Dáil debates

Thursday, 14 October 2021

Saincheisteanna Tráthúla - Topical Issue Debate

Ambulance Service

4:25 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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The next item I have selected is from Deputy Michael Moynihan, which is to discuss understaffing and resources in the ambulance services in counties Cork and Kerry. It is good to hear that the Deputy is looking after Kerry as well. The Minister of State, Deputy Anne Rabbitte, will respond.

Photo of Michael MoynihanMichael Moynihan (Cork North West, Fianna Fail)
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I thank the Ceann Comhairle. I welcome the opportunity to speak on this matter. The issues here have manifested themselves over the past number of months, in particular, in respect of the waiting times for ambulances. In the area I come from in Duhallow, ambulances come from either Tralee or Cork, but they also might come from Limerick. In one instance, an ambulance came from Clare. A number of incidents have been brought to my attention where there was a two and a half hour wait from the time that the GP called for an ambulance for a critically ill patient to be picked up. It is simply not acceptable in this day and age. We had many issues with the National Ambulance Service, NAS, and all the key issues that fed into that over the years. Nowadays, however, there is a long waiting time for an ambulance from the time someone calls for one. It might be different in the city or in the suburbs near the locations of the hospitals, but people are an hour from one of the major hospitals in the Duhallow region. Therein lies the problem, when added to waiting two and a half hours from the time the urgent call comes in.

I am referring to urgent cases that have been brought to my attention, not just the ordinary, run-of-the-mill issues that might need an ambulance; these were extremely ill patients. The GP and the medics decided that it was important that those people were taken to hospital immediately by an ambulance. While sometimes people can be taken by car, it was decided that an ambulance, paramedics, well trained staff, and so forth, were needed to take them to hospital.

Over the years I have been in the back of many ambulances to accompany patients. I could not speak highly enough of the paramedics and other staff and the dedication, commitment and professionalism that they demonstrate when carrying out their work. However, if a seriously ill person is waiting for an ambulance to arrive for two and a half hours after it had been called for, that is simply not acceptable. It is not a service. When it comes to major traumas or strokes, there is an important "golden hour" to try and get somebody into hospital setting.

I appeal to the Minister to get the HSE to target this. Today is 14 October. In the past number of months there was an urgent case where a patient waited for two and a half hours for an ambulance. Others waited for three hours. What will the waiting time be in the first week in January or the last week of December, when we are the height of the winter season? I do not think that there is an urgency in respect of the crisis in the ambulance services. Many of the fine people I know who work in the ambulance service constantly tell me about the difficulties they face, particularly in Mallow Hospital, which is a fantastic acute hospital. It does not take patients from the ambulances. To my mind there is no reason for that. Regulations should be changed. Two and a half hours is too long to wait for an ambulance. There should be ambulances within Duhallow and the wider north Cork region. Ambulances should be there and on call. There should be a basic ambulance service for critically ill people to get them to hospital in time.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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This is the second time I have had to reply about ambulance service in the House. The last time I replied to Deputy Ó Cuív and his colleagues. I am glad to report that they have since received their ambulance in Connemara. We have, therefore, made a little progress on ambulances. I am going to read a script on behalf of the Minister for Health, Deputy Stephen Donnelly. I will convey everything the Deputy said to the Minister. The Deputy might not have realised that I happen to know where Duhallow is. He had me down there over the summer. Once someone goes off the motorway it is easy to get lost around the place.

The Deputy has raised the question of resourcing and response times across the north-west midlands and southern region. I intend to give a national overview of the capacity and performance of the NAS. As the Deputy may be aware, the NAS does not operate a station-based deployment system. Instead, it uses dynamic deployment on a national basis. Dynamic deployment allows staff in the HSE's national emergency operational centre, NEOC, to see all available resources, to prioritise their allocation to the higher acute cause and require an immediate emergency response.

It is important to make Deputies aware that the issue is not the time it takes to get to the patient; it is how quickly the call is answered. If the call is answered within three minutes, that is considered deployed. It is not measured on when the ambulance arrives to the patient. It is important for us to be clear on that, because some Members might not be aware of that. While Deputy Moynihan talks about it taking two and a half hours for an ambulance to arrive, once the ambulance has responded prior to that, that is an efficient call.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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That is ridiculous.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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Absolutely.

