Emergency Aeromedical Support Service: Statements

I welcome the Minister of State, who has five minutes.

I am delighted to have an opportunity to speak about this issue in Seanad Éireann this evening. I spoke about it earlier in response to a Commencement matter raised by Senator McFadden.

The emergency aeromedical support service, the EAS service, which is based in Custume Barracks, Athlone, is an important service provided by the Air Corps. Notwithstanding the well-documented, ongoing HR challenges in the Air Corps, in particular the recruitment and retention of pilots, the EAS service has been delivered without interruption since 2012. It is a service that I have prioritised and that will continue into the future.

I received military advice that the Air Corps will not be in a position to accept EAS taskings by the National Ambulance Service for four days per month for a period of four months. This is regrettable but necessary from a safety and governance perspective. During this time, there will be a training surge to produce a new cohort of aircraft commanders for the EAS service. This will ensure the long-term viability of the EAS service provided by the Air Corps.

The safety of service personnel, HSE staff and patients is the shared number one priority and our whole focus is returning the EAS service to full capacity.

On the 16 days when the Air Corps will not be accepting taskings the Irish Coast Guard will provide reserve cover for the National Ambulance Service. This is line with the 2015 Government decision to establish the emergency aeromedical service. In addition, Irish Community Rapid Response, ICRR, charity helicopter emergency medical service, HEMS, has agreed to provide additional cover using a second helicopter which will be based in County Roscommon on the days when the Air Corps will not be in a position to accept taskings for the emergency aeromedical service. The ICRR helicopter will also continue to be available in the south of the country. I assure Senators that my entire focus is on returning the emergency aeromedical service to full capacity. In that regard, a number of measures are being pursued. They include the reintroduction of the service commitment scheme for pilots, the recommissioning of former Air Corps pilots and the training of junior pilots during this period.

The emergency aeromedical service provided by the Air Corps has completed more than 2,600 missions since it commenced operations in 2012. I pay tribute to the professional and effective service provided by Air Corps personnel. I also acknowledge the support of the Irish Coast Guard and ICRR during the current challenging period. The shared priority is to provide the best service possible using all available resources during the four-day period each month when the Air Corps will not be available for EAS taskings. The interruption is regrettable but necessary from a safety and governance perspective. I assure the House that the emergency aeromedical service operated by the Air Corps will continue. I am delighted to have another opportunity to outline the position on the issue.

I welcome the Minister of State, Deputy Kehoe, back to the House.

Lives are being put at risk as a result of the standing down of the air ambulance service operated by the Defence Forces for 16 days over the winter period due I understand to a shortage of pilots between this week and the end of next February 2020. It is extremely concerning for the regions in which people rely on the service to save lives. It will put pressure on this vital service which is used to transfer critically ill persons in need of urgent medical care. The emergency aeromedical service which has operated out of Custume Barracks in Athlone since 2013 has been one of the services hardest hit by the recruitment and retention crisis which is affecting the Defence Forces, into which I do not intend to go in any great detail as we are discussing a specific matter.

I urge the Minister of State to, please, look at the crisis. I understand he has known about it since 2015, following the workplace climate survey conducted by the University of Limerick and departmental reports that indicated an apparent lack of operational experience and mentoring and supervision in the Air Corps. Unfortunately, instead of moving back from the brink in dealing with the retention crisis in the Air Corps, the Minister of State has ignored the red flags, which has resulted in operational capacity going over the cliff edge, with contagion to other services. When was the Minister of State made aware of the difficulties the service was experiencing and what steps has he taken and is taking to try to alleviate the problem? I again thank him for coming to the House to deal with the issue.

I am sorry for dragging the Minister of State, Deputy Kehoe, into the House, but these are important issues that need to be aired in public. My colleague, Senator Wilson, has addressed the issue of the high-level group within the Defence Forces and the Department of Defence that met in 2015 and 2016. It is my understanding its recommendations were ignored until July this year. All of the delivery dates, on which the Taoiseach gave assurances in July, have passed and nothing has been done.

So as not to take a lot of the Minister of State’s time, I will go through a number of questions very quickly. He has said Irish Community Rapid Response is going to provide cover from County Roscommon during the time when the Air Corps service will not be available. I understand the organisation has one helicopter. From where is the second helicopter coming? Is it being chartered? If so, who will pay for it and what will the cost be?

Is it true that if the number of pilots falls by another one or two, the emergency ambulance service stationed in Athlone will not be available in March? How can the Minister of State guarantee that the service will available into the future? It is my understanding there is a need for ten crews to make the service viable and that we are down to three. Given that senior officers are being deployed to Athlone from Baldonnel, what assurances can the Minister of State give that there is proper supervision in the home base in Baldonnel of the people they will leave behind when they move to Athlone to take over flying duties? Will the Minister of State explain why we are not paying the senior officers who put their lives at risk in carrying out emergency flights all over the country which, as he has pointed out, have been extremely successful the same allowance as other pilots? Will he give me an assurance that they will receive the same allowances as every other pilot who flies, regardless of rank? If they are in the air, they should receive their allowances.

