Seanad debates

Wednesday, 20 February 2013

Adjournment Matters

Ambulance Service

3:10 pm

Photo of Mark DalyMark Daly (Fianna Fail)
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Before commencing I welcome the research staff of St. Vincent's Hospital who work with Senator John Crown. It is apt that my question is on the ambulance service, although a long way from St. Vincent's Hospital.

I welcome the Minister of State to the House. We miss him since he left. The matter I wish to raise concerns the people who will be affected by the proposed cut in ambulance services in Kenmare, Killarney and Cahirciveen. In reality it means people are going to die. That is the stark reality.

The ambulance service in Kenmare is 24/7. What we are hearing through the HSE grapevine is that the 24/7 service in Kenmare, Cahirciveen and Killarney will be reduced to an ambulance car at weekends and after 8 p.m. What that means is that if a person suffers a stroke or a heart attack or there is a serious incident requiring an ambulance in Kenmare, Cahirciveen or Killarney area he or she will get a reduced service. In an example given to me by experts in the field, it was claimed that if an accident occurs in Lauragh at a weekend and the ambulance has to come from Killarney, it would take up to an hour. First, an ambulance car would go to the area which, as described to somebody in the profession, is the equivalent of sending a fireman with a fire extinguisher to a blazing house fire when what is needed is the fire brigade. If the ambulance is required to transport a person to hospital in Cork or Tralee, it would then be called from Killarney. That ambulance could be out on call which means the ambulance from Tralee would have to be called. Tralee is an hour at speed from Kenmare and from Lauragh an hour and 20 minutes. At this stage, as I am sure the good doctor would know, the outcome would be very poor if one was left sitting on the side of a road two hours after the accident took place.

The reason I ask the question is that we have been told the service will be downgraded and that the reconfiguration will happen in the next few months. Public meetings are being planned in Kenmare to prevent this happening. We know that once the ambulance is gone it will not return. Ultimately, people will die. We have carried out an analysis of the ambulance service during the past 12 months which showed that outcomes would have been far worse for people in the community if they had not been transported to hospital by ambulance within an hour of an accident, stroke or heart attack. They were on the operating table within an hour and a half of the event happening. If the ambulance service is withdrawn and downgraded it will take two or three hours to get the person to hospital. As the Minister is aware what will happen is that the person who suffers a heart attack or stroke will occupy a hospital bed and instead of having a stent inserted and recovering in a day or a week, will need rehabilitation and physiotherapy and will cost the taxpayer more. We all know prevention is better than cure. By giving people the attention they need as quickly as possible, the taxpayer will ultimately save money. We are going to be penny wise and pound foolish. We have been told that we are at the tail end of the process, that money had to be allocated to other constituencies to beef up services in west Cork where a campaign was run, which the Leas-Chathaoirleach will be well aware of it, having been involved in it. The HSE will try to make the savings in south Kerry and ultimately lives will be lost and there will be worse outcomes as a result of the proposed and threatened downgrading of the ambulance service.

3:20 pm

Photo of Ciarán CannonCiarán Cannon (Galway East, Fine Gael)
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I am taking this Adjournment matter on behalf of my colleague the Minister for Health, Deputy James Reilly. I thank Senator Mark Daly for giving me the opportunity to address this matter.

The National Ambulance Service, or NAS, is not a static service. The NAS deploys its resources dynamically and on a regional and national rather than a local basis. Dynamic deployment of ambulance resources ensures the nearest appropriate resource is sent to an incident. Senator Mark Daly may be aware that following a Labour Court decision the NAS has been implementing the phased replacement of on-call with on-duty rostering in the southern region. On-call rostering means that a crew is not at work but is summoned for a call-out. The average time from call-out to a vehicle leaving a station is more than 20 minutes. On-call rostering significantly affects response times, operational capacity, compliance with the Organisation of Working Time Act and health and safety for staff. An on-call rostering risk assessment has been carried out for inclusion on the NAS risk register and discussions are pending with the Health and Safety Authority on its concerns about the use of on-call services.

On-duty rostering means that highly trained paramedic crews are in their stations or vehicles to respond immediately to emergency calls. On-duty ambulances and response vehicles are deployed dynamically according to need and demand patterns rather than on the basis of station location and can be at optimal locations at any time based on predictive needs assessments. This allows greater flexibility and responsiveness and will produce better response times and an improved service for the people of Kerry. The NAS has been taking a number of other steps to improve response times, including a performance improvement action plan, more efficient rostering, an intermediate care service for non-emergency clinical transport, the national control centre reconfiguration project and a trial emergency aeromedical service.

On the specific query raised by the Senator, the NAS advises that the current on-call static service in Kerry will be replaced. The NAS is considering the most appropriate model for ambulance services in the Kerry region. Consultation will take place with a wide range of interests including the public, staff, general practitioners and other health care colleagues. Other factors to be considered include the results of the implementation of efficiency measures in other regions, new arrangements under public service agreements, activity and demographic analyses and developments in emergency aeromedical support. In line with the Labour Court recommendations, any new service model must be delivered from within existing resources, not limited to main towns and not based on the current static on-call structure. When the process is completed an appropriate model will emerge. The HSE is committed to briefing Members of the Oireachtas, public representatives generally and community leaders before implementing a final service model.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
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An bhfuil an Seanadóir sásta?

