Topical Issue Debate

Crime Levels

I thank the Acting Chairman for the opportunity to raise the issue of crime in Dublin city centre. Dublin has a reputation as a safe, friendly and welcoming city for visitors, and the city centre has always been a vibrant social hub for residents of suburban Dublin and outlying areas. Unfortunately, Dublin's reputation as a safe city is coming under threat. The threat comes in the form of serious anti-social, criminal behaviour on the streets, and the failure to tackle those issues properly.

The "Your City, Your Voice" survey, carried out by Dublin City Council in 2011, shows that the residents of Dublin are very well disposed to the city, and have a genuine affection for their city. A total of 88% of respondents said that Dublin is a great place to live. However, the survey also revealed some far more worrying statistics. Only 31% said they feel safe in the city centre at night. When asked "What is the worst thing about Dublin?", the single biggest concern, raised by 36% of respondents, was anti-social behaviour, including drink, drugs and crime. There is a genuine concern, which I share, that this is having a serious impact on the image of the city centre. The matter requires urgent attention.

The nature and extent of crime and anti-social behaviour on the streets of the city centre is a major concern. There is a perception that adequate action is not being taken to tackle it. Of particular concern in the city centre is the dealing and use of drugs, which far too often is carried out in the open and without fear of consequences. Along with that we are seeing increased incidents of robberies, violence and unprovoked attacks. Just two weeks ago a man was tragically murdered in an unprovoked attack on Camden Street, and there have been further newspaper reports since of vicious, unprovoked attacks. We have reached a point where the Evening Herald, Dublin’s newspaper, can describe the city centre as “Our Streets of Shame”. The newspaper’s recent study of an afternoon in the life of O’Connell Street paints a bleak picture of violence, drugs, binge drinking and begging. What was outlined is a growing problem, which if not tackled will seriously damage the reputation of our city at home and abroad. It will have a negative impact on the city as a social focus and it will change people’s disposition to go into the city centre. Furthermore, it will impact on the economy and on the business life of the city.

It appears as though the dynamic and pattern of anti-social and criminal behaviour in Dublin city centre has changed and intensified recently. It is essential that provision is made for a special period of intense Garda presence and monitoring on the streets of the city centre. Such a period, of perhaps five or six weeks, should be used to categorise and identify the nature and full extent of the problems, including the underlying dynamic, to identify flash-points, and to assess the impact on the city centre overall.

Following on from this period of monitoring, it is essential that we develop a detailed plan of action, which builds on joint policing. The essence of the 2005 Act that established joint policing committees is that tackling anti-social behaviour and crime is not the sole preserve of the Garda and the justice system, rather, it is an issue best tackled in partnership between the Garda, local businesses, publicans, chambers of commerce, taxi drivers and citizens. Everyone who benefits from the economy of the city centre must be accountable and play their part in tackling the problem. They must give some energy towards solving a problem that affects all of us. Joint policing has regrettably not been properly nurtured in this country. Unfortunately, it has withered on the vine, as it were, in Dublin.

I remind the Deputy that he is over his time.

I am sorry. The Garda can take the lead, but it cannot be held solely responsible. In other countries, the model of joint policing has been developed in such a way that there are different categories of public order personnel who play their part in ensuring public safety. We need to develop joint policing along those lines for Dublin to tackle this problem. I call on the Minister to ensure that this partnership is formed and fostered. The Garda, the city council and other State agencies must engage with businesses to ensure that a full and detailed strategy can be developed to tackle this ever-growing and worrying problem.

I thank the Deputy for raising this matter which is, no doubt, of great concern to him and to all in this House. I am responding on behalf of the Minister for Justice and Equality, Deputy Shatter, who regrets that he is unable to be present due to other business.

The Minister shares the shock and revulsion of all law abiding people at the recent reports of senseless acts of violence on Dublin streets. As well as the deep distress caused by such incidents, the Minister is also very conscious of the harm caused by what is sometimes termed as street crime generally and anti-social behaviour as well as the knock-on effect this has on the overall perception of public safety. Despite the understandable public concern over recent incidents, it is important that the good work carried out by An Garda Síochána is recognised. That is reflected in the latest crime figures published by the CSO which show that in the year to 31 March 2012 there was a reduction of more than 8% in assault and related cases and more than 14% in public order offences. Most categories of recorded crime fell in the period.

