Denis Naughten (Roscommon-Galway, Independent)
Link to this: Individually | In context | Oireachtas source

I move:

That Dáil Éireann:

acknowledges that: — pre-hospital emergency care services in Ireland are changing with the growing and ageing population, and a holistic approach is needed to address the issues that hospitals, ambulance services, community, voluntary services and health care workers are facing;

— Ireland is one of the few countries in the world to boast a National Ambulance Service (NAS) with a single national regulator, the Pre-Hospital Emergency Care Council (PHECC);

— pre-hospital emergency care in regional and rural Ireland is provided by the NAS;

— the NAS works with Dublin Fire Brigade, Air Corps, Irish Coast Guard, Irish Community Rapid Response and Northern Ireland Ambulance Service;

— the NAS provides high-quality, safe and person-centred emergency and urgent care services and is the statutory pre-hospital emergency and intermediate care provider for the State;

— the NAS employs approximately 2,000 staff, including advanced paramedics, paramedic supervisors, paramedics, community paramedics, emergency call takers, emergency dispatchers, aeromedical dispatchers, critical care nurses, clinical hub nurses, doctors and intermediate care operatives;

— at local community level, the NAS is also supported by volunteer-run community first responder schemes;

— community first responders are an integral part of dealing with an emergency in the community in that they have the potential to provide vital lifesaving Cardiopulmonary Resuscitation (CPR) and defibrillator treatment to patients while an ambulance is enroute;

— capacity demand on all pre-hospital emergency care is growing, and the NAS takes more than 300,000 emergency calls annually, with growing demand for service, as the NAS received 1,865 calls a day in December and January, an increase of 19 per cent on the same period a year ago;

— response times are getting longer, and the Health Service Executive (HSE) revealed that the NAS is not meeting the response target times for emergencies, with ambulance response times having increased on average by 10 minutes across some regions since 2019;

— incident duration times and incident queuing times are getting longer;

— life-threatening illness or injury cases are severely compromised by a lack of resources;

— for most patients a quick medical response determines their survival chances; for example, for every minute that elapses after a cardiac arrest, a person's chances of survival decrease by 7-10 per cent, and for every minute that stroke treatment is delayed, a person loses two million brain cells, highlighting the need for faster emergency medical response times especially in the most serious of cases;

— every year in Ireland thousands die from cardiac arrest, approximately 70 per cent of which happen in the home;

— currently there is just a 5 per cent survival rate from cardiac arrest in the community;

— off-load hospital delays have increased, which is compounded by the fact that there are currently less than two acute hospital beds per one thousand people in Ireland, which is below the Organisation for Economic Co-operation and Development average, and for every 82 people forced to wait more than six to eight hours for admittance to a hospital there is one death above the expected mortality rate;

— choking or suffocation is a significant unintentional cause of death in children; and

— the Irish Medical Journal reported in 2020, that there were 4,385 hospital admissions related to anaphylaxis between 2005 and 2016, with the highest rates of anaphylaxis-related admissions occurring in young adults and children; recognises that: — an increase in population numbers and life expectancy will result in significant additional future public health demands, in addition to those currently experienced by health and ambulance services;

— the recently published Royal College of Surgeons in Ireland "Surgery for Ireland" report proposes a new networked approach for emergency surgical care which would place significant additional demand on our ambulance service;

— in 2018, there was a Government decision on the reconfiguration of trauma services following the publication of the report entitled "A Trauma System for Ireland: Report of the Trauma Steering Group", that the plan should not proceed in advance of improvements to air ambulance services and enhanced additional ground ambulance resources;

— while the Telemedicine Rapid Access for Stroke and Neurological Assessment programme has been successful in providing timely care to patients, thus reducing their risk of disability, it remains to be rolled out to all acute emergency departments (EDs);

— the failure to establish a national first responder register by the NAS precludes many of the community first responder scheme volunteers from responding to a local medical emergency, such as cardiac arrest, choking, chest pain or breathing difficulties;

— there is a need to shift more medical care from acute hospitals to community care settings;

— NAS recruitment efforts are currently being overwhelmed by service demand and retention challenges, and in order to meet current and future demands there is a need to:

— recruit an additional thousand NAS staff and resources, including a greater number of paramedics and additional ambulances; and

— double the NAS workforce over the next ten years;

— paramedics are increasingly accepted as healthcare practitioners who can make significant contributions towards improving the health and well-being of populations beyond traditional emergency response and transportation roles, but this needs to be regularised;

— this enhanced scope of practice for paramedics should include the delivery of community paramedics, noting that there are currently just 11 within the NAS, and there is a need to develop specialisms in areas such as aeromedical, retrieval, critical care and mental health paramedics and expanding the scope of practice of frontline emergency paramedics to provide care in line with the Sláintecare principles;

— the paramedic profession has developed significantly in terms of clinical practice over the last 25 years, yet it is not recognised as a profession under the Health and Social Care Professionals Act 2005, nor by the largest employer of paramedics within the State, the HSE;

— this failure of recognition limits career progression, negatively impacts retention, restricts alternative pathways of care and in the case of HSE employees, limits access to health and social care professions (HSCP) education opportunities within the HSE, and as a result the retention of employees within the field of paramedicine generally, and within the NAS specifically, is an area which needs to be addressed;

— PHECC was established under Statutory Instrument No. 109/2000, and in the absence of primary legislation underpinning its role, PHECC cannot:

— protect the Emergency Medical Technician (EMT) or Paramedic title;

— regulate those who do not sign up to its voluntary codes of practice;

— standardise scope of practice across employers as each organisation's medical director must "privilege" the scope of practice for employees/members under the PHECC's "Triple Lock" mechanism addressing credentialing, licencing, and privileging;

— institute fitness to practice processes similar to other regulated professions, such as teaching, nursing, medicine or other HSCP;

— there is an urgent need for a strategic focus on the field of paramedicine, similar to the process undertaken by the Commission on Nursing in the late 1990's, thereby establishing pathways for enhancing patient care through relevant professional governance, appropriate education, and expanded practice, all leading to improving retention of personnel; and

— there is no ready supply of paramedics in Ireland, nor indeed in the international setting, therefore the NAS for the most part must educate its workforce in its own college, and currently the NAS delivers a BSc (Honours) Paramedic Programme and an MSc Specialist Paramedic Programme in affiliation with the School of Medicine in University College Cork; and calls on the Government to: — address the ongoing workforce issues across the entire healthcare system;

— improve the working environment and support for all existing emergency medical care staff;

— establish a commission on paramedicine as a matter of urgency to examine issues, such as:

— primary legislation to recognise and regulate the profession appropriately;

— to ensure that all paramedics have access to an appropriate initial and on-going education;

— institute an expanded scope of practice and specialisms;

— address retention and career progression; and

— tackle the on-going workforce issues within the paramedicine field;

— support the NAS in its efforts to build staffing levels to meet the increasing demand for services, including rolling workforce planning surveys, matching of demand against dynamic deployment models, and the filling of long-term roster vacancies in a timely manner;

— enhance the availability of alternative care pathways available to paramedics, ensuring that care is provided in the appropriate setting including close to or in the home, thereby reducing EDs attendances and associated demand pressure;

— enhance community paramedic numbers to assist in the care of patients with chronic disease in the community setting, thereby reducing ED attendances;

— support the recruitment of additional student paramedics across NAS programmes, and immediately increase by at least 60 students per year the number of student paramedics trained within the NAS College;

— further increase paramedical educational capacity by supporting the establishment of additional campuses throughout the country;

— develop career progression pathways for EMT staff currently operating as intermediate care operators who wish to progress to a paramedic role;

— review and improve the current ED triage system to support a rapid handover of patients from an ambulance to hospital EDs, to ensure emergency ambulances are freed up as soon as possible to become available for 112/999 calls;

— expand the NAS by-pass protocol on the use of model 2 hospitals and their medical assessment and injury units, to treat medically appropriate patients;

— identify through the Advanced Medical Priority Dispatch System what emergency calls could and should have been more effectively dealt with in the community or alternative health care settings;

— undertake an information technology (IT) system review of the NAS to examine current and potential use of IT in the delivery of care, including access to telemedicine support, enhanced pre-hospital diagnostics, on-going practitioner education and enhanced reporting and audit capacity;

— support the development of a public app that allows the 94 per cent of the population with a smart phone to automatically alert ambulance and community first responders to an emergency, and to provide them with advice on performing CPR in the interim;

— install and maintain defibrillators outside all public buildings through a revision of the building regulations;

— provide public funding for defibrillators, to include funding to maintain and monitor the pads and battery replacement;

— ensure the critical care ambulance retrieval service for children operates on a 24/7 basis;

— revise current legislation to facilitate the rollout of additional emergency community medical interventions, such as the provision of epinephrine autoinjectors, inhalers and aspirin in locked defibrillator cabinets, similar or in tandem with public access defibrillators;

— require and fund the provision of epinephrine autoinjectors for emergency use in school and childcare facilities;

— ensure that all staff in school and childcare facilities are trained in the use of the specific epinephrine autoinjector provided to their facility;

— ensure that all staff in childcare services who have completed foundation training undertake and complete a paediatric First Aid Response course funded by TUSLA and the Department of Children, Equality, Disability, Integration and Youth; and

— establish a stand-by pre-hospital emergency response team to deploy internationally in the immediate aftermath of natural disasters like earthquakes, tsunamis, and wildfires.

As Ireland's population grows and ages, pre-hospital emergency care is facing increasing pressure to adapt and the staff within the service are more than willing to meet the challenge. The National Ambulance Service, NAS, has come a long way from the days when it was just a transport service, transporting patients to hospital. The role of the paramedic has changed from being an ambulance attendant to a specialised healthcare worker involved in the delivery of advanced, out-of-hospital emergency clinical care; which is vital to the proper functioning of our health service. However, paramedicine is not considered a profession by the biggest employer of paramedics; the Health Service Executive, HSE.In many countries, the paramedic is increasingly seen as a healthcare professional but, in Ireland, the full potential of the role has yet to be realised. Paramedics are classified as emergency medical technicians, EMTs - healthcare workers on the same paygrades as cleaners and domestic staff. They are not aligned to medical pay scales and remain among the lowest-paid clinical disciplines in the country. Currently, the titles "paramedic", "emergency medical technician" and "advanced paramedic" are not protected. This means that anyone can call themselves a paramedic, even if they do not have the qualifications or experience to provide safe and effective healthcare. This lack of professional recognition makes it difficult to retain staff or recruit new ones. Paramedics themselves have said that they could do much more but their role needs to be clearly defined and legislated for.

One of the areas where they could provide more care is in the delivery of community paramedicine. For this to happen, the community paramedic needs to be recognised as a distinct clinical role, with more autonomy, and the ability to prescribe medication as is the case in other countries, such as the UK. Recognition of paramedicine as a profession, with degree level training and protection of the title, would give our healthcare system a trusted extra set of hands to relieve the pressure faced by our emergency departments every day. Giving more scope for paramedics would mean that more people could be dealt with in their communities and in their homes, providing alternatives, in appropriate clinical circumstances, to overcrowded GP surgeries and emergency departments.

