Cathal Crowe (Clare, Fianna Fail)
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Before I get into the important issue, I thank the Minister of State, Deputy Butler, for taking this Topical Issue. By way of illustration for anyone watching this debate, I sought to raise this, the most important issue in County Clare at the moment, last week in the Dáil, but it was not selected due to the rigmarole. I only had one speaking slot last week, on laws from the 1820 to 1850 period. People in Clare heard me talking about the Great Famine and everything else when there were pressing issues I needed to address. Thankfully, I have speaking time today and will progress this issue.

I want to speak about delays in ambulance care in County Clare. In the critical time following an accident or incident in a home, how quickly an ambulance arrives and then brings someone to an accident and emergency department is crucial. Unfortunately, my family knows this all too well. Today is 2 April, and exactly five months ago today, my mother-in-law was killed in a road traffic accident on the main street of Charleville. Out of respect for the late woman, I will mention her name, Mary Fehilly. We are very grateful as a family for the ambulance service in north County Cork and the air ambulance that brought her to CUH. Unfortunately, the outcome was not a good one and she passed away.

Everything is time critical. I want to illustrate two examples where, in the past week alone, ambulances have not arrived on time in County Clare. The first was on 24 March, where there was a road traffic accident in Doonbeg in west Clare. An elderly woman got out of a car and sat at the roadside. She was very sick and had a headache. She was not fully coherent. Emergency services, including the Clare county fire service, arrived and were outstanding, as they always are, but she had waited on the roadside for a three-hour period before being taken from there. That is unforgivable. I am not blaming the National Ambulance Service - it was run ragged that day and had to respond to several other incidents in the county - but that response time was not good enough. It speaks to undercapacity in County Clare. These matters are time critical. Thankfully, the woman is home and has recovered well, but in the moment following the road traffic accident, nobody knew what her state was, whether there was damage to her spine or whether she would have a cardiac episode. The situation was time critical and a three-hour wait is not good enough. I do not know of any country where someone would have to wait three hours.

The following day, 25 March, there was another incident in west Clare. An elderly woman was unresponsive, with low blood pressure, a history of cardiac issues and diabetes. Her daughter, a nurse, came upon her. The daughter knew, given the vital signs, that there were a lot of red alerts and made a 999 call. She was told an ambulance was on the way. For the next 90 minutes, she heard nothing. There was no update on when the ambulance would arrive. She phoned 999 again and was told she should only ring the number if the situation deteriorated. Eventually, the daughter drove her mother to the hospital. She was freaked out and panicked, driving in traffic from rural roads to join the M18 motorway, knowing that her mother was unwell in the car. Ambulatory care should have brought the woman to hospital.

UHL and the crisis in emergency healthcare in the mid-west is highlighted here every week. For many people, the entry point to emergency care is the arrival of an ambulance. I reiterate for the record, lest it be misconstrued, that I am not criticising the fantastic men and women of the National Ambulance Service or the Clare fire service, which provides ancillary cover until an ambulance can arrive. I am just pointing out that if someone lives at one of the extremities of my vast county in west or north Clare, which are at the polar ends of the county from where I live, that person is a long way from acute care and, as the evidence I provided today shows, from ambulatory care. I hope the Minister of State can provide some news and hope to people in those parts of County Clare because they panic when something goes wrong.

Mary Butler (Waterford, Fianna Fail)
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I again wish to express our deepest condolences to the Deputy on the death of Mary, his mother-in-law, and to the Fehilly and Crowe families. I also want to acknowledge the spirit in which he has raised these issues because at no stage did he criticise the men and women of the National Ambulance Service or our other first responders. Rather, he asked real questions, which he hopes will be addressed.

I welcome the opportunity to address the House on behalf of the Minister, Deputy Carroll MacNeill, regarding the Deputy's request for information on the National Ambulance Service's capacity in the County Clare region. This year's allocation to our National Ambulance Service of €285 million includes €8 million in new service developments to deliver up to 180 additional posts, representing a significant increase on the 2024 allocation.

As far as County Clare is concerned, the National Ambulance Service serves the county from bases located in Ennis, Ennistymon, Kilrush and Scarriff. These 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. County Clare also benefits from the National Ambulance Service's national emergency operation centre clinical hub. It has five active community first responder groups operating in the county, as well as aeromedical support provided by the HSE helicopter service based in Rathcoole, County Cork, and the Irish Coast Guard search and rescue service from its base in Shannon.