An Garda Síochána is using the strong legal powers available under the Public Order Acts and the Intoxicating Liquor Acts to keep our streets as safe as possible, including prosecutions where appropriate. The legal provisions deal with street violence and anti-social conduct attributable to excessive drinking and Garda powers include the seizure of alcohol to prevent under age drinking in public places and to forestall public disorder or damage to property. Gardaí may also issue fixed charge notices for the offences of intoxication in a public place and disorderly conduct in a public place. These are a more efficient use of Garda resources and avoid court proceedings when an offender pays the penalty.

While no area of public expenditure can be immune from our economic difficulties, a significant amount of resources are devoted to policing. Deployment of these resources is a matter for the Garda Commissioner based on where experience and analysis show they are most needed. New Garda rostering arrangements have been introduced in recent weeks. As a result, gardaí can be on duty at the times of the day when they are most needed. This is particularly important in dealing with public order issues, as it is generally certain nights of the week and between certain hours that have the greatest need for Garda patrols.

In Dublin and throughout the country, the Garda works closely with communities, local representatives, businesses and other stakeholders to identify and address problems of street crime and anti-social behaviour. The joint policing committees and local policing fora are important mechanisms for this partnership working, but there are many other avenues for this engagement. Under the Garda policing plan for 2012, liaising with those involved in running licensed premises and other parts of the night-time economy is a particular priority for Garda management.

However, dealing with anti-social behaviour is not simply about policing. Much of the violence is fuelled by young people drinking to excess and taking illegal drugs. This problem is not simply a matter of law and order. Rather, it requires action by parents, educators and those who sell alcohol, not only in public houses, but right across the retail sector. The Minister has indicated that, in the coming months, he intends to put in place new regulations to prohibit the below cost selling of alcohol and also alcohol promotions that encourage excessive drinking. He is in regular contact with the Garda authorities about this matter. These contacts will continue. The Minister welcomes the support from all sides of the House for An Garda Síochána's efforts to keep the streets of Dublin and all towns and cities safe.

I thank the Minister of State for his response. It is important to reiterate that the stakes for Dublin city are high. An unsafe environment is bad for its economy and businesses. Shops, restaurants, pubs and other businesses will suffer if the population does not feel safe on our streets. It will cost jobs. A city with a reputation for crime and anti-social behaviour will turn tourists away. Some 59% of all overseas tourists to Ireland visit Dublin and it is their positive experiences that will encourage the next wave of tourists. This scenario must be maintained.

The recent report by the Lord Mayor of Dublin, Councillor Andrew Montague, on anti-social behaviour reads: "The long term vibrancy of Dublin city is thus of critical importance for the Irish economy." Protecting this will require initiative, resources, research and concerted action taken in partnership between all stakeholders. In this regard, joint policing has not been properly developed in Dublin or the country. It is a pale imitation of what obtains in other cities. We need to examine how the strategy has evolved. For example, there are up to 25 full-time staff working in the field of joint policing in city hall in Belfast. Dublin city is so much the poorer because there is nothing similar here. I urge the Minister for Justice and Equality to rekindle the concept of joint policing. I would like to see a ministerial report on that work being submitted to the House shortly.

I thank the Deputy. The Minister understands the general public's concerns about violent street crime. He wishes to underline the Government's unwavering commitment to tackling all forms of criminal behaviour on our streets. I understand the Deputy's concern about street crime giving the city or certain parts of it a bad name. Like any town or city, Dublin depends a great deal on tourism. We do not want a view of it as having high levels of crime rippling through the tourism sector, as it would cause the economic difficulties outlined by the Deputy. I assure him that I will raise his concerns with the Minister and that the Garda is aware of criminal activity in Dublin. There is no easy solution.

I will also raise the Deputy's point about joint policing not working like it does in other cities. He compared Dublin with Belfast, where several people are employed by the council to work on joint policing committees with councillors, communities and the police force. The Minister is keeping a close watch on what is occurring in the city, as is the Garda. The Minister receives regular briefings on the city's crime levels.