Paramedics, especially community paramedics, could be the link between communities and services such as social workers, community healthcare nurses, pharmacists and GPs. They could even revitalise the home visit role that was once performed by GPs. In Europe, North America and Australia, community paramedicine programmes, working, for example, with older or more vulnerable members of the community, have resulted in up to a 50% decrease in patients being transported to emergency departments.

To make this happen, we want a commitment from Government to establish a commission on paramedicine to transform the role, just as has happened in nursing. The nursing profession is now properly recognised as an equal clinical partner within the health service, rather than as it was historically seen, as an attendant to the doctor. As a matter of urgency, the commission on paramedicine needs to examine issues such as the recognition and regulation of paramedicine as a profession with appropriate primary legislation, an expanded scope of practice and specialisms for paramedicine needs to be clearly set out, and appropriate initial and ongoing education for all paramedics. We must move from voluntary to third level education within the profession in order that it is aligned with the current and future needs of our healthcare services.

Finally, the commission on paramedicine must address the recruitment, retention and career progression issues. More staff are needed due to the increasing demands but that will not happen as long as paramedicine is not seen as an attractive career option. In conjunction with this, pay scales for current staff need to be aligned with the medical profession to reflect and reward the increased responsibilities of the role.

Paramedics could play a vital role in the community. They are trained and experienced but they need support. The role needs to be recognised, regularised and protected. It needs consistency of training and an alignment of pay in accordance with responsibilities. A commission on the future of paramedicine in lreland could make that happen.

Cathal Berry (Kildare South, Independent)
Link to this: Individually | In context | Oireachtas source

Táim fíorbhuíóch a bheith anseo inniu chun caint faoin ábhar seo. Tuigim cinnte go bhfuil sé ar cheann de na hábhair is tabachtaí in Éirinn faoi láthair. Before I speak to the motion, I would like to convey my deepest sympathies to the people of Greece following the tragic train accident there. More than 32 people have been confirmed dead. This accident underscores the importance of having a functioning, fit-for-purpose, pre-hospital emergency care system, which we clearly do not have in this country at the moment.

I agree with what my colleague, Deputy Denis Naughten, said. We need to improve the services. There are massive pressures due to the population increase and the age demographic going in the wrong direction. Our services need to be expanded bearing that in mind. Rather than dwelling on the bad stuff, I have four suggestions that might improve things perhaps not individually in isolation but in combination they would make things a bit better.

The first one addresses regulation. The Pre-Hospital Emergency Care Council, PHECC, is based in Naas, County Kildare. I have visited its premises a number of times. It is a great place with great people but they are hamstrung by the lack of legislation. Deputy Naughten touched on the need for a system in which the roles of emergency medical technician, paramedic and advanced paramedic are defined.

There are two reasons. First, from the point of view of retention, if we want people to have pride in their profession, there needs to be a defined role. In addition, when they show up at an incident, everybody recognises that the scope of practice of an EMT is utterly different from that of an advanced paramedic. The second reason relates to training. I am not convinced that the training output is being maximised. If we agree that the NAS, Dublin Fire Brigade, DFB, and all paramedic capability needs to be expanded, then, by extension, training pathways need to be improved. DFB works through the Royal College of Surgeons in Ireland while the NAS works through University College Cork, UCC. However, the NAS worked through University College Dublin, UCD, up to three years ago. A large dedicated paramedical school in UCD is not only being underutilised, it is not being utilised at all. There is spare capacity in the system that we should look to exploit and take full advantage of. A lot of people do not realise this, but there is also a paramedical course in the University of Limerick. The university is not even plugged into the Irish system. It has to send its trainee paramedics to the National Health Service, NHS, in the UK to get their on-the-road experience. We have work to do from a training point of view. If we want to increase the number of paramedics we should focus on training and maximising output from that perspective.

All the Members in my group represent regional and rural constituencies. There is a lot of work we can do from a community perspective. I acknowledge and welcome the fact that there are now a lot more defibrillators in the community, which is very good from the point of view of cardiac first responders. In the community, you are a long way from an acute hospital and you could be waiting a while for an ambulance. We could look at expanding that further. Instead of just having a defibrillator, we could put EpiPens, aspirin and salbutamol inhalers in the box as well. That would help with anaphylaxis, cardiac arrest and acute asthma attacks. For a start, public buildings should lead by example. We have defibrillators around Leinster House, which we could perhaps use as a pilot scheme. We could put those extra three medicines in and scale up from there. That is from a community perspective.

Finally, I want to address helicopter emergency medical services, HEMS. An excellent Air Corps helicopter is based permanently in Custume Barracks in Athlone, as the Minister of State knows well. There is an advanced paramedic on board from the NAS That is a good model and it works well. However, we do not have a dedicated HEMS helicopter in this jurisdiction. HEMS is a helicopter emergency medical scheme, and it has doctors on board. There is an anaesthetist, a nurse, or an emergency physician. It offers a lot of critical care at the point of impact in a road traffic accident. Northern Ireland, which is a smaller location with a smaller footprint and population, has two fully kitted out HEMS teams. In Wales, approximately 50 miles from here, there are six fully dedicated helicopters and teams. That is something we can look at, and it would take pressure from our road ambulances. In summary, I commend all the people working in the pre-hospital environment. They are doing their bit, and now we must do ours.

Michael Lowry (Tipperary, Independent)
Link to this: Individually | In context | Oireachtas source

In medical emergencies every second counts. When the misjudged decision to close accident and emergency hospitals such as Nenagh Hospital was being fought, we all became familiar with the term "golden hour." The golden hour determines the appropriate treatment, and is critical within the first 60 minutes from the time of injury or the appearance of serious medical symptoms. It is based on the informed belief that once this time has lapsed, the risk of death or long-term complications significantly increases. This was back when ambulances were staffed by a nurse and a driver who were tasked with getting a patient to hospital urgently. There were fears that increased distances to accident and emergency departments could prove fatal. Nowadays highly-qualified paramedics are trained to administer on-the-spot emergency medical care to people who are seriously ill or injured. Their job is to stabilise the patient before they are transferred to hospital.

I support the suggestion from Deputy Naughten to expand the role of paramedics. The National Ambulance Service saves lives. However, time is still of the essence. Delays cost lives. Last week, during a meeting of the Joint Committee on Health, Dr. Cathal O'Donnell stated that there has unquestionably been harm to patients due to ambulance delay. This harm is due directly to deterioration in response times to life-threatening incidents. Ireland has a rapidly growing older population. It is also experiencing significant population growth. This is substantially increasing demand for all forms of healthcare. In 2022, there was a doubling of pedestrian deaths. Drivers accounted for 39% of road fatalities. Some 1,300 people were seriously injured on our roads. Throughout Ireland, an average of 6,000 people suffer heart attacks annually, while 7,500 suffer strokes. Each of these people, along with thousands of others we do not hear about, require prompt emergency care. We need a properly resourced and fully staffed ambulance service to meet these demands. This fact can no longer be ignored. People's health is not a can that continue to be kicked down the road. People deserve the security of knowing that if an ambulance is called it will arrive in the fastest time possible.

Much has been written about people calling ambulances when circumstances do not require one. The public is urged to contact their GP or out-of-hours service for medical treatment and to only call an ambulance in a true emergency. In an ideal world, most people would do this willingly. However, many out-of-hours services do not provide the access many people require. When daily GP surgeries close in north Tipperary, Thurles and Roscrea are covered by a mobile doctor. Patients are seen by appointment at respective centres in both towns until 11 p.m. From that time, until GPs reopen next morning, the overnight Nenagh centre takes over. That is approximately 20 miles from both Thurles and Roscrea. Not everyone is in a position to drive 20 miles in the middle of the night, with a child, an adult or an elderly person who may require medical attention. In many cases, it is not wise or safe to do so. In other cases, people do not have transport. Their only access to medical care is to call an ambulance, and in times of illness people will do whatever it takes to get help. They cannot be faulted for taking the only choice open to them. I have been raising the ongoing issues with our ambulance service in this House since 2001. I have highlighted escalating crises with out-of-hours medical care in County Tipperary. Neglect of these services has been steadily allowed to reach this crisis point. Failure to take immediate action to address those critical issues risks the health and lives of every person in the country.

Regarding University Hospital Limerick, UHL, we were told that the injury unit at Nenagh and Ennis would be upgraded, developed and expanded to cater for patients who do not necessarily need to go to the overcrowded UHL. Yesterday the Nenagh unit was closed due to staff shortages. UHL has cancelled 600 surgeries in the past six weeks. This beggars belief. If the injury unit at Nenagh were properly developed and utilised, it would have the ability to reduce pressure on UHL. We received assurances this would happen. Instead we get the opposite. It is impossible to believe, or have confidence, in the content of briefings or statements on behalf of the University Limerick Hospitals Group. The situation appears to be out of control and can only be described as chaotic. The Minister of State, and her Department, need to get a grip and do whatever it takes to restore a safe, adequate and proper healthcare service to the people of Tipperary and the mid-west region.

Verona Murphy (Wexford, Independent)
Link to this: Individually | In context | Oireachtas source

I am pleased to associate myself with the motion as a member of the Regional Group, and to shine a light and constructively bring about some innovations and improvements when it comes to pre-hospital emergency care and community healthcare. There is no doubt that our hospitals and healthcare services are under pressure. This is mainly due to mismanagement on a grand scale over a number of years. I have had many battles with officials in the HSE and the Department of Health through my work on the Committee of Public Accounts. To say it is difficult to get answers or a clear picture of what is going on is a major understatement. What is clear is they do not believe they should be questioned at all. Funding our healthcare is not the issue. Our spending on healthcare is enormous, and has increased from €14 billion in 2017 to €23 billion in 2022. The major problem is the manner in which the HSE is being managed. The Covid-19 period shone a clear light on the problems we face. We had a handful of people in ICU, who also had Covid. We had politicians using this as justification to grind the whole country to a halt. If this is not evidence enough that our health system is broken, then I do not know what is.

We need a new model, one where not every knock or fall needs hospital attention, where people can get scans and treatments in a local healthcare centre and where drips and other medications can be administered in these centres, rather than having to funnel everything through the hospital system.

The Minister was in Enniscorthy, County Wexford last week to open a new primary care centre in that town. This is a welcome addition to the local healthcare system and should help to bring about better, more timely and more efficient outcomes for the people of Enniscorthy and its surrounds. At the same time, however, plans for a new 96-bed unit at Wexford hospital are being kicked down the road further and further, with no capital budget guaranteed. The motion refers a great deal to the National Ambulance Service and we endorsed the Sinn Féin motion last night based on the need to do something serious about the NAS and its staffing issues. It is, therefore, an appropriate opportunity to highlight and commend all those involved in community first responders schemes throughout the county and country. I refer, in particular, from my perspective to those who volunteer for these schemes in County Wexford. There are important supports to be had for the NAS.

