Topical Issue Debate

With the agreement of the House, we will take the matter raised by Deputy Michael Harty first as Deputy Jonathan O'Brien is not present.

Marine Safety

The issue I raise is marine safety and marine rescue services at Kilkee, a popular seaside resort in County Clare. This is an important issue for those who use coastal waters and those who operate marine rescue and recovery services.

These are essential services and a vital component for those who make a living from fishing off our coast, those who engage in recreational activities and our tourism industry. Water users must be confident that, should they get into difficulty, there are marine rescue services suitable for putting to sea with proper equipment, local knowledge and training in order to competently engage in sea rescue and search and rescue when required, because, unfortunately, many people are recovered from coastal waters who have drowned by accident or suicide.

Kilkee is suffering from structural, operational and funding issues in the supply of marine sea rescue services. Historically, the service in Kilkee was voluntary. Started in 1981, it filled a gap in the Royal National Lifeboat Institution, RNLI, service between Valentia and Galway. In addition to the surface rescue provided at Kilkee, there was also diving recovery because it had a diving centre. The funding of the service was voluntary until 2012 but voluntary subscriptions were very difficult to come by, particularly during the recession. The Irish Coast Guard agreed to take over the running of the service in 2013 but many of the volunteers, with their experience and local knowledge, were not taken on the rota. The number of people involved dropped from 26 to 12. All reference to Kilkee maritime rescue services was removed from the buildings. Former President Hillary unveiled a plaque commemorating and acknowledging the activities of marine service in a voluntary capacity but it was removed.

There was a tragic loss of life in September 2016 when a Coast Guard volunteer was drowned off the coast near Kilkee. There is an ongoing investigation to try to understand the circumstances of that tragic accident. It is being carried out by the Marine Casualty Investigation Board and the Health and Safety Authority. Since the incident, there has not been a full Coast Guard rescue service at Kilkee, which is very unsatisfactory because it is a very busy maritime centre, especially during the summer. In January, a Hungarian man got into difficulties and later died. The Coast Guard was not able to assist the rescue on the water and could only assist on land. I understand that two vessels are located at Kilkee, with one having limited range and capability and the other not fully operational. There was no water-based rescue and a helicopter had to come from Shannon to engage in the operation. Unfortunately, the man died.

Local fishermen and tourists are very apprehensive about putting to sea without having proper Coast Guard rescue back-up. The Coast Guard is made up of professional rescuers and volunteers who must have local knowledge and expertise in the locality. This is the difficulty that is arising regarding the Coast Guard service at Kilkee. I ask the Minister and his Department to intervene and bring about a satisfactory solution so as to restore full rescue services based at Kilkee. He must ensure that these services are of the highest quality.

I thank the Deputy for raising a problem that is very current in County Clare and about which he is extremely concerned.

First, I praise the volunteer members of the Coast Guard who undertake such vital work in support of safe use of our coastline and coastal waters. Kilkee Coast Guard station is the unit which experienced the tragic loss of Caitríona Lucas's life, as mentioned by the Deputy, on 12 September 2016 during a search-and-recovery mission conducted by means of boat and shoreline searches off the Clare coast. The circumstances leading to the loss of life are under investigation by the Marine Casualty Investigation Board and the Health and Safety Authority, and it would not be appropriate for me to comment on the incident until such time as the investigations have reached a conclusion.

Coast Guard units comprise three types, namely, search only or different combinations of search, cliff and-or boat, depending on requirements for local geographic terrain. Originally, a search-only unit, Kilkee Coast Guard unit, was categorised as a search-and-boat unit in 2013 following its assumption of the service previously provided by the Kilkee marine rescue service. Since the accident, in the interests of ensuring the immediate safety of Kilkee volunteers, the unit has been restricted to shoreline searches and inshore boat searches using a soft inflatable rescue boat known as a D-class lifeboat. This is to allow time for the training of new crews and for existing members to be recertified to a sufficient standard to operate the more complex rigid inflatable boats, RIBs, which can venture further out to sea or into more challenging conditions. I can understand why people may feel frustrated by this but I hope the Deputy will also understand the reasons it is being done.

In the meantime, the area normally covered by the Kilkee unit is covered by various other units. There is the Doolin unit directly to the north, the Kilrush RNLI lifeboat inside the mouth of the Shannon, the Aran Islands all-weather lifeboat and the Ballybunion community rescue boat unit directly to the south. Search and rescue coverage is also provided by the Coast Guard's helicopter service, including the helicopter based at Shannon Airport. The restriction on the operation of the larger RIB will be lifted when the crew have attained the necessary team and individual competencies and when the unit has passed an operational readiness audit. I hope it will be done with haste but with care and prudence as well. All Coast Guard units must pass such audits regularly to remain operational. As it takes time for crew to gain the necessary experience and competencies to reach the standard required, this is a process that cannot and will not be rushed.