Patient demand for the National Ambulance Service continues to rise nationally and in the western region, which covers Clare. In 2024, there were nearly 430,000 urgent and emergency calls received from the public, representing an 8% increase nationally on the previous year. In the National Ambulance Service's western region, call volume similarly increased by 8%, or 7,781 calls, during the same period. Despite a significant increase in demand, ambulance response performance has improved nationally and in the National Ambulance Service mid-west region, including Clare, compared to its performance in 2023.

The HSE national service plan sets out key performance indicators for cardiac or other potentially life-threatening calls to be responded to by ambulance in fewer than 90 minutes. In 2024, the National Ambulance Service's national performance for HSE key performance indicators, KPIs, was 73% against a target of 75% for purple calls, that is, life-threatening cases and 46% against a target of 45% for red calls, that is, calls to be responded to by an ambulance in less than 90 minutes. In the mid-west region, the National Ambulance Service's performance met the purple call KPI of 75% and exceeded the red call KPI of 49%. Performance in both call categories last year represents an improvement on performance in 2023.

The nub of the issue is that, in line with international best practice, the National Ambulance Service deploys resources nationally, including in Clare, dynamically. This means that it prioritises resource allocation to the highest acuity calls, which require an immediate emergency response in direct response to patient needs. The National Ambulance Service's dynamic deployment means that Clare may also be supported by bases from neighbouring counties to ensure adequate coverage and rostering for emergency ambulances and rapid response vehicles.

Cathal Crowe (Clare, Fianna Fail)
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I thank the Minister of State sincerely for her response. She comes from County Waterford, a big county. I live on the southern extremity of County Clare, close to the Limerick border. The village of Cross, near Loop Head, is about one hour and 40 minutes from where I live. I could get to the Kildare Village retail park as quickly from my home. That shows how vast the county is. It takes people living in that village an hour and 40 minutes to travel to UHL. When someone has a cardiac episode, the first 60 minutes is crucial in terms of protecting the heart, salvaging whatever you can and keeping someone alive. That so-called golden hour simply does not exist geographically for people living in rural regions. Therefore, they depend on the National Ambulance Service.

Unfortunately, it is a loaves-and-fishes scenario with ambulances and there can be many calls to the dispatch centre. Someone has to triage which call is attended to first. The Minister of State mentioned that the National Ambulance Service had to deal with the highest acuity calls. I outlined two episodes, one in Doonbeg on a roadside following a road traffic accident and the second the case of a woman who was unresponsive in her home. At least in Doonbeg, first responders and the fire service were able to relay, through emergency terminals, how things were. When something goes wrong with someone at home and that person is unresponsive, though, what level of acuity is that given?

Only one thing will fix this. We need an extra ambulance base. I understand there are plans for one in Kilrush. I would love to hear some detail on that. This issue underpins the need for a new hospital and 24-hour accident and emergency department, a campaign led by Friends of Ennis Hospital, including a mutual friend of the Minister of State and I, Angela Coll. We need to do something dramatic to address the shortcomings in healthcare.

Many wonderful things happen in our hospitals each day, but people who live in the peripheral areas of north and west Clare need better ambulatory care. Moreover, they need better access to acute hospital care. I hope the HIQA report that comes out next month will reflect that fact, because there can be no turning back. I do not want one of these families to endure what we endured on 2 November. An acute situation on the roadside can very quickly become a tragedy where a family gathers around a graveside to bid farewell.

Mary Butler (Waterford, Fianna Fail)
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As well as front-line urgent and emergency care, the NAS is also developing and expanding a range of clinically appropriate alternative care pathways to improve patient flow and reduce pressure on busy hospital emergency departments. The medical assessment unit, MAU, pathway for 999 patients introduced in Ennis Hospital treats patients referred by GPs, out-of-hours services, including Shannondoc, and National Ambulance Service paramedics. Last year, the NAS transported 430 patients to mid-west MAUs, including Ennis.

I am pleased to inform the Deputy that the NAS plans to roll out additional community paramedics this year to various areas of the country. Community paramedics respond to low-acuity calls to facilitate more appropriate use of emergency care resources and enhance access to care for patients, contributing to more favourable health outcomes. I am informed that it is planned to include County Clare in this year's roll-out.

I understand the point Deputy Crowe makes. We all have experience of situations where we have to call an ambulance, for example, for an elderly parent. It can be very distressing. I assure the Deputy that there has been no change to the National Ambulance Service roster in County Clare in recent months. It is important to put that on the record of the Dáil. There has been no reduction in service levels in County Clare. Triage is a very difficult situation. I compliment all those who work across the country as first responders. They do an amazing job. I also acknowledge Angela Coll for all her advocacy on healthcare in the Clare region.