The first item selected is in the names of Deputies Sorca Clarke, Ruairí Ó Murchú and Aodhán Ó Ríordáin. They wish to discuss the revised special education teacher allocation model and the calculation of the set allocation for schools for the year 2024 to 2025. This matter was raised earlier and was addressed by the Minister. I call Deputy Clarke.
Saincheisteanna Tráthúla - Topical Issue Debate
Special Educational Needs
Deputy Ó Ríordáin is not here yet and he is listed to speak first, but we will go ahead.
Yes, people have to be here when it is their time to speak.
Every child has a constitutional right to an education and everyone agrees that no child should be left behind. Last month, the National Council for Special Education, NCSE, published its report, An Inclusive Education for an Inclusive Society, which shows a majority of those who engaged with the consultation agreed that children, even those with special educational needs, should be educated in the same school as others. However, they expressed fears about supports in mainstream schools for students with complex needs. The recalculation of allocation for special education teachers does nothing but compound that fear. Some 76.4% of those who engaged in the National Principals Forum survey said that primary school allocations next year would be wholly inadequate and 37% of principals reported a decrease in their allocation despite evidence that classrooms have a higher number of children with additional needs than ever before. The Irish National Teachers Organisation, INTO, believes that for children with multiple needs, these allocations are fundamentally flawed and that the over-emphasis on literacy and numeracy fails to take into account those multiple needs and is in effect counterproductive to the excellent work teachers do to improve literacy and numeracy as it may result in decreased allocations. Inclusion Ireland has said that the decision to remove complex needs will make an already broken system even less accessible for children. AsIAm has said that this change will impact on the most vulnerable children in schools who require the highest levels of support and they risk receiving less support this September as a result of these changes. Ultimately, it will push more students from mainstream education into special schools or special classes, re-enforcing the words of those who took part in the consultation with the NCSE.
Will the Minister of State please review this decision? It is not only those of us on this side of the House who are saying there is a problem. It is groups who are involved in the lives of the children who are most impacted by this decision who are saying it. Parents are saying it. Schools are saying it. Everyone is saying it. I ask the Minister of State today to review the decision.
The Minister of State will appreciate that this is extremely serious. This is the third time I have raised this. I raised it with Deputy Gannon the other night in oral questions and with the Taoiseach yesterday. We would not be raising this if it were not for the deluge of schools making contact with us. They are horrified about what these changes will mean for them. They cannot get their heads around why complex needs have now been taken out as a criterion. In presenting this as a positive adjustment, the Minister of State said that 67% of schools will have enhanced hours or will remain the same. That means that 33% of schools will lose out. She says it will be no more than five hours, but for those schools that is a very detrimental change.
The Minister of State has spoken about the wide-scale consultation she undertook and Department officials are saying the same, but the INTO has said this is fundamentally flawed. Other lobby groups in this area are saying the same. There does not seem to be anyone who agrees with the Minister of State on this change. On that basis, I agree with other speakers that she must review this, put a stop to it and start again.
This is straightforward. We have had an over and back. Like Deputy Ó Ríordáin, I brought it up with the Taoiseach and the Minister of State. As I told her recently, I happened to meet representatives of Scoil Mhuire na nGael in this House and they said they initially thought they may lose two teaching positions and they will definitely lose one. Fiona Mhic Chonchoille of Scoil Naomh Lorcan, Omeath contacted me to say that special education teachers were at their wits end. We are hearing about increased numbers but we are not seeing it. We are talking about kids with complex needs who at this point in time might be scoring highly in maths and English, but if they do not get the supports on the basis of their complex needs, as other speakers have said, they will be forced into special schools. We need to look at these anomalies and deal with this.
I thank Deputies for their contributions. As they correctly pointed out, I have already spoken to most of them on this matter. A number of different misperceptions have been presented in the House and I hope I can address them.
First, there have not been any cuts to special education teacher, SET, posts. There are now more SETs than ever before. This year there will be 14,600 SETs, which is an increase of 1,000 from last year. In the past ten years the number of SETs has doubled to the record figure of 14,600. It is also important to remember that this model does not change the fact that 90% of children with additional needs are in mainstream provision. This is a distribution model to ensure that the children with the greatest level of need in mainstream education can get access to additional teaching support. It provides a transparent means of allocating SET resources to best meet the needs of children and ensure consistency and equity in the system.
