Claire Kerrane (Roscommon-Galway, Sinn Fein)
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For the past 12 years in Roscommon there has been an advanced paramedic on the rapid response vehicle on a 24-7 basis. This was committed to by both the HSE and Fine Gael after the accident and emergency unit in Roscommon was closed in 2011. It was specifically to ensure there would be advanced life support always provided, given the accident and emergency unit was no longer there. At that time, a specific and separate roster filled by advanced paramedics for the rapid response vehicle was put in place and stayed in place until last year. I stress this was part of the improvements committed to for the ambulance service in County Roscommon because of the accident and emergency unit closure. At the time, the HSE promised an enhanced ambulance service.

In 2015, Leo Varadkar, when asked about this, stated a rapid response vehicle crewed by an advanced paramedic providing 24-7 cover in Roscommon was one of the significant improvements made to the ambulance service in Roscommon because of the closure of the accident and emergency unit. He went on to state his intention to drive further improvements in the ambulance service in Roscommon. Instead of that, it was quietly decided last May that a paramedic would fill a place on the advanced paramedic roster. I do believe this was very much done quietly.

I want to make it clear that is not acceptable to the people of Roscommon. The commitment given cannot be rowed back on and the roster of advanced paramedics needs to be restored immediately.

On contacting the National Ambulance Service about downgrading this last year, I was told the rapid response vehicles are resourced by both paramedics and advanced paramedics, that this is not unique in Roscommon and that it happens elsewhere nationally. That misses the point I have already outlined, not to mention the fact people living in Roscommon are further from an emergency Department since 2011.

The latest reply I received from the HSE went a step further in telling me paramedics and advanced paramedics are essentially the same thing, that in recent years paramedics have been upskilled to be able to carry out duties similar to those of advanced paramedics and that there is little difference in their skill set. That is a new one to me. Advanced paramedics are the only staff in the National Ambulance Service that can currently provide advanced life support. Advanced paramedics can administer 23 additional medications for acute emergency medical and traumatic conditions. For example, if a patient is in cardiac arrest, an advanced paramedic can put in an IV line and give enhanced cardiac drugs to increase the patient's chance of survival. Only an advanced paramedic can do this and that is clearly laid out by the Pre-Hospital Emergency Care Council in its documentation.

I want to be clear in saying I am not in any way taking away from the role of paramedics. They are critical to the ambulance service across the State. My point is that there was a commitment made by the Government and HSE to the people of Roscommon and that commitment has been broken. I ask that the roster of advanced paramedics be restored for County Roscommon immediately.

Kieran O'Donnell (Limerick City, Fine Gael)
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I am taking this Topical Issue on behalf of the Minister for Health. I thank Deputy Kerrane for the opportunity to update the House on delivery of ambulance services in Roscommon, including the important emergency response role carried out by the rapid resource vehicle, RRV.

I am informed that in the context of the National Ambulance Service emergency response operations across the country, RRVs are routinely resourced by both advanced paramedics and paramedics. In this regard, I have been assured that the National Ambulance Service is in full compliance with Pre-Hospital Emergency Care Council regulatory emergency response dispatch standards. I am sure the Deputy will appreciate the rapid advances in pre-hospital emergency care practitioner skills sets made in recent years.

I am also informed that a vacancy on the emergency ambulance roster arose last year, which has been offered via a national transfer process. I made inquiries on this matter and the update I got was that the National Ambulance Service has advised the transfer window is not open yet but is expected to be open by the end of this month. The last window was December. That was unsuccessful so the position will be offered again this month.

Turning to ambulance service resourcing in Roscommon more generally, the National Ambulance Service serves the county out of three bases located in Roscommon, Boyle and Loughglinn, which all operate on a 24-7 basis. All three bases are staffed by a highly skilled workforce of intermediate care operatives, paramedics and advanced paramedics, and a fleet of modern emergency ambulances, intermediate care vehicles and RRVs. I note that in the past three years National Ambulance Service staffing in the county has increased by nearly a quarter. It has gone from 26 whole-time equivalents in January 2021 to 32 in December just gone. That is an increase of six, which is 23%.