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
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I will give you a brief opportunity to respond, but Deputy Cannon is not the line Minister and may not be in a position to answer.

Photo of Mark DalyMark Daly (Fianna Fail)
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I am sure the Minister of State will be able to find the answer for me. I am grateful for his statement and for the previous briefing I received from experts in the field. Hidden in the Minister of State's statement is Civil Service-speak for box-ticking and ensuring that benchmarks are reached. When average call-out times are referred to, what is really meant is that a person will be seen by a paramedic or a trained professional. What is not said is that it will not be by a person in an ambulance. It can be half an hour or an hour before emergency medical personnel arrive at a location in some parts of Kerry. When they get to the scene, it will be in an ambulance car. A person might need to be transported, at which point an ambulance will have to be called for. This means more time is lost. Any doctor will tell one that the more time lost in the case of a critical patient, the poorer the outcome.

I loved the reference - it has got to be great - in the Minister of State's speech to on-call risk assessment with regard to where ambulances will be placed. This implies that the HSE has a crystal ball and knows where people will have heart attacks and strokes around south Kerry. It has a risk assessment that tells the HSE to have an ambulance sitting at the Healy Pass or near the tunnel in Glengarriff on a Friday night because that is the part of the world where there will be heart attacks and accidents. The predictive needs assessment is what is being talked about. The HSE is predicting where accidents will occur and will locate ambulances there on Friday and Saturday nights or Sundays between 8 a.m. and 8 p.m.

I see that we will be told before the final service model is implemented but we are not being told what the range of options is. What we will get from the HSE is a briefing when the new service is about to be implemented but nothing about the practicalities on the ground or the effect it will have on people. The HSE is trying to say it will have an ambulance on call, but it will be an ambulance car, which is no good to a person who is lying on the side of the road in Sneem, Cahersiveen or Killarney while the ambulance he or she actually needs has gone somewhere else. That is what we are talking about. People are going to die because we are taking away the 24/7 front-line service provided by the people who were protesting this week in Tallaght. People are going to die as a result of the withdrawal of the ambulance service in south Kerry.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
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The point is well made. I have been more than lenient with the Senator.

Photo of Mark DalyMark Daly (Fianna Fail)
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You have always been like that, a Leas-Chathaoirligh. I acknowledge that the Minister of State is not the man in charge of giving the answer, but he might bring the matter back to the Cabinet.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
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We ask the Minister of State to convey the concerns of Senator Mark Daly to the senior Minister, Deputy James Reilly.

Photo of Ciarán CannonCiarán Cannon (Galway East, Fine Gael)
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I shall do that. I just want to make two quick points.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
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No problem, but briefly.

Photo of Ciarán CannonCiarán Cannon (Galway East, Fine Gael)
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Moving from the model of an on-call ambulance service, under which one may have ambulance personnel sitting in their living rooms at home waiting for a beeper to go off, to a model in which they are in their vehicles or local stations and capable of responding quickly to emergencies is a very positive development. I made the point that there will be extensive consultation with the public, staff, general practitioners and all other health professionals before the final model is arrived at. There is no question about that.

One can carry out reasonably scientific analyses of populations and historical ambulance calls in particular regions. One does not expect that ambulances will be located on the top of mountains with population densities of two people per square kilometre. One can use a lot of past data to inform a decision on the optimum location for an ambulance. The Senator's contribution indicates that there is a great deal of speculation out there, with little basis in fact, as to what might happen. Let us see what the process involves. There will be consultation and the Senator may be surprised by its outcome.

Photo of Mark DalyMark Daly (Fianna Fail)
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Pleasantly surprised, perhaps.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
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We were pleasantly surprised in west Cork last week. One never knows.

The Seanad adjourned at 6 p.m. until 10.30 a.m. on Thursday, 21 February 2013.

3:30 pm

Photo of Ciarán CannonCiarán Cannon (Galway East, Fine Gael)
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I am taking this Adjournment matter on behalf of my colleague the Minister for Health, Deputy James Reilly. I thank Senator Mark Daly for giving me the opportunity to address this matter.

The National Ambulance Service, or NAS, is not a static service. The NAS deploys its resources dynamically and on a regional and national rather than a local basis. Dynamic deployment of ambulance resources ensures the nearest appropriate resource is sent to an incident. Senator Mark Daly may be aware that following a Labour Court decision the NAS has been implementing the phased replacement of on-call with on-duty rostering in the southern region. On-call rostering means that a crew is not at work but is summoned for a call-out. The average time from call-out to a vehicle leaving a station is more than 20 minutes. On-call rostering significantly affects response times, operational capacity, compliance with the Organisation of Working Time Act and health and safety for staff. An on-call rostering risk assessment has been carried out for inclusion on the NAS risk register and discussions are pending with the Health and Safety Authority on its concerns about the use of on-call services.