It is also important to note the work being done in schools to educate young people on the basics of first aid and cardiopulmonary resuscitation, CPR, training. Training like this is often done as part of transition year programmes, but there are also schools that offer training to pupils in every year. The motion also calls for a CPR support app to be made publicly available to help increase the chances of a patient's survival earlier in the chain. It is impossible, especially at current staffing levels, for the NAS to respond instantly to every call, particularly at busy times. I endorse the proposal from my colleague, Deputy Berry, for HEMs. Having a community first responder scheme in a parish can help to increase patients chances of survival. Much work goes into the operation of these schemes, including recruitment, training, fundraising for defibrillators and other equipment and organising rotas. In fairness to the Government, my call to remove VAT on defibrillators was answered. This is a welcome development for community groups that work hard to ensure defibrillators are in as many places as possible.

People are living longer, and with this come all the potential falls, accidents, illnesses, etc., that are, unfortunately, part and parcel of the ageing process. People in general are more conscious of their health and Government campaigns over many years have encouraged people to act fast and to seek help in emergencies. Inevitably, this means calls for ambulance services have increased. In 2022, there were 300,000 ambulance calls, with a 19% increase in December and January compared to the same time the previous year. These trends are suggesting that the pre-hospital care models we are currently relying on may not be the most optimal or even suitable in future. The motion is detailed and calls upon the Government to take several steps to address this. It is important at this point to acknowledge the hard work, long hours, difficult conditions and heartbreaking circumstances our NAS staff have to cope with daily. Overall, I hope the House will join with me in supporting the motion and that, subsequently, the Government will implement the measures outlined in it as soon as possible.

Hildegarde Naughton (Galway West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I welcome the opportunity to address the House on the future of regional pre-hospital emergency care on behalf of the Minister for Health. I join colleagues from across the House in paying tribute to our fantastic healthcare staff, working in pre-hospital emergency care and across the wider system.

The landscape of pre-hospital emergency care is changing, in Ireland and across the world. We have a growing and ageing population and our health service needs to adapt to accommodate this and provide high-quality care. The NAS has a pivotal role to play in meeting this challenge. In recent years, it has undertaken a significant programme of reform that began in 2016 with the vision 2020 strategy, which has laid the building blocks for the transformation of the service. This vision aims to transition the NAS from being a conventional emergency medical service to an agile and responsive mobile medical service. More patients than ever are being treated over the phone, at the scene or preferably in their own homes, in line with the vision of the Sláintecare programme.

This change is backed by funding. As part of budget 2022, the Government invested a record amount in excess of €200 million in the NAS. This represented an overall increase in annual funding of around €30 million since 2019. A further increase in the budget for NAS in 2023 is envisaged once final allocations are confirmed. The service has also seen staffing levels increasing by almost a fifth since vision 2020 was published. Along with the unprecedented funding allocations provided by the Government, this has allowed the NAS to make significant progress in delivering a new model of care.

For example, we have been able to add additional clinical capacity in the National Emergency Operations Centre, NEOC, in Tallaght. This has enabled the NAS to introduce alternative care pathways, such as see and treat and hear and treat. This allows the NAS to assess and treat many patients with the most appropriate level of care, resulting in better patient experiences and a more efficient use of resources. We are continuing to invest in the NEOC clinical hub, which means a growing number of callers clinically triaged to the hub do not require unnecessary conveyance by ambulance to a hospital accident and emergency department where there is no clinical need. In fact, since October 2020, the NAS has treated nearly 50,000 patients through this alternative care pathway. Of those patients treated, more than 43%, or nearly 19,000 people, did not need to be taken to a hospital accident and emergency department. This is a great example of Sláintecare in action and we will continue to develop and grow this crucial service to meet the growing demands of our population.

The Government is committed to supporting the NAS in its development and transformation of patient care. In addition to funding for budgets 2021 and 2022, the NAS has been allocated €6.8 million in targeted funding under the HSE winter plan. This funding is assisting the NAS in responding to an ever-increasing demand for access to emergency services. It is also assisting the NAS in further developing and expanding coverage of its see and treat initiative, including the pathfinder model of care, which involves the service collaborating with healthcare professionals to see and treat older persons in the comfort of their own homes, where clinically appropriate. As with other areas of the health service, our ambulance services are also seeing a sustained demand for emergency resources. This is impacting the NAS’s ability to meet response targets. Included among the reasons for this are significant general increases in the demand for ambulance services. Last year saw a record number of nearly 390,000 emergency calls for an ambulance, exceeding the previous record number of more than 366,000 such calls in 2021, a rise of between 6% and 7%. There has been an even more significant rise in the number of activated emergency calls involving the despatch of an emergency resource, up from 157,285 in 2021 to 178,224 in 2022, which is a increase of nearly 21,000 or more than 13% in a single year. Equally, there is ongoing pressure on hospital accident and emergency departments, which significantly impacts ambulance turnaround times, particularly on the time required to release an ambulance from a hospital accident and emergency department following patient transport, as well as the ongoing need for Covid-19-related enhanced infection prevention and control, ICP, measures.

Regarding ambulance turnaround times, the HSE’s stated target is that 80% of ambulances will be released and available for retasking within 30 minutes of arrival at an accident and emergency department with a patient. I acknowledge this target is not always met. Through dedicated funding provided by the Government under this year’s winter plan, however, the NAS has been able to improve ambulance turnaround times at busy accident and emergency departments. The NAS was also allocated funding for private ambulance companies to deliver a total of 27,000 hours of inter-hospital transfer and discharge services. This crucial investment has helped to preserve emergency ambulance resources for front-line demands. The Government remains committed to investing and growing the NAS to meet the demand for pre-hospital emergency care services as well as developing and expanding its suite of alternative care pathways so that growing numbers of patients receive primary, person-centred care in line with the aims of Sláintecare.

To develop and grow the NAS, we need to ensure an adequate supply of qualified paramedics is coming through. That is why substantial funding has been allocated to increase the number of student paramedics training at the NAS college. The NAS recruitment programme in 2022 was highly successful, with an intake of 175 students into its BSc in paramedic studies programme.

Our fantastic healthcare workers are the heartbeat of the healthcare system, and we need to support them to deliver the best possible care for patients day in and day out. That is why the NAS has developed a HR people plan 2022-25 to enhance employee experience, optimise working environments and meet expectations of health policy in Ireland. The NAS in 2020 launched its holistic model of staff support, called wellness NAS, which details the range of supports available to support the well-being of staff.

In 2022 the NAS was also allocated funding to strengthen management and governance arrangements, and it plans to further strengthen management, technical and business functions as part of the new service development plans for 2023.

Looking forward, a draft new National Ambulance Service strategic plan to 2031 is with the Department for review. This strategy builds on the vision and objectives of the previous strategy and will further develop innovative alternative care pathways for patients. Planning for the new strategy has been informed by demand and capacity analysis to project patient demand into the future. Of course, additional funding will be required to meet the expected rise in service demand.

Since Vision 2020 was launched in 2016, the population has grown by 8% to an estimated 5.12 million. The population of those over 65 years of age has grown by 20% to 768,900 in 2022. These demographic changes informed the work carried out in preparation for the new strategy in terms of the required capacity and in further developing alternative care pathways.

In this context it is clear the National Ambulance Service has a central role in the transition of the healthcare system to a community care model. A key strand of the NAS's strategic reform will be to play an ever-increasing role in delivering patient care in the community and in treating our older population where most clinically appropriate.

One fantastic example of this is the pathfinder model. This innovative service was first trialled in Beaumont and has been rolled out to Tallaght, Limerick and Waterford. The service aims to avoid bringing people over 65 years of age to hospital emergency departments, where clinically appropriate. This approach increases the availability of ambulance resources for front-line emergency response. Sites are being identified for further service expansion this year.

Another recent initiative developed by the NAS, in collaboration with a number of hospital groups, has been the medical assessment unit pathway pilot project. This project was trialled in north Cork and Mallow General Hospital in 2022 and has been rolled out to additional medical assessment units, MAUs, in Ennis, Roscommon and Nenagh. This approach aims to reduce patient presentations at emergency departments and will release ambulances more quickly to respond to other emergency calls. It also allows patients to access an appropriate level of care closer to the home. I expect this service to be expanded later this year to other locations.

It is important we harness the learnings from this and other initiatives as we explore new and innovative ways of working. It is clear that the pandemic fundamentally changed the way in which healthcare services are safely accessed and delivered. The role of pre-hospital emergency care practitioners has changed and will continue to do so as they increasingly become providers of primary as well as emergency care services. The Department of Health is examining the regulatory framework governing the delivery of pre-hospital care in Ireland to ensure that it meets the growing and changing needs of the sector.

I reiterate that the Minister for Health, Deputy Stephen Donnelly, and the Government are committed to supporting the NAS through this transformative period.

Peter Fitzpatrick (Louth, Independent)
Link to this: Individually | In context | Oireachtas source

I welcome the opportunity to speak on this important issue and thank my colleagues in the Regional Group for tabling the motion. Yesterday, I spoke about the recruitment and retention issues in respect of recognition, pay, resources, working hours and poor working conditions within the National Ambulance Service. With this motion, my colleagues in the Regional Group and I are seeking to overhaul the delivery of pre-hospital emergency care services. We are seeking to provide better training for staff in schools and childcare facilities with an expanded role for paramedics.

How, though, can we expect paramedics to take on an expanded role when, under the Health and Social Care Professionals Act 2005, the paramedic profession is not even recognised as a profession? Paramedics do not even get recognition from the HSE, the largest employer of paramedics in the State. This lack of recognition limits career progression, negatively impacts retention, restricts alternative pathways of care and, in the case of HSE employees, limits access to health and social care profession education opportunities within the HSE. As a result, the retention of employees within the field of paramedicine is an area which needs to be addressed. Since 2019, the National Ambulance Service College has brought in 472 staff who commenced training under the three-year paramedic studies programme. Of those, 55 dropped out. That is less than 160 recruits a year. The National Ambulance Service Representative Association warns that, due to poor pay and conditions, ten staff a month are being lost. With the National Ambulance Service estimating a requirement of more than 3,000 paramedics within the next four years to meet its workforce plan targets, these numbers of recruits are abysmal, yet this is a familiar tale. This is a reflection of a service which is under-resourced, under-appreciated and not recognised. We must establish a commission on paramedicine as a matter of urgency to establish primary legislation to recognise and regulate the profession appropriately; ensure that all paramedics have access to an appropriate initial and ongoing education; institute an expanded scope of practice and specialisms; address retention and career progression; and tackle the ongoing workforce issues within the paramedicine field.

We all rely on our ambulance service in times of medical emergencies, whether it is a heart attack, a stroke, an allergic reaction or a choking incident in a child. With this motion, we want to specifically reduce the risks in such emergencies.