Deputies will be aware that this model was introduced in 2017 and there was some criticism after that so the model was updated in 2022, based on feedback from schools and stakeholders. Any updates to the model since then do not change the key principle, which is that the teacher and school know best which children require SET support.
The 2017 model was not updated every year, but rather every two to three years. The model did not keep pace with mainstream allocations and changes to school populations and therefore special education need, SEN, profiles in the school. This was especially true of developing schools, which are those that are rapidly increasing enrolments. As the demographics moved from primary age to post-primary age, there was no mechanism to move the SET support to where it was most needed. Schools expressed concerns that the supports from the HSE to include speech and language therapy and occupational therapy were not routinely available. Therefore there was concern that the HSE would not have a full understanding of the complex needs in the school. Schools were also concerned that some children in their schools were on waiting lists with the HSE and they would not be reflected in the HSE data, even if the data was returned in full. Schools also reported that girls had SENs but these were largely masked or undiagnosed in younger age groups unless they were very complex. Complex needs in girls tend to appear at a later age, but manifest in different ways, including later.
As a number of assertions have been made about the lack of engagement, it is important to stress again that a total of 30 meetings were held as part of the development process, which included 12 consultation sessions that were held with education partners, including management bodies and staff representatives, in the development of the updated model. There was significant engagement with education partners on this. In addition, the NCSE undertook approximately 40 reviews with individual schools to get their feedback for incorporation into the updated model. There have been assertions that complex needs will not be taken into account. That is not correct. The complex needs that were provided for by the HSE since 2017 have been inconsistent, increasingly so in recent years. The data on complex needs was sourced from the HSE which had developed criteria to determine eligibility for access to the children's disability network teams, CDNTs.
For 2023 to 2024, only 5% of verifiable data was returned from the CDNTs despite numerous follow-ups. This meant that for schools for which no data was returned, even when there was a significant need, they would lose resources to those small schools for which there was a return. This created as a by-product a serious inequity in the distribution of resources.
The Minister of State said there are more special education teachers than ever before. There is also evidence that classrooms have a higher percentage of children with additional needs than ever before. I go back to that broken system that Inclusion Ireland spoke of. The Minister of State is familiar with Sarah Dooley, who has been in contact with her office. This is the real-life impact of that broken system. Her sons, John and Patrick, have applied to 19 schools but have not received one offer. Both little boys have ASD and global development delay and are non-verbal. This is the reality whereby parents of children with additional educational needs are consistently and constantly being met with road blocks and blockages to their accessing the constitutional right to education.
It seems from the Minister of State's reply that because one element of Government is making a bags of how it treats children with additional needs, the Minister of State has to take up the slack because children are languishing on waiting lists for assessment and, therefore, the Department of Education has to change its allocation model because the data is not available. It is a complete failure of the entirety of Government. It appears the Minister of State's view is that she is right and everyone else is wrong, including the INTO, AsIAm, individual parents and individual schools. Nobody has been suggesting that there have been cuts to the overall number of special education teachers. The Minister of State should not say that. We are saying that it will have a disproportionate negative effect on a number of schools. They are all pretty horrified by the change. Can we pause it or put a stop to it, have another round of collaboration, negotiation and consultation, and then revisit the issue? The Government cannot continue as is because there is a lot of hurt out there.
That is it. We could all name parents and multiple schools - I am afraid to ring any more of them - who think they will be detrimentally affected by the hours that they require to provide the supports for children with special educational needs. I know engagement has started with some of the officials in the Department, and I welcome that. However, on the basis of what the INTO and others have said, and even the information we have put forward, we must look at these cases from the point of view of not being able to deliver and that children will not get the resources they require. Therefore, we have to at least consider that this allocation model needs to be reviewed if it is to deliver. If there is an issue regarding HSE information, that will need to be dealt with but we know we need to have flexibility, particularly when dealing with children with complex needs who are being failed across the board.
There are 3,000 special classes in the country. We have advanced planning and forward planning consistently. Every child known to the NCSE received a place last year and that will also be the case this September. I do not accept the argument that a significant amount of work has not been done or is not being done with regard to special classes in general. However, if the Deputies have a particular case, they can let me know about it and we will engage on it. I am not saying that anybody is wrong. I am saying I must refute the assertion that has been made to me on numerous occasions that there was no engagement or insufficient or improper engagement. Thirty meetings have been held as part of this development process and 12 of those consultation sessions were held with education partners. I am answering with regard to engagement and it is important that this is noted.