I am mindful of the fact, as reported in the media and articulated by the Deputy, that there have been some concerns voiced in Kilkee about the capabilities of the unit, and I wish to reassure the House that a full safe RIB service will be restored when the unit is ready but not beforehand. In the interim, the safety of our volunteers remains of prime importance and Kilkee Coast Guard unit continues to serve its community as a search unit and as a boat rescue service using its D-class rescue boat.

I take this opportunity to clarify the role of the Coast Guard, which is a division of my Department, in the management of volunteer units and issues that naturally arise from time to time within a cohort of over 900 highly motivated volunteers. A code of conduct is in place that clearly sets out who does what at a local level and, where issues or grievances arise, how these are managed and what appeal procedures are available. I have made it clear in answer to parliamentary questions that it is not appropriate for me as Minister to intervene in such matters.

As the Minister knows, just having shore-based activity is not sufficient to supply a rescue service in a seaside resort like Kilkee. Kilkee has a small population in winter. In the summer, however, the number of people there can rise to 25,000. These individuals avail of the sea-based activities on offer in Kilkee, which is a major tourist attraction. Not having proper sea rescue services is completely unacceptable.

The Minister indicates that the rescue services are covered by other units. Kilrush is a substantial distance away and one must go down the coast, around Loop Head and down the estuary to get there. Doolin is also some distance away. The Minister knows that sea rescue is an immediate requirement and not something that can be delayed for a number of hours so boats can come from other areas or the rescue helicopter can come from Shannon. These are of course essential components but there should be a sea-based rescue service in Kilkee. There were six incidents last year where no sea rescue was available from the Coast Guard. As a result, boats from the diving centre and recreational boats had to go to the assistance of those in difficulty. That is unacceptable.

We must take into account the fact that there is already expertise in the area. These are the voluntary members who were part of the Kilkee marine rescue service and they are still available. They are very anxious to provide a sea rescue service and participate in the coastguard service. There seems to be a difficulty with taking on these volunteers and availing of their expertise and local knowledge, which is critical in any sea rescue. The Minister should put pressure on the Coast Guard to provide a sea-based rescue service before the onset of the forthcoming holiday season, when so many people will come to Kilkee and use the facilities there but for whom such a service will not be provided.

I am impressed by what the Deputy said. He will understand that the Coast Guard has been active in response to this tragic incident and the Coast Guard has kept a vigilant presence in Kilkee. While the unit was off-service for some time, there has been a process to ease it back incrementally to full operability. Training is ongoing in Kilkee as it is in all Coast Guard units. That said, in cases where extra training is required, as is the case in Kilkee due to the stand-down period after the accident, this is being provided and is ongoing. Search and rescue units do not work in isolation for one specific geographic area but in partnership with other resources in the vicinity. Kilkee and its surroundings are comprehensively served by the Coast Guard helicopter in Shannon, an RNLI lifeboat to Kilrush and Inishmore, a community rescue boat at Ballybunion and Doolin-Ballybunion CGUs. In any task, the Coast Guard's first concern is the safety of our Coast Guard volunteers.

In reference to what Deputy Harty said, if there were six incidents of the sort, I will make fresh inquiries to see whether there is anything we can do to give further necessary cover in the weeks and months ahead while awaiting a permanent solution to the problem.

Road Projects

The Minister may be aware that the week before last I tabled a parliamentary question on this issue and received a reply from his Department. The reply stated:

The initial selection and prioritisation of works to be funded is a matter for the local authority. The Department has not received any proposal from Cork City Council in respect of a proposed upgrade of Tinker's cross junction in Cork city.

I was quite happy with the reply and passed it onto my constituency colleague on the ground who is a member of Cork City Council. He raised it with the city council at the roads meeting last Monday. The reply he received from the city council on this proposed upgrade was that the preliminary design, Part 8 planning, detailed design and construction tender processes are complete, the contractor has been selected and the project awaits funding approval.

The Minister will see that we have two differing answers. Cork City Council states that it is shovel-ready for this €2.5 million upgrade of Tinkers Cross and awaiting funding from the Department while the Department's reply states that it has not received an application from the city council. The reason I therefore gave notice of this topical issue is to see if I can get some answers from the Minister. Will he clarify whether the information I received the week before last is correct?

