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Seanad Éireann debate -
Wednesday, 24 Jun 2015

Vol. 240 No. 14

Commencement Matters

Ambulance Service Provision

Táim ag ardú ceiste ar maidin a bhaineann leis an tseirbhís otharcharr i gConamara thuaidh. I raise the issue of the ambulance service in north Connemara, in particular in the Leenane, Maam, Kylemore, Renvyle and Clifden areas. An ambulance crisis steering group was set up in the area due to the concerns that exist and a number of meetings have been held with elected representatives. The group has given two examples to underline the seriousness of the situation. One case related to a young mother who was waiting for more than two hours for an ambulance while haemorrhaging badly a few days after giving birth. A second case related to a serious cardiac patient who presented himself to the doctor at 2.30 p.m. with chest pains. The doctor called an ambulance and it arrived at 4.50 p.m., and the man eventually arrived at the hospital at 6.45 p.m. The response from the National Ambulance Service at a meeting was that the resources are not available to put a workable solution in place. That is totally unacceptable. The group believes the National Ambulance Service, NAS, the Department of Health and the Government have a duty of care towards people and patients in rural areas such as north-west Connemara as much as to people living in other rural areas. We all fully understand living in rural areas creates delays, but we take issue with the often two to three-hour delays in waiting for ambulances to arrive to tend to patients. Their major concern is the waiting time between the call for an ambulance to attend and the arrival of the ambulance at the scene. Although the group has made numerous requests under the Freedom of Information Act for ambulance response times in the area, it appears the National Ambulance Service is reluctant to give the information. That is something I might follow up with the Minister.

A follow-up meeting was held with the National Ambulance Service at which various issues were raised and options were explored. It was put to the National Ambulance Service that the current service is totally inadequate with it regularly being the case that people are waiting more than two hours for an ambulance to arrive. That is the norm rather than the exception. In addition, people who are very ill then face a 50 mile or 60 mile journey. We appreciate that air ambulances are available but NAS helicopters cannot fly in darkness and while the Coastguard helicopters are available, they have only limited use. Both types of helicopter need areas in which they can land safely and an ambulance to transfer a patient to the helicopter, which gives rise to issues concerning that particular option. I noted the case of a man who was waiting for a very long time.

The ambulance crisis steering group has put forward a number of suggestions. There is a Red Cross ambulance in the area and it has been suggested a rapid response unit could be developed with two fully qualified and salaried paramedics being put in place to cover the area, but that would require the support of the Red Cross, the ambulance of which was purchased through fund-raising activities by the local community. Such an approach would have to work in conjunction with the National Ambulance Service. To date, the National Ambulance Service has not been open to such an option on the basis that the Red Cross ambulance is not up to the same standard as an NAS ambulance. People on the ground, however, say they would prefer a Red Cross ambulance than no ambulance or an ambulance that would take two hours to get to them. This is a very serious issue.

It is a remote area of north Connemara. We appreciate resources are tight, but the length of time people must wait for the ambulance service to get to them is completely unacceptable. They need a better response. We need to hear the Government response to this and how it intends to tackle the issue.

I thank the Senator for raising this issue. On behalf of the Minister for Health, Deputy Leo Varadkar, I am pleased to outline to the House current developments in pre-hospital services, nationally and in Connemara. Before doing so, I apologise on behalf of the Minister for his absence. On behalf of the Government, he is attending a funeral linked to the tragic events in California.

The National Ambulance Service is working to ensure high quality and timely emergency pre-hospital care, using all available resources as effectively and efficiently as possible. As with any pre-hospital service, development and modernisation is a continuous process as technology and clinical standards change. A significant and ongoing reform programme has been under way in recent years and it is important to acknowledge the progress being made. The single national control system, with control centres in Dublin and Ballyshannon, is now almost fully operational and is improving control and dispatch performance.

The National Ambulance Service continues to develop the intermediate care service which transports non-emergency patients between facilities, allowing emergency vehicles to focus on emergency calls. The intermediate care service now carries three quarters of non-emergency work. We are also moving to more efficient on-duty rostering and developing a national rostering system. The model of service delivery is changing. The National Ambulance Service is moving away from the care model where ambulance services are provided only locally from a fixed ambulance base in that area. It is moving to strategic deployment, with resources used across a region, in order that if demand increases in one area, other resources can provide cover as required.

