Marie Moloney (Labour)
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I thank the Minister, Deputy Hogan, for coming to the House to take this Adjournment matter, although it does not come under his remit, on behalf of the Minister for Health.

Under the new model of the ambulance service the Health Service Executive wants to move to 24 hour on-duty cover with a view to eliminating the on-call duty. The Minister is familiar with the area being a regular visitor to Kerry and will know the Iveragh Peninsula and the Dingle Peninsula. The new proposed model has its merits and will work well in the midlands and areas where there are other stations around it.

In areas such as the Iveragh and Dingle peninsulas, where the next parish to the west is America, the model will not work well. The golden hour theory will go out the window because if the ambulance has left the Iveragh Peninsula or Dingle Peninsula it will take at least an hour to get the ambulance back again and another hour back to the hospital. Given the topography and the geographical lay out of the terrain which is vast it would take time to get an ambulance to the area. The present arrangement works well with 24 hour service either on-call or on-duty. The people have a service and know that if there are instances of cardiac arrest, stroke or whatever there are people on the doorstep who will be available to help them. The people in those peninsulas have as much right to life as anybody else. We are continuously accused of killing off rural areas. I say, do not kill the people with it. An exception should be made for peninsulas because there is nowhere to go. The nearest ambulance service for a person in Waterville will be in the Killarney or Kenmare areas, almost 80 km away. There is no way an ambulance with get to the area on time in the event of a second mishap. Perhaps the Minister will have good news to the effect that the HSE is willing to look again at the Iveragh and Dingle peninsulas with a view to allowing a continuation of the present arrangement.

Phil Hogan (Carlow-Kilkenny, Fine Gael)
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I am taking the Adjournment matter on behalf of my colleague, the Minister for Health, Deputy James Reilly.

The HSE has confirmed that services are not being diminished in Iveragh or Dingle. However, traditional work practices within the National Ambulance Service are changing, as stations move from on-call to on-duty status.

Being on-duty means our highly trained paramedic crews are in ambulance stations and vehicles to respond to calls, rather than being called out to stations, which is inevitably slower in responding to emergency calls. It also means resources can be deployed dynamically, based on need and demand patterns, not location, producing more flexibility and responsiveness and giving better response times for people in Kerry and a better service.

Under the new system, Caherciveen will have 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 at night. With dynamic delivery, an on-duty emergency ambulance will be available from within the region as required.

I note that ambulance staff sought to eliminate on-call working, that it has been reduced from 44 to 16 hours a week and that this will continue as part of the improvement of regional services and response times. The HSE and unions are committed to ongoing discussions with staff on implementing the proposals, including Caherciveen and Dingle.

In phase 1 of the proposals, east Cork stations with night time on-call will move to on-duty 24/7, 365 days a year. The more rural stations, such as Castletownbere, Kenmare, Bantry, Skibbereen, and Caherciveen, are next, with the service evaluated after each phase. As Dingle will be considered in Phase 3, no decisions have yet been made. With the unique geography of the peninsulas, they will continue to be serviced primarily by emergency ambulance, with an emphasis on on-duty rather than on-call arrangements. In the event of the ambulance being away from the area for a period, existing resources, either rapid response cars or emergency ambulances, will be dynamically deployed close to or on the peninsula to maintain an emergency response.

Finalising the proposal depends on the work practice process, the national service plan and realignment of existing HSE resources to support reconfiguration of ambulance services in Cork and Kerry.

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 it means longer transport times. Having an on-duty service enables a modern emergency response service, with paramedics, advanced paramedics, community first responders and GP out-of-hour services working together to respond to emergencies. This is consistent with international best practice and will ensure compliance with HIQA response standards. On-duty rostering is one of several service enhancements. Others include improved arrangements for control and despatch, practitioner deployment and inter-hospital transfers, all of which will allow the national ambulance service to provide a better, safer, more comprehensive and efficient emergency service for the people of Caherciveen and the Kerry region as a whole.

Denis O'Donovan (Fianna Fail)
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Is the Senator fully satisfied?

Marie Moloney (Labour)
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No. We had a meeting several months ago with representatives of the ambulance service and the HSE and received the same reply, word for word. We asked them to go away and review the situation and come back to us with proposals on how they would provide a service on the peninsulas. We do not believe this service will work in those areas, although I am not saying it will not work in the rest of the country. As I said, it has its merits. However, in these areas it will not work owing to the layout of the land. The ambulance service and the HSE were to come back to us on the issue, but we have heard nothing since. I am a little disappointed that they do not intend to review it or make any changes to the service. As such, I will continue to pursue the matter with the Minister. I will not give up at this stage.