Jennifer Whitmore (Wicklow, Social Democrats)
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Today I raise the issue of the ambulance service in County Wicklow, particularly the service being provided for Arklow and Baltinglass. This issue has been raised with me by constituents who are fearful because there is not a full service being provided in Arklow and Baltinglass at the moment. It was raised recently at the Arklow Municipal District by Councillor Peir Leonard who expressed concerns about it. She read a response she had received from the HSE, which stated that the ambulance service operates a 24-7 response from its Arklow base, excluding Tuesdays when there is no cover in place between 7 a.m. and 7 p.m.

This is not just an Arklow issue. As I said, this is an issue for Baltinglass, where there is also a limited service provided. Apparently, in Baltinglass, no service or no cover is provided on Monday nights. The reason these service gaps exist in Wicklow stems from a decision in 2012 by the HSE to drop or alter overtime operation requirements by the ambulance service. When it did that, it moved it from eight hour to 12 hour shifts. However, that left gaps in a number of stations, and rather than increasing the number of staff, the HSE decided in its wisdom that those areas could go without cover for those two particular days per week.

This has become more of an issue because Wexford Hospital is now closed. That means it is limited in the service it can provide. This is a serious concern for the people of Arklow and west Wicklow. I would appreciate if the Minister of State could give me some information on those particular services, on the response times we are seeing from those services, and on what the Minister plans to do to ensure Arklow, the corresponding district, Baltinglass and west Wicklow have sufficient ambulance cover so that people are not waiting long periods for the help and assistance they need, which is obviously putting their lives at risk.

Kieran O'Donnell (Limerick City, Fine Gael)
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On behalf of the Minister for Health, Deputy Stephen Donnelly, I thank Deputy Whitmore for the opportunity to update the House on the ambulance service in Arklow and elsewhere in County Wicklow.

The National Ambulance Service, NAS operates a 24-7 response from Arklow ambulance base excluding, as Deputy Whitmore stated, Tuesdays, when there is no cover from the base between 7 a.m. and 7 p.m. The Deputy made reference to Baltinglass as well. It is not covered, but maybe it is something which she could follow up with the Minister and look for precise details on the response times, which she has mentioned as well.

However, the National Ambulance Service operates a dynamic model of ambulance deployment. This is in line with international best practice, and allows the National Ambulance Service to prioritise resource allocation to the highest acuity calls which require an immediate emergency response. This means that on a Tuesday between 7 a.m. and 7 p.m. in Arklow, an ambulance from one of the many neighbouring stations will be deployed to respond as the need arises.

The ambulance based in Aughrim is crewed by eight Pre-Hospital Emergency Care Council, PHECC, registered paramedics and advanced paramedics. There are no current vacancies on this base. Additionally, two community paramedics currently operate a 12-hour shift pattern seven days a week from Arklow ambulance base. Community paramedicine provides community-centred healthcare services which bridge primary and emergency care, including expanded roles such as health promotion and disease and injury prevention, as well as acute assessment and treatment of chronic illness exacerbation and minor illness or injury.

Deputy Whitmore made reference to the historical perspective regarding the service in Arklow between 7 a.m. and 7.p.m on Tuesdays. I followed up by getting a bit more information. The Arklow rosters have been set in this pattern since approximately 2010 due to changing work patterns at the time, such as staff moving from a 40-hour week to a 39-hour week, and changing to 12-hour shifts. Cost savings required at the time were also a consideration. The National Ambulance Service is constantly monitoring its resources with patient safety its key consideration. Areas identifying a need will be supported as new service resources are developed and become available. Arklow will be considered through this process.

Regarding ambulance services more generally, the Government has invested very significantly in the NAS in recent years. In fact, record investment of more than €211 million has been allocated to the NAS under the HSE’s 2023 national service plan. This represents an overall increase of approximately €43 million from that allocated in 2019. This unprecedented level of investment has allowed for our National Ambulance Service to undergo an enormous programme of change in recent years. It continues to transform from a service that traditionally transported all patients to hospital for treatment to a service that is clinically led and is now treating more patients over the telephone, at the scene, or in their own homes. We have grown the NAS workforce substantially, with the Government’s investment allowing for an increase of 28% in staff numbers since December 2015.

