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Dáil Éireann debate -
Wednesday, 13 Jul 2022

Vol. 1025 No. 4

Saincheisteanna Tráthúla - Topical Issue Debate

Ambulance Service

I thank the Minister of State, Deputy Feighan, for taking this matter, although I was hoping it would be the Minister for Health, Deputy Stephen Donnelly. I am seeking an update on the site for the new ambulance base for Carlow town and the delays people are experiencing in waiting for ambulances.

I welcome the announcement of the new ambulance base. This went into the capital plan recently, which is welcome. My understanding is the site is at Kelvin Grove, Carlow town. I want an update on the project and its timescale. As the Minister of State knows, ambulance paramedics in Carlow are in a prefab that is unfit for purpose. It is now 2022 and I think it is unacceptable that ambulance paramedics, who do an excellent job, are in a prefab. I am looking for an update on that issue.

My second question is about ambulance waiting times. I have spoken over the years to several ambulance paramedics. My opinion is that the system is wrong and needs to be looked at. When people call for an ambulance, for many, it can be the luck of the draw as to where an ambulance is at that particular time.

I received an email from a constituent who stated that he was waiting for an ambulance in Carlow town for over an hour. He made several calls but no ambulance arrived. He ended up having to go to his neighbour's house to get a lift to the hospital. Luckily, this was not a life-and-death situation but he highlighted it to me. In another case, a young man had been knocked down and was lying in a recovery position. To be fair, he had been attended to but, again, my understanding is that it was well over an hour before the ambulance arrived. In the next case, a man contacted the office who had an emergency call-out to his house. This man is 75 years old. When the emergency arose at 9 p.m., the doctor rang for an ambulance but the ambulance did not arrive until 12.50 a.m. that night. The man is a diabetic with a heart condition and has been in hospital with a very serious condition.

I want to know if anything else can be done in such situations. This is by no means a criticism of any work that is being done by the ambulance paramedics. Is the system working? Do we need more staff? What do we need to do to address this? The Minister of State knows it is wrong to have a 75-year-old man waiting in his home for an ambulance to call. It is unacceptable and we need to address it. Again, I stress it is the system, not the work that the ambulance paramedics are doing.

As the Minister of State is present, he knows I have been raising the issue of the primary care centre for Tullow for the last few years and I am looking for an update on that. If he does not have it tonight, I ask that he would put that in his correspondence to me when he comes back with an answer.

I thank the Deputy for raising this issue, which she has raised on numerous occasions. Since 2016, the National Ambulance Service, including its south-east region, has undergone significant reform and modernisation involving the prioritisation of investment in new service developments, including increased workforce and fleet, and improved technology. Since the end of 2016, National Ambulance Service staffing resources nationally have increased from 1,744 as at December 2016 to 2,037 at the end of May this year, an increase of 293 whole-time equivalents, representing over 16.5% growth in staff over that timeframe. This year, an unprecedented €200 million has been allocated, which includes over €8 million for new service developments. This funding will be invested in building capacity, as well as increasing staffing within the “hear and treat” service in the national emergency operations centre, which advises lower acuity patients of appropriate alternatives to hospital transfer.

As the Deputy knows, Carlow ambulance base is an integral part of the ambulance service and has two emergency ambulances on duty at any one time. The base is supported by National Ambulance Service resources from surrounding ambulance stations, including Baltinglass, Athy, Kilkenny, Portlaoise and Enniscorthy. Dynamic deployment of available resources operates on an area and national basis, rather than a county or geographical boundary basis, to ensure optimum resource use as the nearest appropriate resource is mobilised to the location of an incident.

The priority of dynamic deployment is patient health and welfare in the context of service delivery, which means resources cannot be confined by county boundaries, barriers or borders. The national ambulance service operates a comprehensive safety management system across all of its premises throughout the south east and continues to work collaboratively with staff, the HSE capital and estates unit and external providers to ensure any concerns or issues that occur are dealt with as quickly as possible.

I am happy to confirm that the Carlow ambulance base is included in the capital plan for 2022. The HSE capital and estates unit has been in discussions with the ambulance service regarding the need for a replacement ambulance base for Carlow. As the Deputy mentioned, the Kelvin Grove site has been identified as a possible suitable site. A design team is engaged for the preparation of a development control plan, which will indicate whether it is feasible for the proposed ambulance base to be included along with two other facilities planned for the site. Once the site appraisal is completed, a capital submission will be prepared.