Enhancements to the ambulance service in the west include the introduction earlier this year of 24/7 services in Tuam in Galway and Mulranny in Mayo. Accordingly, in addition to the existing 24/7 coverage for Leenane from Clifden ambulance station, under strategic deployment the new capacity in Tuam and Mulranny stations will provide greater coverage across north Galway and west Mayo in general, including Leenane. Also in 2015, an additional €5.4 million has been provided to improve technology and clinical audit and to address service gaps, particularly in the west. Some 50 additional paramedics are being allocated in the west this year under this process.

The emergency aeromedical support service, EAS, is further assisting service provision in the west. It allows swift transfer of seriously ill or injured patients from remoter areas to the most appropriate hospital. Over 1,000 EAS missions have been completed since June 2012. Galway, Mayo and Roscommon have the highest demand for the service. However, as HIQA noted recently, no feasible increase in resources will address all of the access issues in remoter areas. For this reason, the National Ambulance Service is working with communities to develop community first responder groups, local initiatives which provide basic life support in life-threatening situations until an emergency response can arrive. I understand CFR groups in Connemara currently cover Spiddal, Ahascragh, Moylough, Lettermore, Maam, Leenane and Turloughmore.

There has been ongoing investment in ambulances services and in their capacity and coverage, including in the west, in the face of some of the most stringent budgetary restrictions ever seen. I assure the House, on behalf of the Minister, that the national ambulance service is as focused as possible on addressing and improving services in the west in 2015.

I welcome the allocation of additional paramedics to the west, but apart from that, there does not seem to be much of a change in the situation and it will not assuage the worries of the people in north Connemara. Would it be possible for the Department to make the information on ambulance response times in this area available to me so that I can pass it on to this group in order that we can undertake an analysis of how serious the situation is in the Leenane, Maam, Kylemore, Renvyle and Clifden areas?

I will pass on the Senator's request to the Minister and the Department and check whether it is possible to make the information available.

Hospitals Building Programme

I wish to raise an issue I have raised previously in regard to identifying a site in Cork for a new hospital. We have three main hospitals in Cork, the South Infirmary, the Mercy University Hospital and Cork University Hospital. It is accepted that both the Mercy hospital and the South Infirmary have little space to expand to provide additional services and there is a need to identify a new site. A group was set up in 2009-10 to work on this and it presented a report to the Minister.

In the context of long-term planning, as we have seen in regard to the new children's hospital, which we have been talking about for over 25 years at this stage, we are still in a situation where we are only seeking planning. I understand it will be at least 2020 by the time that hospital project is completed. There is a similar situation in regard to this issue in Cork. We need to work towards a long-term plan for the health service in Cork. The population of Cork is over 526,000 and Cork is part of the regional hospital structure that includes Waterford, Kerry and south Tipperary and further afield. However, all of the specialist services seem to focus on the Dublin region. We need to identify areas where the existing services can be amalgamated and to work towards building a centre of excellence in the Munster region and Cork is the obvious place for it.

In terms of identifying a site, it does not matter whether it is in the docklands, the Blarney area or wherever, but we need long-term planning, and that will mean a plan covering a period of ten to 15 years for delivery. It is in that context that I raise this matter, calling on the Department of Health to accept the need for a new facility in Cork in the next ten to 15 years. The first step towards achieving that is to identify a site and we can then work from there. I am not talking about substantial moneys being spent immediately, but a proposed facility should be part of the overall plan for the health service. It should be accepted that this is essential for the development of the health service in Cork. I call on the Department to come on board with the HSE to identify a site and move forward on this issue.

I thank the Senator for raising this issue. Again, I apologise on behalf of the Minister for Health for his absence, as he is attending the funeral of a victim of the tragedy in California.

The Minister recently met the chairperson of the non-executive advisory board for reconfiguration of acute hospital services in counties Cork and Kerry to receive the board's final report. This report is the culmination of an extensive and pioneering process. The reconfiguration of acute services in counties Cork and Kerry has led the way for the development of hospital groups and the safer provision of services in smaller hospitals. Like most ground-breaking projects, it has not been an easy process but it has been the right one. It both anticipated and reflected developing concerns about smaller hospitals around the State.

