Denis O'Donovan (Fianna Fail)
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Cuirim fáilte roimh an Aire Stáit, an Teachta Corcoran Kennedy, go dtí an Seanad.

Robbie Gallagher (Fianna Fail)
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Ba mhaith liom fáilte a chur roimh an Aire Stáit. I am raising the response times to ambulance call-outs in counties Monaghan and Cavan in the context of two very serious and life-threatening incidents that occurred in the north Monaghan area at the end of December 2016 and the beginning of January 2017. One person collapsed in a shopping centre in Monaghan and another person fell down the stairs of her family home. There was a delay of two hours in one case and two and a half hours in the other case while those involved waited for an ambulance to arrive. It subsequently transpired that the ambulance had to travel from County Longford. An ambulance was called last week in Killeshandra, County Cavan after a young pupil took unwell. The school was informed that it would take 45 minutes for the ambulance to arrive. The school principal, who is to be complimented for acting so quickly, was concerned and decided to contact a local general practitioner, who - in fairness to him - left his practice and went straight to the school. The case was so serious that the GP decided to travel with the child in a car to Cavan General Hospital. Surely this is not good enough in this day and age. I am sure the Minister of State can appreciate the trauma the family went through. Family members were worried about their loved ones and were extremely annoyed and upset about the delays that took place.These cases join a long list of cases in counties Monaghan and Cavan that would explain similar life-threatening delays. Unfortunately, this has been a problem in Monaghan for over a decade. When acute hospital services were removed from Monaghan General Hospital, the people of the county were promised a beefed-up ambulance service to compensate for the lack of services at the hospital. Unfortunately, the people of Monaghan are still waiting.

I wish to clarify the definition of a "golden hour". It is a term people in Monaghan and Cavan are rather familiar with. The golden hour is a period of one hour, or less, following traumatic injury being sustained by a casualty or medical emergency, during which there is the highest likelihood that prompt medical treatment will prevent death.

Today, there is a real and palpable fear among people in Monaghan and Cavan that a delay will occur following an ambulance call-out. Ambulance response times in Monaghan and Cavan are well outside the recommended levels. Indeed, the same applies in the north-east region generally, according to the latest National Ambulance Service statistics. HIQA guidelines are clear: an ambulance should arrive at the scene of a life-threatening emergency in fewer than 19 minutes in 80% of cases. However, last September, this target was met in only 67% of the 809 calls in the north-east region, well below the national average of 74%.

Last week, to great fanfare, An Taoiseach, along with senior Ministers, told us how the Government was going to look after and focus on the needs of rural Ireland. The most basic need of any citizen in rural Ireland is access to health care. Surely, the Minister of State will agree that the ambulance call-out consistency rate is abysmal.

The Minister and the HSE have much to do to establish confidence in the provision of health care in rural areas like counties Monaghan and Cavan. In no way is any criticism today directed at front-line staff. They are put in a difficult position and arrive at the scene where people are upset and distressed. They deserve great praise for the professionalism shown in adverse circumstances as well as for the care and kindness they show to the people concerned and their families. The lack of resources explains inadequate ambulance cover and delays. Ambulances are trying to cover areas that are too extensive to be feasible within time targets. Accountability for delays and poor service must be fixed as a matter of urgency.

I call on the Minister of State to arrange for a commitment to be given to the people of Cavan and Monaghan to the effect that delays of this nature will not continue and that adequate resources will be put in place to ensure people are attended to when the need arises.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank Senator Gallagher for raising this important matter, and I welcome the opportunity to address the House.

Monaghan ambulance base provides a 24-7 ambulance service. In addition, the National Ambulance Service has been moving to a policy of dynamic deployment, whereby vehicles are strategically located in the areas they are most likely to be required rather than located at a particular station. In this regard, Monaghan can also be served by resources based at Castleblayney, Cavan, Dundalk, Ardee and Virginia.

While response times are helpful for performance measurement, it should be recognised that sole reliance on response times does not provide a comprehensive picture of modern ambulance service performance.

A steering group set up by the HSE has been working to define a new set of key performance indicators for the ambulance service. These will include patient outcome indicators to assess performance.

The National Ambulance Service has undergone a significant process of modernisation in recent years, and a number of important service innovations and developments have taken place. The national emergency operations centre has been established. At the centre, emergency calls are received and emergency resources are dispatched. The National Ambulance Service has visibility of all available paramedic resources and vehicles in real time, ensuring that the closest available resource is dispatched to an emergency. In addition, the National Ambulance Service has developed the intermediate care service to provide lower acuity hospital transfers. This frees up emergency ambulances for the more urgent calls. Furthermore, a permanent emergency aeromedical support service has been established to provide a more timely response time to persons in rural areas.The National Ambulance Service is considering alternatives to the current model of care which requires that every patient be brought to an emergency department.

The options under consideration include hear and treat where clinical advice is provided over the phone to callers who can then, if appropriate, be referred to other care pathways. I am advised that a recruitment process is under way for the necessary staff to facilitate the roll out of a pilot hear and treat model of care. This ambulance reform programme is taking place against the backdrop of the Health Information and Quality Authority, HIQA, review of ambulance services, which was published in late 2014, and the National Ambulance Service capacity review published last year. The capacity review examined overall ambulance resource levels and distribution against demand and activity. Implementation of the recommendations of the capacity review will require a multi-annual programme of phased investment in ambulance manpower, vehicles and technology. I am happy to confirm that in that context additional funding has been made available to the National Ambulance Service for 2017 which will provide for the recruitment and training of additional staff, the development of alternative care pathways and the implementation of the electronic patient care record.

Robbie Gallagher (Fianna Fail)
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I thank the Minister of State for her response. I welcome the statement that additional resources will be allocated which, as I said, are very much needed.

When I was first alerted to this incident in Monaghan in the first week in January I contacted the HSE. The incident caused great concern to the people of that county. I asked for the reason for the delay. We are now entering February and I have not got a response. I do not expect the Minister of State to have the answer to that question but this issue needs to be addressed. I take cold comfort, with respect, from the contents of the Minister of State's statement. It is an issue that has to be addressed. If someone is in a critical and life-threatening situation and lies waiting 2.5 hours for an ambulance we have a serious problem and unless we address it, fatalities will occur.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I cannot comment on specific cases but I absolutely understand the Senator's concern. Perhaps it would be more appropriate to refer these specific cases to the National Ambulance Service for investigation. I am sure if the Senator provides it with the details it will investigate those instances.

Robbie Gallagher (Fianna Fail)
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That has been done.