Tom Shehan (Fine Gael)
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I tabled this matter in light of the reduction in the ambulance service in the Caherciveen area, which covers most of Kerry South from Killorglin to Castlecove, a distance of some 40 miles. It also covers the extensive area from Valentia up to Dromod-Maistir Gaoithe. Ambulance cover for the area is being reduced to the hours from 8 a.m. to 8 p.m. I cannot understand the reason this is being done. Medical doctors are fearful that this decision has been taken behind closed doors without knowing the facts. The man with the ultimate decision on this in the ambulance service is based in Kilkenny. Why would he not protect the ambulance service in his own area? He has probably never visited the south Kerry area and does not know the topography of the area we are speaking about.

To put this in context, the importance of the golden hour in receiving treatment is often spoken about and the area concerned is an hour's travel time from Kerry General Hospital in Tralee. If one were to become ill in this area and an ambulance were to arrive immediately, it would still take it an hour to get to Kerry General Hospital but if this proposal were to go ahead, it would take an hour for the ambulance to get to the area from Tralee and another hour from it to get back to Kerry General Hospital. It is crazy. The lives of people will be put at risk. I do not believe that the lives of people living in urban areas are any more valuable than those of people living in rural areas. They deserve the same or a similar service to those living in an urban residence. Furthermore, how will the summer influx of holiday-makers to the south Kerry region be covered if there is only one ambulance covering the area from 8 a.m. to 8 p.m? I would like to hear the Minister of State's response to these points.

Ciarán Cannon (Galway East, Fine Gael)
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I am replying to this Adjournment matter on behalf of my colleague, the Minister for Health, Deputy James Reilly, and I thank the Senator for raising this matter.

The HSE has confirmed to the Minister, Deputy Reilly, that services are not being diminished. What is happening is that traditional work practices within the National Ambulance Service, NAS, are changing, as stations move to on-duty status and away from on-call. Being on-duty means highly trained paramedic crews will be in the stations to respond to calls rather than having to be called out to the station, which is inevitably slower in responding to emergency calls.

The Labour Court recommended that the HSE abolish on-call for all NAS staff in Cork and Kerry. The ambulance staff has sought the elimination of on-call working. It has already been reduced from 44 hours to 16 hours per week and that it will continue to decrease on a phased basis, as part of the improvement of services and response times in the region. There are ongoing discussions with staff on implementing the proposals, including in Caherciveen. The HSE and unions are committed to this process.

This change is to ensure that the needs of people in Cork and Kerry continue to be met in an integrated, safe and effective way by a modern service and within available resources. The focus of the HSE's current plans is to deliver a better service from the funds available rather than saving money. It also means that resources can be deployed dynamically based on need and demand patterns, rather than simply by location, giving greater flexibility and responsiveness. For example, an ambulance operating on a 24 hours a day, seven days a week basis in Killarney or Kenmare would be moving between areas to maintain spatially based emergency cover, based on predictive analysis, and then dispatched every time a rapid response vehicle is dispatched. Effectively, this means that the ambulance would be available to transport the patient by the time the paramedic or advanced paramedic has assessed and treated the patient. This will produce better response times for the people in the Cork and Kerry area and a better service.

The National Ambulance Service proposals are phased. In phase 1 stations in east Cork with night time on-call will have crews rostered on-duty 24 hours a day, 365 days a year. The more rural stations of Castletownbere, Kenmare, Bantry, Skibbereen and Caherciveen will be in later phases. The service will be evaluated after each phase.

Caherciveen will, under the new system, move from on-call at night to full 24 hour on-duty cover. Paramedics will be present at all times, with an on-duty ambulance during the day and an on-duty rapid response vehicle, staffed by advanced paramedics, at night. The dynamic delivery model means that an on-duty emergency ambulance will be available from within the region as required.

Current evidence suggests patient outcomes can be improved by better treatment and stabilisation at the scene, followed by ongoing treatment and transport to the most appropriate centre, even if that means longer transport times. On-duty service will enable a modern emergency response service involving paramedics, advanced paramedics, community first responders and GP out-of-hours services working together to respond to emergency situations. This approach is consistent with international best practice and will ensure compliance with HIQA response times and quality standards.

On-duty rostering is one of several service enhancements. Other developments include improved control and dispatch, practitioner deployment and inter-hospital transfers. All of these will allow the NAS to provide a better, safer, more comprehensive and more efficient emergency ambulance service to the people of Skibbereen and to the Cork and Kerry region as a whole.

Tom Shehan (Fine Gael)
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I thank the Minister of State for his comprehensive response. I imagine that approximately 90% of all car accidents happen at night. How does one cover an accident involving two cars if one paramedic is sent to the scene of the accident where five people may be injured and there is not an ambulance at the scene? An accident occurred in my constituency last year where the fire brigade crew were the first to arrive at the scene and on arrival they then called for an ambulance but by the time the ambulance arrived, it did not make it on time because the scene of this accident was 22 miles from civilisation. This must be borne in mind.

The area we are talking about is vast with much of it is very remote and the topography would be difficult to travel in the best of times. The people of south Kerry in the Caherciveen area are being let down. They will not take this lying down and that there will be a response from the people of the area.