Piloting Training

I thank the Ceann Comhairle and the Acting Chairman for selecting this important issue. I wish to raise the plight of the Irish trainee pilots in Florida who are experiencing a great deal of uncertainty about their futures, the qualifications they hoped to gain, the training they paid considerable amounts of money for and whether they will be able to remain in the US for a further few weeks to try to resolve the issue. There is a question of whether their visas will expire. It is expected that some of them will be put out of their accommodation, as its providers have not been paid.

This is a serious matter, but not just for the pilots in Florida. A number of pilots in Ireland who completed their training in Florida might not receive accreditation. It is incumbent on the Minister concerned to answer a number of important questions. What role does the Department of Transport, Tourism and Sport play in respect of the Piloting Training College of Ireland, which is based in Waterford? When did the Department become aware that issues existed? They have come to light in the past day or so. How many trainee pilots are in Florida? How many trainee pilots' accreditation will be affected by this situation? Will the Government intervene directly and ensure the people concerned will receive the training for which they have paid? I am not suggesting that a universal scheme be opened, but a limited number of people have paid what is, given the economic crisis, a great deal of money. It is within the Government's capacity to make good on that investment. If necessary, the Government should introduce emergency legislation to deal with this crisis and to ensure the pilots will not be required to pay even more money to complete the course, given that they have already paid for it.

Will the Minister of State tell us if there are any other accredited pilot training centres or schools in Ireland, and if there are, what action the Department is taking to ensure nothing like this happens again?

I accept and understand that there is not, as such, bonding or insurance in place to protect the fees of the students, but has the Government given any consideration to introducing emergency legislation to require a bonding or insurance scheme to be put in place in order that this issue cannot arise again? The problems have been euphemistically described as "trading difficulties" but they are anything but that for the families and students who have scrimped and scraped to try to put together the €85,000 required to complete one of these courses. Many of the people involved have loans at high interest or have borrowed from within and outside their families to take on this course, and they now find themselves with the potential to lose everything.

It is the type of issue that arises from time to time where swift Government action is necessary, and I appeal to the Minister of State to convey to the Minister a desire among most people in the House that the Government would give every possible assistance to ensure the welfare of the students in Florida is taken care of and, if necessary, that the Government would put in place the funds to ensure the students succeed in reaching their final qualification without being required to borrow further.

I apologise on behalf of the Minister, Deputy Varadkar, who is unable to be present. He had hoped to take this matter but cannot because these matters are being taken earlier than planned.

The Pilot Training College Waterford, PTCW, is a privately owned and operated flight training college, and the company has a pilot training college in Melbourne, Florida. The Irish Aviation Authority, IAA, which comes under the remit of my colleague, the Minister for Transport, Tourism and Sport, regulates, approves and oversees flight training organisations in Ireland. The lAA's primary functions in this regard are the oversight of the safety, quality and standard of the training being delivered, the conduct of examinations and flight tests. The Minister has been informed by the IAA that PTCW had a contract in place with the Florida Institute of Technology to deliver the flight training in Florida. Training is carried out in Florida to take advantage of the better weather for training in visual flight operations.

On 26 June, the IAA was notified that the Florida institute was ceasing all training activities for PTCW due to a commercial dispute between the two companies concerning payments. The IAA immediately sent a senior inspector to Florida to establish the training situation. It has been established that students have paid PTCW for training and PTCW has a commercial relationship with the Florida institute to provide flight and ground training, etc. However, the IAA has no role in the contracts between self-sponsored or airline-sponsored students and their training organisation.

The IAA has advised the Minister that at a meeting yesterday with representatives of PTCW, it sought evidence and assurances that sufficient funding was available in the company to continue operations in Waterford, given that the Florida operations have ceased. Representatives of PTCW informed the IAA that they were investigating restructuring options but that this process could take approximately ten days to complete. On foot of this information, the IAA immediately suspended the flight training approval for PTCW.

The IAA is committed to re-engaging with any proposals emerging from the restructuring process that PTCW has informed it will commence, but in the interim, training in Waterford has been suspended. The IAA has assured the Minister that it will make every effort to ensure all training conducted to date in Waterford and Florida will be credited to the training records of the affected students. Representatives of PTCW have informed the IAA that they will endeavour to mitigate any losses suffered by students as part of the restructuring process, and both the Minister and the IAA hope a satisfactory outcome can be achieved to enable students to complete their training. The IAA continues to assist in every way possible, including directing students to alternative providers.

