Holly Cairns (Cork South West, Social Democrats)
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I thank the Ceann Comhairle for including this Topical Issue. Emergency services response times are a constant concern in rural areas and County Cork is one of the areas seriously affected by significant ambulance delays. Despite the best efforts of paramedics and other staff, over a third of calls had response times in excess of an hour in the first half of 2021. The distances involved have been cited by the National Ambulance Service as one of the reasons for delays. This is a massive source of worry for rural residents, particularly households on the peninsulas in Cork South-West.

The resourcing of the National Ambulance Service remains a crucial matter, as is the inadequate number of ambulances and paramedics. However, recent changes in Kerry and Donegal are working on allowing fire and rescue personnel to act as first responders in health emergencies. This is a very practical and potentially life-saving measure that should be adopted in all counties as soon as possible. We have excellent fire and rescue services in Cork staffed with personnel trained as first responders. It makes sense they would be deployed in cases where ambulances are delayed or immediate attention is required, such as instances of cardiac arrest.

Towns and villages in Cork South-West, including Schull, Castletownbere, Bantry and Dunmanway have fire stations with staff who, by the nature of the work, are in the area and available to respond. This matter has been brought to my attention by such staff, who are eager to assist those in need in their locality. They are motivated to save lives and the Government should respond accordingly. I am seeking that the Government pursues this as a national policy. I appreciate it is a complicated matter across Departments, local authorities and public and voluntary bodies. However, given the potential benefit of this policy, it should be rolled out in every county. Furthermore, it is a common-sense approach that effectively uses resources that are already available.

This move would not only potentially save lives but it would also provide comfort to the people of west Cork and other rural areas. It is not about replacing the ambulance service but rather supplementing it with trained professionals already in the area. These people may provide backup when it becomes clear an ambulance will be delayed. This is about getting first responders to people in need while an ambulance is on its way.

The Ministers for Health and Housing, Local Government and Heritage should take leadership on this matter. Kerry and Donegal are ahead of the curve on this and have shown it is possible. Similar changes are also being proposed in Northern Ireland after a pilot scheme in 2016. Instead of the National Ambulance Service having to engage with all relevant bodies and local authorities on an individual basis, could the Government not step in here, with the line Ministers providing a forum or mechanism for a co-ordinated approach? In doing so, they could bring all the stakeholders together and make this happen.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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The Deputy has certainly put forward a very strong case for this type of co-operation. It is important, particularly as we have come through the Covid-19 crisis, which has highlighted significant challenges in rural areas. I am very familiar with that part of the country.

To begin, I should clarify that the provision of a fire service in its functional area, including the establishment and maintenance of a fire brigade, the assessment of fire cover needs and the provision of fire station premises, is a statutory function of individual fire authorities under the Fire Services Acts 1981 and 2003. My Department supports fire authorities by establishing policy, setting national standards for fire safety and fire service provision, providing a central training programme, issuing guidance on operational and other related matters and providing capital funding for priority infrastructural projects.

Fire services are provided in Ireland by local authorities in accordance with the provisions of the Fire Services Acts 1981 and 2003. Under this legislation, there are 31 local authorities that provide fire prevention and fire protection services for communities through 27 service delivery structures. Local authority fire services are delivered by approximately 3,300 local authority staff engaged at 217 fire stations nationwide, with 16 of these stations being staffed by full-time firefighters. A further four are mixed full-time and retained and 197 are staffed by retained firefighters.

Responsibility for the provision of emergency medical services, including pre-hospital emergency care, rests with the HSE, which operates the National Ambulance Service and emergency departments in hospitals in accordance with health sector legislation and national policy. Fire authorities created under section 10 of the Fire Services Act 1981 and 2003 are empowered under section 25 of that legislation to carry out or assist in any operation of an emergency nature.

The National Ambulance Service, NAS, may call for assistance before its crews reach an incident and many fire services are equipped with automatic external defibrillators. The majority of fire services have trained their firefighters in cardiac first responder and emergency first responder to Pre-Hospital Emergency Care Council standards for health and safety reasons. Fire services personnel in many fire stations are, therefore, already trained and equipped to a standard that could enable them to respond to life threatening emergencies. Given the infrastructure of fire services around the country and particularly in rural locations, the retained firefighters service is well placed to assist the HSE with responses to such life-threatening emergency calls.

