Seanad debates

Wednesday, 12 July 2017

10:30 am

Photo of Martin ConwayMartin Conway (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister of State, Deputy Daly, to the Seanad and I congratulate him on his appointment, which in my view is well-deserved.

I rise today to raise the extremely important issue of management of the ambulance service. There has been a lot of media coverage in recent years, particularly in recent months, of the ambulance service in regard to response times, ambulance service provision in particular areas and the drafting of ambulances from one county to another owing to the lack of paramedics on duty at any given time, as a result of which patients are left exposed. Every year, many thousands of people visit County Clare. To say that the ambulance service in County Clare is poor is an under-statement. More often than not, paramedics are on sick leave and so on. As I said, there has been much media coverage on this issue.

I understand that a review has been undertaken of the management of the ambulance service. I think the review was carried out by Mazars but I am not 100% sure of that. I understand also that there are significant recommendations in the report in terms of the failings at management level within the ambulance service and what should be done and that this report was finalised some time ago but has not yet been published. I am asking the Minister of State to give a commitment today that if he and his officials have not yet had sight of the report, they will seek a copy of it and that it will be published. I am concerned that it has not been published because there is some retro-fitting going on in terms of management trying to implement the recommendations before the report is published.

The purpose of a review is to identify problems and shortcomings and what needs to be done to resolve them. Why would any organisation be afraid of publication of a critique of how it does its business? I am sure it cost a lot of money to produce the report. To allow it to remain on a shelf unpublished is unacceptable. As in the case of every other organ of the State, the ambulance service has a responsibility to be transparent. It is my contention that until such time as this report is published there will be a lack of transparency on the service. We all rely on a good, effective, efficient, fast responding ambulance service. Any of us could need it at any time. Many of our citizens need it on a daily basis but unfortunately their needs are not being met. Citizens do not have confidence in the ambulance service and, unfortunately, many of the people working on the ground within the service do not have confidence in it either.

If nothing else comes from this engagement other than that the report is published it will have been a good day's work.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Senator for his welcome and good wishes. They are much appreciated. I also thank him for raising this issue, which gives me the opportunity to provide an update to the House on the reform of the National Ambulance Service, NAS. The NAS has undergone a significant process of reform in recent years and a number of important developments have taken place. The National Emergency Operations Centre has been established. This centre receives the emergency calls and dispatches the emergency resources. The NAS now 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 NAS has developed the intermediate care service to provide lower acuity hospital transfers, which frees up emergency ambulances for the more urgent calls. I should also mention that a permanent emergency aeromedical support service has been established to provide a more timely response to persons in rural areas.

This ambulance reform programme is taking place against the backdrop of the HIQA review of ambulance services, which was published in late 2014 and the NAS capacity review which was published last year. The HIQA 2014 review of pre-hospital emergency care services recommended that the NAS review management structures to ensure managers at all levels are supported to deliver their goals.HIQA advised that job descriptions should be reviewed against business requirements and current management capabilities ought to be assessed against revised job descriptions. It was also recommended that training be provided to managers in a number of core areas.

In response to the authority's review, the HSE commissioned the consultancy firm, Mazars, to carry out a review of the organisational design of NAS in 2015. Mazars was requested to develop plans regarding human resources. organisational structure and workforce. While I understand that this review has been completed, it has not yet been published. The question of publication, and the timing of same, is an operational matter for the HSE. In March 2017, HIQA published its review of progress made to implement the recommendations of the 2014 review of pre-hospital emergency care services. The review commended the progress made in terms of the management structure in the NAS. A key change was the appointment in 2015 of a dedicated HSE national director of ambulance services and emergency planning. The creation of this role has helped to facilitate the required reform at an appropriate level within the HSE. Additionally, the appointment of a NAS quality and patient safety manager has resulted in an improved focus on risk management, incident reporting and the management of compliments and complaints.

The Senator also raised other matters regarding the ambulance service. I am pleased to inform him that the NAS has taken a proactive approach to service development, including the recruitment and training of additional staff, a revised fleet replacement policy, the development of alternative care pathways and the implementation of new technology such as the electronic patient care record. A total of €7.2 million in additional funding was provided in 2016 for the NAS, which included €2 million in development funding. This year, an additional €3.6 million has been made available, including €1 million for new developments. Development funding will be used to increase the number of paramedics and intermediate care operatives in line with the capacity review recommendations.

Photo of Martin ConwayMartin Conway (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister for his comprehensive reply. He confirmed what I know about the 2015 review. We are now in the middle of 2017 and one can assume that this review has been completed. My challenge to NAS management is to ask what they have to hide. I would also like to know why they will not publish the report. I acknowledge that this is an operational matter, as the Minister of State pointed out. The NAS should publish the report. What has it got to hide?

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I concur with the Senator's sentiments. This is an essential and valuable service for everyone. It is not just about those who have had the experience of needing an ambulance but it could happen to us, or any one of our loved ones, any day. This issue affects every person in the country. It may not be someone's problem today to have to rely on an ambulance but it could be some day. We want to make sure the service is 100% right and people have genuine fears. The Senator has a responsibility to bring this to the House's attention and he has done that well. I support him in seeking transparency and openness. There should be nothing to hide in a service as critical as the ambulance service, irrespective of the operational matters. With the Senator's blessing, I will ask the HSE for a more comprehensive reply as to why this report has not been published to date, and when it intends to publish it. It is in the public interest that this would be published and I will revert directly to him with the information as soon as I can get it.