I accept the Minister is not present because business moved a bit more quickly than anticipated. I asked a number of questions and I am sure the Minister of State will communicate those to the Minister for Transport in order that I can get a direct reply. I am not for a moment suggesting the IAA has not done everything possible, and the reality is the IAA's role is principally about regulation. For that reason, the reply given by the Minister of State relates largely to that body.

The issue is not that the students should be directed to alternative providers. That would be fine if they could come up with the wherewithal to pay for it. As far as I am concerned, the Government should step in and deal with the affected students. I accept this is a private concern but, unfortunately, independent students have committed a large amount of resources to what they expected to be a State-regulated company. Generally when there is such regulation, there is an expectation that a course would meet a particular standard, not just in accreditation and the ability to teach but also in the viability of its future. There seems to be some clear gap in the regulatory process if a company like this is not bonded or does not retain student fees in an escrow account or similar format to ensure that what is paid for can ultimately be delivered.

There is work to be done by the Government to ensure this does not happen again and that any other flight school does not suffer the same fate. Students have found themselves caught in the middle and the State should step in to provide the necessary resources or, with the assistance of another flight school, see that the students get their training without any further expense.

The Minister is very much aware of the financial input that each of these trainees and their families and parents have given, and the Deputy mentioned a significant amount of money. It is a major commitment from any individual to put into a person's education. It is an investment and I have no doubt that when these people paid this money, they never thought the problem we are facing would come about.

The Minister and the IAA are doing everything possible to find a solution to this problem. The Deputy understands the issue is independent of the actions of the Government and the IAA but both the Minister and the IAA have some role to play. We must nevertheless respect the independence of the company involved. On 26 June the IAA was notified that the Florida Institute of Technology was ceasing flight training activities for the PTCW due to commercial disputes, and the IAA immediately sent a senior inspector to Florida to establish the ongoing training position for the students involved. The IAA is committed to re-engaging with the company involved when the restructuring is complete.

The Minister is in close contact with the IAA to see if anything can be done to enable the students to complete training. I have outlined the Minister's views on alternative providers. If there was an opportunity to go to an alternative provider that is recognised by the IAA, many students would take it up. The Minister is very much aware of the concerns of the students as outlined by the Deputy, and I will bring any questions posed by the Deputy to the Minister's attention. I apologise again on behalf of the Minister for his absence.

Hospital Services

I welcome the Minister of State, Deputy Shortall. I acknowledge the role of the Friends of Letterkenny General Hospital in raising €500,000 of necessary funds towards a cardiac catheterisation laboratory in Letterkenny. The group intends to raise a further €700,000 to bring the total funding to €1.2 million. This represents a vast amount of fund-raising. This is an example of the positive effort of so many groups throughout the country. They are aware of what is needed in a particular area and they are willing to put their shoulder to the wheel.

The group is not working separately but in conjunction with management and consultants. This is not a separate fund-raising initiative. The United Kingdom NHS has pointed out that in 2015 there will be a significant deficit in cardiac catheterisation capacity in Northern Ireland. Letterkenny General Hospital has the only HSE-employed interventional cardiologist in the north west. Funding has been approved for a second cardiologist there. It has the capacity to build on an existing strength. The danger with cross-Border co-operation and all the associated challenges is not to acknowledge the strength of one particular hospital. Altnagelvin Area Hospital has its strengths and Letterkenny General Hospital has its strengths. There is a real opportunity here to build a critical service that will facilitate not only the population of Donegal or north Leitrim but also patients from Derry to Tyrone.

When we discuss cross-Border synergies and co-operation it is important to place a value on the existing strengths and capacities at particular hospitals. If there is an interventional cardiologist in Letterkenny, the only one in the north west, approval for a second cardiologist and community commitment and involvement in respect of fund-raising, then we should bring all of this together and tap into the goodwill. As legislators, we will not be rewarded in any way by the community if we bypass its wishes.