The Minister may not be familiar with the junction itself but it is right outside a community centre and next to an estate entrance. It is used several times a day by residents from the estate who wish to cross the main road over to the shops and the community facilities. It is an extremely busy junction that is used daily by articulated lorries coming from Tivoli to get to the Blackpool area. The upgrade is vital but the difficulty is that no one seems to know what stage the project is at because we are getting different answers from the Department and Cork City Council.

I will address that issue in a second because it is one which can be resolved very quickly, but I will address the substantive issue first. I was not aware of the information the Deputy has just provided when preparing for this subject but I will address it at the end.

The improvement and maintenance of regional and local roads together with traffic management in Cork city is the statutory responsibility of Cork City Council. Works on those roads are funded from the council’s own resources, supplemented by State road grants. The initial selection and prioritisation of works to be funded is also a matter for the council. Before the financial crisis, local authorities could regularly apply for grants for specific improvement works for the strengthening, widening or realignment of rural roads where the proposed scheme cost generally less than €5 million. However, the extent of the cutbacks in grant funding during the crisis meant this grant scheme had to be curtailed after 2013 because expenditure on maintenance and renewal was falling well short of what was required to maintain adequately the regional and local road network.

The capital plan for 2016 to 2021 provides for the gradual build-up in funding for the road network but it will take some years yet to reach the level required for the adequate maintenance and renewal of the network. For this reason, there is limited scope at present for funding projects under the specific grant programme. Any projects proposed by local authorities for consideration under this grant programme are assessed by the Department on a case-by-case basis. All projects put forward by local authorities for consideration must comply with the requirements of the public spending code and my Department’s capital appraisal framework, and it is important for local authorities to prioritise projects within their overall area of responsibility with these requirements in mind. Cork City Council has not, however, sought funding for the Tinkers Cross junction improvement scheme under this grant heading.

I understand that there was an original design for the Tinkers Cross scheme funded by the National Transport Authority. I also understand that, on foot of discussions in 2017, the National Transport Authority and Cork City Council agreed to prioritise funding for the nearby Ballyvolane to city centre, or Ballyhooley Road, element of the northern ring road corridor in 2018 and a contractor is on-site with these works. There is, therefore, no funding allocation at present for Tinkers Cross in 2018.

I am puzzled by what the Deputy says and do not doubt it for a second. It seems to me that there is a complete lack of contact somewhere between the local authority and my Department. The Deputy said that there appears to be no contact or response even though the application has been made. I think that is what the Deputy is saying. If that is the case, I apologise. However, I do not know if it is. I will immediately make inquiries with my Department about it. If the Deputy gives me the name and the point of contact after the debate, I will ensure that contact is made in the next 24 hours. Would that be alright?

That is perfect. I appreciate it. I do not know if contact has been made with the Department either. It could also be that the information from Cork City Council is wrong. I am not for one moment saying the Department is wrong in its answer to my parliamentary question. When the Minister gave the answer last week, it kind of fitted in with everything that I was hearing on the ground, which was that the city council had not made an application and that there was an application for a wider project which was under way. This appears to have been confirmed in the Minister's reply. Therefore, when I spoke to the local councillors on the ground, they followed it up because we were under the impression that we were awaiting funding. When I told them the Department was saying no application had been made for funding, they went back to the city council. The answer from Cork City Council dates from last Monday and it is very clear, however. It states that the contract has been selected, that the tender process is complete and that it is awaiting Government funding for the project. I would appreciate it if the Minister were to clarify the situation. I will provide him with the details of the contact person in Cork City Council and he can pass those on to the departmental officials to follow up on the matter.

I thank the Deputy. I guess this is a misunderstanding because the officials in my Department in that particular area are super efficient. I have never come across anything like this happening or there being a lack of response to something so important. My guess is that there is a mismatch somewhere which we will be able to sort out between ourselves one way or the other.

Hospital Services

I wish to express my thanks to the Ceann Comhairle for affording me the opportunity to raise this issue. I welcome the Minister for Health to the House and thank him for taking the debate. As he will be aware, the medical assessment unit at Mid-Western Regional Hospital, Ennis was established following reconfiguration of acute hospital services in the mid-west region.

Medical assessment units, MAUs, facilitate the immediate assessment, diagnosis and treatment of patients presenting with medical conditions. Patients are referred to the MAU by a case manager, their GP, Shannondoc, or through University Hospital Limerick, once it is established they are suitable for the service.