A review process is available. Schools can fill in an application form for a review on the NCSE website and submit it through the school portal. It is important that this is done. This new model provides a solid foundation for a roadmap of continuous enhancement over the coming years. No complex needs hours have been removed from the model. The hours have been reapportioned as an indicator of educational need. Complex needs are measured in two ways. First, those students who are performing at the lower levels in standardised tests that indicate the greatest level of need for additional learning support and, second, the pupils with more complex needs and who have been exempted are given the highest weighting within the model.
Antisocial Behaviour
I cannot help but acknowledge that there is no representative from the Department of Justice here. This is probably the third time I have raised a Topical Issue on the issue of safety in and around Dublin city centre and neither of those-----
If a Deputy is unhappy and wants the Minister from a particular Department to be present, the Department is supposed to liaise with Deputies and if a Deputy indicates to it that he or she is not happy and wants to wait until the Minister is available, we will always facilitate that.
Absolutely but it is also important to put on record that I received a communication from the Department of Justice that did not offer a change. The Minister of State, Deputy O'Donnell, will do in terms of dealing with this issue because there is an immediacy to it. I want to discuss chronic law-breaking not just in the north inner city of Dublin because it is wider than that. I will break it down to be a bit more specific. Like most people around the Chamber, I am spending most evenings knocking on doors and talking to people in the run-up to the referendums and the local elections. The issue that comes up consistently is the issue of law-breaking, open drug-dealing, antisocial behaviour and the feeling that this has no consequences.
It takes a multitude of different forms. When I am up around Dominick Street, the issue is people hanging around the Luas stop, jumping on the Luas trams, snatching phones, jumping off at the next stop and moving on and people attacking students around the DIT campus. On Dorset Street, which is a gateway to the city, there is a high level of dereliction, an issue that comes under the brief of the Minister of State. With regard to the laneways off Dorset Street, there is a feeling that there is an acceptance that drug dealing will happen there without any degree of enforcement. If I move down towards the Royal Canal way that goes into the IFSC, this beautiful renovation undertaken by Dublin City Council in the past number of years has become a no-go zone. It is a place where you will see any number of predominantly younger children, who themselves are victimised by being brought into this trade, flying up and down on scooters delivering different packages from one end to the next to the detriment of people's safety in the area. Up in Hardwicke Street, there is also the belief that open drug-dealing is being tolerated. I am certainly not the first to say that in this Chamber over the past four decades.
There is a belief among the residential communities in the north inner city that what is happening happens without consequence. I do not doubt for a second that there has been a large increase in the number of gardaí in the commercial city centre, which is really welcome because people have to go about their business there. However, the residents of that environment obviously do not feel that their minimum expectation of being able to open their door and go about their day feeling safe has been met. That is really frustrating. I do not for a second believe there is only a policing solution to this issue. I think it is far more complex but in the immediate term, people just want to know that if they call An Garda Síochána, a garda will turn up and that they can go about their day without seeing people in a chronic condition of chaos, which also seems to be tolerated. That is the problem. Wherever I go knocking on doors around the north inner city, people highlight the feeling of being unsafe and that is because they are unsafe.
Beyond that, there is a core belief that the authorities and indeed the State do not have these people's back. They rightly say that what is tolerated in the north inner city would not be tolerated in any other part of the city or country. When I attended a meeting of residents in Dorset Street a couple of weeks ago, they highlighted the dereliction, the decay, the absence of lighting and the poor visibility on the laneways. They made a comparison between Dorset Street and other arteries into the city such as Ranelagh where the sequence of streets is almost the exact same but where there is a world of difference regarding what is tolerated. Once again, I have come in pursuing answers and I hope the Minister of State can give them to me. We need a greater degree of action.
I am taking this matter on behalf of the Minister for Justice, Deputy McEntee. I thank Deputy Gannon for raising it. In fairness to the Deputy, he has raised it on many occasions.
As the Deputy may be aware, the Government's approach to the misuse of drugs is set out in Ireland's national drug strategy, Reducing Harm, Supporting Recovery. This is a health-led approach to drug and alcohol use in Ireland and it represents a whole-of-government response to reduce demand and associated harm. The Government is also committed to limiting access to illegal drugs to the greatest extent possible.