At local level, the National Ambulance Service is supported by volunteer-run community first responder schemes, which are an integral part of dealing with an emergency in the community. They have the potential to provide vital life-saving CPR and defibrillator treatment to patients while an ambulance is en route. A local business owner in Dundalk had a heart attack and it was only for the first responders in his community that he made it to the hospital and, thankfully, survive. However, the lack of a national first responder register precludes many of the community first responder scheme volunteers from responding to a local medical emergency. This needs to be resolved. I congratulate Joan McAdam on the implementation and creation of a local register of working automated external defibrillators, AEDs, and first responders in a local parish in Dundalk. That needs to be done at a national level. We know that any delay in accessing treatment has an impact both on survival rates and for the level of care needed in the hospital setting. For example, for every minute that elapses after a cardiac arrest, a person's chance of survival decreases by 7% to 10%, and for every minute stroke treatment is delayed, a person loses 2 million brain cells. Faster emergency response times are required. With that in mind, and on the back of the technological revolution, we are pushing for the development of a public app that allows the 94% of the population with a smartphone to automatically alert ambulance and community first responders to an emergency and to be provided with vital advice on CPR in the interim.

We know from the headlines this week that the National Ambulance Service is struggling to meet timelines. Concurrently, emergency service demand is significantly increasing, with the number of emergency calls in 2022 up 15% on 2021. Increasing population numbers and life expectancy will increase future public health demands. The reality is that if recruitment targets are not met and demand continues to rise, performance will continue to decline and people will die, unless community paramedics and first responders are trained. We need to fund the provision of epinephrine auto-injectors for emergency use in schools and childcare facilities and revise current legislation to facilitate the roll-out of additional emergency community medical interventions, such as the provision of epinephrine auto-injectors, inhalers and aspirin in locked defibrillator cabinets, similar to or in tandem with public access defibrillators. Most importantly, we need to provide the required training to all staff in schools and childcare facilities by enforcing the completion of a paediatric first aid response course funded by Tusla and the Department of Children, Equality, Disability, Integration and Youth.

Adults and children have unquestionably suffered harm due to ambulance delays. Overall, we need to overhaul the delivery of pre-hospital emergency care services, from better training for staff in schools and childcare facilities to an expanded role for paramedics. In order to succeed, however, we need to look into the career recognition of paramedics and the recruitment and retention issues as well as training issues for paramedics and community first responders. We need to act now before patients die.

Peadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

Cuirim fáilte ollmhór roimh an rún Comhalta Phríobháidigh seo ón nGrúpa Réigiúnach. An cuspóir atá ag an rún seo ná cabhair a thabhairt d'othair agus do dhaoine atá i gcruachás san áit ina bhfuil siad chun cabhrú leo leigheas a fháil agus a gcuid saolta a shábháil gan brú a chur ar chóras na n-ionad éigeandála timpeall na tíre. I pay credit to the Regional Group for this solution-based Private Members' motion and I urge the Government to take on board the solutions in it.

It is clear that the really important individuals in society, the first responders and those who bring healthcare to the site of an emergency, must be treated properly. They must be given proper pay and conditions as well as recognition because if we do not have those individuals in our time of need, we simply will not have the outcomes our constituents need.

Listening to the Minister of State's speech, the disconnect between the reality people are experiencing on the ground and the Government's rhetoric on this matter is a chasm. We have to recognise that we are breaking records in this country. We have a record-breaking number of people on trolleys, record-breaking wait times in accident and emergency departments across the State and a record-breaking number of people on waiting lists for hospital treatment. All of those performance indicators are leading to worse outcomes for patients. In many cases, they are leading to deaths. A recent report indicated that 1,300 people are dying in the State as a result of hospital admission wait times. Well over 100 people are dying monthly as a result of the pressure on our hospital services. It is not for the lack of money. We have never spent so much on health. Ireland is spending more in its health budgets than any other European country. Some 21% of the State's budget goes on health. It is not getting to the front line, however, because it is getting caught up in all the layers of management within the HSE.

It is becoming increasingly difficult to run a proper ambulance service. We know the call-out times are taking longer. Last year, it took over an hour for an ambulance to reach the life-threatening emergency in response to 6,200 ambulance call-outs. In 28% of call-outs, the paramedic is not reaching the person with a cardiac illness on time. In nearly one third of all cases where an ambulance is attending a cardiac illness emergency, it is not arriving in time. The turnaround times are getting longer. The average turnaround time in Dublin for an ambulance or paramedic to deposit a patient in the hospital is 39 minutes. This is causing major difficulties. In Our Lady of Lourdes Hospital, Drogheda, we recently had 11 ambulances waiting for five hours to deposit patients. The system is turning the hospital into an ambulance car park. For each of the individuals affected, the outcome was reduced as a result. On the evening in question, no ambulances were available in counties Monaghan, Cavan, Meath and Louth because those ambulances were tied up in Our Lady of Lourdes Hospital, Drogheda. That is a shocking state of affairs. The motion simply seeks to ensure we can start creating some emergency service opportunities in the community by providing paramedics with the necessary skills, investment and training to be able to provide more help at the scene of an emergency. It also seeks to ensure paramedics are given more supports for paediatric first aid training in childcare; establish a national register for working in accident and emergency departments and ensure it is properly maintained; ensure availability of basic first aid equipment in locations within the community; and establish and maintain a national first responder register.

We need to protect off-duty first responders who come across major accidents. If they help in those cases, they are liable for any harm they may cause. For example, if they come across a person who has had a heart attack and in providing cardiopulmonary resuscitation they damage a rib, they can be sued directly. We need to protect these skilled people who seek to help individuals in their time of need.

David Cullinane (Waterford, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I am sharing time with my colleagues. I commend the Regional Group for tabling this motion. We tabled a similar motion last night and the response from the Minister, which was a scripted speech on the motion, was nothing short of disgraceful. Rather than accepting the reality of the challenges that paramedics in the NAS and patients face, with lengthening wait times for ambulances as shown in the data presented to us by the HSE, the Minister spent most of his time attacking the Opposition and my party and seeking to hide behind the hard work of paramedics. It is about time he got his head out of the sand and started to face up to the challenges and problems in the NAS.

Healthcare and emergency care workers are faced with difficult and challenging circumstances in hospitals, as are front-line paramedics in the NAS. Last week, at the Joint Committee on Health, we heard directly from the NAS and the Dublin Fire Brigade that capacity is being outpaced by demand and that the increase in demand is putting a huge burden on the NAS. Response times have increased by 50% since 2019 for the two category 1 life-threatening call-outs, echo and delta. A 50% increase since 2019 is substantial but the length of time people are waiting for an emergency response increased from an average of 18 minutes in 2019 to 27 minutes in 2020. In the south east, where I live, the average wait time is 33 minutes for a life-threatening incident call-out. We should bear in mind that this is a region that does not have 24-7 emergency cardiac care so people depend on the NAS to bring them to Dublin or Cork if they have a cardiac emergency.

We know what needs to happen and we have said this to the Minister for some time. We need a comprehensive workforce plan to train and recruit more paramedics. The NAS tells us it has to recruit an additional 2,000 staff over the next five to six years, yet it is nowhere near reaching that capacity. Much more needs to be done. If we are to properly support staff in the NAS, we need to put that workforce plan in place.

Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

While I was raising this subject with the Taoiseach yesterday, there were some young girls present from Sancta Maria College in Louisburgh. Two of them told me afterwards about the impact that the absence of a fit for purpose ambulance service in Mayo has had on them. One told me about her sister having an anaphylactic shock and that she had to be rushed to hospital in a car, while the second told me she had lost her grandmother while waiting for an ambulance. That is the reality of not having an ambulance service that is fit for purpose. It is not just the ambulance services of course because there are also delays and long turnaround times in the hospitals. I commend the Regional Group on the solutions it has put forward. We also put forward solutions last night.

This morning, we heard Councillor Michael Kilcoyne tell Midwest Radio that an elderly person has waited for five days on a trolley in Mayo University Hospital. This is becoming normalised; that is the problem. It is being accepted by the Government but it is totally wrong. Excuse after excuse can be put forward but it is not right. The Minister of State knows that people are losing their lives because we do not have a system that is fit for purpose. We have to ask why that is the case, why there are flows through the hospital and why ambulances are backed up outside hospitals when that should not be the case. We will hear another excuse for that but we have to fix this problem, particularly in counties such as Mayo where people travel in ambulances for over 50 miles on bad roads, arrive at a hospital and then have to wait hours outside just to get in because the hospital is backed up. It is a serious situation and I have never seen as bad as it is now. It has to be resolved.

Martin Browne (Tipperary, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank the Regional Group for bringing this motion to the House. I welcome the opportunity to discuss it because County Tipperary is particularly affected by the Government's failure to support ambulance services and paramedics. The HSE's standards require an ambulance response time of 19 minutes or less for 80% of life-threatening incidents. In Tipperary that is far from the case. I will praise the ambulance staff, including the paramedics, first responders and all those across the services. I warned about this in 2014 and nothing has been done since by successive Governments. The one common denominator since then has been that Fianna Fáil and Fine Gael have been in power during that time.

They are trying to ruin this vital service. The Minister's response to the Sinn Féin motion last night only reinforces that belief. The response reveals that in the south region, which includes south Tipperary, the percentage of life-threatening incidents responded to within the target of 19 minutes fell from 73% in December 2019 to 61% in December 2022 for cardiac and respiratory arrest, and from 47% to just 28% for other life-threatening incidents. For the west region, which includes north Tipperary, the percentage of life-threatening incidents responded to within the target of 19 minutes fell from 69% in December 2019 to 59% in December 2022 for cardiac and respiratory arrest and from 54% to just 36% for other life-threatening incidents.

While the Government sought to amend Sinn Féin's motion yesterday by deleting it, it failed to note that the Ministers, Deputies Paschal Donohoe and Michael McGrath, choose not to provide the funding needed to reverse the trend in ambulance response times. I know this motion calls for the National Ambulance Service bypass protocol on the use of model 2 hospitals and for medical assessment and injury units to be expanded. This would be welcomed but we need to ensure the NAS is given the supports it needs to shoulder this workload. It is not for it to resolve the unfinished issue of reconfiguration in the mid-west. That is the Minister of State's job. The Government needs to publish the multi-annual capacity and workforce plan to meet the needs of patients and improve the ability of the National Ambulance Service. It also needs to configure services so that the needs of people can, where appropriate, be addressed in their communities, thereby taking pressure off the service and emergency departments, such as at University Hospital Limerick, by increasing the use of our model 2 hospitals in a safe, clinically effective manner, and by listening to the 87 consultants in their call for urgent intervention.

We are past sticking plaster measures from this Government. The mid-west health region needs a serious multi-annual plan to tackle capacity for staff and patients, especially in light of the temporary closure of Nenagh injury unit, which is down to staffing issues.

Mark Ward (Dublin Mid West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank the Regional Group for giving me the opportunity to discuss this important motion on pre-hospital care. The Minister of State will not be surprised that I will focus on children's mental health in the limited time available to me. We all know that early intervention is key. When children get the care they need when and where they need it, they are less likely to need moderate and acute mental health care as they go on. They are less likely to arrive at emergency departments. I received a response to a parliamentary question which indicated that between January and November last year, after arriving to emergency departments in three hospitals, Crumlin, Tallaght and Temple Street, 741 children were admitted to hospital. This means 741 children were under that much duress. Nothing else was available and so they arrived at our emergency departments with their parents, looking for help. That is not counting how many other children arrived at emergency departments who did not have to be admitted to hospital. Those children would also have received follow-up treatment. That is not good enough. We need to move away from that model.