I acknowledge the engagement by the Deputy in relation to the National Ambulance Service's Loughglinn ambulance base. Ambulance resources in the Roscommon region are deployed by the service dynamically in line with international best practice, which allows the service to prioritise resource allocation to the highest acuity calls that require an immediate response.

The National Ambulance Service is also a vital partner in supporting the delivery of the HSE’s urgent and emergency care plan through development and expansion of a range of clinically appropriate alternative care pathways to improve patient flow and reduce pressure on emergency departments. In this regard, I particularly welcome two alternative care pathway developments last year in Roscommon which involved the implementation of medical assessment unit and local injury unit patient pathways for 112-999 patients who, where deemed clinically appropriate, do not require treatment in a busy hospital emergency department and can be better looked after in an alternative care setting.

The further development and expansion of initiatives such as these in Roscommon are vital in transforming the delivery of urgent and emergency care, improving patient access to care and enhancing patient healthcare experiences and outcomes. I know the National Ambulance Service is committed to providing these going forward. I extend my sincere thanks and gratitude to the staff of the National Ambulance Service and to all the ambulance services for their commitment and dedication to patient care in County Roscommon and across the country.

Claire Kerrane (Roscommon-Galway, Sinn Fein)
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Gabhaim buíochas leis an Aire Stáit. I thank him for taking this matter on behalf of the Minister, Deputy Donnelly. I have two points to counter the one that keeps being thrown back that RRVs everywhere are routinely crewed by either a paramedic or an advanced paramedic. That is well and good but the point is the commitment was made that an advanced paramedic would be there 24-7 to cover Roscommon, specifically because of the closure and loss of the accident and emergency unit. It has been in place for 12 years and last May, very quietly, it was decided all of a sudden we did not need a full roster of advanced paramedics and would instead replace one with a paramedic. That is paired with the fact the people of Roscommon are now further from an emergency department than when the accident and emergency unit existed.

Those were the two grounds on which this commitment was made. It was made by the HSE and Fine Gael. The accident and emergency department was lost to the people of Roscommon. They were promised a very advanced ambulance service and now, from what I can see, that is being downgraded very quietly.

The paramedic and the advanced paramedic do not do the same job and do not have the same skills. That is outlined very much by the Pre-Hospital Emergency Care Council, which the Minister of State referenced in his response. There are 23 additional medications the advanced paramedic can administer. In cases of cardiac arrest, which is just one such instance, the advanced paramedic can act in a way that will see that patient more than likely have a better chance at survival. Only they can administer that medication and it is absolutely incorrect to suggest both types of paramedic do the same job and have the same skill set. That is not correct.

I ask that the Minister of State bring this back to the Minister, Deputy Donnelly, because what has been outlined this evening is not satisfactory. I again ask that the roster of advanced paramedics that was committed to and promised by the Minister of State's party and the HSE be restored immediately.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Deputy Kerrane. I will take back the points she raised to the Minister. In my opening statement I concentrated for the most part on ambulance resourcing and some recent alternative care paths in County Roscommon. I will now focus on the service nationally and touch on the investment in our National Ambulance Service and its future plans.

This Government has invested very significantly in the National Ambulance Service in recent years. This year the total National Ambulance Service budget will comprise €227.7 million. This represents an overall increase of over €58 million or nearly 35% from that allocated in 2019, which is the last complete year unaffected by Covid-19. As a direct result of this investment, the National Ambulance Service workforce has also grown substantially, with over 2,300 whole-time equivalents as of December 2023, which represents an overall staff increase of some 37% since December 2015.

Such investment has also allowed for the National Ambulance Service to undergo a significant programme of strategic reform from a conventional emergency response and conveyance service to an agile, mobile, medical service involving the introduction and development of a range of "See and Treat" and "Hear and Treat" alternative care pathways designed to treat growing numbers of patients at the most appropriate level of clinical need in the most appropriate care settings. I can tell the House a new National Ambulance Service strategic plan is at an advanced stage of development. The new strategy will look to build on recent progress and further align the NAS more closely to wider healthcare reforms with a focus also on bridging gaps between patient demand and available capacity.

I conclude by reiterating my acknowledgement of the professionalism and dedication of the NAS’s talented workforce, including in Roscommon, and to thank it for the essential service it continues to deliver for us all every day.