In 2010 the report, Reconfiguration of Acute Hospital Services, Cork and Kerry: A Roadmap to Develop an Integrated University Hospital Network, was published following wide consultation. Following the 2009 review of acute services in counties Cork and Kerry by Horwath and Teamwork, the roadmap provided a practical guide for developing safe and sustainable clinical services in the region.

The plan involved integrating acute services into one hospital across six campuses. Complex care would be centred in larger facilities, with as much acute care as possible being provided locally. Professor John Higgins was appointed director of reconfiguration and the advisory board, chaired by Mr. Michael O'Flynn, was established.

The process has driven unprecedented change in acute care provision in the region. This has been achieved during extremely challenging economic times, with reduced budgets and staff numbers and increased activity levels. A major initiative was making the South Infirmary Victoria University Hospital the State's first dedicated elective hospital, in combination with the modernisation and reorganisation of emergency facilities across Cork city from five hospitals to two. The process is not yet complete. Since the roadmap, the south-south west hospital group has been established, in line with the hospital groups report. As the Senator said, the group includes acute services in Cork, Kerry, Waterford and south Tipperary. Therefore, there is now a need to fully integrate acute services in Waterford and south Tipperary into the wider group.

The road map recommended a single elective hospital in Cork, amalgamating the Mercy University Hospital and the South Infirmary Victoria University Hospital, to be built in a modular fashion over ten to 15 years. While the Minister acknowledges the board's recommendation, work needs to be done on assessing options and analysing the cost-benefit of any such project. Regarding site selection, a significant amount of work needs to be done before any concrete plan emerges that would support a rational and sustainable choice of location. The question of site selection would be a matter in the first instance for the south-south west hospital group, with input, as necessary, from HSE estates. The Minister and his Department would not have a direct role in that regard.

Regarding capital funding and site acquisition costs, the HSE would need to consider the proposal and prioritise the project in the context of other capital requirements around the country. The Minister and his Department would have no objection to any proposal to undertake an options appraisal for the new hospital, as well as a cost-benefit analysis, as the first steps towards assessing the viability of the proposal.

I thank the Minister of State for the reply and dealing with the matter in detail. I am concerned that the Minister and the Department would not have a direct role. The Minister is the person who develops policy. We are discussing reconfiguring the Mercy University Hospital and the South Infirmary Victoria University Hospital, which is accepted by everybody. However, we also need to examine the development of specialist services, in regard to which we are focusing on Dublin. The Minister can play a part in policy development. Not all specialist services should be located in the Dublin area. As part of the reconfiguration, we need to consider the development of specialist services for the entire Munster region. The Minister has a part to play in this and I ask that the matter be taken up with him, as I intend to do. The Department can become more proactive in the matter with the HSE. While the HSE is stating it cannot do anything because the Department has not given the go-ahead, the Department is stating it is not its problem, given that it is up to the HSE to come back to it. The Department should indicate to the HSE that it needs to progress the matter and that it will give serious consideration to what it states. The reply does not seem to indicate this, rather it seems to pass the matter back to the HSE. There is a need for clarification in the matter.

As the Senator said, the Minister is clear that, in the first instance, it is for the HSE to identify sites. I have been involved in the issue, on which I have met the HSE and local doctors. Contrary to the view the Senator has taken from the response, the crucial element is that the Minister and his Department have no objection to any proposal to undertake an options appraisal, which seems to be very reasonable to start the process, as well as a cost-benefit analysis. These are obvious and realistic first steps towards assessing the viability of the proposal. A cost-benefit analysis would almost certainly confirm the Senator's view of needs and requirements in the southern region. Not all specialised services are to be located in the Dublin area, as the Senator suggested. On the contrary, there is a strong commitment to the provision of services, particularly in the second most densely populated area of the State. The Minister, in making the point that, in the first instance, it is not a matter for the Department, leaves an obvious route for local engagement for the HSE and the group in the southern region to pursue with him his support for a cost-benefit analysis and an appraisal of the options for the location of a new hospital.

Sitting suspended at 10.55 a.m. and resumed at 11.30 a.m.
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