When I talk about early intervention, I refer to the earliest intervention possible. I will talk about early intervention in psychosis, which is about spotting and treating mental health disorders at the earliest possible stage so that we can put measures in place to avoid children needing to access acute and moderate mental health care or attend an emergency department. The responses to our parliamentary questions so far indicate that no funding has been allocated to the early intervention in psychosis national clinical programme for 2023 because the national service plan has not yet been finalised. We are three months into this year. The Government is not showing any sense of urgency whatever in tackling this issue.

We also need to develop a model for counselling in primary care. We have counselling in primary care for adults but no counselling in primary care for children. The basic, simple talk therapy that children need is not available. Sinn Féin in government would deliver that. I could talk about lists left, right and centre, for example, the 11,000 children who are waiting for primary care psychology, of whom 4,000 have been waiting for a year, and the 4,000 who are waiting for an appointment with CAMHS, of whom 400 have been waiting for a year. I could go on all day about these lists. It is just not good enough. Behind every one of these statistics I mention is a child with hopes, dreams and ambitions who is being denied the opportunity to reach his or her full potential. We must put measures in place to sort that out.

Thomas Gould (Cork North Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank the Regional Group for tabling this motion. Last night, Sinn Féin tabled a similar motion. This shows that the Opposition is united in recognising the crisis in our emergency services. In Cork and Kerry, response times for ambulance care have risen by over 70% since 2019. This puts huge pressure on paramedics and those working in the ambulance service. I met some of them with the Sinn Féin spokesperson on health, Deputy David Cullinane, in 2021, when they outlined the crisis they were facing. The situation is much worse now. Shockingly, 72% of life-threatening incidents are left without a response for longer than 19 minutes, which is the target that is given. This is way off-target. It is not the fault of the paramedics or the National Ambulance Service, but it is the Government's fault. The Minister of State is a member of Fine Gael, which has been in power for 12 years. The Minister and others in government say they are working on it, or, as the Minister of State said earlier, they are learning. I do not know how long it takes the Government to learn, but it should have learned by now. This crisis has been with us for some time. I am not making this a personal issue for the Minister of State but it is about this Government and Fine Gael's attitude towards healthcare, especially the ambulance service.

I have had to ring the ambulance service numerous times for constituents. I raise two particular cases. In one, a Sinn Féin councillor met a lady who was distressed. She was pregnant and had collapsed at the side of the road. She was alone and afraid. He stayed with her for almost an hour before an ambulance arrived. There was an incident where I was in Cork city with my family and a young woman collapsed. When I rang 999, I was told an ambulance would take over 40 minutes. Mercy University Hospital was four minutes away and Cork University Hospital was ten minutes away but all the ambulances were queued up, unable to offload patients because of the crisis we have in emergency departments. We had to put the young lady into my car to get her to the Mercy hospital because the ambulance service would have taken over 40 minutes.

There is a crisis now and the Government must act. I want to say to all those on the front line, the paramedics and ambulance service and emergency department staff, that we appreciate the work they are doing and it is about time the Government supported them.

Pádraig Mac Lochlainn (Donegal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I want to take the few minutes I have to talk about the situation in Donegal. We have a significant challenge with our ambulance service across the county. On too many occasions, people in life-threatening situations have waited for too long and in some instances they have lost their lives unnecessarily. One proposal that has been put forward to the Government again and again relates to fire and rescue personnel. In Donegal, as in all rural counties, we have fully-trained emergency responders who are being totally underutilised. There are fire stations dotted throughout Donegal and staff from them could be deployed as emergency first responders in cardiac and respiratory emergencies. This is a tremendous back-up service which is ready to go and is not being deployed. I ask that the National Ambulance Service proactively engage with local authorities to make sure there is a memorandum of understanding and local authorities are not financially punished for using that.

Sinn Féin tabled a motion on the future of the fire and rescue service across the State. We have personnel who are respected and trusted in communities having to protest outside the Dáil and gather in the Public Gallery. They have asked to be deployed as emergency first responders as an initial response until the ambulance gets there. I want to impress on the Government that we have an under-resourced National Ambulance Service. The response times across the country are totally unacceptable but I must speak with authority about Donegal. I cannot understand, for the life of me, why there has been a failure to make sure the National Ambulance Service and local authorities reach an agreement, why the local authorities are not financially punished and why our fire and rescue personnel are not being deployed properly.

Patricia Ryan (Kildare South, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I too thank the Regional Group for tabling this motion on the future of regional pre-hospital emergency care. I welcome the opportunity to speak on it. First, I echo the thanks and commendations given by my colleagues to our healthcare workers, especially our front-line healthcare staff who work so diligently to save lives. I represent a rural part of Kildare and Laois where the quick interventions of paramedics in the ambulance service can be the difference between a good outcome and a bad outcome and getting a timely medical intervention or not getting one and, ultimately, it can be the difference between life and death.

Paramedics who staff ambulances are often overworked due to chronic understaffing issues across the entire healthcare system. Last month, Naas General Hospital issued an appeal to patients not to visit the emergency department unless absolutely necessary. The very same appeal was issued again last week. Last night, Sinn Féin brought forward a motion to alleviate the crisis in the National Ambulance Service but the Government rejected our motion and will probably seek to reject this motion. This will lead to further burnout and fatigue of front-line healthcare staff which will ultimately put lives at risk. The Minister must publish a multi-annual capacity and workforce plan immediately to meet the needs of patients and improve the ability of our National Ambulance Service, Dublin Fire Brigade and other vital services as this is particularly important to the people of south Kildare, whom I represent.

I will finish with this point. Deputy Conway-Walsh spoke about an elderly person who spent five days on a trolley. I heard from a 94-year-old woman who recently spent 24 hours on a chair. The Minister might think that is good enough but I certainly do not.

Chris Andrews (Dublin Bay South, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank the Regional Group for bringing this motion. I heard the Minister for Health, Deputy Stephen Donnelly, say last night that Sinn Féin believed front-line staff were failing. We do not believe front-line staff are failing; we believe the Government has failed. The Government has failed paramedics and front-line health workers and it has failed in housing and in protecting inner city communities. The list is endless. The Government has failed to support front-line paramedics to keep up with the demand for emergency services. The failure to provide this much-needed support puts lives at risk.

As per the HSE's own standards, 80% of life-threatening incidents should be responded to by ambulance within 19 minutes. Dublin Fire Brigade responded to only 19% of delta incidents within 19 minutes. These front-line workers, the heroes to those in need of urgent care, are struggling. They are struggling to keep up with the demand for emergency services and they face immense pressure. The Government urgently needs to publish a multi-annual capacity and workforce plan to meet the demands of patients. This will also improve the ability of the National Ambulance Service and Dublin Fire Brigade to save lives. A serious plan is needed with targets and timelines if the ambulance service is to reverse the trend and improve outcomes. The increase in response times is bleak. It shows clearly that the ambulances services are under serious strain and pressure. This is exactly what paramedics have been warning about for years. Ambulance service staff have offered solutions that would make a difference but they are not being listened to. There are not enough crews or ambulances. We need a serious and comprehensive recruitment campaign to address the shortfalls in the ambulance service.

Denise Mitchell (Dublin Bay North, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

We now move to the Labour Party slot. Deputy Seán Sherlock is sharing time with Deputy Wynne.

Seán Sherlock (Cork East, Labour)
Link to this: Individually | In context | Oireachtas source

I am happy to share my time, although it will curtail my speech significantly, which the Acting Chair will be happy to hear.

The Labour Party fully supports the motion. There is no question about that. I will speak specifically about Mallow General Hospital because the Minister of State, Deputy Naughton, referred to it. The Minister of State noted in respect of Mallow that there is now a collaboration between hospital groups and the National Ambulance service. She continued:

This project was trialled in north Cork and Mallow General Hospital in 2022 and has been rolled out to additional medical assessment units, MAUs, in Ennis, Roscommon and Nenagh. This approach aims to reduce patient presentations at emergency departments and will release ambulances more quickly to respond to other emergency calls. It also allows patients to access an appropriate level of care closer to the home. I expect this service to be expanded later this year to other locations.

I submitted a parliamentary question, the exact wording of which was to ask the Minister for Health about the status of the project for paramedics to treat patients in Mallow General Hospital, the number participating in the project to date, and the funding allocated to the pilot project. The response I received from the national director of the National Ambulance Service on 9 February of this year was that the South/Southwest Hospital Group and the National Ambulance Service jointly implemented a referral pathway - that is the key phrase here - for clinically appropriate patients to the medical assessment unit in Mallow on a pilot basis. The response further stated that the outcome of the initial pilot, which was conducted over a three-month period, demonstrated the safety of this pathway model for patients and the model was therefore expected to continue into the future.

That response is too vague for me. We need further specifics on what this pilot actually means and what metrics have been yielded up in response to this three-month pilot. If this is being lauded as a solution to the trolley crisis and the ambulance crisis, what we need are clear data on how effective that has been. The lack of information in the response to my parliamentary question suggests to me that there was a little bit of optics in this exercise and perhaps not a whole pile of substance. What we need to hear from the Ministers and the Government is how this project will be rolled out because it could have a significant impact on level 2 hospitals such as Mallow, Ennis and Roscommon in terms of ensuring inter-hospital ambulatory care is provided and that people who have been in the hospital system do not have to queue and go back in through the accident and emergency department if there is a clear pathway for them to come back to the level 2 hospital they were being treated in already. That would clearly have an impact on numbers but I suspect the lack of substance in the response to the parliamentary question indicates this is only an optics exercise. I want to hear more from the National Ambulance Service. It is insufficient and disgraceful that the NAS should respond in this way to a Member of the Oireachtas who submits parliamentary questions seeking detailed information of this nature.

A second issue arises from a different parliamentary question. How many minutes do I have left?

Denise Mitchell (Dublin Bay North, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The Deputy has 90 seconds remaining.

Seán Sherlock (Cork East, Labour)
Link to this: Individually | In context | Oireachtas source

In that short time, I will quote a letter a paramedic wrote to me recently. It states:

We are paid as ambulance drivers whereas in fact we are trained and qualified as paramedics after completing a two or three-year course depending on the year you started. We are paid as emergency medical technicians where we should be getting paid as qualified paramedics.

That point needs to be addressed in terms of morale within the National Ambulance Service. The HSE tells us it has set up a workplace health and well-being group tasked with ensuring the deliver of high-quality staff support. I can tell the House now, based on a submission made to me by someone who works for the National Ambulance Service, that the group is not properly operational. What we have, chapter and verse, are examples of people who are working far in excess of the safe level and working extended house to cover backfill shifts when people are absent or there is not a service in place. There is a serious health and safety issue here and it must be addressed.

Violet-Anne Wynne (Clare, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I commend the Regional Group on bringing forward this incredibly important and thorough motion and thank Deputy Sherlock and the Labour Party for sharing time with me.