It is important to note the proactive role of the Minister with responsibility for health in Northern Ireland, Mr. Poots, and his close co-operation and working relationship with the Minister of State, Deputy Shortall, and the Minister for Health, Deputy Reilly. They have worked to analyse possible solutions in these straitened times. Perhaps in five or ten years time there will be a whole new landscape. Altnagelvin Area Hospital could work with Letterkenny General Hospital and Erne Hospital could work with Sligo Regional Hospital. We need to ensure at the beginning that the turf wars that have prevailed in hospitals and that will continue to prevail in future do not become the raison d’être of service provision. There is a capacity at Letterkenny General Hospital to provide this cardiology service. The team, the commitment and funding are in place as well as Government approval for a second cardiologist. We should honour this and we should be careful about how we move in the advanced co-operation between two hospitals on different sides of the Border. Everyone has the same overall objective, that is, to provide quality service for the people living in the north west.

I thank Deputy McHugh for raising this matter. I am responding on behalf of the Minister for Health, Deputy Reilly. The Deputy has raised the important issue of how we organise our health services to ensure we have safe and consistent treatment for patients throughout the country in a way that is affordable. This is being tackled through the clinical programmes and through the reorganisation of our hospital system and the establishment of our hospitals into groups. One of the issues which will be taken into consideration in the formation of hospital groups is the availability of services in Northern Ireland and any opportunities that exist for synergies. Decisions such as this will not be taken on a stand-alone basis. In the case of the development of standards for acute coronary care, the national clinical programme for acute coronary care syndrome has designed a streamlined approach to the treatment of all patients with the varying forms of acute coronary syndrome. It has also developed a standardised pre-hospital protocol for response, triage, treatment and transport of patients with these syndromes.

Every patient with an acute coronary syndrome should be diagnosed correctly and without delay and then managed according to the national protocol. Acute coronary syndromes are divided into three broad categories: ST elevation and myocardial infarction, STEMI, or full-blown heart attack; non-STEMI or threatened heart attack; and unstable angina. It is recognised internationally that STEMI's are best treated in a centre of excellence where the patient can be taken to a cardiac catheterisation laboratory and the blocked vessel opened. A primary percutaneous coronary intervention, PPCI, centre is a major cardiology centre that has at a minimum two cardiac catheterisation laboratories, at least five interventional cardiologists and 24 hour, seven day on-call staff including medics, nursing, technical and radiography staff. Given current resources these centres are placed in Galway, Dublin and Cork. The number of STEMIs per annum is small, approximately 2,000, and therefore the number on average that present to Letterkenny General Hospital is of the order of one every nine days.

The creation of hospital groups and trusts is at the heart of the Government's reforms of the acute hospital sector. It is integral to a stronger and more systematic process of performance management for hospitals while ensuring clinically safe and consistent services for patients.

In June the Minister announced the appointment of Professor John R. Higgins to work with the special delivery unit in the role of chairperson of a strategic board to assist the Department of Health in the design and establishment of hospital groups. As chairperson, he will have a key role in progressing the creation of hospital groups which, the Minister envisages, will be set up quickly on an administrative basis. Initial meetings with stakeholders, including meetings between Professor Higgins and each public hospital, have commenced and will continue during the summer. Representatives from Letterkenny General Hospital have been invited to meet Professor Higgins and the strategic board shortly as part of the consultative process and its inclusion in a specific hospital group will emerge from this process.

Following this process, hospitals will be allocated to groups on an administrative basis. Work will commence on governance and management frameworks for hospital groups, aligned to the recommendations of the HIQA Tallaght report. It is not anticipated that independent hospital trusts will be established until 2015, because much development is required in other areas, including universal health insurance and the underpinning legislation to create a comprehensive and robust system of efficient health care and safe patient care.

The need for a cardiac catheterisation laboratory in the north west is fully accepted. One important issue is to ensure that the potential for cross-Border patient flow in respect of acute services is exploited to the greatest extent feasible subject to the agreement of both jurisdictions. In this respect I am satisfied that the Minister has recently agreed a formal process for ongoing engagement with the Northern Ireland Department of Health and the Health and Social Care in Northern Ireland service and the terms of reference are being finalised. The decision on the location of the cardiac catheterisation laboratory will be made in the context of the establishment of hospital groups, taking into account the cross-Border synergies.

I commend the commitment of the Friends of Letterkenny General Hospital who, as Deputy McHugh has noted, have made a major contribution to service developments in the hospital and to the people of Donegal during this period. I thank him for raising the matter.

