Jackie Cahill (Tipperary, Fianna Fail)
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I have spoken to a number of paramedics in my home town of Thurles regarding a lack of resources in the south-east area that is resulting in a drainage of ambulances and paramedics from the Thurles area, where they are needed. The ambulances in Thurles are based in the town with the intention of responding to emergency calls locally.

I will give the Minister of State an example of an average day for a paramedic in the Thurles area to explain to him why the service, as it stands, is totally unacceptable. During one Saturday shift, the Thurles ambulance travelled from its base in the middle of Tipperary to a call in Kilkenny, some 50 km away and in a different healthcare region. En route, the ambulance was diverted to a call deemed to be a higher risk in Castlecomer, County Kilkenny. The crew changed route and headed for the location to which it was directed. The ambulance then received another call and was told to go back to Kilkenny. The paramedics managed to make it to the location and dealt with the issue in question. The ambulance then returned to a call in Thurles anden routewas redirected to Kimaganny, County Kilkenny, a distance of 45 km from Thurles. It is worth noting at this point that, of all of the locations I have mentioned, Thurles is the only one in the mid-west region which this ambulance should serve and to which these paramedics are assigned.

While the paramedics were driving to Kilmaganny, they received a call to tell them that they were now needed in Arklow, County Wicklow, as theirs was the closest available ambulance in the area and this was a higher priority call. Arklow is 130 km from Thurles. Then, as the paramedics followed their route across the bottom half of Leinster, they were again told to stand down.

The message came through that they were now needed in New Ross, County Wexford. New Ross is 80 km from Thurles and almost the same distance from Arklow. That was not the end of it. Before the ambulance could get to the call in New Ross it was again diverted. This time, the Thurles-based paramedics were told to go to a call in Enniscorthy, County Wexford, which is 30 km from New Ross and almost 100 km from Thurles, County Tipperary, which is their base. Finally, before the paramedics were able to reach the call in New Ross, they were again directed to stand down and told instead to attend to a call in Waterford. Waterford is 50 km from Enniscorthy and 80 km from Thurles. Out of all these calls only one was in the area that this ambulance and these paramedics are supposed to be servicing. Out of these eight calls during a 12-hour shift, the paramedics only got to attend one. In all other instances they were redirected to another area either because an ambulance closer to the scene had become free or because there was a higher priority call somewhere else. These paramedics spent almost their entire shift driving around the south-east of the country. During that time the environs of Thurles, where the ambulance was supposed to be based, was left without any service. The paramedics who should have been servicing that area were in the south east. Due to lack of resources in the south east, ambulances are being redirected and taken out of the areas where they are supposed to be operating to make up the shortfall. This is simply not on and it is a bad use of resources. I would nearly say it was an abuse of resources.

I do not believe this situation is unique to Thurles. It is nonsensical that an ambulance and paramedics will be pulled out of a town in the middle of Tipperary to go to a call in Arklow. Yet, that is the reality of the situation. The timetable I have set out from last Saturday and the list of calls are not unusual. Unfortunately, they are the norm for a paramedic based in Thurles. The first obvious issue is that the ambulance should not be pulled from the Thurles area to serve in other regions unless for genuinely exceptional circumstances. It should not be a regular occurrence. Yet, that is what is happening.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I welcome the opportunity to address the House on behalf of the Minister for Health, Deputy Donnelly, in respect of the ambulance service in the south-east region and in Thurles in particular.

The National Ambulance Service makes use of historical data and future projections of service volumes in determining the allocation of resources and deployment locations within an area. Therefore, to increase the response capacity of the south region of the National Ambulance Service, in 2020 an additional six whole-time equivalent posts have been allocated specifically to the south east. In addition, a further eight full-time posts have been allocated to assist in the implementation of the recommendations of the report, A Trauma System for Ireland. It is projected that these 14 posts will be filled before the end of 2020.

The National Ambulance Service continuously evaluates its services and aligns them to available resources and activity levels. It is not a static service and as such deploys its resources in a dynamic manner. It operates on an area and national basis as opposed to a local basis. The dynamic deployment of ambulance resources ensures that the nearest appropriate resource is mobilised to the location of the incident.

The National Ambulance Service has undergone a significant process of modernisation in recent years and several important service innovations and developments have taken place. Many of these innovations are aimed at improving response times and resources availability in rural areas. Recent initiatives include the development of alternative pathways of care and a clinical hub, which facilitates a hear-and-treat model of care. This went live in the national emergency operations centre in March 2018. The hub has now been expanded to provide a public information telephone line on available mental health supports and services. The service diverts some lower acuity patients away from busy emergency departments and frees up some emergency capacity. In addition, the National Ambulance Service has developed the intermediate care service to provide lower acuity hospital transfers. This frees up emergency ambulances for more urgent calls. Community paramedics have also been introduced in rural and urban areas to allow patients to receive care closer to home. It is anticipated that such initiatives, coupled with the aforementioned increase in staff numbers, will help to improve availability of ambulance resources across the south-east region.

Over 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 €173.9 million. This will support the National Ambulance Service in continuing to deliver a high-quality service throughout the country.

Jackie Cahill (Tipperary, Fianna Fail)
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I thank the Minister of State for his answer. Unfortunately, it is not what we see happening in reality in my home area.

The second obvious issue I want to address is response times. The ambulance services are under pressure to meet a 90-second turnaround from when the call comes in to getting an ambulance on the road. It appears little thought has been put into where that ambulance is coming from. Surely, we must look to see how long an ambulance takes to arrive at a call, not how quickly it can be put on the road. The situation we have means an ambulance such as the one in Thurles is being directed to drive around the country all day without actually making it to calls, all the while leaving a large area without a service that it desperately needs. I am asking for additional resources in order that our emergency services and paramedics are not spending their shifts driving from call to call and being redirected without even reaching the person in need, time and time again. Our region, the south east, needs additional resources in order that Thurles, which is in the mid-west region, is not drained of its paramedics and ambulances to fill the gap.

I read out the timetable. It is nonsensical to think that an ambulance in Thurles would do such driving around the country. We must take a serious look at the National Ambulance Service nationwide. Measuring response times in terms of how long it takes to put an ambulance on the road is not correct. It should be measured by how long it takes to get to the call and the person in question.

I was talking to one of the paramedics who told me they were being redirected to a call in Kilkenny after being redirected from Borris-in-Ossory. He said they were passing by Borris-in-Ossory and contacted the central location to find out whether to do the call in Borris-in-Ossory on the way because the patient would be going to Kilkenny. He was told not to because there was an ambulance on the way from Ballinasloe to deal with the call. This type of inefficiency cannot be allowed to continue. It is happening at the moment and the paramedics are getting frustrated with the use of their resources.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Deputy Cahill for raising this important issue. I assure the House that the National Ambulance Service is focused on continually improving the ambulance service in the south-east region and throughout the country. The improvement of the service is being implemented through a multi-annual reform programme, Vision 2020, which prioritises investment in new developments, increased manpower and fleet and improved technology. Recent developments such as the new community paramedic model of care and the hear-and-treat clinical hub will divert some lower acuity patients away from busy emergency departments and free up emergency capacity in the south east. I thank Deputy Cahill again for raising this important issue. I hope that this can be resolved in the near future.