Since its opening in Ennis in 2013, the number of patients presenting at Ennis MAU has increased every year, with between 20 patients and 35 patients attending it every day. Following a comprehensive business case submitted by the University of Limerick hospital group to the Department of Health, the service was extended from a five-day to a seven-day service in May 2016. The then Minister for Health, Deputy Varadkar, visited the hospital where he received a comprehensive presentation from Dr. Tom Peirce, the consultant in charge at the MAU, on the merits of extending the service into the weekends. I was delighted when the service was extended. I compliment Dr. Tom Peirce and his team for delivering a top-class service to the people of County Clare. The stated aim of the MAU team is to have same-day diagnosis, treatment and discharge of patients whenever possible.

Last Tuesday, however, a misleading claim was made in the House that weekend MAU services at Ennis Hospital will be discontinued. That misinformed charge has led to unfounded headlines in local newspapers declaring proposed reductions in services at the unit. Following discussions with the chief executive officer of the University of Limerick hospital group, Professor Colette Cowan, and with the Minister for Health on several occasions yesterday, it is my understanding that the seven-day MAU service is secure and will not change. In fact, it will be improved with the construction of a new MAU area, a new minor injuries unit and a new radiology area.

I thank the Minister for being in the Chamber this evening, as he is now in a position to bring absolute clarity to this situation. Will he place on the record of the House the accurate position regarding the future of the MAU at Ennis Hospital? Such clarity is now required following the unfortunate events of this week.

I welcome this opportunity to provide assurance to the House regarding the continued operation of the Ennis MAU. I thank Deputy Carey for tabling this Topical Issue matter and providing me with a chance to allay any concerns in Ennis or County Clare regarding the continued operation of the MAU. I also acknowledge the presence of Deputy Harty, Chairman of the Oireachtas Committee on Health, in the House.

Ennis Hospital is a constituent hospital of the University of Limerick hospital group. As such, it plays an important role in meeting the health care needs of the population of the mid-west. The smaller hospitals framework, published in 2013, outlines the need for smaller hospitals and larger hospitals to work together in hospital groups.

The MAU in Ennis Hospital operates Monday to Friday, 8 a.m. to 6 p.m., and on weekends from 10 a.m. to 6 p.m. Patients are referred there for medical assessment by their GP or by Shannondoc via the Bed Bureau. The service is consultant-led and facilitates the immediate assessment, diagnosis and treatment of patients presenting with medical conditions such as chest infections, urinary tract infections, fainting episodes, anaemia or non-acute cardiac problems. The Ennis MAU opened in 2013. In May 2016, it became the first of the four MAUs within the University of Limerick hospital group to operate on a seven-day basis. The numbers of patients attending for medical assessment has increased over the past year, with between 15 and 25 patients assessed daily.

The hospital group chief executive officer, to whom I have spoken directly on this issue, has advised that the current concern surrounding the future of the seven-day service does not arise from any top-down initiative or proposal from the University of Limerick hospital group. I have also been assured by the Department and the HSE that, not only has no such decision been made, there is no such proposal from group management.

Deputy Carey will appreciate the executive and clinical directors are required to visit all hospitals in the group to review and discuss service delivery as per normal oversight arrangements and in line with good management practice. It is important that senior management and clinical directors would visit smaller hospitals to check data, assess how they are doing and look at the metrics.

In that context, I understand that last week the chief clinical director and clinical director for medicine met the team at Ennis Hospital and many issues, including the MAU, were discussed. The chief clinical director and clinical director for medicine sought data on the weekend usage of the Ennis MAU. This information will allow the executive to assess the impact and effectiveness of the MAU and inform how best the service can be optimised in the interests of the people of Clare. Ennis Hospital is integral to the proper functioning of the University Limerick hospital group. A properly functioning MAU and injury unit are essential to help minimise unnecessary presentations to the emergency department at University Hospital Limerick in Dooradoyle.

University of Limerick hospital group continues to identify opportunities to increase activity in Ennis Hospital. It is examining proposals to increase vascular and plastic surgery at the hospital. The national patient experience survey carried out in May 2017 found that 88% of all inpatients in Ennis were happy or very happy with their overall experience. This is a tremendous tribute to the staff and management at Ennis Hospital and the care they provide. The programme for Government commits to extending opening hours of MAUs. If anything, I want to see Ennis Hospital do more, as does the University of Limerick hospital group. We will look at other opportunities to do so. There is no proposal from the University Limerick hospital group, the HSE or the Department to reduce the opening hours of Ennis MAU.

