Seanad debates

Wednesday, 20 November 2019

Nithe i dtosach suíonna - Commencement Matters

Ambulance Service Provision

10:30 am

Photo of Keith SwanickKeith Swanick (Fianna Fail)
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I welcome the Minister of State to the House. He is probably aware of the desperate situation regarding ambulance services in rural areas. Councillor Erin McGreehan from Louth recently raised with me the specific issue of ambulances in the Omeath area of north County Louth. At present no ambulances are operating in this district of the county.

It has been revealed that ambulance services in Louth have taken over an hour to respond to emergency call-outs on at least six different occasions in the last year. A freedom of information request has revealed that on one emergency occasion in Louth last year it took an hour and 27 minutes for an ambulance to arrive at the scene. Out of the six occasions where ambulances took more than an hour to respond in the county, waiting times were between an hour 18 minutes and an hour 27 minutes.

This is not to do with trolleys backing up and the dysfunctional situation in our emergency departments. Insufficient resources are being directed towards rural areas. What does the Minister of State plan to do, in a holistic fashion, to deal with this issue and ensure that we can get the ambulances to bring the patients to the hospitals in a timely fashion?

Ambulance turnaround times measure the time interval from ambulance arrival at a hospital to when the crew is ready to accept another call. In a number of hospitals, the emergency departments are completely overcrowded and this will get worse with the winter flu season approaching. This overcrowding contributes significantly to delays in ambulance turnaround. The lack of resources in rural areas is a different problem. We are not dedicating enough resources to rural locations. If we are serious about reducing the turnaround times, it means that we need to reduce the length of time people are spending in our emergency departments. With that in mind the escalating overcrowding in hospitals being reported by the INMO's figures is of particular concern. We have a long way to go in this regard and the failure to recruit more nurses has exacerbated the issue.

I accept that there are challenges in rural areas and that we cannot expect to achieve the same turnaround times as urban areas, but they could be vastly improved. We need to increase the number of ambulances and paramedics, but we also need to support community first responders to help with emergencies in rural areas.

Details released under the Freedom of Information Act show that nationally on 123 occasions this year it has taken an ambulance at least an hour to arrive at a life-threatening emergency. Some 26 of these were in Wexford while the longest response time was in Mayo. I thank the Minister of State for coming to Belmullet to visit the district hospital. While I am talking about Louth today, the Erris Peninsula is as big as the entire county of Louth. He will be very familiar with this from his part of the country. We are fortunate to have an ambulance base in Belmullet, albeit an hour and ten minutes away from Castlebar.

Rural areas need an increased service. We have a great air ambulance that I have used, thankfully infrequently, as a GP in rural Mayo. Increasing the number of community paramedics and first responders would be sensible and pragmatic, and may alleviate some of the problems we have today.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I welcome the opportunity to address the House, on behalf of the Minister, Deputy Harris, regarding the ambulance service in north County Louth. The National Ambulance Service has three bases in Louth, namely Dundalk, Drogheda and Ardee, from which emergency ambulances and intermediate care services are provided.

The National Ambulance Service has been moving to a policy of dynamic deployment, where vehicles are strategically located where they are most likely to be required, rather than located at a particular station. In this regard, Louth can also be served by resources based at neighbouring counties. The adoption of a dynamic deployment approach was recommended in the National Ambulance Service Baseline and Capacity Review, published in 2016. The ambulance dispatch points were identified following an analysis of demand based on historical data from the regional control rooms. There are ongoing reviews of rosters and strategic deployments of ambulances in the region to ensure that deployed resources remain relevant to demand.

The baseline and capacity review also identified particular difficulties serving rural areas. The review indicated that the only practical way to improve first response times in rural areas is through voluntary community first responder, CFR, schemes. The National Ambulance Service continues to work with local CFR groups across the region to enhance services with eight CFR groups currently operating in County Louth.

The National Ambulance Service also works closely with the Northern Ireland Ambulance Service to provide a better and more responsive service for patients in Border counties, including County Louth. Co-operation is formalised in two memoranda of understanding signed in September 2019.

I note that the Senator seeks the provision of an adequate ambulance service, but I assure him that the Government aspires to the provision of a quality, responsive service. The National Ambulance Service has undergone a very 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, where emergency calls are received and emergency resources are dispatched. The National Ambulance Service now has full visibility of all available paramedic resources and vehicles in real time, ensuring that the closest available resource is dispatched to an emergency.

Recent developments also include the development of alternative pathways to care. The Hear and Treat clinical hub went live in the National Emergency Operations Centre last year. This is an important service in that it diverts some lower acuity patients away from busy emergency departments and frees up emergency capacity. These initiatives are helping to improve the availability of ambulance resources throughout the country, including in north County Louth.

In each of the recent years, additional investment has been directed towards the National Ambulance Service. This year the National Ambulance Service budget has increased to an unprecedented €168.6 million which supports the National Ambulance Service to continue to deliver a high-quality service. I can confirm that in line with the Programme for a Partnership Government commitment, additional funds will be made available to the National Ambulance Service in 2020.

Photo of Keith SwanickKeith Swanick (Fianna Fail)
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I thank the Minister of State for his comprehensive response. While the ambulance is based in Belmullet, if the ambulance is not available locally we have to get an ambulance down from Castlebar or Ballina.

Returning to north County Louth, I would like the Minister of State to consider expanding the co-operation with the Northern Ireland Ambulance Service. Places such as Omeath are only ten minutes away from Daisy Hill Hospital in Newry and yet ambulances are being dispatched from Drogheda, leading to a response time of an hour and 20 minutes, when it could be a ten- or 20-minute response time from across the Border.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I again thank the Senator and take his comments on board. As I pointed out, two memoranda of understanding were signed in September 2019. The benefits are only starting to emerge and that is ongoing.

Having been a Minister of State in the Department for a number of years, I have had occasion to visit many health service facilities and see the progress and in some instances the lack thereof.The Senator will trust my bona fides when it comes to making a judgment like this.

I recommend to any Member to visit the National Ambulance Service and meet its director, Mr. Martin Dunne. I do not have any skin in the game but my impression is that the it is one of the most progressive aspects of our health service. It is impressive to see how the reform agenda has taken hold and how the service has been modernised and extraordinarily progressive in the development of response-led services to meet the needs of the patient and improve response times. It is unfortunate that there will always be outliers and we will all hear stories about an ambulance that took an hour and 20 minutes to arrive. We do not hear the thousands of stories where ambulances or community response cars are typically available within a 20-minute response time in most areas they are deployed. The community response cars are fantastic and they have advanced paramedics. The Senator, as a doctor, will understand and appreciate that.

I genuinely suggest to Members with concerns about the National Ambulance Service that it is well worth going visiting its headquarters. I commend the service highly on the progressive, proactive, can-do approach that the director and the team have adopted under the reform agenda. I am proud of their achievements and Members who have the opportunity to visit them will also be. I thank the Senator for raising the issue.