Mark Daly (Fianna Fail) | Oireachtas source

I welcome the Minister and thank him for outlining the situation with the health budget. The choices made in regard to cuts in the health budget are the thin edge of the wedge. It took six months to get the facts and figures on ambulance cover throughout the country, including my county.

It is a stark example of where we are at in terms of being in need of an ambulance today in Kerry. Three people a day who are in a life-threatening situation, be it due to a car accident, a heart attack or stroke, might find they will have to wait for up to an hour. In some instances people must wait for twice as long as HIQA's standard of 18.5 minutes for an ambulance to arrive.

Apart from the issue of geography, the resources do not exist. Two years ago, four ambulances covered the area. The Millstreet ambulance, which covered north-west Cork and the east Kerry and Killarney area, was withdrawn and then Killarney’s second emergency ambulance was taken away, which meant that instead of four ambulances covering the area, there were two. Twelve months ago the second emergency ambulance disappeared and now two ambulances cover an area previously covered by four ambulances. If one has a heart attack, a stroke or one is involved in an accident in Kerry, one could wait for up to an hour. The situation is that three people every day do not get an ambulance to hospital within the critical time.

As the Minister is aware, when a person who has a heart attack does not get to hospital on time, the recovery period is longer and sometimes the outcome is fatal. Instead of leaving hospital early, such a person must stay longer in a high-dependency bed, and instead of going home, he or she is sent to a nursing home before eventually going home. The associated cost might have been alleviated had the person got to hospital on time. I am just talking about a small area in one county. If one takes the number of ambulances that have been withdrawn from the system, the knock-on effect is enormous.

I accept the Minister will examine the matter but I am aware the ambulance service has been told to cut costs. The long-term cost in terms of ongoing care for those who did not get to hospital on time is exponentially greater. I refer to the worst 10% to 20% of calls, the ECHOs and DELTAs, the critical emergencies, yet ambulances continue to be withdrawn. The Department should provide the Minister with the number of ambulances currently compared with three years ago. The figures are frightening and the outcomes are tragic.

In his address the Minister referred to service delivery. Another issue he could examine is a systems failure of monumental proportions. When one arrives at an accident and emergency department, one would imagine the ambulance crew would simply hand over the patient with data analysis and charts, but that is not the case. Paramedics tell me they must stay with the patient until someone takes the patient from them. Sometimes they must wait for between one hour and three hours, during which time the ambulance is not available to the community. That does not cost anything, it is just a systems failure, but if it were addressed by the HSE, more ambulance hours would be available and paramedics could deal with more emergency calls.

I am aware the Minister has been trying to address waiting lists but there has been an increase of 1,764 in the inpatient waiting list between January and August, bringing the total to 8,692. The question is how to address the problem. We have seen a 333% increase - 9,000 - in the number of people waiting for outpatient appointments, bringing the total number to 41,604. Not dealing with such patients early has disastrous consequences not only for the individual involved but for the health service in terms of how it can better deliver services and care.

If that patient is dealt with quickly it will not cost the service as much in the long term.

On the fair deal scheme, all of us have experienced situations where we were told the waiting time would be 12 weeks but it has now extended to 14 and 16 weeks. That is a waiting period of four months for an elderly person to get on to the scheme. There has been a cap on budgets and money allocated elsewhere but it is another systems failure whereby high dependancy beds in our acute hospitals, Cork University Hospital and others are not being freed up. That has had a knock-on effect on the waiting lists for inpatients because the beds are not available as a result of the fair deal scheme not functioning correctly, and not enough funding is being put into it.

Another knock-on effect has been on the ambulance service. Funding to the ambulance service has been cut so much ambulances do not get to patients in time. Those patients spend longer in hospital, which ties up beds. Our waiting lists with regard to inpatients has gone from 1,700 to 8,692. That is the domino effect of one issue on another. I ask the Minister to examine the ambulance issue nationwide because not only is it a problem in Kerry and Cork but all along the west coast. There is no doubt that distance is a factor. We hear talk of deploying helicopters and dynamic deployment. Dynamic deployment is a good way of saying we are guessing where the accident will happen. If those in the national ambulance service are asked what that means, they will give one a long explanation but it is really that they are dividing resources because resources have been cut. In the long run it is costing the health service and the Minister's Department more money than it should but it is also having a major knock-on effect on other services in terms of tying up beds and ensuring poor and in some cases fatal outcomes for the patient.