Wednesday, 13 May 2015
Ambulance Service Provision
I accept that. However, in this instance, I had really hoped to see the Minister, Deputy Leo Varadkar, because the issue relates directly to his responsibilities. I have been in the Minister of State's position and understand it, but this is a critical situation.
The issue is very urgent and I am anxious to hear the response from the Department. I take the Minister of State's point, but I will proceed. Perhaps the Leader will examine the issue generally of which Ministers or Ministers of State come to the House to take particular Commencement matters.
My question relates to the need for a rapid response ambulance service in County Roscommon, asks specifically about the total number of ambulances, their location and personnel, that are available in the county each day, and seeks an explanation for the unsatisfactory response times. The current situation is totally inadequate and unacceptable to the people of Roscommon and surrounding areas, who have had no accident and emergency service at Roscommon County Hospital since 2011 when it was closed by the Fine Gael-Labour Party Government which falsely promised a rapid response ambulance service. The HSE has failed to deliver that service in the four years since the wrongful closure of the accident and emergency department.
The Sunday Timeson 10 May included an exclusive story by Eoin Young-Murphy, an investigative journalist with the Roscommon People. Mr. Young-Murphy unearthed an e-mail from Liam McMullen, consultant surgeon at Roscommon County Hospital, criticising the HSE's failure to deliver an ambulance service to the county following the closure of the accident and emergency department four years ago. In correspondence between Mr. McMullen and the Minister for Health, which was obtained under freedom of information, the surgeon claimed the hospital's patients had been "thrown to the wolves".
Mr. McMullen e-mailed the Minister on 13 January after watching an RTE "Prime Time" report of a leaked study which claimed Ireland is too rural to meet recommended ambulance response times. Mr. McMullen wrote: "You wonder why I, a long-time Fine Gael supporter, will now be voting for local independent candidates." He said there was no longer any way to justify to the public the closure of the accident and emergency unit:
It was hard enough to try to explain why you were closing Roscommon A&E department and to put some kind of honest medical, surgical reasoning behind the decision. That reasoning was based on the promise of an adequate rapid response ambulance service. This is manifestly not in place nor apparently will it ever be.According to guidelines drawn up by the Health Information and Quality Authority, HIQA, in 80% of cases, an ambulance should arrive at the scene of a life-threatening incident within 90 minutes. According to the national ambulance service figures for last November, this target was met in only 50% of cases in counties Roscommon, Mayo and Galway.
Mr. McMullen also was critical in his e-mail of the HSE decision to commission a UK consultancy firm, Lightfoot Solutions, to undertake a review of the ambulance service. He urged the Minister:
Stop listening to the HSE management. They would not know a patient if they fell over one. Their only goal is to advance up their own management ladder. This means parking their problems with yet another management consultants' firm from England at huge cost.He went on to criticise the HSE's inability to make decisions: "On no account will they take a decision about anything other than to make sure that no trouble lands on their boss's plate, so that their own future advancement is secure." Mr. McMullen advised the Minister not to cut himself off from what is happening in hospitals. He wrote: "You are quite happy to cocoon yourself in and to be unquestionably reassured by ... management blather and deceitfulness... You have lost all sense of judgment and analysis."
This document was secured under freedom of information, as I said. Mr. McMullen's words are particularly striking given that he was among those who justified the closure of the accident and emergency unit in Roscommon at the time on the basis of the promise from Government of the provision of a rapid response ambulance service. That did not materialise, of course, and it is due to the diligent work of Mr. Young-Murphy that this correspondence has come to light. It is a fairly dramatic development. The people of Roscommon are very aggrieved that the Taoiseach and previous Minister for Health, Deputy Reilly, as Opposition Deputies, gave written commitments before the 2011 general election that the accident and emergency department would be open on a 24-7 basis, 365 days per year. There has been an absolute betrayal of that undertaking to the people of Roscommon. The e-mail from Mr. McMullen to the Minister, Deputy Varadkar, is quite explosive.
