Declan Breathnach (Louth, Fianna Fail)
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A serious situation has been brought to my attention by paramedics and our local radio station, LMFM, today relating to the north-east ambulance service, which has resulted in a serious deficit in the service available and an inability to respond to calls due to a lack of staff and a lack of vehicles being available. Last night, within the nine stations in the north east a total of 22 staff should have been rostered for duty. Unfortunately, there were only 12 and in most cases they were rostered on a single person basis. Stations affected last night included those in Drogheda, Ardee, Virginia, Monaghan, Castleblayney and Dundalk. Basically, this meant that in Castleblayney, where there should have been two staff on an ambulance, there was only one rostered on duty. One staff member cannot man or take out an ambulance except to act as first responder in the event of a cardiac arrest.

This problem began approximately eight months ago, when management informed the staff in Monaghan and Castleblayney stations that new rosters were to be introduced without delay bringing six new staff in total to the region. Needless to say, this was welcomed by all staff and a roster was worked on to incorporate the new staff. Around November of last year, management then said they had never agreed to six new staff and instead appointed two to Monaghan and two to Castleblayney. New rosters were eventually agreed and put into place with management insisting that they were to become operational on certain dates. I believe those dates were to be in January for Monaghan and from last Monday for Castleblayney. The rosters have become operational but no new staff have been provided to populate these rosters. It has been described to me as like putting an amount of orange cordial into a larger amount of water. It might look all right but it does not taste the same. The service now has the same staff attempting to fill a bigger roster. They were already short staffed beforehand so this has added greatly to this serious problem.

Ongoing staff shortages are due to a combination of sick leave, annual leave and the simple fact that there are not enough staff. In addition to these problems, this week paramedic staff were also on electronic patient care report training. The staff had to be released to attend the training. The training is to facilitate the move from paper to electronic care reports for patients. Again, this is being completed to a management deadline with little or no consideration for the impact on already depleted services.

The lack of an ambulance in Castleblayney is problematic. The new roster came with the understanding by staff that an ambulance would be provided to complete the roster. Staff were recently told that this ambulance is now not available and that they should use the ambulances they have. That is all well and good except that on Monday, Tuesday, Thursday and Friday there is a 7 a.m. crew and a 10 a.m. crew for 12 hour shifts. If both these crews are out on late calls at 7 p.m., then there would be no ambulance available to deploy even if there were staff on duty. The practice has been that when a problem occurs with rostering, a text is sent out looking for staff to cover the shift. This is a regular occurrence. The core rostering system does not work and the failure by those in charge to engage with staff is adding to the problem.

Catherine Byrne (Dublin South Central, Fine Gael)
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I welcome the opportunity to address, on behalf of the Minister for Health, Deputy Harris, the matter of the ambulance service in the north east. The Minister, Deputy Harris, is pleased to inform the House that six additional staff have been approved to be deployed to the Monaghan and Castleblayney ambulance stations. The additional staff are expected to be in place in the coming weeks and will provide an additional emergency ambulance at both stations during weekdays.

The Deputy referred to access to vehicles. Significant capital funding has been allocated to the HSE National Ambulance Service annually to support the vehicle replacement policy. The National Ambulance Service has undertaken a number of measures to address the issue of ambulance service provision in the north east. There has been significant investment in manpower, fleet and technology in recent years. An additional 25 patient and clinical care staff were assigned to the north Leinster region during 2018. This region covers the counties referred to by the Deputy. The Minister, Deputy Harris, acknowledges that in the Border counties the National Ambulance Service works closely with the Northern Ireland Ambulance Service to provide a more responsive service for the region.

The capital review published in 2016 identified particular difficulties in serving rural areas, such as the north east. The capital review indicated that the only way to improve first response times in rural areas in particular is through voluntary community first responder schemes. The National Ambulance Service continues to work with local CFR groups throughout the region to enhance services, with 29 CFR groups operating in the counties of Louth, Monaghan, Cavan and Meath.

The National Ambulance Service has undergone a significant process of modernisation in recent years and several important service innovations and developments have taken place. The national emergency operations centre has been established. Emergency calls are received and emergency resources are dispatched from the centre. The National Ambulance Service now has full visibility of all available paramedic resources and vehicles in real time, ensuring that the closest available resource is dispatched to an emergency. In addition, the National Ambulance Service has developed the intermediate care service to provide lower acuity hospital transfers, thus freeing up emergency ambulances for the more urgent calls. A permanent emergency aeromedical support service has been established to provide a more timely response to persons in rural areas. Other recent developments include the development of alternative pathways to care. The hear-and-treat clinical hub went live in the national emergency operations centre in March last year. This service diverts some lower acuity patients away from busy emergency departments, freeing up some emergency capacity. The anticipation is that such initiatives will help to improve the availability of ambulance resources in the country, including in the north east.

In recent years, year-on-year additional investment has been directed towards the National Ambulance Service. This year the National Ambulance Service budget has increased to an unprecedented €168.6 million. This will support the National Ambulance Service in continuing to deliver a high-quality service in the region.

Declan Breathnach (Louth, Fianna Fail)
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I thank the Minister of State for her reply. I welcome the fact that she has admitted there is an issue. While some of the remarks of the Minister of State are at variance with the situation, I welcome the fact that there is commitment to implement the full complement of six staff as per her statement and the fact that additional ambulance vehicles will be made available. I will be holding the Minister of State and the Minister for Health, Deputy Harris, to account in this regard. Having said that, rural Ireland and regional health services are not the same as in Dublin city, where there are up to six emergency departments. Down through the years the Department of Health, in its wisdom, reduced the number of emergency departments. In the north east we basically have an emergency department in Our Lady of Lourdes Hospital in Drogheda and Cavan General Hospital.

We introduced minor treatment units in Louth County Hospital in Dundalk and in Monaghan Hospital. To leave people who have concerns and are vulnerable in rural isolation - it is perhaps not as acute in the north east as it is in other areas, although it is when compared with the facilities available in the Dublin region - is very unfair. We need to have enough emergency medical vehicles, ambulances, paramedics and, indeed, advanced paramedics available.

I draw the attention of the Minister of State to the issue of recruitment of ambulance staff, which is not like the recruitment of members of An Garda Síochána, but unfortunately it is being treated in the same way. It is a national appointment. A simple solution would be not having ambulance personnel travelling from places as far away as Donegal to work in Davitt Road in Dublin, for example. Staff should be deployed in their localities. The recruitment system for paramedics should not be national. There could be a national application system, but people should be appointed locally and the rosters would work much better.

I look forward to further communication with the Minister of State on this issue and on the concerns not only about the staffing of the ambulance service but the concerns of the people I represent who are vulnerable when it comes to the ambulance service as in the case last night where ambulances were not available and the roster was not sufficient to cover the region.

Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister for Health, Deputy Harris, I assure the House that the National Ambulance Service is focused on improving the ambulance service in the north-east region and throughout the country. The improvement of service is being implemented through the multi-annual reform programme and through the National Ambulance Service reform plan. New developments are being processed, manpower has been increased, we have improved the fleet and we are availing of new innovative technology. The Minister for Health, Deputy Harris, has also been assured by the National Ambulance Service that additional staff will be deployed to the Monaghan and Castlelayney ambulance stations shortly, which will further improve the capacity in the areas.

I have taken a note of the concerns the Deputy has raised and I will ensure they are passed on to the Minister for Health, Deputy Harris.