4:35 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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The poor person on the floor wants the ambulance now, not whenever they receive the telephone call

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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Exactly. It is important for us to understand what we are talking about and where some of the gaps in the service are. This model represents international best practice and has been highlighted by the Health Information and Quality Authority, HIQA, as a way to improve response times and NAS performance generally. Using this model does mean that non-serious or non-life-threatening calls will sometimes experience a longer wait for an ambulance. The wait times for lower-acuity calls have presented a particular challenge recently, as the NAS has seen unusually high demand. This is in line with the current experience of many areas of our acute health service. As the Deputy may be aware, there is a shortage of qualified paramedics in Ireland, but the NAS has been incrementally building capacity in recent years through implementation of the Vision 2020 strategic plan.

In 2021 the NAS received additional funding of €10 million, which included further funding for additional paramedic staff. As part of budget 2022, an additional €8.3 million will assist in modernising and building up the capacity of our National Ambulance Service. To help to meet the immediate capacity challenges, the NAS advises that it has redeployed approximately 45 paramedics from Covid-19 related work to emergency ambulance duty. Over the short to medium term, I understand that a further 80 paramedics are due to graduate from the NAS college this quarter, which is significant. The paramedic programme is a three-year course, and there are over 200 student paramedics at different stages of the programme, with a further 100 students scheduled to commence in January. To support workforce planning over the longer term, the NAS has commissioned an independent analysis of demand. The results of the analysis will provide greater clarity about staffing requirements over the coming years. The NAS has highlighted the particular difficulty with service delivery in rural areas that was noted in the 2016 Emergency Service Baseline and Capacity Review. The review suggested that the most practical way of providing an initial response to many calls in rural areas is through voluntary community first responders. While that may be successful in certain cases, in critical cases, an ambulance and clinical diagnosis are required.

Photo of Michael MoynihanMichael Moynihan (Cork North West, Fianna Fail)
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Over the last decade, the ambulance service was removed and after much lobbying and negotiations, we got the ambulance back. I am talking about the time that a general practitioner, GP, arrives at a patient's door, assesses the patient and says that an ambulance is needed to get the patient to hospital immediately. It takes 2.5 hours from that call until the ambulance gets to the door. Let us be clear about what I am challenging. It is not about when the call is logged. It is from the time when the GP makes a medical assessment and says that an ambulance is needed. I could go into personal stories but do not want to bring them before the Houses of the Oireachtas. It is simply not acceptable. Some fine people in the ambulance service have said that when they come to retirement age, that is it. If people want to stay in the ambulance service, with the staffing shortages, why not bring retired staff back? Many have come to me to say that they would stay on for another year, or two or three years, but the date is set. I welcome that there will be 80 more paramedics.

I fear that the National Ambulance Service and HSE do not understand that there is a crisis. We are not getting the service that we deserve. We were getting a better service a number of years ago. In the last months in 2021, the crisis has erupted and the waiting times have been substantial. Mallow General Hospital and other hospitals need to be looked at to make sure that they can accept patients, depending on the medical need at the time. It is crucially important that we address the time between when it is decided that an ambulance is needed and when an ambulance comes. It is another hour in the ambulance to either Tralee or Cork from my region, which is not acceptable. I would like if the Minister of State could go back to the powers that be to say that what is going on is unacceptable and it needs to be addressed. There needs to be a proper ambulance service throughout the country but especially, as I am debating today, in my area in north Cork and the Kerry region, which the ambulance would also cover. We need to have a proper ambulance service, which we do not have at present.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I assure the House that the Government is committed to the strategic reform of the National Ambulance Service. I will take on board everything the Deputy has said. Let us have action and meet with the HSE and CHO 4 to see what plans they have to ensure that there are not repeated instances of what the Deputy has spoken about today. I know that Deputy MacSharry was also originally to be a contributor to this so perhaps we should have a meeting with CHO 1. We found it beneficial when we had a cross-party meeting regarding CHO 2, where we met with the National Ambulance Service to discuss how it could put an action plan in place. It knows the gaps and does the best that it can. It is coming under pressure. I have spoken with it. As we come out of Covid, the NAS is seeing a significant rise in the need for its services with an increase in frailty among older people. We have to see how we can work together. Eighty people will come on board. We will have to see how the investment can support the Deputy, Duhallow and the people in the surrounding areas.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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I thank the Minister of State for being here to deal with all those matters.