I am pleased to have an opportunity to inform the House of current developments in pre-hospital services, both nationally and in the Roscommon area. The National Ambulance Service, NAS, is working to ensure the provision of high-quality and timely emergency pre-hospital care services, using all available resources as effectively and efficiently as possible. As with any pre-hospital service, development and modernisation is an ongoing process, as technology and clinical standards change. A significant reform programme has been under way in recent years. As part of this, additional funding of €5.4 million was provided this year to improve technology and clinical audit and address gaps in service, especially in the west.
It is important to acknowledge that progress is being made. The single national control system, which is now almost fully operational, is improving our control and dispatch performance. We continue to develop the intermediate care service, ICS, which transports patients between facilities, allowing emergency vehicles to focus on emergency calls. The ICS now carries three quarters of the non-emergency workload. We are also moving to more efficient on-duty rostering and developing a national rostering system. Fifty additional paramedics are being allocated in the west this year as part of that process.
Services in the Roscommon area have been enhanced significantly since 2011. Emergency cover in Roscommon town is currently provided by three ambulances during the day and two at night. In addition, a rapid response vehicle, crewed by an advanced paramedic, provides cover on a 24-7 basis. It is important to note that we are changing our model of service delivery from one where services are provided to a local area from a fixed ambulance base located in that area to a model of strategic deployment. The general area of Roscommon can be supported from the north by services from Boyle and Carrick-on-Shannon, to the east by crews in Longford and Mullingar, and to the south from Athlone. In addition, services are now coming on stream at Tuam and Mulranny stations which will enhance the coverage across the region of north Galway, west Roscommon and east Mayo. Refurbishment of the former Garda station at Loughglynn, which is intended to provide dispatch services, is now completed and discussions are under way concerning staffing of the facility.
We have also seen the establishment of the emergency aeromedical service, EAS, which is operated from Athlone by the Air Corps and staffed by NAS advanced paramedics. The EAS provides swift transfers of seriously ill or injured patients to appropriate hospitals, and almost 1,000 missions have been completed since June 2012. Roscommon and Mayo are the two counties which have benefited most from the availability of the EAS.
These are all significant achievements, but we intend to drive further improvements to the service. This year, for example, we expect to receive the report of an independent capacity review to determine current and future service needs. Among the areas being examined are staff numbers and skills mix, as well as resource deployment locations. I am confident these reforms and reviews will lead to improvements in our pre-hospital emergency care services to the benefit of the people of Roscommon and the rest of the country. I hope my reply has addressed some of the issues raised in the e-mail to which the Senator referred.
I understand the Minister of State's situation regarding commitments and the difficulty of getting to the Chamber. She has been most responsible to this House and made herself available on almost every occasion she was requested. I hope she is aware of the deep concerns in Roscommon regarding the psychiatric services, as I outlined last week. I urge her to take a hands-on approach, come to Roscommon and see what is happening in Castlerea and elsewhere. Her direct involvement would be of help. I have begun to avoid attending any HSE briefings. To be frank, I have no faith or confidence in the management of the psychiatric service in Roscommon. I do not trust the people involved and what they are doing. There is a total contradiction between what we are being told in the Dáil and Seanad and what is happening on the ground.
The Senator raised a matter that was discussed in the House last week. There are several issues to address concerning mental health services in County Roscommon. I am in the process of compiling a list of the more than 50 new posts we have put in place there. I am gathering both names and locations because I am constantly being told these appointments were not made. When that information is available to me, which will be in the very near future, I will supply it to the Senator and everyone else. Senator John Kelly also raised the issue with me.
I will be bringing in the people who are saying this is not happening and, if needs be, I also will bring in the more than 50 additional staff we have put in post. The only further comment I will make is that sometimes a service is used to achieve other aims. Senator Leyden should know that more than most because he has seen it happening for long enough. Sometimes, too, we politicians allow ourselves to be used. I have been there myself and am not placing that blame on anyone's door. It is necessary to put this matter to bed once and for all. Equally, it is necessary to reassure people who are in need of the service that both management and the staff who deliver the service are competent and capable people working for the good of patients, not for the good of other agendas.