Why is pre-emergency care so important for people living in rural communities? It is because they struggle with access to primary healthcare in their communities. They are the ones who have been losing GPs for the past number of years. For example, in my constituency of Clare, the number of GPs available is 25 below the national average. That is according to figures from the Clare Public Participation Network. As the Minister of State knows, this is not a new phenomenon. The GPs who are still in situare inundated with huge levels of demand and people are waiting for appointments. Some people even have to travel great distances to bring their own blood samples to the hospitals themselves as they cannot get appointments on time. On more than one occasion, my office has had to call GPs outside the county for emergency appointments for constituents who were in need. This is not what a modern European society should be like.

As the Minister of State will appreciate, what is not mentioned here are the stress, anger and frustration felt by families and the burden and fear that my constituents live with, not knowing whether they will be able to get an ambulance or, worse, if an ambulance will get to them before time runs out.

What about the question of confidence in our health service infrastructure? Presentations to UHL declined after the horror that was the Christmas period not because people stopped getting sick, but because people were too scared to roll the dice and step into that warzone. I heard the Taoiseach reassuring people that they should not fear UHL. When he said this, it was clear that he is a Deputy for a Dublin constituency. However, the good people of Clare need more than words by way of reassurance. They need a commitment that accident and emergency services will be reinstated in Ennis as part of a model 3 hospital to complement UHL in Dooradoyle, which is a model 4 hospital. As the Minister knows, ours is the only region not to have a model 3 hospital. That fact is not lost on the people of Clare. I hear it in my clinics and in calls with my constituents every single day. The people of Clare are fighting for their lives.

The introduction of the Ennis MAU pathway, whereby a small number of patients were brought to Ennis hospital to tackle the overcrowding at UHL, seemed like a positive move. However, as time went on it was clear that no additional resources had been provided to Ennis hospital to support this. In addition, it has directly impacted elective surgeries, with many now being pushed back by months. Those delayed surgeries will lead to more people needing unscheduled care arising from non-treatment of their issues. To date I have been stonewalled by the Department with respect to information I have requested on this.

On the point of the reporting of figures, I submitted 11 parliamentary questions over the course of a week in November to try to ascertain the true picture of ambulance care in my constituency. I was told that there were no data available because the NAS did not view response times by county as a key performance indicator. As a representative of a county of more than 127,000 people, the only key performance indicator I care about is their ability to access care in a timely manner. If anything is taken from my contribution, I hope it is that the Minister needs to address this as a matter of urgency.

Jennifer Whitmore (Wicklow, Social Democrats)
Link to this: Individually | In context | Oireachtas source

I thank the Regional Group for the opportunity to discuss this important issue. The Social Democrats are fully supportive of all the calls being made today. It is telling that there are two motions on the NAS this week. Related issues were also discussed at the Joint Committee on Health. Pre-hospital emergency care is a vital cog in our healthcare services. Paramedics and other workers in the NAS provide life-saving care every day, often in incredibly challenging contexts. However, this crucial service is under-resourced, with insufficient staff and vehicles to meet current needs. Health emergency 999 calls have increased by 14% since 2019. Life-threatening cases relating to illness, injury, cardiac or respiratory arrest account for almost half of all emergency calls. By the standards set by the NAS, nationally it responds to 71% of calls relating to life-threatening cardiac or respiratory arrest in under 19 minutes. This figure is 43% for life-threatening cases due to illness or injury. This gives an indication of the scale of the current situation. However, with our growing and ageing population we will need even more emergency service personnel. Not only must the Government ensure the retention of as many staff as possible, but it must also engage in a massive recruitment campaign in order to meet current and future needs. Ordinary people, especially older people, need to have the confidence that an ambulance will be available to respond rapidly to their calls.

The glaring point on this matter is the recruitment and retention of staff. Entry into the profession is not easy. At a time when we should be facilitating people to enter the profession, barriers are being put up. For example, students in the BSc in Paramedic Studies cannot get placements in the NAS. Instead they go to the UK to learn on the job. Many of them are then snapped up by the NHS which recognises their skills and qualifications. Those who choose to return to Ireland face barriers in becoming paramedics due to a convoluted entry process for the rolling recruitment. There are young people who want to become emergency healthcare professionals and serve their communities. Instead of being enabled to do so, they are faced with obstacles. This is not good enough.

Their working conditions are challenging and often dangerous. Reports from paramedics reveal how overstretched they are. It is common for shifts to run over time with 12-hour shifts extending to 15 hours and more. This is unsustainable and unsafe, both for patients and staff. Staff are being burnt out. It impacts their health and family life. It leads to low morale in the service and ultimately makes recruitment and retention more difficult. It must also be recognised that paramedics and others operate in stressful and sometimes dangerous circumstances. They attend sites of accidents, violence and domestic violence and, unfortunately, face situations where people assault them or attack their vehicles. The NAS had more than 330 reported incidents of assault on active staff between 2020 and December 2022.

The NAS currently has 1,900 emergency medical staff such as paramedics, critical care nurses and doctors. The workforce plans lays out a need for over 1,300 more of them by the end of 2024. Given the current conditions, it is unclear how this target can be met.

It is also important to remember that this is not a stand-alone matter. Challenges in the NAS inevitably impact other areas of healthcare. The proposed ban on people seeking home births when based more than 30 minutes away from a maternity hospital was inherently linked to the availability of ambulance services. The slim rationale in the HSE report last year was that in emergency situations pregnant people needed to be less than 30 minutes from a maternity hospital. Such a decision would impact all of Wicklow, west Cork, Kerry, Clare, Roscommon, Donegal and Monaghan. This was a significant proposal by the HSE. The move was strongly opposed by many families as well as the Midwives Association of Ireland. They knew it was a thinly veiled attempt to drastically restrict home births. One of the major concerns was that due to a lack of availability of ambulances, the arbitrary 30-minute distance could become 20 minutes or 15 minutes, thereby restricting the service even more. Home births are essentially an opt-in system with women and pregnant people encountering many soft barriers. We need a fully functioning ambulance service to enable people’s choice to have a home birth.

When I tabled a number of parliamentary questions in relation to home births, I received some interesting replies. When the Minister spoke about this matter in the Chamber, I found it interesting that he referred to a blue light distance. When I asked paramedics what a blue light distance is, they did not know. When I asked the Minister about the matter in a parliamentary question, he referred back to the HSE to find out what the definition of a blue light distance is. It seems that this policy is being made up on the hoof. This is not acceptable when it comes to such a fundamental right as a woman’s right to have a baby at home and have the supports with her.

Another issue is the interface between ambulances and acute hospitals. We have cases of much-needed ambulances and staff being kept for long periods at hospitals due to constraints in emergency departments. As I stated, 50% of calls are classified as non-life-threatening, which means that people with breaks, falls and other issues can be left in ambulances until space is found for them. This ties up ambulances for hours, adding further strain to the system.

Out-of-hours GP services are also relevant to this discussion. Edoc, Caredoc, Kdoc and Kildare and West Wicklow Doctors On Call provide fantastic care at night and at weekends, but they are overstretched. Insufficient staffing levels mean these vital services cannot provide the cover needed for the people of Wicklow and many other counties. Families struggle to get appointments and have to go even further away. This in turn puts additional stress on the NAS and emergency departments as parents with sick children and others have nowhere else to go. The Government and the HSE must address the need for more GPs and locum staff in this area as well as the provision of more paramedics.

Today’s discussion has been a timely reminder of the importance of our ambulance service and the dedicated people who staff it. Too often we assume that due to its importance, the ambulance service is a Government and HSE priority. However, the debates this morning and last night highlight the systemic issues in the service, particularly the problems with recruitment and working conditions. They are beyond alarming. They put lives at risk. This motion calls for much-needed support for staff, including improving the working environment, facilitating more people to enter and progress as emergency service professionals, and improvements in our community emergency infrastructure. All of these measures are important. Individually and collectively, they will help to save lives and improve health outcomes. I urge the Government to act now.

I also urge the Government and the Minister to talk to paramedics, ask them for an honest assessment and listen to their lived experiences. I have spoken to paramedics. I have paramedics in my family. I know first-hand the stresses they are under. They want to do their best, to provide the service and to care for people. That is why they went into the job. What they find is that because of the systemic problems, they cannot provide that level of care not only to their patients but also to themselves. They are finding it very difficult. Those I have spoken to are looking at the exit door. They cannot wait to get out because they know they cannot continue in the system as it is at the moment. I urge the Minister to have a truthful and honest conversation with paramedics and to ask them to explain exactly what their lived experiences are.

That in itself would be very informative.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

I would like to thank the Regional Group for this important and timely debate on emergency services. I commend the emergency services, which continue to provide everybody with emergency cover. We all have emergencies during one part of our lives. The services do a crucial job in protecting us and our families and friends. That has to continue.

The pandemic has thrown up a significant number of challenges with healthcare. During the pandemic, emergency services, paramedics and the fire brigade were pinned to their collar in terms of the challenges they were up against.

The Minister will understand that response times are absolutely critical in order to achieve better outcomes. We would all agree with that. The National Ambulance Service came before the Joint Committee on Health last week, along with the Dublin Fire Brigade. They stated there are major challenges with staff retention across the board in the health service, along with capacity issues and issues that go back decades in terms of resources. They have stated that demand far outstrips supply. In a situation like that, there will be worse outcomes for people who need an ambulance at a particular time. That has to be addressed. The issues identified by the National Ambulance Service and the Dublin Fire Brigade have to be addressed because if we do not have capacity, people will die.

When paramedics and the fire brigade reach an emergency department, there is another issue. The INMO, along with other unions, has stated that there are situations in emergency departments which are not conducive to patient safety or to staff safety. Unions have continuously told the Government that if it does not address these issues, people will die in emergency departments and staff will leave due to being demoralised and burned out. We will have an enormous problem because people with decades of experience will not continue working in that environment. That has to be addressed because otherwise we will be talking about this continuously.

The INMO has said it will go as far as industrial action in the pursuance of staff safety in emergency departments and other hospital departments. It is crucial that we address these issues because if nurses' organisations such as the INMO are saying that they are finding themselves in unsafe situations and environments in hospitals, the alarm bells surely have to ring. We have to address staff retention and underlying issues of capacity.

I have said this many times, and I will say it again: people go to emergency departments because they need medical help. People are waiting on trolleys for hours, and sometimes days, which is not acceptable. I do not know how anybody can find that acceptable. Ireland is a very wealthy country. People have paid tax all of their lives and when they need care at a particular time they have to wait days for it. That is completely dysfunctional and cannot be acceptable. I know the Minister does not accept people having to wait days for care. That is not an exaggeration; it is what has really happened to many people. People are waiting hours and days in emergency departments. In the time the Minister has left in this Administration, it is important that he addresses what the INMO has said about staff and patient safety.

Mattie McGrath (Tipperary, Independent)
Link to this: Individually | In context | Oireachtas source

I compliment the Regional Group on bringing forward this motion on pre-emergency care, which is a critical component of the healthcare system in Ireland. It plays a vital role in the management of emergencies and saving lives, which is the most important thing for any of us in this House or anywhere else. The motion refers to emergency medical services provided to patients outside of hospital settings, usually in the event of an accident or sudden illness.