I thank the Minister of State for the extensive response. It is possible to read between the lines of what she has said. In fairness, the Minister of State is working within the realm of existing policy with respect to potential hospital trusts within this jurisdiction. From reading between the lines I detect an openness to considering cross-Border synergies. I have no intention of putting words in the mouth of the Minister of State. A really welcome feature of the response is that there is a broad vision not only for existing policy within the Twenty-six Counties but also for determining whether we can have some form of cross-Border co-operation.

I call on all stakeholders within hospitals - there is a lot at stake and that is why we use the term "stakeholders" - to examine the broader picture. There will be turf wars, suspicion, fear and misunderstandings, but there are opportunities. There is an opportunity to provide a high-quality service in the north west. Bearing in mind that Galway, Dublin and the southern region are facilitated, the response this afternoon implies the north west will be represented in some shape or form.

I know the Ceann Comhairle will allow me to digress a little on cross-Border co-operation. Yesterday was a significant historic day for North-South relations. The North-South Interparliamentary Association, which was set up yesterday, will be the first formal mechanism to allow communities and citizens, rather than politicians, north and south of the Border to lobby and campaign through a joint mechanism. The Ceann Comhairle is co-chairman with Mr. William Hay, whose family originally comes from Donegal. I have a personal interest in the latter's geographical connections. I congratulate the two co-chairmen, who have equal status, on their vision and for pushing forward this mechanism. It will help the Minister of State, Deputy Shortall, the Minister, Deputy Reilly, and all the other Ministers interested in cross-Border synergies to pursue realistic goals. I look forward to working with the Ceann Comhairle on the body and to continuing work with the Minister of State and Minister on cross-Border synergy.

The Deputy is absolutely correct that there is significant potential for a high level of co-operation between our health service and its equivalent in the North. Many of the possibilities are being explored actively. There is much potential for synergy. Just last weekend, I met two of my counterparts, Mr. McCann and Mr. Bell, on co-operation in respect of drugs and alcohol. We will be working closely in this regard. The Minister, Deputy Reilly, and I met Mr. Poots some months ago and the issue raised by the Deputy was very much to the fore. There is much potential and it is being pursued actively. I thank the Deputy for raising the matter.

Ambulance Service

I thank the Ceann Comhairle for selecting this matter. It is, without doubt, a very important issue that has an impact on the lives of many thousands of people, not only in the town of Skibbereen but also in its catchment area. The provision of pre-emergency care is essential to the delivery of an acute hospital service. Communities right across Cork, including Bantry and my home town of Youghal, have been threatened with the removal of vital ambulance cover for more than a year. The communities have cried "Halt".

The Government's plan to reconfigure the ambulance service, coupled with its hospital reconfiguration programme and the recruitment embargo, has the potential to have a devastating effect on health service provision and the lives of many. Before the Minister's plans for ambulance services have even taken effect, we have seen the service in Skibbereen cease. Last Monday, this large population centre was left without an adequate and appropriate ambulance service due to the lack of cover and the HSE's apparent unwillingness to pay overtime.

I stated in the Chamber before that a rapid response vehicle manned by a paramedic is not the same as an ambulance manned by an advanced paramedic. The current approach must end. I would like to know what immediate action will be taken to ensure an adequate and appropriate ambulance service will be provided for the people of Skibbereen and its hinterland. They are just as entitled to cover as anyone else.

I thank the Ceann Comhairle for selecting this issue and I welcome the Minister of State, Deputy Shortall, to the Chamber. West Cork does not have what one would call a normal accident and emergency unit. We have a good service in Bantry hospital that covers cardiac and respiratory emergencies but we do not have a dedicated accident and emergency unit. Our ambulance service is our accident and emergency service. This week, the people of Skibbereen and its hinterland have been left without this service. The sick leave of one paramedic has effectively led to the withdrawal of the ambulance service in the area. One quarter of the entire west Cork ambulance service has been taken off the roster.

I do not know whether anybody knows how terrified the people of Skibbereen are over the prospect of not having ambulance cover. In the absence of a new role for the ambulance service in west Cork, such as dynamic dispersal or allocation, as might have been spoken about by the Minister, we have no appropriate service. The existing service is very rigid. Due to the absence of one paramedic, the ambulance service has been withdrawn from the people of Skibbereen. This is hard to take. The public service is used to an embargo on recruitment and overtime, but these embargoes should not apply to emergency services. It is not right that a service cannot cope if one person takes a sick day. There are many HSE managers who are well paid to do what they should be doing, namely, manage. This is a classic case of management that cannot deal with the redeployment necessary to maintain basic emergency services for Skibbereen. This is not because of an overtime issue. I ask sincerely that the Minister of State, through her office, instruct the management to do what it is paid to do, that is, manage the situation.

