Imelda Goldsboro (Fianna Fail)
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I welcome the Minister of State.

Maria McCormack (Sinn Fein)
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I raise serious concerns about the current state of the National Ambulance Service, particularly its impact on rural communities like those in County Laois. Recently, I met local paramedics who were very honest about the chaos they face daily.

Let us be clear, a decade ago regional ambulance control worked far better with quicker response times with local knowledge that saved lives. Since the move to a single national dispatch centre, the situation has dramatically deteriorated. Paramedics are now regularly sent all over the country. A crew dispatched from Laois to Galway could be stuck in Galway overnight. This situation leaves Laois with no ambulance available for long periods.

This is not an abstract problem. It costs lives. I spoke the last day about the impact this had on my own family, but today I want to share another heartbreaking story with the Minister of State. It is the story of Lauren McEvoy and her late mother. On 9 March 2023, Lauren's mother suffered a brain aneurysm at home at The Heath, Portlaoise, County Laois. Despite multiple 999 calls, with an ICU nurse explaining the critical nature of the situation, the ambulance took more than two hours to arrive. It had been dispatched from Clara, County Offaly. Even though Portlaoise hospital is just six minutes away, the ambulances in Laois were dispatched from much farther away than they needed to be. When the ambulance arrived, a further 45 minutes were lost at the scene. It was 10.30 p.m. before Lauren's mother was finally admitted to Beaumont Hospital.

Imelda Goldsboro (Fianna Fail)
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I caution the Senator about mentioning names.

Maria McCormack (Sinn Fein)
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Yes, that is fine. I have permission from the family to mention names.

Imelda Goldsboro (Fianna Fail)
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Thank you.

Maria McCormack (Sinn Fein)
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It was 10.30 p.m. before Lauren's mother was finally admitted to Beaumont Hospital, which was more than eight hours after the first emergency call. Tragically, Lauren's mother passed away shortly afterwards. One year later, the family still awaits a full response to their complaint. It is just not acceptable. We know the National Ambulance Service is in crisis. We are all listening to paramedics in our communities, but in Laois it is costing lives.

Paramedics have also raised with me the worsening conditions they are facing. We know that, in Laois, overruns are now normal, meaning crews regularly miss their breaks and health and safety guidelines are ignored. Staff burnout has reached crisis level and there is an extremely high turnover of paramedic staff. It is clear the system is at breaking point, and front-line workers and communities are now paying the price.

I specifically highlight the situation in Laois. As I mentioned the last day, Laois has just one ambulance base compared with its neighbouring county of County Offaly, which has a smaller population but has two ambulance bases. Laois paramedics and residents suffer disproportionately as a result. I urgently call on the Minister to immediately implement some temporary plan for Laois to keep Laois-based ambulances within a defined radius of Laois until staffing and base resources can be properly addressed. The people of Laois cannot continue to face hours without any ambulance cover. Every minute lost is a risk to life. We owe it to Lauren's mother and countless others to fix this broken system before more lives are lost.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Senator McCormack for raising this issue today, which I am taking on behalf of the Minister for Health, Deputy Carroll MacNeill. I wish to update the House on the delivery of pre-hospital emergency care in County Laois and the vital pre-hospital emergency response role delivered by our National Ambulance Service, NAS.

The National Ambulance Service serves the Laois-Offaly region from four bases located in Portlaoise, Edenderry, Birr and Tullamore. All four bases are staffed by a highly skilled workforce of pre-hospital emergency care practitioners. In the past 18 months, front-line ambulance staffing in the NAS Dublin-Midlands health region has increased by almost 10%. The Laois-Offaly region is also served through the national emergency operations centre clinical hub, which advises callers on locally available alternative care pathways, as well as five active community first responder schemes. Further support is provided by the emergency aeromedical support service based in Athlone, as well as the Irish Coast Guard search and rescue service.