Given the work entailed and the timeline to move from identification and assessment of a suitable alternative site to the completion of works and building handover, remedial and refurbishment works at the existing station have been carried out to address shortcomings in regard to health and safety requirements. Further improvement works are planned for later this year. All projects being progressed must be compliant with the public spending code. The final decision to proceed with the construction of a project cannot be made until the tender process has been completed and the costings reviewed to ensure the proposal remains affordable and delivers value for money.

The Deputy mentioned the proposed primary care centre for Tullow. I do not have any information on that but I will take her views to the Minister and try to get a reply as quickly as possible.

I thank the Minister of State. It is important that there is communication with us and with ambulance paramedics. I know the great work that is being done and the number of call-outs that are being achieved, especially during the Covid crisis. Will the Minister of State come back to me with more definite timescales and outlining the framework plan? It is important that we have a specific timescale because of the urgency of the situation. I know there are other projects earmarked for delivery, such as the plans for the Holy Angels day care centre, which is another excellent project for Carlow town. I welcome that. It is important that we get moving on the ambulance base as soon as possible and that information is communicated and updates given. I ask the Minister of State to keep that in mind and to keep me informed.

I would be very glad if he can come back to me on the primary care centre for Tullow, which was meant to have been built two years ago. I still have not found out what site has been identified for it. There is an urgent need for this facility in Tullow. I ask for it to be a priority and for the Minister of State to come back to me on it. I thank him for allowing me to raise two issues.

We are almost at the end of the session and I am happy to help the Deputy. I thank her for raising the issue of the provision of an ambulance base in Carlow town and for allowing me to outline what has been done to help people experiencing delays. A significant programme of work is under way to transform the national ambulance service from an emergency medical service to a highly adaptable and responsive mobile medical service that is well positioned to treat patients at the lowest appropriate level of acuity, resulting in a better experience for the patient and the more efficient use of resources. A programme of reform and modernisation has been under way within the service, which includes increasing the fleet and technological improvements.

The Deputy asked for updates and timescales. I will try to get those from the Department. As she knows, Carlow ambulance base is an integral part of the ambulance service, with a replacement ambulance base included in the capital plan for 2022. That is good news.

Work is under way on identifying and securing a feasible site. The Deputy has raised this issue several times and it is nice to have some good information for her.

She is getting two for the price of one as I will also follow up on the primary care centre for Tullow as quickly as I can.

I thank the Minister of State.

Ambulance Service

Thart ar bhliain ó shin, tháinig mé féin, an Teachta Ó Cuív agus an Teachta Connolly le chéile agus d'ardamar cheist faoi otharcharr Chonamara. Bhí rath leis an gceist sin. Ó shin, tá fhios againn go bhfuil otharcharr ann. An fhadhb atá ann faoi láthair ná nach bhfuil an base ann, rud atá fíorthábhachtach.

This time last year, na Teachtaí Ó Cuív and Connolly and I came together to highlight the urgent need for an ambulance service in the Conamara area, which had been lacking that service for some time. We were quite lucky and successful in our request and an allocation has been made in this regard. The issue we are trying to get to the bottom of now relates to the provision of an ambulance base in the area.

As Deputy Farrell said, we had nothing this time last year. Since then, we did very well in getting an extra ambulance, an additional emergency vehicle and 11 staff. A decision has been made on where the base will be located. What we are missing now is the building. The delivery of all the extra services we were promised was done in record time, between September and December last year. I remember the Minister of State, Deputy Rabbitte, promising to take action on this matter when we raised it a year ago. Now we are looking to the Minister of State, Deputy Feighan, to do something very simple. Will he make sure we get the ambulance base in Recess, Connemara gan tuilleadh moille?

Tá an dream seo ag streachailt ar an talamh le breis agus seacht mbliana. De bharr na hoibre atá á ndéanamh acu, i dteannta le Teachtaí Dála, tá dul chun cinn déanta. Progress has been made but this issue has been going on for more than seven years. The local group has kept up its campaign and kept the pressure on us. Approximately one year ago, as my colleagues said, we raised this matter in the House and progress was made on the provision of extra staff, an additional ambulance and a rapid reaction team.

