Dáil debates

Tuesday, 2 April 2019

Saincheisteanna Tráthúla - Topical Issue Debate

Ambulance Service Response Times

5:25 pm

Photo of Eamon ScanlonEamon Scanlon (Sligo-Leitrim, Fianna Fail)
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I call on the Department of Health to commit to providing additional ambulance fleets and personnel in the north west in order to reduce response times in the region. Unfortunately, lengthy ambulance response times are not unusual there. They are, however, unacceptable. People in rural areas are treated deplorably when it comes to access to out-of-hours health services. It is now evident that if more than one emergency arises at a time in the Sligo, Leitrim and Roscommon area, our communities must wait up to two, three or four hours for emergency services. The lives of people in the north west are as important as those of people in cities or elsewhere in the country.

I accept that there are challenges in providing services in rural Ireland and that we cannot expect to achieve the same turnaround times as are experienced in urban areas. However, the response times in rural areas could be and need to be vastly improved. The waiting times for ambulances are too lengthy. The current situation in County Leitrim in that regard is totally unsatisfactory.

More and more ambulances are being called away to cover larger centres. The dispatching of ambulances from one county to cover another due to the lack of paramedics on duty at any one time, as often occurs with the ambulances assigned to Leitrim and north Roscommon, is totally wrong and leaves people highly exposed. Our ambulance service often deals with life or death situations but it does not have the capacity to deal with the call-outs it is receiving. Fatalities may be inevitable.

We need a new ambulance unit in Carrick-on-Shannon and extra personnel to manage the fleet there. People in rural Ireland are losing confidence in the ambulance service, which is a pity because, as all Members know, its staff are dedicated, committed and very helpful. I am sure that the families of several Members have called 999 seeking an ambulance - I know mine has. It is sad that the staff are losing confidence, but it would be very sad if the people who need the service also lose confidence.

The ambulance stationed in Carrick-on-Shannon serves south Leitrim and north Roscommon but at times may be as far away as Monaghan, Mayo, Tullamore or even Mullingar, leaving no ambulance cover in its primary area. It is very alarming that there are only ever two ambulances on call for the entire County Leitrim. Those ambulances may not be available if an emergency call comes in as they may be covering for other ambulances in urban centres or responding to other emergency calls. What is more alarming is the lack of action on the part of the Government, which seems unconcerned about this issue or the fact that elderly people may have to wait from two hours to five hours for an ambulance. People have contacted me with concerns and I have passed on those details to the HSE.

I am advised that there is no short-term cover available for ambulance staff, meaning ambulance cover may be dropped if staff members are out sick as the minimum required number of staff members would not be met. That is the sad reality. Ambulance staff work around the clock, with a 20-hour shift not being unheard of for staff in the north west. That is completely unsatisfactory and it is dangerous. I am sure the Road Safety Authority does not condone unsafe practices such as the hours being worked by ambulance drivers. I know exactly what I am talking about on this issue and the people who have been affected. The current practice is wrong. Those people are worn out.

Access to out-of-hours health services in County Leitrim is extremely limited. The HSE promised to implement measures in terms of new personnel, ambulances and first responder schemes in Leitrim and north Roscommon as advised by the 2015 capacity review that was published in 2016 for the National Ambulance Service. Some 24 new recruits to the ambulance service were passed out quite recently, but all of them were posted to major urban centres.

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I welcome the opportunity to address the very important issue of the ambulance service in the north-west region on behalf of the Minister, Deputy Harris, and I thank Deputy Scanlon for raising it. I am pleased to inform the House that 12 additional staff have been approved for deployment in the north-west region for 2019. These staff will provide additional emergency capacity to the region in the coming year.

The National Ambulance Service has furthered several developments in order to address the issue of response times and ambulance cover in the north west. In Border counties, the National Ambulance Service works closely with the Northern Ireland Ambulance Service in order to provide a more responsive service for patients. An EU-funded pilot of a new community paramedic model of care in Border counties has been completed. Community paramedics safely and effectively provide care in Border counties, with a consequent reduction in unnecessary ambulance journeys to emergency departments and hospital re-admissions. On resources in the north west, under the first phase of the programme two community paramedics were assigned to Buncrana, County Donegal.

The capacity review published in 2016 identified particular difficulties serving rural areas such as the north-west region. It indicated that the only practical way to improve first response times in rural areas is through voluntary community first responders, CFR, schemes. The National Ambulance Service continues to work with local CFR groups across the region to enhance services. I am pleased to state that the Government is fulfilling its commitment in A Programme for a Partnership Government to increase the number of CFR groups year on year. In the north west, 19 CFR groups are currently linked to the National Ambulance Service and 14 other groups there are in training to provide first response in emergency medical situations.

The National Ambulance Service has undergone a significant process of modernisation in recent years and there have been several important service innovations and developments. A single cohesive strategic plan for ambulance services, entitled Vision 2020, has been developed by the National Ambulance Service. It sets out the actions necessary to implement the various recommendations and to address the range of other demands facing the ambulance service.

The national emergency operations centre has been established and is the location for the receipt of emergency calls and dispatch of emergency resources. The National Ambulance Service has visibility of all available paramedic resources and vehicles in real time, ensuring that the closest available resource is dispatched to an emergency.

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. It diverts some lower acuity patients away from busy emergency departments and frees up emergency capacity. It is anticipated that such initiatives will help to improve the availability of ambulance resources nationwide, including in the north west.

In recent years, additional investment has been directed towards the National Ambulance Service. This year, its budget increased to an unprecedented €168.6 million, which will support it in continuing to deliver a high quality service throughout the country, including in the north west.

Photo of Eamon ScanlonEamon Scanlon (Sligo-Leitrim, Fianna Fail)
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I welcome that 12 new recruits will be coming to the north-west region. The current situation could not be allowed to continue because it is neither acceptable nor safe. I have previously raised the first responder scheme in the House because it makes sense to roll it out in the north west. Fire fighters in Dublin are trained to paramedic level, meaning that paramedics are available 24-7. This should also be the case in the regions. Last year, vital discussions on this issue took place between the National Ambulance Service and the national directorate for fire and emergency management. I welcome the information provided by the Minister of State in that regard.

The capacity review published in 2016 indicated that community first responder schemes are a practical way to improve first response times in rural areas. I acknowledge that the Minister of State mentioned such schemes and I welcome that they are being considered.

With 12 new recruits being assigned to the area, it is important that a second ambulance be based in Carrick-on-Shannon in light of the demand in the area for services. As the population of the county is widely dispersed and because the ambulance based in Carrick-on-Shannon may be called upon to provide services to nearby centres such as Monaghan and, in particular, Mullingar, possibly to cover for an ambulance which may have been moved to Dublin, it is crucial that a second unit be based in Carrick-on-Shannon in the future.

5:35 pm

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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Again, I thank the Deputy for raising this important issue. I accept he was one of the Deputies who was very involved in raising the first responder issue previously.

On behalf of the Minister, Deputy Simon Harris, I assure the House that the National Ambulance Service is focused on continuing to improve service in the north west and throughout the rest of the country. The improvement is being implemented through a multi-annual reform programme. Through the National Ambulance Service reform plan, Vision 2020, new developments are being progressed in order to continue to deliver a high-quality service. Recent developments, such as the new community paramedic model of care, will divert some lower priority patients from the busy emergency departments. I will inform the Minister of other issues raised by the Deputy.