I am aware of the recent press coverage concerning ambulance coverage in County Laois, in particular anxiety expressed by local public representatives, including Senator McCormack, that ambulances normally based in Laois are being sent out of the county on other calls. It may be helpful, therefore, if I detail the system of national ambulance deployment operated by the National Ambulance Service. Ambulance resources across the country, including in County Laois, are deployed by the NAS dynamically in line with international best practice. This means the NAS prioritises resource allocation to the highest acuity calls that require an immediate emergency response. The national emergency operations centre has oversight and visibility of all pre-hospital emergency resources nationally. This allows the National Ambulance Service to dispatch resources in the most efficient and effective way, ensuring that the nearest available emergency resource to the scene of an emergency is always dispatched. The operation of dynamic deployment has served to address some of the historical safety issues that occurred under the old ambulance station-based static system, where the nearest ambulance did not always respond to an emergency call. It is the case, however, that, with significant increases in urgent and emergency call activity nationally, which between 2019 and 2024 has seen the total number of calls rise by nearly a quarter, some lower acuity patient calls have, at particularly busy periods, experienced a longer wait for an ambulance.

The Government continues to prioritise increased investment in our National Ambulance Service. This year’s allocation of €285 million for the NAS includes €8 million for new service developments to deliver up to 180 additional posts. This will help to support capacity building in our front-line emergency services, further expand the NAS suite of alternative care pathways and help to further develop NAS specialist services.

As I alluded to, patient demand for NAS services continues to rise, with nearly 430,000 urgent and emergency calls received last year, representing an increase of 8% from 2023. The further development and expansion of alternative pathways of care are, therefore, vital in transforming the delivery of urgent and emergency care, improving patient access to care and enhancing patient healthcare experiences and outcomes. With around 7% of all urgent and emergency calls now being triaged to the national emergency operations centre clinical hub for successful treatment through an alternative care pathway, the National Ambulance Service is committed to the continuous development of these pathways, which preserve front-line emergency ambulances for higher acuity responses.

I extend my sincere thanks and gratitude to the staff of the NAS and all our ambulance services for their commitment and dedication to patient care, both in County Laois and across the country. I will bring the point Senator McCormack raised to the Minister, Deputy Carroll MacNeill, Department officials and the National Ambulance Service.

Imelda Goldsboro (Fianna Fail)
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Does the Minister of State need to attend the vote in the Dáil?

Kieran O'Donnell (Limerick City, Fine Gael)
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Yes, but I will come back.

Imelda Goldsboro (Fianna Fail)
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I propose that the House suspend for the duration of the vote in the Dáil. Is that agreed? Agreed.

Maria McCormack (Sinn Fein)
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I thank the Minister of State for his reply. I respect he is taking this Commencement matter on behalf of the Minister, Deputy Carroll MacNeill, but Laois and Offaly are not the one county or the one constituency and they are not the one region for the National Ambulance Service. We had regions ten years ago - I think there were 11 regions - and now we have one dispatch centre.

Having spoken to my local paramedics, I know that, looking at Laois and Offaly together, there are four bases, but I am talking about County Laois having only one base and the impact this has on the communities and paramedics. I note the big investment put into the National Ambulance Service but, according to paramedics on the ground, they are still working the same roster they have been for 20 years. The new staff members coming in are covering people who are out on long-term sick leave.

These paramedics are at breaking point, given the pressure they are under. I spoke to a crew member who, on Friday night, was dispatched from Portlaoise to Thurles and then to Clonmel. That is 110 km away from the base. We are in a very difficult situation in Laois. I ask the Minister of State to ask the Minister for Health to give urgent consideration to the ambulance service in County Laois.

Kieran O'Donnell (Limerick City, Fine Gael)
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I again thank Senator McCormack for raising this important matter. In my opening reply I outlined the commitment of this Government, with significant additional funding for the National Ambulance Service in 2025.

I will bring the particular point the Senator has raised in respect of Laois to the attention of my colleague, Minister for Health, Deputy Carroll MacNeill, the Department and the National Ambulance Service. I will ask them - no doubt they will have looked in on this debate - to take on board what the Senator has said.

By way of general observation, as well as additional emergency ambulances, this extra investment in staffing will also benefit patients who do not need an emergency response or to be brought to a busy hospital emergency department. In recent years, as part of the ongoing reform programme, the National Ambulance Service has established a range of see-and-treat alternative care pathways. These include a pathway service whereby advanced paramedics and occupational therapists visit primarily older people in their homes or in community care.

Finally, I reiterate my thanks to the staff of our National Ambulance Service and emphasise the Government's commitment to investing in building further capacity in the service and overseeing continuous strategic reform.

Imelda Goldsboro (Fianna Fail)
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I thank the Minister of State. I welcome the Walsh family and Colin McEnirny, guests of Senator Ahearn, to the Chamber this afternoon. They are very welcome and I hope they enjoy their visit.