Paul Coghlan (Fine Gael)
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I welcome the Minister of State, Deputy Finian McGrath.

Robbie Gallagher (Fianna Fail)
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I welcome the Minister of State and thank him for his visit to the Holy Family school in Cootehill yesterday, which went down very well. Everyone enjoyed the occasion and we look forward to a new facility there sooner rather than later.

I raise the issue of ambulance delays, particularly in rural Ireland. One might ask what chance ambulance crews have if they do not know where they are going. How can they quickly and efficiently find their way to patients in rural locations specifically? Does the national ambulance strategy have a protocol on the matter in place? A number of incidents over the years have led local communities, especially in rural Ireland, to wonder how the service is directing its ambulances and how the crews are assisted in reaching an emergency once it has been called in to it. Two incidents last July involving the same unfortunate family in County Monaghan illustrate this point in starkest detail. A 44 year old husband and father suffered a cardiac arrest on 9 July in Ballybay town, but he had to wait one hour and 15 minutes for an ambulance to arrive at the scene. 999 was immediately called and CPR was carried out. A defibrillator was immediately brought to the scene and telephone contact was maintained with the emergency services throughout. A full hour after the initial emergency call and the commencement of CPR, a strong pulse was identified, but a further 15 minutes elapsed before the ambulance arrived, having travelled from Navan via a diversion through Dunshaughlin in County Meath. Despite the best efforts of all involved, 15 minutes later the man was pronounced dead in an ambulance on Main Street, Ballybay, before he could be transferred to Cavan General Hospital.

On Tuesday, 18 July, the late man's father, who was in failing health, required an ambulance due to a dangerously high temperature. At 2.32 a.m., his wife telephoned the doctor on call and outlined her husband's condition. She was put through to ambulance control, which informed her that an ambulance was in Shercock approximately seven miles away. She gave directions, the location's Eircode and so on, but no ambulance arrived. A full hour later, their son drove towards Shercock to bring the ambulance to the house, but encountering no ambulance, he returned to the house. Following a series of phone calls to the doctor on call, they discovered that the ambulance was sitting outside a local shop and totally lost, with no satnav or contact telephone numbers for the patient, resident or family after having travelled from Monaghan town. One hour and 25 minutes later, the ambulance arrived to a traumatised household. The gentleman was transferred to Cavan General Hospital and diagnosed with pneumonia.

There have been numerous incidents throughout the country of delays of this nature, including one in Dundalk recently where a young man bled to death after waiting more than 40 minutes for an ambulance.

HIQA has advised that best practice is to have a dynamic deployment of ambulances rather than a strategic placement of vehicles and for the nearest vehicle to attend the scene, and that this is what we are moving towards. In many areas, however, people are left with little ambulance cover, including in counties Monaghan, Laois and Sligo, an entire county that is only covered by two vehicles.

This is a serious issue and it must be addressed. When accident and emergency units in local hospitals were closed, including in Monaghan, we were promised a beefed up ambulance service. Unfortunately, that has not proven to be the case. Clearly, a lack of services and personnel is causing this problem. We cannot allow a situation like the one in Ballybay to happen again. We need clarity from the Department of Health on this point.

Finian McGrath (Dublin Bay North, Independent)
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I thank the Senator for his initial comments. I was delighted to visit the Holy Family special school in Cootehill yesterday and to announce that, at long last, there will be funding for a new school. Planning and design is under way and I hope that building will start in early 2018. I wish the school well. As the Senator knows, the staff are fantastic and great people who have an amazing relationship with the young people with disabilities. I commend them on, and thank them for, their great work.

This Commencement matter is an important one. The two incidents the Senator mentioned were serious and I welcome the opportunity to address the House on the broader issue.

Ambulance response times in August for the north-east region were below target. However, I understand that the National Ambulance Service, NAS, is working to address the issue, including by working closely with the Northern Ireland Ambulance Service to improve response times for patients in Border counties. Ambulance response times are helpful for performance measurement, but it should be recognised that a sole reliance on response times does not provide a comprehensive picture of modern ambulance service performance. Response time performance is being globally reviewed in terms of whether it is the only appropriate measure of patient care.While rapid deployment and timely arrival are accepted, patient outcome indicators are being viewed as a more appropriate measure of patient care and experience. A key performance indicator, KPI, group chaired by Dr. Philip Crowley, national director of quality improvement, has developed KPIs in line with patient experience and outcomes and these have been submitted for implementation. This is in keeping with current international trends. I have been advised by the NAS that it is improving regional coverage and deployment across rural areas. It is moving away from ambulance provision from fixed bases to dynamic deployment, as urgently needed in the two cases mentioned by the Senator. This means that resources can be used across a region in order that if demand increases in one area, other resources can provide cover, as required.

With regard to locating addresses, the NAS computer-aided dispatch system identifies both the incident location and the nearest available resource. The system also utilises an automatic vehicle location system which enables the dispatcher from the National Emergency Operations Centre, NEOC, to direct the responding resources to the incident. The NAS is implementing a new vehicle system which will include a navigation tool. This will allow responding crews to view the same mapping system currently available to NEOC dispatchers to provide directions to incidents. This system will be rolled out during 2017 and 2018.

The capacity review published last year identifies particular difficulties in serving rural areas such as this region. The capacity review indicated that the only practical way to improve first response times in rural areas was through voluntary community first responders, CFR, schemes. The NAS continues to work with local CFR groups across the north-east region to enhance services. I am advised that in August 2017, 25 CFR groups were operating across the north-east region.

The capacity review also examined overall ambulance resource levels and distribution against demand and activity. Implementation of the recommendations made in the capacity review will require a multi-annual programme of phased investment in ambulance manpower, vehicles and technology. An additional funding of €7.2 million was provided in 2016 for the NAS, including €2 million in development funding. In 2017 an additional sum of €3.6 million was made available which included €1 million to fund new developments. I can confirm today that additional funding will be made available for the continued development of the NAS in 2018 and that this will be set out in the national service plan 2018.

Robbie Gallagher (Fianna Fail)
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Unfortunately, the experience of the family I described does not match the statement made by the Minister of State, but I hope the future will look much brighter for others. The family contacted the Minister for Health at the time through my office and sought a meeting with him. Unfortunately, he was not available but directed us to the National Ambulance Service with a view to arranging that meeting. I would appreciate it if the Minister of State could use his office to assist us in that regard.

Finian McGrath (Dublin Bay North, Independent)
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The Senator has raised a number of crucial issues. First, on the matter of services in rural Ireland, ass far as I am concerned, people living in rural Ireland have the same rights to an ambulance service and good quality health services as people living in urban areas. This is a very important matter when it comes to discussing strategic health service plans the length and breadth of the country. Speaking as a Minister of State, what happened to the family in question was unacceptable and I know that the Senator is aware of other similar incidents. In answer to his question I can confirm that I will bring his concerns to the attention of the Minister for Health and make this a priority issue. I will also raise the other issues brought up by the Senator in this very important debate. We are talking about people's lives and have to make sure people living in rural Ireland who are citizens of the State are entitled to the same health service and have the same rights and protections as the rest of us.

Paul Coghlan (Fine Gael)
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I thank the Minister of State and the Senator.