At a local level, An Garda Síochána continues to target those involved in the sale and supply of illegal drugs through Operation Tara. Operation Tara, which has a strong focus on tackling street-level dealing across the country, also seeks to disrupt and dismantle the drug trafficking networks that impact on our communities and prosecute those involved at every level. Recent successes of Operation Tara include the seizure of €500,000 worth of drugs in County Kildare on 5 January, €235,000 worth of heroin in Dublin and Meath on 3 January and a further €80,000 worth of various drugs in Dublin on 16 January.
Let us also not forget that in 2023, Ireland saw the largest drug seizure in our history when a vessel carrying a significant quantity of controlled drugs was intercepted off the southern coast. These drugs were almost certainly destined for the Irish market but, thankfully, the vessel was intercepted and the drugs seized before they reached our communities.
More generally, An Garda Síochána has received an unprecedented budget of over €2.35 billion for 2024, including provision for the recruitment of between 800 and 1,000 gardaí. The Garda Commissioner has assured the Minister, Deputy McEntee, that whatever resources are needed to ensure the continuation of high visibility policing in Dublin, they will be made available. In the past year, 280 new gardaí have been assigned to the Dublin region, including 115 since mid-December, adding to the resources that Garda management have available to provide a high visibility policing service in the city centre and beyond.
There are a number of ongoing Garda operations in Dublin to combat crime and antisocial behaviour. Operation Citizen continues to reassure the citizens, visitors and business community that Dublin city centre is a safe place to visit and socialise in.
Community safety is about people being safe and, importantly, feeling safe in their own community. The Dublin North Inner Local Community Safety Partnership continues to ensure that local communities and service providers work together to identify the actions needed specific to their local community to ensure it is a safe place to live, work in and visit. There is also the north inner city task force, which is chaired by Mr. Jim Gavin.
In line with these goals, the Minister was pleased to launch the Dublin partnership safety plan last September. The plan outlines 50 actions across five priority areas aimed at addressing community safety concerns in the north inner city, including drug-dealing, antisocial behaviour and improving the physical environment.
In my role as Minister of State with responsibility for local government, I gave a commitment to the Deputy that I would make contact with the new CEO of Dublin City Council, Mr. Richard Shakespeare, and I have done so. The Deputy is probably aware that the council launched a new antisocial behaviour strategy in December. It is increasing the number or staff in the antisocial behaviour unit from three to seven and is in the process of recruiting the extra staff. The unit, which will be headed up by a senior executive officer with seven staff, will deal with one aspect, namely, antisocial behaviour.
I appreciate the concerns of the community the Deputy represents. That is the up-to-date position from the Minister for Justice on Garda resources and operations. I have also outlined my interaction with Dublin City Council as Minister of State with responsibility for local government. I await the Deputy's further contribution.
I thank the Minister of State for his comprehensive reply and appreciate his response on an issue I raised previously. That is highly beneficial.
I noted that a lot of young people are being groomed into the drugs industry. They are given electric bikes and then zoom up and down different networks and pathways in the area. I fully believe that those young people are victims. I am not looking for a criminal response but a pathway out of this.
The Minister of State has responsibility for local government. The pitches in Fairview Park come under the auspices of Dublin City Council. Sheriff YC, East Wall Bessborough FC and Belvedere Youth Club are all football teams which have done incredible work over the years in providing outlets for young people who might otherwise be at risk. Their pitches have been destroyed. This issue has captured a lot of attention over the past couple of months. It was initially caused by a car driving through Fairview Park. We then had a couple of different motorbikes in the past couple of weeks. This means that young people, who we are keeping a very tentative hold of, cannot play their games on Sundays. I probably would not have raised this issue if the Minister for Justice had been present but since the Minister of State is here, I ask him to intervene to get those pitches back. That would be brilliant in terms of providing an outlet.
On the issue of improving the aesthetic of the north inner city through the Minister of State's brief, the residents of the streets surrounding Dorset Street consistently highlight the fact that the appearance of Dorset Street creates a sense that nobody is in control. It looks as though it is in decay and lawlessness has been allowed to fester. I ask the Minister of State to speak to Dublin City Council about how to improve that thoroughfare into the city. We should be doing that. People coming into the city from the airport go through the area. All the other streets look much better than Dorset Street. We also need zero tolerance of open drug-dealing and street-drinking. Residents need to feel that when lawlessness and law-breaking occurs, the State has their back by responding in a way that would be viewed as a matter of course in other communities.
I ask the Deputy to send me a structured email so that we can formally follow up with Dublin City Council on the issues he has raised on behalf of the people he represents.
