John Kelly (Labour)
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I welcome the Minister and thank him for taking this debate.

I am rather concerned about what appears to be a serious lack of paramedics in the west of Ireland. I remember in 2006 or 2007, when Professor Drumm was in charge of the HSE and there was talk of closing the accident and emergency department in Roscommon County Hospital, he promised that we would almost have an advanced paramedic at every crossroads in the country. That never materialised. I do not blame the staff who operate the ambulance service or the paramedics we have. They provide an excellent service within the limited resources available. I acknowledge that a person can be lucky, and when the system works it works very well. If it happens to be the case that an advanced paramedic is within ten or 15 minutes of a patient, it is a great service.However, I spoke to one paramedic who told me that there is a need for 100 additional paramedics in the west of Ireland.

Some years ago, west Roscommon was ear-marked for an ambulance base. To date, this has not been delivered. There is a dispute involving staff who do not wish to move from their present location to this new ambulance base. It is not being staffed, outside of what is already in the system. This is different to the other two ambulance bases promised at the same time, on Achill island and in Tuam, which were staffed.

The week before last, in my hometown, a 19 year old lad had a heart attack. The ambulance and paramedics were called. Two local firemen worked on him to keep him alive as long as they could. Unfortunately, he was dead by the time the ambulance arrived 40 minutes later. Later on that day, in the same estate, an ambulance was called for an elderly man. The ambulance arrived and the man was put into the back of it, but the ambulance would not start. Elderly people had to push the ambulance down the hill to start it. Later on that evening, conditions were not great and there was a car accident. Again, the ambulance took 40 minutes to arrive at the scene. It is nearly a crime in Dublin not to have an ambulance within eight minutes, but it is hit and miss down the country. It really is a matter of luck on occasions. I have no doubt the HSE will tell the Minister that we have a great system which is working well. The evidence on the ground is to the contrary.

I have a solution to the problem for rural Ireland. It is one which can be implemented within 12 weeks. I have run it by the Minister for the Environment, Community and Local Government, Deputy Alan Kelly. I have spoken to firemen about it. There will be no resistance to this suggestion. Four firemen out of every brigade in local towns, in counties such as Roscommon, could be trained to emergency medical technician, EMT, level. They could be first responders. The training course takes just 12 weeks. I ask the Minister to consider piloting this in County Roscommon so that we can prove there is a better system. This suggestion would enhance the paramedic system in place at the moment.

Leo Varadkar (Dublin West, Fine Gael)
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I thank Senator Kelly for raising this matter and giving me the opportunity to update the House on our plans for ambulance service improvements this year. I am happy to confirm that those plans include providing more paramedic cover in the west of Ireland, although certainly not one at every crossroads. In 2015, a €5.4 million budget increase has been provided to the National Ambulance Service to help address service gaps. In that regard, provision is being made for 50 additional paramedic posts in the west. Some of these posts will be used to staff ambulance stations at Tuam and Mulranny and others will assist in the move from on-call to on-duty rostering. On-call rostering means paramedics remain at home and wait to be called out. This, on average, results in a 20 minute delay in despatching an ambulance. We are therefore moving from this to on-duty rostering where crews will be in their stations or vehicles ready to go immediately on despatch.

It is also intended to expand the number of community first-response teams, particularly in more rural and sparsely populated areas. These are volunteer groups in the community who are registered and trained to a certified standard. The National Ambulance Service calls out a local responder to a cardiac emergency in the area. This responder gets to the scene before the arrival of the ambulance crew, applies his or her cardiac training and increases the person's chance of survival. There are currently over 100 teams operating around the country at present but we need more and are working on this.

Of particular benefit to western counties is the emergency aeromedical support service. This service was established under this Government and is particularly targeted at the midlands and west. It provides rapid access to appropriate treatment for very seriously ill patients where this may be difficult to achieve by road. I am currently looking at proposals to examine the service on a permanent basis and I am in discussions with my colleague, the Minister for Defence on this matter.

Discussions around ambulance response times can become emotive. We only seem to ever hear about the delays. We do not hear about the high quality treatment being provided by our paramedics and how the service has improved so much in recent years. It is important to point out that response time performance is improving year on year in the face of increasing demands. Response-time targets only measure one aspect of ambulance performance. Ideally they would be part of a suite of assessments. Internationally, more and more ambulance services are moving towards patient outcomes as a better indicator of performance. The National Ambulance Service introduced a patient-outcome target for out-of-hospital cardiac arrests last year and more are being developed.

Currently there are three major reviews of the ambulance service under consideration, namely, the recently published HIQA review, the national capacity study and the Dublin ambulance service reviews.These three reviews, when taken together, will provide us with very good information to help drive further service improvement. I am working with the HSE to prepare an action plan on completion of all three reviews within the timelines to realise a new strategic vision for our ambulance services. I assure the House that the National Ambulance Service is focusing on addressing some of the service gaps in the west in 2015. Specifically, that will involve 50 new paramedics and a move from on-call to on-roster service, which is very important.

The Senator suggested that we should use fire crews in these circumstances. I certainly think there would be a strong case for training them up as community first responders. That makes a lot of sense. I cannot for the life of me see any reason that is not a good idea. It would be a little trickier to train them to emergency medical technician level. I would need to see a worked-up proposal on that. If a person who is trained to such a level does not use his or her skills regularly, he or she can become deskilled and that can actually be unsafe. That would have to be worked up and considered carefully in consultation with the pre-hospital emergency care council.

John Kelly (Labour)
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I thank the Minister. I agree with him that the issue of poor call-out times for ambulances is an emotive one, particularly when things go wrong. I praised the ambulance staff and the paramedics in my contribution. I acknowledged that if the patient is lucky enough to have them arrive on time, he or she will receive a far better service from them. I would appreciate it if the Minister would discuss with his colleague, the Minister, Deputy Kelly, my suggestion that firemen should be trained up. They are all local to towns. Some of them are already trained as first responders while others need to receive such training. If they had the right training, the life of the 19 year old lad I mentioned, who was a neighbour of one of these firemen, could have been saved. Who knows? We do not know. I appreciate the Minister's answer. I would like it if he spoke to the Minister, Deputy Kelly, about my suggestion.

Leo Varadkar (Dublin West, Fine Gael)
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I would certainly be happy to discuss it with the Minister, Deputy Kelly. As I have said, if they are willing to be trained as community first responders, that would make a lot of sense. I think the possibility of training them to become paramedics would have to be examined carefully to make sure we would have the quality of service we need. The main improvement we want to make in the west this year involves the recruitment of 50 additional paramedics, as provided and budgeted for in the 2015 service plan. The move from an on-call ambulance service to an on-roster service is also crucial. Many of the delays west of the Shannon can be attributed to the fact that ambulance crews in many parts of the country have to be called out from home. This year, we intend to move to a system whereby they are based in the ambulance station or in the vehicle. That will cut up to 20 minutes off calls. I think that is really significant.

John Kelly (Labour)
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I thank the Minister.