However, the undertaking to provide an ambulance base seems to have no substance. One might say it has no base and that is where we need the Minister of State's help. The project is with the HSE's capital and estates unit, as I understand it. We certainly need pressure to be applied in this regard. I checked the file and it was seven years ago, in 2015, that action was first sought on this issue. For the group to stay together for that length of time indicates how serious this is for people in Maam, Recess, Clifden and Oughterard.

I thank the Deputies for raising the important issue of ambulance services in Connemara. It is an issue on which good progress has been made but it has been going on since 2015. I am aware that the Deputies are engaging with the proposals for an ambulance base in Connemara. I can confirm that the project for a new ambulance base, to be located in the village of Recess, is in the HSE's capital plan for 2022. I am advised by the HSE that preparation for works at the new facility is at an advanced stage. In the interim, national ambulance service crews in north Connemara are being deployed from a base in Clifden. This temporary measure will remain in place until works at the building in Recess are completed and the site becomes operational.

I am aware that response times remain a challenge. As previously stated in this House, a 2016 national review of ambulance capacity has highlighted that, in many instances, the most effective way to improve emergency response times in rural areas is through community first responder schemes. Community first responder groups are comprised of trained volunteers who are supported and dispatched by the national ambulance service. These groups respond to particular medical emergencies, such as cardiac arrest, respiratory arrest, chest pain, choking and stroke, while an emergency response vehicle is en route to the patient. A total of 177 community first responder groups are operational across the country, including 12 groups in County Galway.

I fully appreciate the need to make progress on the new facility in Recess, and I have received reassurances that this project is being progressed. Currently, the HSE estates unit is engaging with the local authority regarding road access for the proposed base, and it is anticipated that a planning application will be submitted in quarter 3 of 2022.

This year an unprecedented €200.7 million has been allocated to the NAS, and this includes €8.23 million for new developments. This funding is being invested in additional front-line capacity as well as increasing staffing within the hear and treat service in the national emergency operations centre, which advises lower-acuity patients of appropriate alternatives to hospital transfer. Overall, the funding for new service developments will allow for the recruitment of 128 additional whole-time equivalent staff.

I reiterate that the Government is committed to continuous improvement in the NAS, in response to the increased need we continue to see across the country. Investment in capacity increases is best illustrated by the 200 student paramedics currently enrolled in the NAS college on various stages of the BSc. (Hons) Paramedic Studies programme, and the 2022 NAS recruitment programme for paramedics, student paramedics and intermediate care operatives which launched earlier this year. I assure Deputies that the NAS is focused on improving patient care, clinical outcomes and response times in rural areas, including through the ambulance base project in Recess, and that the Government is invested in facilitating these strategic developments.

I do not understand how much of this answer relates to the specific questions we asked. From what the Minister of State has said, I take it that preparations for the new facilities are at an advanced stage. In the interim, deployment is occurring from the base in Clifden. As Deputy Connolly said, the reality is that this campaign group has been fighting for a long time. To be perfectly honest, and I say this as a member of the Opposition, this was a good news story for the Government that it had delivered in respect of an ambulance. I do not understand why it is not following through to the last bit to try to get this project through as fast as possible. This base is extremely important for the people in the local area. The Minister of State said there is a challenge in respect of waiting times. A challenge in this context can mean death for people in respect of waiting times. Therefore, I would like to see this project pushed through.

I thank the Minister of State for his reply, two small paragraphs of which related to the specific issue. I accept and always believed that planning permission would be required for this project. The Minister of State said in the answer that this would be applied for in the third quarter of this year. The third quarter is July, August and September. This is 13 July, and if the application for planning permission does not go in this month, I cannot see all that much progress being made in August because different people will be coming and going. Can we get a firm commitment that this timeframe will be adhered to, because there will be a minimum of at least three months after the application has been submitted before planning can be legally approved, and that is if there is no appeal? Therefore, we need this to keep moving forward. It will be well into next year before this building is completed. We accept that we must go step-by-step, but we need absolute confirmation that these deadlines will be adhered to.