I thank the Minister for bringing absolute clarity to this situation first-hand in the House. It is also reassuring to hear of the positive developments happening at Ennis Hospital. The retention of seven-day MAU services is important as the more patients who can be diverted from University Hospital Limerick, the better.

Notwithstanding the opening of a new €25 million state-of-the-art emergency department in University Hospital Limerick, there is an issue with bed capacity in the mid-west which is compounding the trolley crisis in University Hospital Limerick. The Minister is aware of the proposal to provide 96 additional acute beds in the hospital which has been submitted to the Department. Will this proposal be included in the capital plan to be published tomorrow? Will the Minister give us a sneak preview of it?

After receiving such clarification on the first matter, Deputy Carey is now trying to get me into awful trouble by having me reveal details of the Government's capital plan, which will be considered at the Cabinet meeting in Sligo tomorrow and will be published in the afternoon. He is correct that the people of the mid-west have been left without proper hospital bed facilities. Bizarrely in the past, Governments in boom times thought it was a good idea to reduce the number of beds in our hospitals. Thankfully, that is not the policy of this Government. We are committed to expanding the number of beds.

I commissioned a bed capacity review, which I published in full and which is available on my Department's website. It stated that even after the health service is reformed, we will still require 2,600 additional acute hospital beds by 2031. I am conscious that the people of the mid-west and in the University Limerick hospital group have a shortage of hospital beds and require more. I am pleased we were able to invest €25 million of taxpayers’ money in a new state-of-the-art emergency department in Limerick, serving the people of Clare. However, it is clear we need to put more beds in.

I am aware there is a 96-bed ward proposal from the hospital group. I would like that to be looked upon favourably. It is badly needed and should have been delivered years ago. It is terrible it was not delivered during the time of the previous economic boom. I am determined we will deliver it.

I am also conscious we need to relocate and redevelop the maternity hospital and move it alongside the acute adult hospital in Limerick. The Government knows the needs of the people of Clare. Deputy Carey and his Oireachtas colleagues from Clare highlight them regularly.

I hope that, as part of the €115 billion capital plan that we will publish, we will tomorrow be able to show good faith and commitment to the people of Clare in terms of advancing some of those important projects.

The outpatients department at Ennis general hospital has also been reviewed in terms of quality and capacity requirements. As the Deputy will probably know, the HSE is in the process of procuring new accommodation for the department, which I hope is good news for the people of Ennis.

Ambulance Service Provision

I appreciate the fact the Minister has attended to take this matter, given his particularly busy schedule today. He is also getting ready for tomorrow.

Approximately three weeks ago, a 13 year old girl waited for an ambulance for 50 minutes after she took seriously ill at her home in west Roscommon. She suffered a serious neurological attack. Only for the help of a neighbour, a former nurse, her family is convinced that she would have died. As the emergency occurred, her father rang 999 and was told that the ambulance would not arrive for around 50 minutes. It was coming from Sligo, which was the nearest an ambulance could be found. At this stage, the man's daughter was seriously ill. She was struggling to breathe and he asked for an emergency response. Without a doubt, an air ambulance should have been called in at that point, but none arrived. What a traumatic and stressful situation for any family.

When the ambulance arrived, the staff were excellent. In a short space of time, they stabilised the girl and her breathing and made her comfortable.

When the accident and emergency unit in Roscommon closed, we were guaranteed an increased ambulance service for the county. That has not happened. The people of west Roscommon have been left without a service. While I acknowledge that, from time to time, the air ambulance does a good job and gets to places quickly, this was a serious situation and one about which I am sure the Minister would be concerned.

In January 2016, an ambulance base was opened in Loughglynn, close to where the family lives in west Roscommon. However, no permanent ambulance staff are located there. An ambulance comes from Roscommon University Hospital and parks at the building when one is available.

Will the Minister consider putting in place a permanent ambulance team in Loughglynn to serve the vast countryside of west Roscommon? It is desperately needed, which is a message that the Minister has also been given by others. I hope that he will be able to bring solace to the people of that area so that they do not live in fear of being unable to get an ambulance quickly when it is urgently needed.

I thank the Deputy for raising this important and sensitive matter. I also thank him for telling me of the difficulty that a particular constituent of his experienced. It is important that such issues be brought to the floor of the House, as we are referring to real people when we talk about statistics, numbers, resources and decisions. I will ask the HSE and the National Ambulance Service, NAS, about the matter that the Deputy has brought to my attention.