There are wonderful groups of people out there and paramedics do a top-class job. In my community we have a first responder group. I could not say enough about the co-ordinator, Sean Byrne, and his team. It is led by Emma Lonergan, Joe Lynch and Ger O'Dea from the National Ambulance Service. The first responders have now been trained to a high standard under Donal Lonergan's care. There is a compliance officer and guidance. They are full-blown paramedics who do an excellent job. There are 18 volunteers who are ready, willing and able to assist any time they are called out.

Similar groups throughout the country were called out 200 times in January, which takes significant pressure off the National Ambulance Service. These groups are doing good work. They are volunteers and give of their own time. The officers in our group include Marian O'Dwyer, treasurer; Ciara Lonergan, secretary; and Sean Byrne, chairman. They do an excellent job and are willing, ready and able. Many communities are the same. Ní neart go cur le chéile. That is the way we want to operate.

There are failings in the HSE which are holding up ambulances. As we discussed yesterday, the National Ambulance Service is not fit for purpose in the co-ordination and management of emergency care. I want to salute community responders. They are saving lives and are putting their shoulders to the wheel. They do heroic duty and great work.

Michael Collins (Cork South West, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Regional Group for this important and excellent motion. As we heard yesterday, there are major issues with the National Ambulance Service. Unfortunately, the Minister was not present for the debate. I presume he had to miss it for a genuine reason. He needs to sit up and listen because people are dying on the side of the road and in their homes because of the lack of a proper ambulance service.

I want to concentrate on the possibility of using hospitals like Bantry General Hospital. I want to compliment the staff of the hospital, which is no doubt one of the finest hospitals in the country. The people who go to there tell me about the excellent and speedy care they receive, which is second to none. It is astonishing to think that people who fall and break a bone in Ardgroom, Castletownbere, the Sheep's Head Peninsula, Mizen Head, Bandon or Clonakilty pass the hospital to go to CUH, which is overcrowded. It is an astonishing situation that people have to lie in the back of an ambulance.

I have been criticised by Senators and Deputies in west Cork who have said that I should not give out about Bantry General Hospital. We have an excellent hospital which is not being used to the best of its ability thanks to the HSE and decisions being made elsewhere. People are flying past the hospital with patients who require minor treatments. Those people could be looked after in their own area.

I compliment the staff. I refer to SouthDoc doctors and nurses. I was in a clinic in Clonakilty recently and spoke to doctors, nurses and other staff who never got a Covid payment. They worked day and night during Covid. It is terrible that they did not get the €1,000 other workers received.

Danny Healy-Rae (Kerry, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Regional Group for this very valuable motion. I want to praise ambulance drivers and paramedics in County Kerry for the great work they do. They are under increased pressure because, as we all know, doctors' surgeries are generally open from 9 a.m to 5 p.m. five days a week. There are 128 other hours in every week. People get sick during those hours, be it late at night, at weekends or whenever, and need to be seen to. SouthDoc is our out-of-hours service, which is under savage pressure.

Places like Kenmare, which is central to many people in places like Lauragh, Sneem, Bonane and Kilgarvan, are often left without any doctor. For the people in Gneeveguilla‎ and Rathmore, their out-of-hours service is in Millstreet, which is in another county.

Doctors are under severe pressure. In Killarney alone, there are approximately 4,000 new people, who are refugees, etc., but there is not one extra doctor. For most patients, a quick medical response will determine their survival chances. For people who get a cardiac arrest or a stroke, minutes count. We need more out-of-hours doctor services because invariably it falls to the ambulances and the paramedics to deal with people in very rural areas in a limited amount of time. When they come to the accident and emergency department at University Hospital Kerry in Tralee, they have to wait to get their patients in.

Michael Healy-Rae (Kerry, Independent)
Link to this: Individually | In context | Oireachtas source

First, I would like to thank and acknowledge the Regional Group for tabling this important motion. At the time when the ambulance service was centralised here in Dublin, I was vehemently opposed to that. I want to thank and acknowledge the past and present management structure of our National Ambulance Service in County Kerry. They do the very best with what they have, but unfortunately the structure means that at times there are big gaps in our ambulance service not due to any fault of theirs but because of the structure and the way it is set up. If you take an area as vast as the Iveragh Peninsula, if the Cahersiveen ambulance is gone, an ambulance from Killarney or Kenmare, or even from outside the county, might have to go down to the Iveragh Peninsula. That does not make sense. It is not a good use of our ambulance time.

The personnel who work there go beyond the call of duty and they work diligently at the service they provide. We need more doctors in the community, but it is getting harder and harder to get doctors to live, work and provide a service in our communities compared to what we had before. That is making more and more people go to our larger hospitals, which increases the waiting times in those places.

I want to thank people like Gary Stack and the organisers in SouthDoc in County Kerry. The work they do in the out-of-hours service is tremendous. They really do their best but we need to up our game and we need to do more. I want to give an example of what ambulance personnel do. There was a situation in the heart of Kenmare where Rachel O'Sullivan was giving an emergency birth to her twins, Ryan and Amber. Bryan Kelly from the ambulance service in Kenmare came to the rescue and saved the life of one of the twins. It was the little girl who was in trouble during her delivery. It was thanks to that ambulance technician's skill and expertise that on a kitchen floor in a house in Kilkeana outside of Kenmare this lovely little child was successfully brought into the world. That is our ambulance service and our ambulance personnel. They are people who work for the Minister, the Government and the people of Ireland. I salute and thank them, but we must resource them more. We must give them more money. We must give them a better-organised structure so they can do wonderful things, as Bryan Kelly did the day he brought the twins into the world and saved the life of one of them. That is what you call a good day's work by a good Kerry man.

Michael McNamara (Clare, Independent)
Link to this: Individually | In context | Oireachtas source

If Deputy Healy-Rae needs more time, I would be happy to share time.

Denise Mitchell (Dublin Bay North, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

No, we will move on now to the Independent Group.

Michael McNamara (Clare, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Regional Group for tabling this timely and important motion. Paramedics and the ambulance service have become a crucial aspect - if not one of the most important aspects - of our healthcare system. There was a time when they were not even considered part of the health system; they were merely considered to have a role in conveying somebody to the health system. Now, they are one of the most crucial parts of the health system. What happens in the immediate aftermath of an accident and their arrival will, more than almost anything else, determine the outcome. It is therefore crucial they are adequately resourced.

I spoke to last night's motion on the inadequate resourcing of the ambulance service. The figures about meeting the desired outcome, which is to respond within 19 minutes of a call, unfortunately speak for themselves. The percentage of cases of respiratory or cardiac arrest in which paramedics reached the patient within 19 minutes, which is the target, dropped from 69% in December 2019 to 59% in December 2022. In all other cases of call-outs, it has dropped to 43%. That is a great concern. We can only assume it is a result of resourcing, or else it is a matter of the centralisation of services and the fact that ambulances are being sent right across the country. I mentioned a case in which an ambulance was sent from Ennis to Enniskillen and, as a result, there was a delay in getting a case in north Clare.

Centralisation generally has not worked terribly well in the health service. Certainly in the HSE, there was a move away from the health boards to the HSE. There may have been a degree of political interference under the old health board structure, but at least there was a degree of accountability. The former Mid-Western Health Board, like all health boards across the country, was accountable to its members and to the elected representatives from the local councils. It seems that the HSE is theoretically accountable to nobody, other than perhaps the Minister. Sometimes one wonders who is accountable to whom with the regard to the relationship between the Department of Health and the HSE. The HSE answers parliamentary questions, which I appreciate, and I suppose it is at the Minister's behest that they are referred on. However, it was very much established not to be accountable. Regardless of whether we are talking about the HSE or any other aspect of the public service, it is damaging when there is a move towards taking it away from public accountability. I think there was such a move with the establishment of the HSE.

Returning to the ambulance service, the issue of paramedic training has been raised. There is a master's programme in the University of Limerick, but almost all the graduates coming out of it have to go abroad to seek work. There seems to be a bit of protectionism, frankly, going on in the NAS. It is a tribute to the University of Limerick that it has set up this course. It is greatly desirable because we need more paramedics in the country. Yet, in order to get practical experience and to get employment, almost all the graduates - although I know there were some recent exceptions that almost proved the rule - have had to go to England to get work experience and to get employment thereafter. I ask the Minister to intervene to look at this problem, which was also raised with the Minister of State, Deputy Rabbitte. I do not expect him to have an answer right now on the floor of the Dáil, but I ask him to look at the issue, to see what it is and to make sure there is not a degree of protectionism going on. Anything like that at a time of such dire need would be damaging to public confidence and to the public service that people rightly demand.

I tabled a parliamentary question to the Minister on the percentage and number of call-outs to the NAS in which the patient in respect of whom the call-out was made had already died by the time the ambulance arrived. Obviously, there is no fault to be given in every case in which a case the patient has already died. While there could be fault, none should automatically be given. When the Minister referred to the matter to the HSE for an answer, as is the normal course, I was surprised to learn that it does not maintain or record these statistics. I would have thought it would be a useful statistic to maintain and one that should be maintained in the future. I ask that it be maintained in future. There is an important balance to be struck. Some useful information could be gleaned from those statistics, just as information has been gleaned from the statistics around the percentage of call-outs that arrive within the target time, which is unfortunately dropping.

I again thank the Regional Group for putting forward the motion. It is important and I will be happy to support it. I am not sure whether the Government tabled a countermotion but, regardless of whether it did, I hope the spirit of the motion will be heeded, that the crucial role played by the NAS and paramedics will be acknowledged by the Government and that they will be adequately resourced to fulfil that role. They are a crucial, if not the most crucial, part of our healthcare system in determining outcomes.

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome this important and timely debate tabled by the Regional Group on the future of our National Ambulance Service. I commend the sponsors of the motion on what is a fair and constructive approach to improving these services. This contrasts starkly with yesterday's Sinn Féin motion on the same topic, which was littered with spin and failed to acknowledge the progress being made by the women and men who work throughout Ireland in the NAS. Deputies will be aware that in parts of Dublin, ambulance services are delivered by Dublin Fire Brigade, and the comments I am making today apply to both these groups of healthcare professionals.

The motion rightly calls for more funding, an expansion of the workforce, not least in terms of the highly trained ambulance crews we have, and better response times, especially in certain regions and parts of the country. Colleagues are right to call for these and the Government will not oppose the motion. There are parts of the country where response times need to be a lot better, where there remain too few paramedics and where those paramedics who are there are being asked to work under sustained pressure. There are parts of the country where the ambulance bases are either outdated or simply not fit for purpose. For these reasons, we have been investing, over the past three years, at record levels in our National Ambulance Service. To the great credit of our ambulance teams, they have been turning this funding into better response times, new fleet, more paramedics and more services for patients.