Gabhaim buíochas leis an Aire Stáit. Is dea-scéala é i ndáiríre. Tá sé deimhnithe anseo faoi dhó go bhfuil rudaí ag dul chun cinn, go mbeidh cead pleanála riachtanach agus go mbeidh sé á chur i bhfeidhm le linn an tréimhse trí mhí seo idir mhí Iúil agus mhí Mheán Fómhair. It is late at night and I welcome any good news at this point after a long week. In the two relevant paragraphs, the Minister of State has told us he is advised that the new facility is at an advanced stage. I have to welcome this. It is good news. He then told us that a planning application will be made in the quarter we are in now. As was pointed out by Deputy Ó Cuív, we are going into the holiday period. Looking back at the progress made since 2015, certainly the politicians have had something to do with it, but far more praise must go to the group on the ground. It is a small, dedicated group of people who have gone through winter, summer and all the other seasons. Over the two elections in my experience, they have pushed for this. We will not go into the figures because the time is up, but we need absolute certainty regarding this facility.

I thank the Deputies again for raising the issue. I assure the House the Government remains committed to ensuring the NAS delivers an enhanced service in Connemara through the establishment of the new base in Recess. I reiterate that this region is receiving additional support in the interim through the temporary crewing deployment arrangements I outlined. The strategic development of the NAS is a multiannual reform programme that will require continued investment in response to identified capacity deficits and changing population need.

I am aware the Deputies have been engaging with proposals for an ambulance base in Connemara. It is good to confirm that the project for the new ambulance base is in the HSE's capital plan for 2022. Preparation is in train for works at the new facility. This is at an advanced stage. In the interim, NAS crews are being deployed from Connemara. I fully appreciate the need to make progress on the new facility. The project is being progressed. The HSE estates unit is engaging with the local authority regarding road access for the proposed base. It is anticipated that a planning application will be submitted in the third quarter of 2022. Deputy Ó Cuív made a valid point. This is the third quarter of the year and we are coming into the summer holidays. I am very aware of the work of the HSE estates unit in the west and north west. I will get onto the Department tomorrow to find out whether it has made an application. If an application is not made by the HSE estates unit through the local authority, this project could be delayed. There is urgency and I hear what the Deputies are saying. I thank them for raising this important issue.

Social Insurance

The Minister of State, Deputy Brophy, is taking the matter in the absence of someone from the Department of Social Protection. His background of being self-employed is appropriate to answer this query. This matter stems from a constituent who is almost a neighbour of mine. He retired at the beginning of 2022. This query is also in the context of trying to encourage more people to make provision for private pensions and the auto-enrolment system being introduced by the Department. The matter centres on a specific point. The constituent in question and others who have approved retirement funds, ARFs, and who receive an annual income from those funds of €5,000 or less are not liable for PRSI on it. There is an exemption for self-employed PRSI on income under €5,000.

However, this was not brought to the attention of the individual and is not brought to the attention of others in a similar position. As we move forward, I suspect a great many people may potentially be caught in a similar situation. When my constituent contacted the Department of Social Protection, he was allowed, as we all know, a four-year refund, which is the maximum the Department and Government agencies allow. The problem is that he paid his 4% contribution for more than ten years. As a result, he has suffered the loss of six or seven years of PRSI contributions. When he contacted his insurance provider, he was directed to the Department. The Department quite rightly, understandably and efficiently refunded him four years of payments but he was left at a loss for the rest. There is a clear lack of communication that this anomaly exists, not least a lack of communication with the public who have invested in ARFs.

It is also unjust that people have been making contributions which they were not required to and were not forewarned about. I spoke directly with the Minister, Deputy Humphreys, about the issue earlier today. I realise that I may not have phrased the Topical Issue matter accurately when I submitted it this morning, but it does raise the question that there is a cohort of people who made contributions for which they will receive no benefit. They made PRSI contributions that they were not obliged to make and they will be at a loss because of them.

It is incumbent on the Department of Social Protection, in the first instance, to communicate this issue to the public when they are deciding to contribute to the approved retirement funds, ARFs, and the insurers to make that information clear to people when they are deciding to make provisions for their retirement. This anomaly exists and I suspect quite a few people will be surprised when they reach retirement age and discover that they should not have been paying a contribution for which they will receive no benefit.

