Claire Kerrane (Roscommon-Galway, Sinn Fein)
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First, by way of background, the accident and emergency department in Roscommon was closed in 2011. On the back of that, a commitment was made that there would need to be much better ambulance cover for Roscommon because we are farther away from the next nearest emergency department. Both Fine Gael, which was in office at the time, and the HSE committed to ensure there would be advanced life support. It would always be provided given the accident and emergency was no longer there. At that time, a separate roster for advanced paramedics on the rapid response vehicle was put in place. Until 2023, that had been in place for 12 years. In 2015, Leo Varadkar, the then health Minister, restated that a rapid response vehicle crewed by an advanced paramedic providing 24-7 cover in Roscommon was one of the significant improvements made in Roscommon because of the closure of the accident and emergency department. He went on to state his intention that there would be further improvements because we had no accident and emergency department and we were farther away from the next emergency department.

Instead what has happened, and I have been raising this for about a year, is that the advanced paramedic roster on the rapid response vehicle has been filled by a paramedic instead of an advanced paramedic. On the roster that was full with advanced paramedics, one advanced paramedic is missing, meaning that when calls are made, sometimes there is no advanced paramedic when there should be.

I recall last year a further reply from the HSE telling me that paramedics and advanced paramedics were the same thing, and that paramedics had been upskilled and could carry out duties similar to that of advanced paramedics. Of course, that simply is not true. Advanced paramedics can administer an additional 23 medications for acute emergency medical and traumatic conditions like a cardiac arrest. They are the only paramedics in the National Ambulance Service who provide the advanced life support that is needed quickly in very urgent cases.

We started with the use of a paramedic filling the AP roster and now, in the past week, it has been said that the rapid response vehicle – I have confirmed this with management in the National Ambulance Service – is being taken off the road in Roscommon on Thursdays, further downgrading that commitment and breaking that promise to the people of Roscommon. That shift had been filled by overtime. I understand it is a saving to the National Ambulance Service of about €350 a week. It is detrimental to the people of Roscommon should an urgent call come in and there is no advanced paramedic.

We have also had the situation in Roscommon where the air ambulance was relocated to Dublin in November arising from works in Athlone. It was due to come back in January. It is March now, and we are still waiting. I note the majority of calls for the air ambulance come from County Roscommon. We are without the advanced paramedic 24-7 cover, the promised rapid response vehicle and now the air ambulance.

I wish to make a point I have made a number of times in the House. I am concerned with the direction in which the National Ambulance Service is taking the service. It appears to be dismantling entirely the role of the advanced paramedic. It is the policy of the director to go in a different direction. It is looking at establishing something else, which is not even up and running yet. It has not been and is not training advanced paramedics anymore. It also has not been doing the privileging courses. We have about 14 or 15 people in the National Ambulance Service working as paramedics who are fully qualified APs but did not qualify here. The privileging course to make them APs and allow them to work here has been suspended. It is said it will be rolled out in May, but there is no guarantee they will manage to do a privileging course for 14 to 15 people, which is ridiculous.

Kieran O'Donnell (Limerick City, Fine Gael)
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On behalf of Minister, Deputy Carroll MacNeill, I thank Deputy Kerrane for the opportunity to update the House on the delivery of pre-hospital emergency care in County Roscommon and the important emergency response role delivered by our National Ambulance Service.

The National Ambulance Service serves the county of Roscommon 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 pre-hospital emergency care practitioners, including paramedics, advanced paramedics and emergency medical technicians. In addition, the National Ambulance Service operates a fleet of modern emergency ambulances, intermediate care vehicles and rapid response vehicles from these bases. I acknowledge the engagement by the Deputy on the establishment of the national ambulance base in Loughglinn.

Ambulance resources in the Roscommon region are deployed by the National Ambulance Service dynamically in line with international best practice. This means the National Ambulance Service prioritises resource allocation to the highest acuity calls that require an immediate emergency response, in direct response to patient needs.

On the specific issue raised by Deputy Kerrane, I am informed that the National Ambulance Service currently operates two rosters at its Roscommon base. One is for the operation of a rapid response vehicle and the other for the emergency ambulances. The rapid response vehicle roster has four paramedic posts and, in February 2025, had two vacancies. I understand an offer has been made for one of these posts through the National Ambulance Service national transfer process and that options for the filling of the second post are being examined.

