Thursday, 23 September 2021
Saincheisteanna Tráthúla - Topical Issue Debate
I raise the problem with ambulance services in Laois-Offaly. There have been a number of cases over the past two years of very long delays and, in one case, a no-show. One case was an elderly man in Clonaslee left lying in a yard. That went on for over two hours. There was a case in Rathaniska in a sports field involving a massive delay. There was a case in Portlaoise recently where there was a no-show to pick up the injured party. They had been advised by the ambulances services not to move the injured person. The reason for this, I am told, is there was no ambulance in the county at the time because the ambulance based normally in Laois could be in Waterford, Wexford or other parts of the south east. The deployment can stretch that far, and it is the same for Offaly.
There was a case in Naas recently where a horse fell on a man and he was trapped underneath the horse with a broken hip and internal bleeding. The ambulance was despatched from Portlaoise to pick him up and when they were within 2 km of him after travelling over 50 km, they were stood down and sent to an non-emergency in Athy.
Kilminchy is across the road from the hospital, 500 yd away. An ambulance was sent from Birr to pick up an elderly woman and bring her to the hospital in Portlaoise. There is a case of a Portlaoise ambulance crew being sent to west Offaly. They arrived at the gate, the people inside saw they were there and the next thing they were told they were stood down. The ambulance staff had to explain that the householders had seen them and they could not be stood down.
Having spoken to staff, there are different problems. Dynamic deployment, because of the shortage of staff, is causing problems. I have raised this with different levels of the National Ambulance Service, and indeed with Paul Reid twice in the last two weeks. There is an issue of a shortage of staff, which he has confirmed for me, of up to 25%. Scotland has 5,000 staff; we have 1,800. There are many graduates coming on stream next year and I welcome that but the distance issue has to be examined in terms of deployment.
I am aware that there are working groups established and that the distance is being examined, but this is a really important issue to try to get a grip on. It is a key issue.
Notwithstanding the debt of gratitude we owe front-line workers, healthcare workers especially, I wish to raise, as my colleague has done, the issue and the plight of the ambulance services. There are serious concerns, worries and fears in my community and constituency as a result of incidents relating to ambulance services. Reports from crews and patients around the country over the past year or so suggest serious concerns about delays in ambulances arriving to treat patients. These delays were once an occasional occurrence but, unfortunately, now seem to be making the news daily. In one week alone, in a small town in my constituency, three cases were highlighted to me in which very serious delays occurred. Paramedics are also being dispatched, as the previous speaker said, to calls way outside of their own regions, irrespective of the levels of cover locally. In turn, many calls in the midlands recently have been answered by crews from as far away as Roscommon, Ballinasloe, Athy, Maynooth and Cavan. This, of course, is because the midlands crews themselves have been dispatched to other regions. Staff suggest that keeping crews in their own areas, as was the case previously, would improve response times. They state that until the centralisation of the control centre there were never, and they do not ever remember, delays of two to three hours or more, as has been the case in recent times. Crews are desperate for things to improve but staff morale because of this, as the Minister of State would appreciate, is very low. It is leading to huge absence levels. I believe up to 50 shifts were left uncovered in one part of the country last week alone. It has been relayed to us that some staff were released from front-line duty to carry out Covid swabbing. Returning them to front-line duty should be considered as an option to improve staffing levels at present. I implore the Minister of State to insist on improvements and measures that can improve operations and to put in place a mechanism by which that is reviewed as soon as possible and regularly thereafter.
I welcome the opportunity to address the House, on behalf of the Minister, Deputy Stephen Donnelly, on ambulance resources and services, particularly those in the Laois and Offaly region. I join my colleagues in giving my gratitude to the healthcare workers in these very difficult times.
The National Ambulance Service, NAS, does not operate a station-based deployment system but instead uses "dynamic deployment" on a national basis. Dynamic deployment allows staff in the HSE's national emergency operations centre to see all available resources and match them with service demand requirements in real time.
While Laois and Offaly have between five and nine vehicle resources, support is also provided by crews based at Athy, Roscrea, Carlow and Athlone and by crews from the NAS north Leinster region as whole.
The 2014 HIQA report into pre-hospital emergency care highlighted this process as a way to improve response times and NAS performance generally. Using dynamic deployment allows the NAS to prioritise resource allocation to the higher acuity calls that require an immediate emergency response. It also allows the NAS to categorise non-serious or non-life-threatening calls and to provide a resource appropriate to the patient's need. This does mean that lower acuity calls will sometimes experience a longer wait for an ambulance, and this has been a challenge in recent years.