Within Roscommon, the NAS operates from a number of bases. As the House will be aware, though, the NAS dynamically deploys resources to respond to incidents as they arise. This is achieved in the Roscommon area by dispatching resources from adjacent ambulance stations in neighbouring counties. Resources from ambulance stations including Carrick-on-Shannon, Tuam, Longford and Athlone can be, and are, deployed to incidents in Roscommon as required in addition to the resources of ambulance bases in Roscommon.

As the Deputy outlined, in order to develop services in Roscommon further, the NAS acquired the former Garda station at Loughglynn, refurbished it and opened it as a dispatch point in 2016. However, I take the Deputy's point. The ambulance service in west Roscommon has been reviewed a number of times in terms of available resources and demand for services. Since 2011, extra staff have been assigned to Roscommon to provide an additional 24-7 emergency ambulance and a 24-7 rapid response vehicle. In addition, an intermediate care vehicle has been deployed to Roscommon to undertake inter-hospital and inter-facility transfers.

As the Deputy alluded, Roscommon is well served by the Emergency Aeromedical Service, EAS, which operates from Custume barracks, Athlone. I am eager to see whether we can do more in the aeromedical space, since that would enable the EAS in Athlone to do even more in the Deputy's part of the country. That service was established to provide a more timely response to persons in rural areas and is available seven days per week in daylight hours. The service is specifically targeted at the west of Ireland, with the highest demand for services coming from counties Galway, Mayo and Roscommon.

The capacity review, which was the first review of the ambulance service that I published when I became Minister, examined overall ambulance resource levels and distribution against demand and activity. Future investment in ambulance services will be guided by that capacity review.

In recent years, year-on-year additional investment has been directed towards the NAS, but I accept that we have more to do. This year, an additional sum of €10.7 million has been made available, which includes €2.8 million to fund new developments in the ambulance service, for example, the development of alternative pathways to care, with the "hear and treat" clinical hub expected to go live soon in the national emergency operations centre. This will divert some lower acuity patients to alternative care pathways and will free up some emergency capacity. In time, it is hoped that such initiatives will help to improve response times around the country, including in the west Roscommon area.

I should also mention that the capacity review identified particular difficulties serving rural areas such as County Roscommon. Outside the greater Dublin area, the population is widely dispersed with a relatively large population living in rural areas. Due to this population distribution, Ireland has a far higher percentage of activity in rural areas than other ambulance services. This is something with which we must grapple. When we compare ourselves with other jurisdictions, our population is dispersed in a different way. That is a good and welcome thing, but it means that there are extra challenges in ensuring that we get ambulances to every part of this country as quickly as we would like. We need to approach these challenges head on.

As well as additional investment in the ambulance service, the review indicated that one of the practical ways of improving first response times was through our community first responder, CFR, schemes. I am pleased that the NAS is working closely with local CFR groups across the country in order to develop and enhance services.

I assure the House that the NAS is focused on improving the ambulance service in west Roscommon and throughout the country. I will bring directly to the NAS the concerns and points highlighted by Deputy Eugene Murphy on the floor of Dáil Éireann. I will ask that the NAS revert directly to the Deputy on those specific issues.

It was nice to hear the Minister say that he was worried about people rather than numbers. That is important. I acknowledge his statement that an ambulance can sometimes be in an area and get to a location quickly, but this happened after a family came home from church on a Sunday. That should have been a quiet day, but no ambulance was available in Roscommon to get there. Getting an ambulance from Sligo took 50 minutes. There was a shortage of ambulances in the area.

The Minister has acknowledged that there is a difficulty - we have a sprawling countryside. As he is well aware as a Member of the Dáil, however, our responsibility has to be to our people.

We must do our best for our people and serve them. That is why I am pressing this case so hard. I am grateful for the Minister's answer. Hopefully, there will be some progress towards putting the service in place. It would be welcome. If the Minister puts the service in place, I will be the first to stand up publicly and give him credit for doing it.

I agree with the Deputy that we have a responsibility to all of the people of this country regardless of where they live. In fact, in many ways we have a particular responsibility to people who live in rural and regional communities in terms of putting services in place. That is why we have increased the budget for the NAS year on year. We increased it by more than €10 million this year, including an amount of €2.8 million that will enable us to invest in more ambulances and paramedics. The Deputy will agree on the importance of the NAS following an evidence-based assessment and targeting resources in the areas most in need. I hear clearly the case that he and all Oireachtas Members from Roscommon make about the need for more resources for its ambulance service. I will pass those comments directly on to the NAS and ask it to contact the Deputy directly on this matter.