On-duty rostering means that highly trained paramedic crews are in their stations or vehicles to respond immediately to emergency calls. On-duty ambulances and response vehicles are deployed dynamically according to need and demand patterns rather than on the basis of station location and can be at optimal locations at any time based on predictive needs assessments. This allows greater flexibility and responsiveness and will produce better response times and an improved service for the people of Kerry. The NAS has been taking a number of other steps to improve response times, including a performance improvement action plan, more efficient rostering, an intermediate care service for non-emergency clinical transport, the national control centre reconfiguration project and a trial emergency aeromedical service.

On the specific query raised by the Senator, the NAS advises that the current on-call static service in Kerry will be replaced. The NAS is considering the most appropriate model for ambulance services in the Kerry region. Consultation will take place with a wide range of interests including the public, staff, general practitioners and other health care colleagues. Other factors to be considered include the results of the implementation of efficiency measures in other regions, new arrangements under public service agreements, activity and demographic analyses and developments in emergency aeromedical support. In line with the Labour Court recommendations, any new service model must be delivered from within existing resources, not limited to main towns and not based on the current static on-call structure. When the process is completed an appropriate model will emerge. The HSE is committed to briefing Members of the Oireachtas, public representatives generally and community leaders before implementing a final service model.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

An bhfuil an Seanadóir sásta?

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I will give you a brief opportunity to respond, but Deputy Cannon is not the line Minister and may not be in a position to answer.

Photo of Mark DalyMark Daly (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I am sure the Minister of State will be able to find the answer for me. I am grateful for his statement and for the previous briefing I received from experts in the field. Hidden in the Minister of State's statement is Civil Service-speak for box-ticking and ensuring that benchmarks are reached. When average call-out times are referred to, what is really meant is that a person will be seen by a paramedic or a trained professional. What is not said is that it will not be by a person in an ambulance. It can be half an hour or an hour before emergency medical personnel arrive at a location in some parts of Kerry. When they get to the scene, it will be in an ambulance car. A person might need to be transported, at which point an ambulance will have to be called for. This means more time is lost. Any doctor will tell one that the more time lost in the case of a critical patient, the poorer the outcome.

I loved the reference - it has got to be great - in the Minister of State's speech to on-call risk assessment with regard to where ambulances will be placed. This implies that the HSE has a crystal ball and knows where people will have heart attacks and strokes around south Kerry. It has a risk assessment that tells the HSE to have an ambulance sitting at the Healy Pass or near the tunnel in Glengarriff on a Friday night because that is the part of the world where there will be heart attacks and accidents. The predictive needs assessment is what is being talked about. The HSE is predicting where accidents will occur and will locate ambulances there on Friday and Saturday nights or Sundays between 8 a.m. and 8 p.m.

I see that we will be told before the final service model is implemented but we are not being told what the range of options is. What we will get from the HSE is a briefing when the new service is about to be implemented but nothing about the practicalities on the ground or the effect it will have on people. The HSE is trying to say it will have an ambulance on call, but it will be an ambulance car, which is no good to a person who is lying on the side of the road in Sneem, Cahersiveen or Killarney while the ambulance he or she actually needs has gone somewhere else. That is what we are talking about. People are going to die because we are taking away the 24/7 front-line service provided by the people who were protesting this week in Tallaght. People are going to die as a result of the withdrawal of the ambulance service in south Kerry.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The point is well made. I have been more than lenient with the Senator.

Photo of Mark DalyMark Daly (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

You have always been like that, a Leas-Chathaoirligh. I acknowledge that the Minister of State is not the man in charge of giving the answer, but he might bring the matter back to the Cabinet.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

We ask the Minister of State to convey the concerns of Senator Mark Daly to the senior Minister, Deputy James Reilly.

Photo of Ciarán CannonCiarán Cannon (Galway East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I shall do that. I just want to make two quick points.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

No problem, but briefly.

Photo of Ciarán CannonCiarán Cannon (Galway East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Moving from the model of an on-call ambulance service, under which one may have ambulance personnel sitting in their living rooms at home waiting for a beeper to go off, to a model in which they are in their vehicles or local stations and capable of responding quickly to emergencies is a very positive development. I made the point that there will be extensive consultation with the public, staff, general practitioners and all other health professionals before the final model is arrived at. There is no question about that.

One can carry out reasonably scientific analyses of populations and historical ambulance calls in particular regions. One does not expect that ambulances will be located on the top of mountains with population densities of two people per square kilometre. One can use a lot of past data to inform a decision on the optimum location for an ambulance. The Senator's contribution indicates that there is a great deal of speculation out there, with little basis in fact, as to what might happen. Let us see what the process involves. There will be consultation and the Senator may be surprised by its outcome.

Photo of Mark DalyMark Daly (Fianna Fail)
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Pleasantly surprised, perhaps.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
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We were pleasantly surprised in west Cork last week. One never knows.

The Seanad adjourned at 6 p.m. until 10.30 a.m. on Thursday, 21 February 2013.