A 2016 emergency service baseline and capacity review highlighted particular difficulties associated with ambulance services in rural areas as Ireland's population density is significantly different from those of many other countries. This review suggested that the most practical way of providing an initial response to many calls in rural areas is through voluntary community first responders, CFRs. Community first responders are members of the community who are supported by the ambulance service in providing a high level of initial response within their local community. The NAS has worked hard to grow the CFR scheme over the years, and in 2021 a total of 275 schemes have been established, including 19 schemes covering Laois and Offaly. While it was necessary to temporarily stand down these groups due to the pandemic response, 103 of the 275 are now operational again, including ten in Laois and Offaly. The NAS is continuing to work on reactivating all such groups.
As the House will be aware, the NAS also continues to provide significant support to the HSE's response to the pandemic, particularly in respect of the national testing and vaccination programmes. This is being delivered against a backdrop of an overall increase in both hospital activity and emergency calls in the latter half of this year. The NAS anticipates that the release of staff from Covid-related duties in the coming months will improve resource availability across the board. I can advise that in 2021, the NAS has been allocated additional funding of €10 million, which includes funding for additional paramedic staff in line with the baseline capacity needs that have been identified.
I wish to highlight to the House the progress that has been made in recent years through the NAS strategic plan, Vision 2020. The NAS has been undergoing a significant process of modernisation that includes service innovations aimed at providing alternative pathways of care and helping to improve resource availability and response times. The Government is committed to this strategic reform plan, which has been developed to ensure we have a modern, agile and responsive National Ambulance Service.
I thank the Minister of State for his response and join the other Deputies in thanking the ambulance crews and the staff for the absolutely magnificent work they have done over the past year, in particular the past year and a half.
As for the reply, the Minister of State said that while Laois-Offaly has between five and nine "vehicle resources", which can mean cars as well, support is also provided by other crews from Athy, Roscrea, Athlone, etc. The problem is that the region has been left exposed because at times all the ambulances are drawn out of the area. It was confirmed for me yesterday and again this morning by Paul Reid that the issue of distance is being looked at. It has to be looked at for a simple reason. I am not going to argue with the Minister of State that there should be a strict county boundary - in other words, that a Laois ambulance has to go to Craiguecullen, which is a distance of 28 miles, and that the Carlow ambulance half a mile away cannot go there. Of course the Carlow ambulance should be able to go there, but there has to be some distance factored into this.
Staff are overworked. They have no breaks sometimes. There is a huge redeployment of Covid staff. That needs to finish. Other staff can provide Covid services. We need to return those staff involved in Covid services to ambulance services now. I appeal to the Minister of State to do that. We need to increase the number of ambulances-----
I appreciate the Minister of State's response. Looking over it and listening to what was contained in it, I would respectfully say that the dynamic deployment mechanism, as well thought out and well considered as it may have been, does not appear to be having the desired impact or results one would have expected initially. It is as a result of that and the frustrations and the morale within the service that genuine medics are reconsidering their future role.
I note too that part of the overall package in addressing this included the community first response system, which the Minister of State says is beginning to come back on track after Covid or as it recedes. We welcome that too. There has been a modernisation of many facilities in my constituency among others, which of course helps in ensuring that work is done in a professional manner in the surroundings people deserve. I ask, however, that some effort be made on the part of the Minister's office to liaise with the HSE in order to ensure that there is some local engagement processes that would lead to new processes that can help in the delivery of the service and, as I said, is monitored-----
I thank the Deputies once again for raising this issue, notwithstanding, as we said, the challenges of the Covid pandemic and the demands it places on our services. The National Ambulance Service is committing to reducing response times in the Laois and Offaly regions and across the country.
Deputy Stanley noted that the distances are being looked at, which is to be welcomed. I hope we can have better consultation on such issues. Deputy Cowen said that the dynamic deployment mechanism is not working for Laois-Offaly. He asked that the Minister liaise with stakeholders on the issue and ensure there is local engagement. I will take his points back to the Minister.
In line with the National Ambulance Service's strategic plan, Vision 2020, the service is undergoing a multi-annual reform programme that prioritises investment in new developments, increased manpower and fleet, and improved technology. This year, an unprecedented €187 million-plus is being invested in the service, including €10 million in new funding that has been allocated to priority areas that will continue to progress strategic reform. The funding facilitated an increase in paramedic staff numbers to target capacity deficits and is being used to progress the development of alternative patient pathways. These include hear-and-treat and see-and-treat services that are designed to manage low-acuity calls in an integrated manner, which may mean that emergency department attendance can be avoided for those patients.
I assure the House that the Government will continue to support these developments within the National Ambulance Service and to prioritise strategic measures that contribute to better patient outcomes. Deputy Cowen spoke about the need to retain these very valuable staff, including advanced paramedics and ambulance personnel. There are challenges in that regard, particularly following the Covid crisis, when ambulance service staff, like many front-line staff, are burnt out. We must recognise that.