I thank the Deputies for giving me the opportunity to address this issue. I am responding on behalf of the Minister for Health, Deputy Reilly.

The HSE's national ambulance service, NAS, has been progressively improving and modernising emergency ambulance services in Cork and Kerry. As part of this process, stations and crews are changing from being on call to having on-duty rostering. Being on duty means our highly trained paramedic crews will be on-site in their stations or in their vehicles to respond to dispatches, rather than being alerted and then having to make their way to the station when called out. This drastically reduces deployment times for emergency vehicles. On-duty status means resources can be deployed dynamically. This means that vehicle location during a shift is based on need and demand patterns such that vehicles will not just be sitting at a station. This produces greater flexibility and responsiveness. Under the dynamic model, on-duty emergency ambulances are available from within a region as required. This will produce better response times for the people in Cork and Kerry and a better service.

Current evidence suggests patient outcomes are improved by better treatment and stabilisation of the patient at the scene, followed by ongoing treatment and transport to the most appropriate centre, even if that means longer transport times. On-duty rostering of ambulance staff will, therefore, support a modern emergency response service involving paramedics, advanced paramedics, community first responders and GP out-of-hours services working together to respond to emergencies. This approach is consistent with international best practice and will assist with compliance with HIQA response times and quality standards.

I note that ambulance staff themselves sought the elimination of on-call working, that the relevant period has already been reduced from 44 hours to 16 hours per week in the region and that it will continue to decrease on a phased basis as part of the improvement of services and response times. There are ongoing discussions with staff on implementing the proposals, and both the HSE and unions are committed to this process.

The HSE's NAS is engaged with union representatives, through the Labour Court, regarding on-call arrangements for ambulance services in the south west. All parties have accepted that, in accordance with a Labour Court recommendation, providing ambulance services under on-call arrangements should cease. The National Ambulance Service has begun removing on-call arrangements by focusing on east Cork in the first instance. It has been agreed that the arrangements for the removal of on-call in east Cork will be reviewed after six months with a view to implementing similar arrangements in west Cork by mid-2013.

It is important to note that emergency ambulances are staffed by paramedics working in pairs. Where an individual paramedic does not report for duty, the other paramedic on that shift is available to respond to emergency calls. While an individual paramedic cannot transport patients to hospital, support is provided through strategic deployment of available resources. This ensures a patient transporting vehicle is available. The HSE national ambulance service is committed to implementation of the HSE attendance management policy and continues to manage absenteeism on this basis. I thank the Deputies for raising the matter.

I thank the Minister of State for her response. I had so many calls and e-mails this week from constituents, young mothers and elderly persons from Skibbereen who were terrified because they did not have ambulance cover. Could we get a commitment from the Minister of State that what happened in Skibbereen on Monday last will not happen again and what measures will be put in place to ensure the planned reconfiguration does not produce similar occurrences across rural areas?

I thank the Minister of State for her response. I fully understand what the ambulance service is trying to do, both in west Cork and nationally. However, I want to come back to the deficiency in the ambulance service in Skibbereen, currently and possibly for a number of weeks because this particular paramedic is on sick leave. We all have heard in recent public debates how sick leave throughout the HSE and other public bodies is expensive and costs a great deal of money. It should not cost lives and that is what the people of Skibbereen are genuinely afraid of.

Notwithstanding the progress and the future plans of the HSE for the national ambulance service, this pinch-point is a staffing issue, a resource issue and a management issue. We are in the old regime in Skibbereen and there is no reason, in the absence of these plans and dynamic deployment, that this situation should be allowed to continue. Will the Minister of State go back to the HSE national ambulance service so that the people of Skibbereen will not have to live in fear that they will not have an ambulance when called for?

I very much appreciate the concerns raised by the Deputies. As I stated in my reply, the HSE ambulance service is committed to better management of absenteeism. Quite clearly, there was an issue recently and that level of service is a matter of concern. I am willing to undertake to convey the concerns expressed by both Deputies to the Minister for Health.