As the Minister of State with policy and legislative responsibility for fire safety and the provision of fire services by local authorities, a primary concern must remain, in accordance with the Fire Services Acts 1981 and 2003, that local authority-provided fire services are meeting their statutory obligations in respect of their primary role in the provision of fire services and fire safety. These responsibilities include the important activity of community and other fire safety initiatives as well as response to fire and emergency calls such as road traffic accidents, river rescues, chemical or hazardous spills for example. Fire services generally respond to calls for assistance from external bodies in accordance with protocols operated within the three fire services regional communications centres.

The feasibility of fire services, outside the Dublin Fire Brigade area of operations, being commissioned by the HSE to provide a response service in support of the NAS in responding to life-threatening emergency calls was discussed at national level at the fire services national oversight and implementation group, which consists of fire services management and staff representatives, and it produced a discussion document as the basis to underpin discussions with the health sector. The document was discussed at the management board of the National Directorate for Fire and Emergency Management in July 2018 where a number of issues including the transfer of risk and mechanisms for funding were raised, and these remain as items of discussion with the Department of Health.

Any proposal for formalising this assistance would need to be subject to appropriate governance and cost reimbursement arrangements and to be set in the context of a service agreement with the HSE and the National Ambulance Service, which would not impact on or adversely affect fire services' primary roles.

Holly Cairns (Cork South West, Social Democrats)
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I thank the Minister of State for his reply and for his overview of the situation. This is a sensible policy with the potential to save lives and make a real difference in dispersed communities in rural areas. The National Ambulance Service is pursuing this approach and many fire and rescue personnel support this idea. Also, the Pre-Hospital Emergency Care Council priority dispatch standard allows for the use of appropriately trained fire and rescue staff to respond to certain categories of emergencies as first responders. We now need the Government to fit the pieces together and make it happen, and to bring together all the stakeholders at national and local levels with the common goal of deploying all available resources to save lives. This is about the practical and responsible use of available personnel and resources. I absolutely realise that it would require negotiation and new agreements, but given the prospect of saving lives and offering assurances to vulnerable groups in rural areas, I believe it will be worth it.

It is important to note that the ongoing issues with the ambulance service remain. We require more ambulances based around the country and staff who work reasonable hours to be able to respond safely and effectively to emergencies. We must also have a service that reaches all communities in a timely manner. This policy is about fire and rescue service staff serving as first responders, which is a stopgap measure until an ambulance arrives. We still need more ambulances and we still need more paramedics.

I urge the Minister of State, Deputy Noonan, to bring this matter up with the relevant Ministers at Cabinet and to please push this policy as a very practical intervention for rural communities, and surely all communities.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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I absolutely will. It is very important that we do. Another important point is related to Covid-19. The pandemic has presented challenges to the fire services in the delivery of services. Our Department has monitored regular reports from the fire services on the impact of the pandemic on staffing levels and business continuity. In recent weeks, in line with trends among the general population, fire services have experienced heightened disruptions due to the transmissibility of Covid-19, the Omicron variant, and close contact-related staff absences. This will be temporary of course. The fire services' management have employed a range of tools to limit the disruption to the service. Following a Government mandate in late December 2021 authorising the use of voluntary derogation exemption, exempting fire services staff from Covid-19 close contact isolation requirements under strict conditions, our Department built the derogation into a broader suite of updated guidance and contingency measures for fire service management. This was to ensure the ongoing provision of fire services amid the highest rates of pandemic infection since the onset of the pandemic.

Fire services would also look to assist other emergency services when called upon. However, there currently exists no formal arrangements between the fire services, the HSE, and the National Ambulance Service to provide a first response served nationally, and fire services under no statutory responsibility to provide those services on behalf of another service.

Deputy Cairns has, nonetheless, raised an important issue. As the Deputy has outlined, the examples in Kerry and Donegal should be given consideration. The HSE and the National Ambulance Service were in correspondence with the Chief Fire Officers Association to explore the willingness and the ability of the retained firefighters service to offer support to the National Ambulance Service during November 2021, so there is a precedent there. The Deputy has raised an important issue that I will take back to the relevant Ministers.