On behalf of the Minister, Deputy McEntee, I thank the Deputy for raising this issue in the House. While the Minister for Health and his Department lead the Government response to drug use, tackling this issue will continue to be a priority for the Minister, Deputy McEntee, and her Department.
As the Deputy is aware, the Government has agreed to establish a committee to consider the report of the Citizens' Assembly on Drug Use. We hope to have the committee up and running soon and that it will report back within seven months. The Deputy referred to younger people being victims. That will form part of the committee's considerations.
For An Garda Síochána, the priority in respect of drugs is to disrupt and dismantle organised crime gangs and drug-dealing operations and to remove illegal drugs from circulation.
The Government has taken a number of steps to tackle antisocial behaviour and criminality. These include providing An Garda Síochána with its largest ever budget to support a highly visible Garda presence on our streets; giving An Garda Síochána the tools and technology to fight crime in a digital era by rolling out improved CCTV and body-worn cameras which, we hope, gardaí will have in use in the next number of months; increasing a range of maximum sentences, including for assault causing harm and assaulting a peace officer; introducing facial recognition technology to help solve serious crime; increasing the number of judges to improve the efficiency of the courts; and increasing the number of prison spaces by 400.
The Minister and Government will continue to ensure gardaí have the necessary resources to build stronger, safer communities, including in Dublin city centre and the inner city.
Hospital Overcrowding
It is clear Connolly Hospital is in crisis. Everybody will be shocked by some of the reports that have come out in the past week alone. I raised this matter with the Tánaiste some weeks ago when a concerned member of staff contacted me about the closure of the endoscopy unit in Connolly Hospital, which had been under serious pressure. I wrote to the hospital and received an email in reply stating, "As part of the HSE Winter Unscheduled Care Planning in Connolly Hospital, elective procedures have been temporarily reduced for the month of January." I sent the email from Connolly Hospital to the person who contacted me and who had obviously listened to the exchange between the Tánaiste and me on the day in question. The individual in question wrote:
It needs to be addressed that Connolly does not have enough beds for the population it is serving [the Minister of State should bear in mind that this was several weeks ago]. The ED department is under huge pressure all the time and the numbers being returned are not reflecting the true situation. The hospital are using the line that procedures have been cancelled due to the winter initiative if that is the case the winter has been going on since last winter. They are outsourcing procedures to other hospitals ... However there are still large numbers waiting and referrals still coming in.
That was two weeks ago. We have since had other reports.
Speaking on the radio the other morning, the INMO's Phil Ní Sheaghdha described the conditions in Connolly Hospital as "inhumane". She said: "When the HSE does not plan knowing what happens every winter this is the type of immediate reactionary solutions that hospitals are trying to find because there simply isn’t enough capacity.”
A member of staff put their neck on the line by saying there is a serious crisis in the endoscopy unit and also mentioned the emergency department. The nurses organisation has said the conditions in Connolly Hospital are inhumane. Another nurse, who contacted Dublin Live, described the situation there as “chaotic” and a danger to patients. She said:
Moving patients into these totally inappropriate areas is not fair on patients or staff. This room has been set up as a ward but there’s no bell if someone becomes ill and there’s no extra staff allocated.
There’s no toilet or shower facilities and there’s also a very long walk down a corridor to the nearest toilet. This area was never in a million years for people to stay over[night], never mind use it as a ward.
They have recently repurposed it in the hope to get around 12 patients in there. It means there are no physiotherapy facilities for people recovering ...
They have repurposed a physiotherapy gym to deal with the overcrowding in Connolly Hospital. This is really serious. We know that people die in emergency departments if they are on trolleys and not getting appropriate care. I do not know how anyone could not feel shocked listening to the stories from the staff, the people who work there. It is utterly shocking.
I am taking this matter on behalf of the Minister for Health, Deputy Stephen Donnelly. I thank Deputy Paul Donnelly for raising the question of overcrowding at Connolly Hospital, Blanchardstown. Connolly Hospital, Blanchardstown, is a major teaching academic hospital within the RCSI Hospitals Group. It has a catchment population of upwards of 331,000 people and serves a mixed urban and rural catchment, including Finglas west, Lucan, Dublin 15, north Kildare and south Meath. In addition to 24-hour emergency care, scheduled services include acute medical and surgical care, acute psychiatric services and outpatient diagnostic, therapeutic and support services. It is recorded that there has been a significant increase in demand for emergency care nationwide in 2024, with approximately 122,000 emergency department attendances in January. This is an increase of 10% compared with the same periods in 2022 and 2023.