I am aware the Deputy raised this matter directly with the Minister, Deputy Humphreys, at an earlier meeting. I am taking this Topical Issue matter on her behalf.

Social insurance coverage was extended to self-employed workers in 1988. Since then, self-employed workers whose income is €5,000 or more in a contribution year, are liable to pay a social insurance contribution at the class S rate of 4%, subject to a minimum annual payment of €500. Self-employed contributors are currently covered for a wide range of social insurance benefits, including the contributory State pension; the contributory widow's, widower's or surviving civil partner's pension; the contributory guardian's payment; maternity, adoptive and paternity benefits; the invalidity pension; the partial capacity benefit, if in receipt of the invalidity pension; the self-employed jobseeker's benefit; and the parent's benefit.

The scope to the charge of self-employment social insurance contributions and the underlying nature of self-employment are wider than those that apply to contributions payable by employed contributors. A person is defined as a self-employed contributor on the basis of income received rather than economic activity. Unearned income falls within the scope of self-employment for social insurance purposes, both for the purposes of paying self-employment contributions and for establishing possible entitlements.

Drawdowns from the approved retirement fund are chargeable to income tax and are reckonable emoluments for social insurance purposes. The social insurance class S charge is deducted at source by fund managers for people aged under 66 years, or if the recipient of the distribution is a modified class contributor, the charge is recorded as class K.

The Social Welfare Consolidation Act 2005 provides that an application for the return of contributions shall be made within four years of the last day of the contribution year in respect of which the contributions were paid. I know the Deputy acknowledged this in his contribution about the case he raised. This timeframe is in line with the Revenue time limit for the refund of taxes. As is the case with tax refunds, there is no discretion within the governing legislation to allow contributions to be returned outside this limit.

I know, as most people do, that Revenue has no wriggle room in terms of refunds beyond four years but, on the other hand, there is always wriggle room to chase up unpaid taxes. This is understandable but it should work both ways. I realise that in the context of this Topical Issue debate, we will not be able to change the four-year rule. I will endeavour to speak with the Minister and the Minister of State afterwards and ask them to ensure that this anomaly is flagged when people are considering contributing to the ARF, and that it will become mandatory for the insurer taking these contributions to notify those who will be in receipt of an annual income from this source of less than €5,000, that a PRSI contribution is not required.

I note from the Minister of State's response that self-employed contributors are entitled to receive a wide range of social insurance benefits. I know that PRSI contributions fall under all sorts of different categories, but several benefits that are available to other PRSI contributors, such as dental and other benefits, are not available to the self-employed.

I return to the original issue raised. The person I referred to was not self-employed. They worked in different pay as you earn, PAYE, jobs but for the purposes of calculations, they effectively became self-employed when they used part of their income for the ARF 12 years ago. This put them into a new category that they we not previously aware of. The Department should be to the fore in resolving that lack of clarity and information.

I hear very clearly what the Deputy said about clarity around the information. I will raise this with the Minister on behalf of the Deputy, as I know he did earlier. As I outlined, there are parameters within which this takes place, in particular, the four-year time limits, which is consistent with the process in other areas. The Deputy's key point on providing clarity of information and awareness to people is very important and I will continue to raise that with the Minister on his behalf.

Lobbying Reform

This is about Uber. I pay tribute to the International Consortium of Investigative Journalists for its excellent work in publishing the Uber leaks. It revealed a major corporation, valued at $44 billion, setting itself up as a disrupter, a modern company and so on, but in reality pursuing the old, tried and tested methods of major capitalist corporations.

One, it highlighted major exploitation of workers. These people provide nothing more than an app and made themselves incredibly rich, by driving down terms and conditions across the world.

Two, Uber used money to buy political influence and was willing to go to any ends to achieve its aims. It is worth quoting one of Uber's people who said, "Violence guarantee[s] success. And these guys must be resisted." He called for a counter protest to be organised in Paris against taxi drivers in order to create violence to drive through Uber's programme. What did it look like in this country? It looked like Uber writing the manifesto for Fine Gael. The election manifesto of 2016 states, "New platforms are being developed that allow everyone to earn extra income in this sharing economy." It sounds great. Is it accurate, as John Moran claims and Uber accepts, that this was effectively written by Uber? Did Fine Gael or Uber write it? It was an incredible case of corporate capture by the largest political party in Ireland at the time. I have another question. Does that continue? Is lobbying ongoing? Is there a relationship between lobbying and the statement of the leader of Fine Gael, the Tánaiste, a month ago when he again said that Uber could be brought into Ireland, going against the advice of the National Transport Authority, NTA?