With the motion being a notable and worthy exception, debate in the Oireachtas and more widely on our ambulance service tends to focus on what is not working. The debate rarely acknowledges the progress that is being made. If this narrative were to be believed, one would be forgiven for thinking the women and men working in our ambulance service were failing in their drive to make things better for patients. Of course, not only is this relentlessly negative narrative not true and not only is it deeply demoralising for our healthcare professionals, but this narrative of failure is, in fact, the opposite of the truth. Last year, the average response time was 25 minutes. This January, it was 22 minutes. In January 2022, of 30,000 incoming calls, 35 people had waited more than two hours, whereas this year, that figure fell to 30. In January 2022, 114 people waited more than one hour, while this January, that fell to 81, and our ambulance crews and management are determined to keep driving down that figure. The target for echo calls, that is, cardiac and respiratory emergency response, is 80% to be responded to within 19 minutes. Last year, crews hit 71%, while this January, they increased that to 77%. The target for delta calls, that is, all other emergencies, is 50% to be responded to within 19 minutes. Last year, crews hit 43%, whereas this January, they increased that to 48%, and they are determined to meet those targets.

Deputy Cullinane earlier described as “disgraceful” my putting on record the progress being made by our healthcare professionals. The truth may not suit the Deputy's narrative, or that of Sinn Féin, that Ireland is somehow a failed State. It may not suit the Sinn Féin narrative to see the ambulance response times getting better or new services being rolled out. It may not suit the Sinn Féin narrative to see waiting lists, for the first time in many years, falling last year and again this year, but that does not make any of those things less true. I and the Government commend our healthcare professionals on the progress they most definitely are making.

Last year, the Government invested a record €200 million in the NAS. This represented an overall increase in funding of approximately €30 million on 2019 and there is another significant investment this year. Staffing has increased by one fifth since 2016 and needs to go further. Additional clinical capacity in the NEOC in Tallaght has introduced new care pathways, including see and treat and hear and treat, which have been successful. Since October 2020, almost 50,000 patients have been treated through these new pathways, with nearly 19,000 of them as a result not needing to be brought into an emergency department.

The pathfinder model has been rolled out in Tallaght, Limerick and Waterford, and additional sites are being identified for this year. Another recent initiative has been the medical assessment unit pathway, which was first trialled in Cork last year and has been rolled out in Ennis, Roscommon, Nenagh and Loughlinstown, with additional sites being identified for expansion later this year. Substantial funding has been allocated to increase the number of student paramedics training in the NAS college. The NAS recruitment programme is very successful, with 175 students enrolled in its bachelor of science, BSc, programme in paramedic studies.

None of this is to detract from the significant challenges for patients and ambulance crews, particularly in certain parts of the country. More funding and more paramedics are needed. The service needs to continue to evolve from an emergency response service to a mobile medical service. To that end, I asked the director of the National Ambulance Service to develop a new strategy. The HSE board reviewed the draft plan in recent weeks and it is now with my Department. It addresses many of the issues the Deputies raised through the motion. This evolution of the NAS is just one part of a fundamental reform and reshaping of our health service towards community- and home-based care where possible, freeing up hospitals to do the most complex work for patients.

A total of 165 primary care centres are now fully operational, while a further 14 are under construction, with 12 of them due to be completed this year. The construction of ten community nursing units was completed last year and 13 more are being built this year. Last year, the contract for the community nursing unit, CNU, public-private partnership project was awarded. This will deliver 530 beds on sites at Ardee, Athlone, Clonmel, Killarney, Midleton, St. Finbarr's Hospital in Cork and Thomastown. For older persons with care needs, 426 public intermediate beds have been delivered to date, with 31 more coming on line in the coming months. Some 539 private intermediate care beds are contracted weekly, while 132 private beds are managed locally.

We are in the middle of creating 96 new primary care teams in every part of the country, as well as 60 specialist teams for older people and chronic disease management. Ninety-four of those 96 primary care teams are in place. A total of 2,500 of the 3,500 staff sanctioned have been hired and are now working in every part of the country. There are 18,000 more healthcare professionals working in the HSE now than there were at the start of 2020, and an additional 6,000 are going to be hired this year. We are aiming to hire more than 300 of those into the National Ambulance Service, including more EMTs and more general and advanced paramedics. Critically, as colleagues will be aware, the Government recently sanctioned a new rapid response team of 200, which is going to be put in place this year as well.

I acknowledge the extraordinary efforts of our ambulance crews and those working in our NAS throughout the country. When Covid arrived, they were often the first on scene, with testing and tracing, treatment and vaccinations. Since Covid, they have turned State funding into better response times, new services and an expanded and highly trained workforce. When they say they need further investment, modern bases and more paramedics, I and the Government hear them, agree with them and will continue to invest in them.

I thank the Deputies for a constructive motion, full of excellent ideas, which I will discuss with the Department in the context of the new strategy we are looking to launch shortly.

Seán Canney (Galway East, Independent)
Link to this: Individually | In context | Oireachtas source

I acknowledge the Minister's appraisal of our motion as balanced. We acknowledge that progress is being made and the work that is being done by everyone involved.

I could make a number of comments to the Minister at this juncture, and not all negative. We have great potential to develop pre-hospital services rapidly. One area is the paramedics themselves. Their career path needs to be developed so that they are trained to do more medical work in the communities. They are not just ambulance drivers any more. We have to make sure they are trained in the IT systems we have and that there are more of them. The Minister was in Tuam recently at the primary medical centre. Just up the road from that there is the new ambulance base which was built approximately seven years ago. It is a fine facility, capable of running two ambulances full time but there is only one in operation 24-7. They find it a struggle to deal with the call outs they get because there is only one ambulance. When that goes out the next ambulance has to come from Galway but they go down as far as Knock. We need to beef up those resources.

Earlier, my colleague, Deputy Berry raised the issue of students and training at UL. When they do their on-the-road training, they have to go to the NHS in the UK. Then they find it difficult to come back here and get jobs. We are a small country with 5 million people which, as the Deputy pointed out, is the size of Birmingham. We should be able to ensure that we do the on-the-road training here. That is something I would ask the Minister to look at very seriously.

While we are talking about potential, my own community group, Belclare community council, is buying a new defibrillator. They are buying it themselves out of their own resources. The local GAA club is also buying one and we will share them and the facilities we have. I often think that these are an asset for everyone and the State should provide them. I acknowledge that the Minister has taken the VAT off the equipment. I came across a man at the top of Croagh Patrick last May. He was talking about how there were no defibrillators or anything on Croagh Patrick. He was a first responder himself. We discussed it a few times when we stopped to get our breath on the way up and we met at the top and we discussed it again. By God, did I not meet him at the bottom again and he said he was going to do something about it? Last week, the Air Corps landed two of the units onto Croagh Patrick. This man ended up on "The Late Late Show” and got €15,000 of a bursary. He was named Mayo Man of the Year by the Mayo Association of Dublin. Darren Forde is his name and he is from Hollymount. He is a credit to this country. He is full of enthusiasm. He has developed a box that will be eco-powered. It can be put in place in a matter of minutes. I believe the Department and the HSE should have a meeting with that guy because he has the ideas and the will to deliver. That is where our potential is. It is not to be looking within the HSE for the answers; the answers are out in our communities. It is important that we harness that.

Returning to the Minister’s visit to Tuam, I have a big problem with the fact that we still do not have the X-ray facility at the primary care centre. That facility would take people out of the emergency department in Galway. It does the X-rays locally and they are read in Portuncula Hospital in Ballinasloe. I know the Minister said it would be delivered before June and I hope to God that is what is going to happen because the funding was made available in 2017.

I also welcome that the outpatient building in Merlin Park has commenced construction on-site. It is another worthy project to get done. The failing, again, is the time taken to do this. We have discussed this previously. We need to put a big effort into short-circuiting the time it takes to deliver these kinds of projects. The elective hospital in Galway needs to be looked at to see how we can best deliver it in the quickest time for the people of the region. If we do that, we will be doing something that is right and is honourable for the people.

I have an issue with the HSE regarding a day centre in Loughrea. It is probably part of the attitude of the HSE. It has decided to take a purpose-built day centre, which was a model for this country and to redesignate as part of a community nursing unit. It was only built in 2011. Today it can only be used one day a week for older people in Loughrea and the surrounding area. We are having a public meeting tomorrow night about it but I want to put on record here that the HSE is wrong in what it is doing. It is going to spend more money creating another facility some place else on the site which, first, is not fit for purpose, in my book and, second, has a purpose-built unit that should be held for older people.

Denis Naughten (Roscommon-Galway, Independent)
Link to this: Individually | In context | Oireachtas source

There are up to 10,000 community defibrillators in Ireland, according to the Irish Red Cross. Some of these are maintained by approximately 200 community first-responder schemes registered with the NAS This falls well short of the 275 first responder schemes registered with the NAS before the pandemic. The vast majority of these defibrillators have been funded by local communities or through government grants, yet there is no national database outlining their location, whether they are maintained, whether they are accessible or who is trained to use them.

For most patients a quick medical response time determines their chances of survival. For every minute that elapses following a cardiac arrest, a person’s chances of survival decreases by 7% to 10%. With the ambulance response-time target set at 19 minutes for a cardiac arrest, this is too late. Despite the failure to reach the response target times in over half of such emergencies, last year just 268 of the NAS first responders arrived at the scene of an emergency before the ambulance.

In a dispersed rural country like Ireland, we need local people to be at the scene of such emergencies within the first three to five minutes if people are to survive. While the National Ambulance Service community first-responder schemes are struggling to recruit volunteers, we are only scratching the surface with willing volunteers. For example, a pilot initiative supported by Roscommon LEADER partnership has identified and registered more than 480 first-responder volunteers in 40 community groups with 234 defibrillators, yet not one of them is on the national ambulance service system. The local community has rolled out an app that not only allows users to ring emergency services with location co-ordinates but also identifies where the nearest accessible defibrillator is located and enables the notification of the nearest six trained CPR responders. It then talks the person through performing CPR until those responders arrive. This is the type of community innovation, if supported, that can save lives.

In January, two children died in choking-related tragedies involving food within two days of each other. As parents, all our hearts go out to those families. Tragically choking and suffocation is a significant cause of unintentional death of children in Ireland. Incidents related to choking are quite frequent in children and in toddlers, in particular, when they are learning to eat. Toddlers are more likely to put anything that they can lay their hands on into their mouths and it is a big risk but the current law only requires one staff member present in a childcare facility to be trained in first aid for children. In the case of chocking, minutes can be the difference between life and death. There are many reports of the only trained staff member in a facility being unavailable or even freezing in such emergencies.

The former Minister for Health, James Reilly, stated, "I am very anxious that all people working directly with children in the early years sector have an appropriate Paediatric First Aid qualification." We are still waiting for that to happen. We must ensure all staff in childcare services undertake and complete a paediatric first-aid response course, funded by Tusla and the Department of Children, Equality, Disability, Integration and Youth.

On average, there is a hospital admission related to anaphylaxis every day, with the highest number of admissions occurring among children and young adults, yet most schools and childcare facilities do not have an epinephrine autoinjector for emergency use. Even where they are in schools because a child has a particular allergy, staff are not trained to use them. It seems that we expect the child to self-administer with the EpiPen when experiencing anaphylaxis. Epinephrine autoinjectors should be provided in all schools and childcare facilities. All staff must be trained in the use of the specific EpiPens on their premises. I commend the motion to the House.