We have to get accountability and answers for this family. I will support the Deputy in this endeavour at whatever level I can. I will certainly impress on the Minister my desire to see this matter brought to a conclusion.

I know Deputy Niamh Smyth has met representatives of the National Ambulance Service. That was mentioned in the briefing note which was made available to me. I understand the service has undertaken to get back to the Deputy with the answers and with more detail on the operational failures that occurred that day. That is the very least it should do for the family in question and indeed for all the Deputy's constituents. We do not want to be tearing down the confidence in the system of everybody who is worried about their parents or indeed about themselves. We owe it to them to provide assurances that the mistakes which have been made - I appreciate that this is a very polite word to use - will not happen again. We need to assure them that someone is being held accountable, that systems have changed since this incident and that lessons have been learned and implemented from it. I will certainly do everything I can to support the Deputy in this regard. I will make sure to impress it on the Minister.