The Department of Health has been in communication with the RCSI Hospitals Group and understands that Connolly Hospital, Blanchardstown, experienced a surge in emergency department attendance in early February. Having done my own checks, that surge occurred on 7 and 8 February. In response to this surge and following a risk assessment, on the night of 7-8 February, some suitable patients were transferred from the emergency department to an appropriate ward area while awaiting discharge. The priority was to reduce clinical risk and relieve pressure on the emergency department. I checked this and the area in question is a physiotherapy department, not formally a gym, and it is not longer in use as a ward area for the emergency department.
The Minister's officials have been in ongoing contact with the RSCI Hospitals Group on this issue. I understand how difficult this has been for patients and staff. The priority was to reduce clinical risks and relieve pressure on the emergency department at that time. The area is no longer in use for that purpose.
Urgent and emergency care pressures are no longer just experienced during winter periods and prolonged levels of high daily presentations and congestion are now being experienced throughout the year. Presentations to emergency departments of those aged 75 years and older were up 33% and 26% nationally compared with the same period in 2022 and 2023, respectively. As of 9 February, 1,126 non-ICU acute beds have been provided nationally over the number available in January 2020. This includes 78 beds in Connolly Hospital.
The Government is committed to the development of large hospitals such as Connolly Hospital, Blanchardstown. A number of key projects are under way at various stages at Connolly Hospital. The Taoiseach met hospital management in December to discuss the developments at the hospital.
The new Connolly education and research centre aims to transform the educational programmes and enhance the student experience for graduate entry medicine students and clinical placement students based at the hospital. This new building is well on the path to completion, with all structural works completed and internal works progressing. Construction is due for completion in May 2024 and the building should welcome the first intake of students later this year. A dental education centre, including endocrinology, rheumatology and an infusion suite, is also planned for Connolly Hospital, Blanchardstown, and a second CT scanner will be provided for diagnostics services at the hospital.
This investment underlines this Government’s commitment to improving services for the people of Blanchardstown and the surrounding area. The Government recognises the valuable work done by the staff in Connolly Hospital and aims to support the ongoing development of services at the hospital.
While I recognise the difficulties caused to patients, the physiotherapy unit used to relieve pressure on 7 and 8 February is no longer in use for that purpose.
I thank the Minister of State for his answer. I expected statistics, including the extra 78 beds, to be mentioned. It is completely understandable that there will be emergencies and pressures at times. There will be times when the hospital is overcrowded due to certain circumstances, whether it be a flu epidemic or respiratory issues. However, this is not something that happened in January or February 2024 or December 2023. In 2018, in an article in the Irish Independent, the current Minister of State, Deputy Jack Chambers, raised exactly the same questions as those I am asking today. He stated that hospitals should not have to suspend vital screening of patients that may show up cancer. He also stated:
These day wards and beds are inappropriate to be used as a spillover for seriously ill inpatients being admitted to overcrowded A&Es. It is particularly troubling when this surge in emergency departments' admissions was entirely predictable.
That was in 2018. The INMO warns year after year that this crisis will happen - not that it has happened but that it will happen. Staff who are working in these departments are telling us that this is not just a problem in the winter of 2023 or 2024 but is an annual winter issue. In fact, winter does not stop in some of these hospitals.
While I understand that some work has been done and a limited number of extra beds have been provided, it is clear that what is being done is not enough when we have people in completely inappropriate places, there are no alarms, no extra staff and no way for people to shower or access toilet facilities. This is in a modern hospital in this day and age. The Minister of State, Deputy Chambers, made those comments in 2018, so this is not something new. It happens year after year. I guarantee, if we are here this time next year, that I will probably seek a Topical Issue debate on exactly the same issue unless we get to grips with it.
I appreciate the Deputy’s contribution and his genuine sentiments on the surge in attendance at Connolly Hospital, Blanchardstown. I also thank him for raising this important topic and acknowledge that he has raised other issues.
The Government understands how important it is to make quality patient services available to people in Blanchardstown and everyone across the country. As I outlined, Connolly Hospital experienced a surge in attendance at the emergency department on the night of 7-8 February. It took the decision to reduce clinical risk to patients by transferring some suitable patients to an appropriate ward. It was a physiotherapy ward. It is not formally a gym but part of the physiotherapy department. As stated, the hospital's priority was to reduce clinical risk and relieve pressure on the emergency department. This ward is no longer being used for that purpose.