The rapid response vehicle had been delivered in Roscommon through a combination of basic pay and overtime, but I understand that the rapid response vehicle is not currently rostered for daytime services on Thursday, which the Deputy alluded to. However, the National Ambulance Service operation of dynamic deployment means that Roscommon continues to be served by neighbouring National Ambulance Service bases for both emergency ambulance and rapid response vehicles.

As well as front-line urgent and emergency care, the National Ambulance Service is also a vital partner in the development and expansion of a range of clinically appropriate alternative care pathways to improve patient flow and reduce pressure on emergency departments. I particularly welcome two alternative care pathway developments in Roscommon in recent years involving the implementation of medical assessment unit and local injuries unit patient pathways for 112 and 999 patients. This means patients who are deemed clinically appropriate and do not require treatment in a busy hospital ED can be better looked after in an alternative care setting such as a medical assessment unit or a local injuries unit.

Patient demand for national ambulance services continues to rise, with nearly 430,000 urgent and emergency calls received last year, a year-on-year rise in volume of 8%. The further development and expansion of alternative care initiatives are vital, therefore, 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 the continuing development of these alternative pathways.

I extend my sincere thanks and gratitude to the staff of the National Ambulance Service and to the staff of all our ambulance services for their commitment and dedication to patient care, both in County Roscommon and throughout the country.

Claire Kerrane (Roscommon-Galway, Sinn Fein)
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If patient demand for NAS services continues to rise, with nearly 430,000 urgent and emergency calls received last year, representing a year-on-year rise in volume of 8%, why then has the National Ambulance Service stopped training advanced paramedics? Why has it stopped the privileging courses? Fully qualified advanced paramedics who have trained elsewhere, some I understand in the Defence Forces, can only work as paramedics. That privileging course the National Ambulance Service eventually agreed to run in May of this year might not be able to manage the 14 or 15 people. How can it not run a course for 14 or 15 people and allow them to be advanced paramedics?

I am concerned about an acknowledgement that we have more urgent and emergency calls but the only paramedics in the National Ambulance Service who provide advanced life support are not being trained. They are not being respected or recognised either. In fact, I believe they are being dismantled entirely, and Roscommon is a case in point. Management keeps saying they cannot fill the roster in Roscommon. They will not fill it when they are not doing privileging courses and they are not training APs. I am also aware there are advanced paramedics in Roscommon willing to take up a full-time role on that roster but they are stopping themselves from doing it because they are constantly being pulled to cover. If someone became the AP on that roster, they are put off doing that because they are constantly being pulled to cover elsewhere.

We need that roster in place and that decision needs to be reversed. We are not near an accident and emergency department. That is why we got the air ambulance, which is available but further away; it is based in Dublin. An AP can be the difference between life and death. I do not say that to scare people. It is the absolute reality. Nowhere in the Minister of State's response did he acknowledge that a commitment was made to the people of Roscommon and that commitment has been broken. I acknowledge the Minister of State's comments about Loughglynn, where I was lucky enough to be able to deliver a 24-7 service because the previous director Martin Dunne was excellent at engaging and doing what was right. That is also an issue now because we have no engagement at all, unfortunately, with the new director.

Kieran O'Donnell (Limerick City, Fine Gael)
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I note the points the Deputy raised in respect of Roscommon and the roster. There are currently two vacancies. I understand an offer has been made for one of the posts through the National Ambulance Service national transfer process and options for the filling of the second post are being examined. I have asked my Department to follow up on that issue with the NAS and to look at the particular issue of rostering for daytime services on a Thursday. I understand the needs of the people of Roscommon.

The Deputy raised other issues, including the AP courses. My Department will follow up with the HSE on that matter as well. She also referred to the air ambulance service, which was supposed to be in place in January. We will also follow up on that point. However, with respect to the key element the Deputy raised - the removal of 24-7 advanced paramedic cover in Roscommon - she is effectively speaking about the roster for daytime services on Thursdays. I have been led to understand that an offer has been made for one of the two vacant posts through the NAS transfer process and that the options for filling the second post are being examined. We will be following up with the NAS on those particular two vacant posts in the context of providing a roster for the daytime services on Thursdays.