Tuesday, 6 April 2004
I welcome the Minister of State to the House and thank him for responding to this item on the Adjournment. I am concerned that in the near future the ambulance service in Kenmare may be amalgamated with that in Killarney. I understand that for about one third of every 24-hour period, the ambulance needs of Kenmare are to be serviced from Killarney. This could put lives at risk and is a considerable downgrading of the current service. The ambulance based at Kenmare hospital serves Sneem,Lauragh, Tuosist, Bonane, Blackwater, Kilgarvan, Kenmare and down to the Black Valley. This is a very large geographical area stretching from the County Cork border near Coolea to Ardgroom on the Beara peninsula, and to Castlecove on the Iveragh peninsula. The terrain is mountainous with poor roads and many remote glens on both peninsulas, covering an area of 80,258 hectares. The density of the population is one of the lowest in Kerry with only eight households per kilometre. Due to the uneven road surfaces, one has to drive slowly to prevent patients and staff being sick in the back of the ambulance. Journey times are, therefore, made longer, adding another 40 minutes to the response time which is totally unacceptable. The "golden hour", the time GPs aspire to get patients with serious injuries, myocardial infarctions, etc, to the nearest hospital and which is vital for favourable patient outcome, will almost be over before an ambulance arrives at a patient's house to begin the long journey to either Tralee or Cork.
Kenmare town is 75 km. from Tralee and 85 km. from Cork, making much of the area over two hours journey from the nearest hospital. The further reaches of either Sneem or Lauragh can add another tortuous 40 km. to this journey. It is inconceivable to imagine maintaining cardiopulmonary resuscitation on a collapsed patient or waiting for an hour at the scene of a road traffic accident while an ambulance is mobilised from Killarney.
The 2002 census saw a rise of 12% in the population of the greater Kenmare area, while that of Kenmare town rose by 30% since the 1996 census. The 65 years of age and over group constitutes a higher percentage of the population than the national average. With an influx of immigrants, Kenmare is also one of the most cosmopolitan towns in the south west. Of those retired persons coming to live permanently in this isolated area, most are not only from abroad but also from Cork and Dublin. They are at a time in life when they are most likely to need hospital admission as emergencies via, for example, the cardiac ambulance in cases of suspected myocardial infarction. Kenmare is one of the premier tourist destinations in Ireland, having two five star hotels and numerous other hotels, guest houses and self-catering accommodation to service the huge influx of visitors in the tourist season, which now extends to most of the year. It must be remembered that 1.2 million tourists visited Kerry in 2000 with a resultant demand on services, including medical services.
Kenmare has a vibrant night-life and can be called the Temple Bar of the south west. There are particular difficulties for emergency services at weekend nights when large discos, with up to 800 people attending, are held in the town. New night clubs have opened since licensing hours have been extended and are attended by large crowds of local young people, tourists and those from neighbouring towns such as Macroom, Bantry, Glengarriff, Castletownbere, Sneem and Killarney. The take-away food outlets do not close until 4 a.m. Such an influx of young people, with alcohol readily available until the small hours, has the potential to trigger incidents of assault, accidents and road traffic accidents, as these young people journey home again having partied until daybreak.
Maternity patients in labour need the services of a rapid response ambulance service to transport them safely and quickly to the nearest maternity unit in Tralee or Cork. This service is even more vital now that a large asylum seeker reception centre is based in Kenmare. Extending the response time to call-out will result in unsafe practice with deliveries of babies taking place in transit on the side of the road.
One of the arguments justifying the removal of the service to Killarney is the low call-out rate — 370 calls per year — of the Kenmare ambulance. Over the years, the people in the area have always been aware of how isolated they are and the Minister of State is aware of the south doc scheme. The people of this area responded most generously when called on to fund the equipping of a cardiac ambulance. I would be glad if the Minister of State would consider appointing an additional emergency medical technician team to this area. I appeal to the Minister of State and the Southern Health Board not to take the retrograde step of downgrading the ambulance service in the Kenmare area. This service has the backing of all medical practitioners in the area.
I wish to alleviate any belief of an imminent threat to the ambulance service in the Kenmare area. Senator Coghlan spoke in great detail of the lie of the land of the Beara peninsula. I am familiar with the area, but the Muntervary peninsula is possibly nicer.
The 2001 report of the strategic review of the ambulance services forms the basis for the development of future pre-hospital emergency medical services. It identifies aspects of the emergency ambulance service which need to be addressed in order to bring the service into line with best international practice and to ensure effective and quality driven practices. The report recommends that the service be developed at a number of levels. Principal among the proposed developments are the elimination of on-call as a means of providing emergency cover, improved fleet reliability and the roll-out of the emergency medical technician advanced programme. There is evidence of a direct relationship between the speed of response and good outcomes in life threatening emergencies, such as cardiac arrest and major trauma.
The elimination of on-call is designed to facilitate further improvement in response times. The Minister for Health and Children was pleased to provide funding in excess of €3 million in 2004 to facilitate the continuing phasing out of on-call arrangements in a number of regions. It is hoped to extend this programme. Additional capital funding of €2.5 million was provided in recent months to enable the service providers to improve fleet reliability. This includes continuing with fleet and equipment replacement programmes which are essential pre-requisites for enhanced speedy and appropriate care. In addition, the Minister has announced approval for the development of the emergency medical technician advanced programme. Considerable work has been done by the pre-hospital emergency care council, in conjunction with the Department of Health and Children, in preparing the legislation necessary to give effect to the introduction of this programme in 2004. The introduction of emergency medical technician advanced training is the single most important development which is taking place in the emergency ambulance service. The health strategy also refers to the importance of the first response.
Senator Coghlan is aware that responsibility for the provision of ambulance services in the Kenmare area rests with the Southern Health Board. I am advised that concern has been expressed by a number of GPs in the Kenmare and Sneem catchment area about the future of the service. The board was happy to be in a position to allay this fear and has advised the GPs that it has no plans to close or reduce the future of the Kenmare ambulance station. The board is addressing the key recommendations of the 2001 strategic review and is advancing arrangements for the reduction of the on-call element of the staff workload at the Kenmare station. The Department of Health and Children is advised that measures aimed at achieving this are the subject of discussion between members of the board's ambulance management team and ambulance personnel. The resource implications associated with the board's proposal for the elimination of the on-call element are the subject of consideration within the Department of Health and Children.
I assure Senator Coghlan and the House that the Government is fully committed to the development of our emergency ambulance service. A great deal has been achieved in the development of the service, although I recognise that much more remains to be done. It is essential to maintain the progress that has been made and to continue the process of service development so that effective pre-hospital emergency care is accessible to those who need it most, when and where it is required.
Senator Coghlan is concerned that there are plans to close, reduce or put into question the future of the Kenmare ambulance station. The Southern Health Board has indicated to my Department that there is nothing to fear from the operation, enhancement and development of the Kenmare ambulance station. The changes in the on-call element of the service are in line with the findings of the 2001 strategic review. If Senator Coghlan wishes to raise any aspect of the matter or any related issues, I will be happy to try to respond to him. Alternatively, he can take the matter up directly with the Southern Health Board. If he has any further concerns, I will be happy to try to address them.
I thank the Minister of State for his reply. I accept his categorical assurance that there are no plans to close, reduce or put into question the future of the Kenmare ambulance station and I am pleased that is the case. I would not have expected less from the former chairman of a joint committee on which I served.