The increase in numbers of attendees is also being felt on a national scale, with emergency department attendances in January 2024 up by 10% compared with the same periods in both 2022 and 2023.
There are a number of capital developments in train at Connolly Hospital designed to improve patient experience, including the education and research centre and laboratory transfer, a second CT scanner and a dental education centre including an endocrinology, rheumatology and infusion suite.
The Government and the Minister for Health are committed to the ongoing development of services and care in Connolly Hospital and will continue to support the hospital in developing its valuable services into the future.
Ambulance Service
For the past 12 years in Roscommon there has been an advanced paramedic on the rapid response vehicle on a 24-7 basis. This was committed to by both the HSE and Fine Gael after the accident and emergency unit in Roscommon was closed in 2011. It was specifically to ensure there would be advanced life support always provided, given the accident and emergency unit was no longer there. At that time, a specific and separate roster filled by advanced paramedics for the rapid response vehicle was put in place and stayed in place until last year. I stress this was part of the improvements committed to for the ambulance service in County Roscommon because of the accident and emergency unit closure. At the time, the HSE promised an enhanced ambulance service.
In 2015, Leo Varadkar, when asked about this, stated a rapid response vehicle crewed by an advanced paramedic providing 24-7 cover in Roscommon was one of the significant improvements made to the ambulance service in Roscommon because of the closure of the accident and emergency unit. He went on to state his intention to drive further improvements in the ambulance service in Roscommon. Instead of that, it was quietly decided last May that a paramedic would fill a place on the advanced paramedic roster. I do believe this was very much done quietly.
I want to make it clear that is not acceptable to the people of Roscommon. The commitment given cannot be rowed back on and the roster of advanced paramedics needs to be restored immediately.
On contacting the National Ambulance Service about downgrading this last year, I was told the rapid response vehicles are resourced by both paramedics and advanced paramedics, that this is not unique in Roscommon and that it happens elsewhere nationally. That misses the point I have already outlined, not to mention the fact people living in Roscommon are further from an emergency Department since 2011.
The latest reply I received from the HSE went a step further in telling me paramedics and advanced paramedics are essentially the same thing, that in recent years paramedics have been upskilled to be able to carry out duties similar to those of advanced paramedics and that there is little difference in their skill set. That is a new one to me. Advanced paramedics are the only staff in the National Ambulance Service that can currently provide advanced life support. Advanced paramedics can administer 23 additional medications for acute emergency medical and traumatic conditions. For example, if a patient is in cardiac arrest, an advanced paramedic can put in an IV line and give enhanced cardiac drugs to increase the patient's chance of survival. Only an advanced paramedic can do this and that is clearly laid out by the Pre-Hospital Emergency Care Council in its documentation.
I want to be clear in saying I am not in any way taking away from the role of paramedics. They are critical to the ambulance service across the State. My point is that there was a commitment made by the Government and HSE to the people of Roscommon and that commitment has been broken. I ask that the roster of advanced paramedics be restored for County Roscommon immediately.
I am taking this Topical Issue on behalf of the Minister for Health. I thank Deputy Kerrane for the opportunity to update the House on delivery of ambulance services in Roscommon, including the important emergency response role carried out by the rapid resource vehicle, RRV.
I am informed that in the context of the National Ambulance Service emergency response operations across the country, RRVs are routinely resourced by both advanced paramedics and paramedics. In this regard, I have been assured that the National Ambulance Service is in full compliance with Pre-Hospital Emergency Care Council regulatory emergency response dispatch standards. I am sure the Deputy will appreciate the rapid advances in pre-hospital emergency care practitioner skills sets made in recent years.
I am also informed that a vacancy on the emergency ambulance roster arose last year, which has been offered via a national transfer process. I made inquiries on this matter and the update I got was that the National Ambulance Service has advised the transfer window is not open yet but is expected to be open by the end of this month. The last window was December. That was unsuccessful so the position will be offered again this month.
Turning to ambulance service resourcing in Roscommon more generally, the National Ambulance Service serves the county out of three bases located in Roscommon, Boyle and Loughglinn, which all operate on a 24-7 basis. All three bases are staffed by a highly skilled workforce of intermediate care operatives, paramedics and advanced paramedics, and a fleet of modern emergency ambulances, intermediate care vehicles and RRVs. I note that in the past three years National Ambulance Service staffing in the county has increased by nearly a quarter. It has gone from 26 whole-time equivalents in January 2021 to 32 in December just gone. That is an increase of six, which is 23%.
