Christopher O'Sullivan (Cork South West, Fianna Fail)
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I thank the Minister of State for being here to take this Topical Issue matter on the ambulance service in the west Cork area. The service is stretched and we urgently need extra ambulances to serve the people of the region. It is important that I explain the geography of west Cork. It is a huge area, bigger than most counties. For example, from the edge of Cork city to the Dursey Sound takes well over three hours to drive, and that is at a good speed. Travelling from somewhere like Clonakilty in the southern part of Cork to Macroom in the north takes well over an hour. It is a vast area. There are not enough ambulances to serve the area and provide safe outcomes.

There are five ambulance bases, in Clonakilty, Castletownbere, Bantry, Skibbereen and Macroom. Even at that, the service is stretched to its limit. The waiting times for ambulances are far too long. To compound that, because the National Ambulance Service, NAS, provides the service, these ambulances cover far more than the geographic region I have explained. Ambulances often serve Cork city and get stuck there, which means there is extra pressure on the west Cork area. Ambulances often serve Kerry. I have nothing against people in Kerry being able to avail of ambulance services, but that puts a serious strain on the service in west Cork.

I was contacted recently by a lady who called an ambulance for her daughter, which took three and a half hours to arrive. The House will have to bear with me in respect of the geography involved. The ambulance went from Cork city all the way west to Castletownbere, on the far west of the county, and then back to Skibbereen, for whatever reason. I am sure the ambulance service knew exactly what it was doing and had to travel that route for a reason, but that meant the woman's daughter was waiting for three and half hours for an ambulance, which is far too long. This is going to put lives at risk.

As with many parts of Ireland, there are islands off the coast of Cork. An islander rang an ambulance but the wait time was so long that the lady had to put her parent into the car, take the ferry and bring them to the hospital. It is not good enough. We need to increase the number of ambulances serving west Cork and the number of personnel. From a visit by the Minister of Health to west Cork this summer, my understanding is that an extra full-time ambulance with eight personnel was to be provided in Bantry to take the pressure off. That would be an amazing start, but we need to know when that will happen and when the personnel will be in place. Furthermore, when will there will there be more ambulances in west Cork? We need them desperately.

Ossian Smyth (Dún Laoghaire, Green Party)
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I thank Deputy O'Sullivan for asking this question. I will answer it on behalf of the Minister for Health, Deputy Stephen Donnelly. The question relates to ambulance services in west Cork.

As the Deputy will be aware, the NAS serves the west Cork region 24-7 through a highly skilled workforce of intermediate care operatives, paramedics and advanced paramedics. There is a fleet of modern emergency ambulances, intermediate care vehicles and rapid response vehicles. There are 12 ambulance bases covering the entire county of Cork, of which four are in west Cork.

The NAS deploys these resources in the region dynamically, in line with international best practice. That allows the NAS to prioritise resource allocation to the highest acuity calls that require an immediate emergency response. The region is also served by a number of NAS alternative care pathways that include the Pathfinder see-and-treat service, the NAS national emergency operations centre, NEOC, the clinical hub hear-and-treat service and community paramedic and intermediate care services. The Pathfinder initiative launched in Cork in April 2023 to improve outcomes for older people by providing safe alternative care at home rather than in hospital emergency departments. On average, two thirds of patients seen by Pathfinder following a 999 call have remained at home rather than having to be brought to an emergency department. Pathfinder was launched in Kerry in 2023 and also serves west Cork.

An intermediate care service currently operates in the Bantry area of west Cork seven days a week. It provides low acuity inter-hospital patient transfer and discharge services to help preserve emergency ambulance resources in the region. A medical assessment unit, MAU, pathway for 112 and 999 patients is also permanently in place following a successful trial which involved Mallow General Hospital in 2020.

There is also further support provided by the Government funded south-west helicopter emergency medical service, HEMS, and the Irish Coast Guard search and rescue service. Since commencing operations on 16 February 2023, the south-west HEMS had carried out 328 emergency tasks by the end of September 2023.

Regarding ambulance services more generally, the Government has invested significantly in the NAS in recent years. Record investment of over €219 million has been allocated to the NAS under the HSE 2023 national service plan. This represents an overall increase of approximately €50 million from that which was allocated in 2019. This unprecedented level of investment has allowed for the NAS to undergo an enormous programme of change and reform recent years, continuing a transformation from a traditional emergency ambulance service to an agile mobile medical service.

As a direct result of this investment, the NAS workforce has also grown substantially, with an increase of 32% in total staff numbers since December 2015. As well as the significant increase in staff numbers, the NAS has also made major advancements in the way it delivers patient care. For example, building clinical capacity in the national emergency operation centre in Tallaght allows the NAS to assess and treat many patients at the lowest appropriate level of acuity, resulting in a better experience for patients and a more efficient use of resources.

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

Christopher O'Sullivan (Cork South West, Fianna Fail)
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I thank the Minister of State. It is important that he mentioned the Government-funded air ambulance helicopter service. It is an extraordinary service, which ran on voluntary donations and charity fundraising for years. It is important that the Government is now backing it because without it we would be in dire straits. Even with that addition, it is still not enough. There are still parts of west Cork that are not being served properly by an ambulance service. We need to bolster the service. We need extra ambulances and staff.

I want to thank, from the bottom of my heart, the staff of the ambulance service for their extraordinary commitment and passion. However, they are experiencing burnout and are stressed and under severe pressure as a result of the workload and the lack of support and personnel.

That is why what I request is so important. I am not sure whether the Minister of State has the answer today but I would love one as quickly as possible on when the full-time ambulance with eight personnel announced for Bantry during the summer will be in place. Have the personnel been recruited? When can we expect to see the new ambulance up and running? I thank the Minister of State.

Ossian Smyth (Dún Laoghaire, Green Party)
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I thank the Deputy. I do not have the specific answer for him but I will ask the Minister, Deputy Donnelly, to get him an answer on the question of an additional ambulance with eight staff located in Bantry. I thank him for acknowledging the success of the helicopter emergency service. He does recognise that this is not just about the number of ambulances providing a good emergency call-out service as the approach also involves considering how we can treat people before an ambulance arrives, particularly when such long distances must be covered.

With regard to some programmes, a large proportion of people, or even a majority, realise they do not need an ambulance and can be treated at home. The community first-responder programme has been important. There were 30 teams two years ago and there are now 39 across Cork. They provide services like cardiopulmonary resuscitation and defibrillation and in many cases help to sustain patients. Not all of the investment should go towards additional ambulance services. As far as possible, we want to make sure people survive their emergency event and get the best treatment as soon as possible through the correct care pathway. It would be crazy not to use remote services. If we can provide a service over a video or audio link that can keep a patient alive or give him or her a better outcome, we definitely should put resources into it.

The Deputy is aware that paramedics’ skills are now far beyond those that they would have had some years ago, when they were mostly driving and lifting people in and out of ambulances. Paramedics now have many qualifications to obtain and they can give considerable care in the ambulance or on site on arrival. I will come back to the Deputy on his specific question. I acknowledge that he needs an answer.