As well as the significant increases in staff numbers, the NAS has made major advancements in the way it delivers patient care. For instance, building clinical capacity in the National Emergency Operations Centre, NEOC, in Tallaght has facilitated the introduction of alternative care pathways like see and treat and hear and treat, which allow the NAS to assess and treat many patients at the lowest appropriate level of acuity, resulting in a better experience for the patient and more efficient use of resources.

Recent investment has resulted in enhanced clinical and patient care capacity in the clinical hub with a view to ensuring a growing percentage of callers to the NEOC in Tallaght who are triaged through the hub do not need conveyance by ambulance to a hospital emergency department where there is no clinical need.

I extend my sincere thanks and gratitude to the staff of the NAS and to all of our ambulance services for their commitment and dedication to patient care in Wicklow and across the country.

Jennifer Whitmore (Wicklow, Social Democrats)
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I thank the Minister of State for the additional work and effort he has put into coming up with some information on that. Fundamentally, Arklow and Baltinglass do not have full cover at the moment. They are now relying on ambulance cover from other parts of the county, and indeed other parts of the country. This has been in place since 2010, which was a very different environment economically. There was obviously a need to make cuts. However, we are no longer in that economic situation, and it is inconceivable that we have two large towns in our county which are relying on ambulance services from other parts of the country to provide a service. That gap has been in place for those two towns for 13 years, and it is time the HSE and the Minister put enough staff and resources into those stations so that they can provide a full coverage to their districts.

Other stations which were also cut in 2010 have had their service fully restored. They have had the additional investment in their staff and stations, and I would ask that the Minister for Health does the same for Arklow and Baltinglass to make sure they can operate on 24 hours a day, seven days a week, and that they are fully functional and independent insofar as is possible.

I agree with the Minister of State's sentiments with regard to our ambulance service. It does an incredible job. However, I have some ambulance personnel in my own family, and I know from talking to them that they are incredibly stressed, under-resourced and working 12-hour shifts which can extend to 14- or 16-hour shifts. This investment is critical not just for the patients of Wicklow to make sure they get appropriate and quick healthcare but also for the ambulance staff who are under increasing pressure and stress.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Deputy Whitmore. As I have stated, the National Ambulance Service is constantly monitoring its resources, with patient safety its key consideration. Areas identifying a need will be supported as new service resources are developed and become available. Arklow and Baltinglass will be considered in that regard.

This is a matter I will bring back to the Minister, Deputy Donnelly, but I ask that the Deputy follow up in her own structured way with the Minister's office on those particular points, and the Minister and his office can then take the matter up with the NAS in a structured way.

I reiterate to the Deputy that the Government remains absolutely committed to investing in and growing our National Ambulance Service. The service does great work, and the people on the ground - the ambulance drivers, paramedics and all across, even the people working in the offices - do phenomenal work. In my opening statement, I alluded to progress we made in recent years, and the rest of the challenges facing us. I would like to talk briefly about the plans for the coming years.

To meet the demands of our growing and ageing population, the NAS is developing a new strategic plan to 2031. Deputy Whitmore's particular request might be fed in as part of that review and strategic plan. This plan will set out a very ambitious roadmap for our National Ambulance Service in the coming years. It will see the National Ambulance Service continue its long-term evolution from a patient transport service to a modern, responsive and mobile medical service. Government is committed to supporting the NAS to progress its reform of delivery of pre-hospital emergency services. I acknowledge there is still work to be done, but the Deputy should rest assured that we will be working closely with the National Ambulance Service and the wider health services on this.

I again acknowledge the tireless efforts of the National Ambulance Service and its talented and dedicated workforce, and thank them for everything they do.