I acknowledge the engagement by the Deputy in relation to the National Ambulance Service's Loughglinn ambulance base. Ambulance resources in the Roscommon region are deployed by the service dynamically in line with international best practice, which allows the service to prioritise resource allocation to the highest acuity calls that require an immediate response.
The National Ambulance Service is also a vital partner in supporting the delivery of the HSE’s urgent and emergency care plan through development and expansion of a range of clinically appropriate alternative care pathways to improve patient flow and reduce pressure on emergency departments. In this regard, I particularly welcome two alternative care pathway developments last year in Roscommon which involved the implementation of medical assessment unit and local injury unit patient pathways for 112-999 patients who, where deemed clinically appropriate, do not require treatment in a busy hospital emergency department and can be better looked after in an alternative care setting.
The further development and expansion of initiatives such as these in Roscommon are vital in transforming the delivery of urgent and emergency care, improving patient access to care and enhancing patient healthcare experiences and outcomes. I know the National Ambulance Service is committed to providing these going forward. I extend my sincere thanks and gratitude to the staff of the National Ambulance Service and to all the ambulance services for their commitment and dedication to patient care in County Roscommon and across the country.
Gabhaim buíochas leis an Aire Stáit. I thank him for taking this matter on behalf of the Minister, Deputy Donnelly. I have two points to counter the one that keeps being thrown back that RRVs everywhere are routinely crewed by either a paramedic or an advanced paramedic. That is well and good but the point is the commitment was made that an advanced paramedic would be there 24-7 to cover Roscommon, specifically because of the closure and loss of the accident and emergency unit. It has been in place for 12 years and last May, very quietly, it was decided all of a sudden we did not need a full roster of advanced paramedics and would instead replace one with a paramedic. That is paired with the fact the people of Roscommon are now further from an emergency department than when the accident and emergency unit existed.
Those were the two grounds on which this commitment was made. It was made by the HSE and Fine Gael. The accident and emergency department was lost to the people of Roscommon. They were promised a very advanced ambulance service and now, from what I can see, that is being downgraded very quietly.
The paramedic and the advanced paramedic do not do the same job and do not have the same skills. That is outlined very much by the Pre-Hospital Emergency Care Council, which the Minister of State referenced in his response. There are 23 additional medications the advanced paramedic can administer. In cases of cardiac arrest, which is just one such instance, the advanced paramedic can act in a way that will see that patient more than likely have a better chance at survival. Only they can administer that medication and it is absolutely incorrect to suggest both types of paramedic do the same job and have the same skill set. That is not correct.
I ask that the Minister of State bring this back to the Minister, Deputy Donnelly, because what has been outlined this evening is not satisfactory. I again ask that the roster of advanced paramedics that was committed to and promised by the Minister of State's party and the HSE be restored immediately.
I thank Deputy Kerrane. I will take back the points she raised to the Minister. In my opening statement I concentrated for the most part on ambulance resourcing and some recent alternative care paths in County Roscommon. I will now focus on the service nationally and touch on the investment in our National Ambulance Service and its future plans.
This Government has invested very significantly in the National Ambulance Service in recent years. This year the total National Ambulance Service budget will comprise €227.7 million. This represents an overall increase of over €58 million or nearly 35% from that allocated in 2019, which is the last complete year unaffected by Covid-19. As a direct result of this investment, the National Ambulance Service workforce has also grown substantially, with over 2,300 whole-time equivalents as of December 2023, which represents an overall staff increase of some 37% since December 2015.
Such investment has also allowed for the National Ambulance Service to undergo a significant programme of strategic reform from a conventional emergency response and conveyance service to an agile, mobile, medical service involving the introduction and development of a range of "See and Treat" and "Hear and Treat" alternative care pathways designed to treat growing numbers of patients at the most appropriate level of clinical need in the most appropriate care settings. I can tell the House a new National Ambulance Service strategic plan is at an advanced stage of development. The new strategy will look to build on recent progress and further align the NAS more closely to wider healthcare reforms with a focus also on bridging gaps between patient demand and available capacity.
I conclude by reiterating my acknowledgement of the professionalism and dedication of the NAS’s talented workforce, including in Roscommon, and to thank it for the essential service it continues to deliver for us all every day.