The third point, which we will perhaps go into later, is the fact that much of the lobbying went unregistered.

There are two really important factors at play. The first is about lobbying and the relationship between former officials, lobbyists, Ministers, senior Government officials, advisers, and in this case, Uber and the Fine Gael Party, in addition to the privileged access lobbying affords. Revelations clearly indicate that not all of the lobbying was documented or revealed, and recording of such details was deliberately avoided.

The second factor is transport policy. The NTA is actively encouraging people into the taxi industry to address a shortage of taxi drivers but, as recently as 17 June, the Tánaiste - the man who would be Taoiseach in the next number of months - is advocating for the introduction of an Uber- or Lyft-style model to liberalise the market. If you are someone who is considering entering the taxi industry but the Tánaiste is saying that we should consider introducing an Uber-style model, what decision will you make? That model fundamentally undermines the industry. Will the Minister of State put on record the Government's position on the future of the taxi industry as it relates to Uber?

I thank the Deputies for raising this matter. I am answering on behalf of the Minister for Transport.

The Minister for Transport, Deputy Eamon Ryan, met Uber representatives on 10 June 2022. At that meeting, Uber stated that it was satisfied with the regulatory structure of the SPSV industry in Ireland, as it was clear to the company how it could legally operate here.

The Department and the NTA are committed to the existing regulatory arrangements. The Minister is encouraged to hear that the NTA's driver recruitment campaign is, to date, 25% ahead in the number of applications received in comparison to its 2019 campaign. The campaign has been running since 4 July and will be open for a three-week period.

As a member of Fine Gael, does it trouble the Minister of State that Uber wrote a section of its election manifesto in 2016? Does he know if that is the case and, if so, does it trouble him? Does it trouble him that Mr. John Moran, a former political insider and Secretary General of the Department of Finance, was boasting to Uber about how he could effectively bypass the regular registered lobbying practices by getting personal access to the then Minister for Finance, former Deputy Michael Noonan, by dropping over to his house or sending him a text or because he knew at which pubs to find him? Does it bother the Minister of State that much of this actual lobbying, which should have been registered, was not? What is the Government's plan to ensure this kind of practice cannot be followed again and does not have to be revealed by leaks?

The Minister of State did not touch on the lobbying issue at all. There is much that needs to be done in that regard. My colleague, Deputy Mairéad Farrell, introduced the Regulation of Lobbying (Amendment) Bill 2020, which the Government kicked down the road. Among other matters, this is something to which the Government must revert.

I am reading significantly into the Minister of State's final comment that the Department and the NTA are both committed to current transport policy. In fairness, Mr. Hugh Creegan of the NTA has resisted changing it and the NTA's position has been clear. The question is, what is the position of the Government and, specifically, Fine Gael? There is a crisis in the taxi industry. We need to hear from the Government that it is committed to a regulated taxi industry and shares the concern about a deregulated or unregulated competing model. I believe the officials stated that they could not see how the two "could rationally co-exist". Please, will the Minister of State put on the record that we will not see the introduction of an Uber-style model in the taxi sector?

To make it absolutely clear, I am answering as a Minister of State on behalf of the Minister for Transport. Ireland's SPSV regulatory framework requires that all drivers and vehicles be licensed as a means of protecting the consumer and helping to ensure public safety. Furthermore, no special regulations have been developed to govern the carriage of passengers by passenger cars that are not SPSVs. Therefore, the classic model where anyone with a car and the relevant app may provide taxi services does not exist here. The Minister for Transport believes that the protection of the consumer and personal safety are vital objectives and must continue to be central to how the SPSV industry is regulated and operated.

Cuireadh an Dáil ar athló ar 12.07 a.m. go dtí 9 a.m., Déardaoin, an 14 Iúil 2022.
The Dáil adjourned at 12.07 a.m. until 9 a.m. on Thursday, 14 July 2022.