Wednesday, 20 January 2016
Ambulance Service Provision
I am pleased this morning that it is the Minister State, Deputy Kathleen Lynch, who is in the House to take this matter, because I have found in the past that not only is she aware of what is going on but she has a great knowledge of and insight into the actual situation. Equally important, I have found her to be a listening Minister of State who persists and perseveres, sometimes against the head, as she did in the case of community nursing homes - I am keen to put that on the record. The nursing homes in Abbeyleix and Shaen in Portlaoise were earmarked for closure, but, thanks to the intervention of the Minister State, Deputy Lynch, she was able to secure the funding to invest in these important community nursing homes. This ensures they were upgraded and brought up the HIQA standard and rules. She saved the day for the elderly and the communities of Laois. I wish to acknowledge that on the record today.
Today, I have a bleak warning for the Minister of State.The National Ambulance Service, NAS, is overstretched, under-resourced and understaffed to the point of lives being put at risk. I make no bones about saying that. It is a difficult job at the best of times and a stressful one on a good day. It is intense work. The service is often the lifeline between the community and life-saving medical intervention at a hospital, including surgery.
The service cannot cope with the demands being placed on it. I do not raise this matter lightly and I have witnessed what is happening at first hand. How is it possible that a hospital as large as the one in Portlaoise, which serves a large catchment area that includes south Kildare, north Tipperary and the entire midlands, is often left without any ambulance cover whatsoever? That is the reality. In the past fortnight, ambulances from Portlaoise were dispatched to places as far away as Enniscorthy to pick up the slack resulting from a lack of ambulances covering Kilkenny, Carlow and Waterford. How can this be possible? Ambulances from Portlaoise have been dispatched to Carrick-on-Suir in south Tipperary, leaving the midlands without ambulance cover for hours on end. This is not acceptable or sustainable.
Ambulance drivers and paramedics are at their wits' end and are being stretched beyond belief. I witnessed this before Christmas at a commemoration of UN veterans in Portlaoise. A man collapsed at the event within a mile of Portlaoise hospital but there was still no ambulance after 45 minutes because the vehicles had been dispatched to elsewhere. However, paramedics who had been attending the commemoration - it was an Army and Air Corps event - had the skills and training necessary to resuscitate and save him. He had to be brought to hospital in a car after they deemed him fit to be moved. No ambulance was available. I am not making up stories or crying wolf. The ambulance service cannot operate at its current staffing and resourcing levels.
This issue is feeding into doubts about the future of and safety and staffing levels at Portlaoise hospital. There are question marks over the 24-7 accident and emergency unit. In an unprecedented move this week, Laois general practitioners, GPs, raised questions about why the HSE had not come forward with a plan to commit to the hospital's future status, including a 24-7 accident and emergency service of which the ambulance service would be a core part. That announcement was supposed to be made in September but the issue has been fudged and long-fingered until after the election. This is not acceptable and I will not countenance any situation in which the ambulance service in Portlaoise is diminished or under-resourced further or where there is any question of a threat of undermining the hospital's status, its 24-7 accident and emergency service and the proper resourcing and staffing of same.
I thank the Senator for his kind remarks, although I am never certain that remarks of that type can get one a reward, seeing as how people usually believe that one will do something great the next time around as well.
Sometimes, it is not possible to resolve every issue. In my personal experience and that of a close family member, however, the ambulance or pre-hospital care was fascinating and incredible. The Senator is right about staff ensuring that people are stabilised by the time they reach hospital instead of facing into the awful dash that is usually the case following a serious incident.
I am pleased to be able to outline to the House current developments in pre-hospital emergency care services in the midlands and nationally. The NAS is working to ensure the provision of high-quality and timely pre-hospital emergency care services, using all available resources as effectively and efficiently as possible.
As with any complex modern health service, development and modernisation form an ongoing process as technology and clinical standards change. A significant and ongoing reform programme has been under way in recent years. Funding of €7.2 million has been provided this year to ensure that response times are maintained, including €2 million to recruit and train extra staff and expand the community first responder scheme, which trains local volunteer groups to respond to cardiac emergencies. Last year saw the opening of the national emergency operations centre, NEOC, in Tallaght and the establishment of a single national control system. This project is delivering improved technology to improve response times. Developments such as national digital radio, national computer-aided dispatch, mobile data and electronic patient care reporting will allow the NAS to deploy resources more effectively and efficiently.
The emergency aeromedical support service, EAS, was permanently established in 2015. It ensures that seriously ill or injured people in remote areas have timely access to appropriate clinical care. While targeted mainly in the west where road networks may not allow for timely transport to hospital, the EAS can be tasked anywhere in the State. More than 1,200 EAS missions have been completed since June 2012. The intermediate care service, ICS, which was set up to provide transfer for non-emergency patients between hospitals, allows emergency vehicles to focus on emergency calls. In October 2015, 88% of the inter-hospital transfers previously carried out by ambulances were handled by the ICS.
It is important to note that the model of service delivery for our ambulance service has changed. It is no longer considered appropriate for an ambulance station to provide services only to its own area. For this reason, the ambulance service is moving to dynamic deployment, whereby all resources in a region are deployed across that region as a single fleet in response to demand. This means that, in the midlands, services are provided across the region from Tullamore to Edenderry, Longford, Mullingar, Athlone, Birr and Portlaoise. Services in the region have been enhanced with additional staff based at Edenderry ambulance station in order to provide additional cover. The introduction of a rapid response vehicle in Tullamore further augments services. New rostering arrangements for the region have been agreed between the NAS and trade unions and will lead to greater efficiencies in the service.
The Senator can rest assured that the Government intends to drive further improvements in pre-hospital emergency care that will benefit the people of the midlands and the rest of the country. From personal experience, I know those involved to be an incredible group of people who deserve our support. I hope that, with our finances improving, we will be able to invest in the service further.
I accept the Minister of State's assertion that there must be reforms and that, with radical improvements through the use of new technology and flexibilities, we must have a modern ambulance service that can be dispatched. I also second her sentiments regarding the professionalism, commitment and hard and vital work of ambulance crews. However, I have first-hand knowledge of the crews in Portlaoise being understaffed and overstretched. I understand them operating within a region or catchment area, but I cannot understand how Enniscorthy and Carrick-on-Suir fall into Portlaoise's area. It does not make sense, either in terms of safety or the useful deployment of resources and services.
In the case that I mentioned, a man collapsed - almost fatally - within a mile of the hospital on a Sunday morning but no ambulance was available. That makes no sense. There are issues with resourcing and staffing. While a central hub in Tallaght may work efficiently and effectively from an accounting point of view, we must consider whether it is effective from the point of view of patient safety and patient care, with particular regard to the status of Portlaoise hospital and the demands placed on it by the size of the population that it serves.
Portlaoise was in the news again this morning following the publication of the report on a tragic incident that occurred six years ago. Our thoughts should be with the two parents in question as well as other parents. The concentration on Portlaoise and the midlands area must be continued. It will include the ambulance service.
The Senator is right to raise this issue, as additional investment is required. With the economy improving, I hope that this investment will be made available.