The Minister of State adverted to the recommissioning of pilots. It is my understanding two lieutenant colonels have been recommissioned, neither of whom is flying in an operational capacity. Will they fly as lieutenant colonels or as administrative officers? What other pilots are in the pipeline to be recommissioned in the near future?

We find ourselves in a situation where the people of counties Roscommon, Mayo and Sligo and in various other rural parts of the country are really worried about the availability of helicopters. Many of those watching the debate need to know where we are precisely on all of these issues.

I thank the Minister of State, Deputy Kehoe, for coming to the House again. I will not rehash everything I said earlier when I sought and received assurances from him that the air ambulance service would continue to operate fully from Custume Barracks in Athlone, something I feared would not happen.

There has been reference to the number of lives saved by the air ambulance service. I referred earlier to the 159 car accidents that had occurred and 15 seriously ill children. Councillor John Dolan from Athlone was lifted by an air ambulance. If that had not happened, I believe he would not be with us today. It is a really vital service and I appreciate the Minister of State’s commitment to it. However, I cannot fail to mention the reason we have a difficulty is related to the difficulty in recruitment and retention which comes down to pay and conditions. There is no point in my rehashing the arguments because the Minister of State is as aware of them as anybody else.

The Minister of State has referred to three things that he is doing, one of which is reintroducing the service commitment scheme for pilots. The second is the recommissioning of former Air Corps pilots, while the third is providing for the training of junior pilots in the next four months. Will he elaborate a little on each of these points? I would like to know what he means by the reintroduction of the service commitment scheme for pilots. How many junior pilots are there and will the number be enough to have the ten teams that are necessary to keep the ambulance service going from Athlone?

There is no point in rehashing all of the arguments. Some people are using this issue for political gain, which I do not think is good. We should acknowledge that the Minister of State has come back to the House a second time. I appreciate the fact that he gave me a clear commitment earlier that the air ambulance service would be fully operational after 1 March and that it would stay in Custume Barracks in Athlone.

I thank the Minister of State for coming to the House. The top Army official has put the blame for the cutbacks in the air ambulance service such that the service will be withdrawn for 16 days this winter squarely on the Minister of State and the Taoiseach. Incentives were put in place to entice pilots to stay in the Air Corps but it is clear that they have not worked. This is not a new problem. As other Senators mentioned, it goes back to 2015. The issues of recruitment and retention in the health service and the Air Corps have been staring us in the face, but there has been no planning. We have lost much organisational experience which cannot be passed on to the younger people who may have taken over, although they are few and far between. It is disappointing that, like many other sectors, air ambulance services will be dependent on charity. The Irish Community Rapid Response does an excellent job and will step in with its helicopter.

In June 2018, my colleague, Deputy Ó Snodaigh, asked the Minister of State about the then recent decision to grant a contract worth €7 million for night time ambulance services to a commercial company. The Minister of State acknowledged that capacity constraints within the Air Corps impacted on the services it provided, including services to the HSE. Obviously, there was a service level agreement with the HSE and the Minister of State was of the opinion it could not be met, so the service provision went to a commercial company.

In April 2018, Deputy Ó Snodaigh tabled a question asking whether there was capacity within the Air Corps to go beyond the services it was supplying. He was asking about growth and investment in the area. It is a poor reflection on the management of the Defence Forces that the Air Corps is unable to retain pilots, air traffic controllers or those who could operate the equipment or aeroplanes. When Deputy Ó Snodaigh visited Baldonnel, he saw equipment sitting in hangars at night because insufficient cover was available. In his reply, the Minister of State stated that it would not be possible for the Air Corps to deliver the requirement sought by the HSE and confirmed that his Department did not tender for the service because of a lack of substance. He stated that he had a pathway to address the issues and had made a submission regarding pilot retention to the Department of Public Expenditure and Reform and the Public Service Pay Commission. Obviously, that submission fell on deaf ears, given that we are in this situation which has recently been revealed.

What is being done to recruit, retain, attract and train pilots and the required ancillary staff, including paramedics? Is it being done with gusto or is there a shake of the head or shrug of the shoulders and an admission that we cannot do it? Is there a plan for the future? What pathway does the Minister of State propose?

The public and all present are well aware of the issues of recruitment and retention. I am particularly aware of such issues in the health service. The little that is being done falls far short of what is needed. I refer to the exodus of medics, particularly nurses, which had been predicted to occur as a result of the chaos of working in the health service. The fewer staff one works with, the less inclined one is to remain in the job, given the increase in workplace stress. The issue of the two hours which nurses work for free has not been addressed. The exodus of pilots and support staff was predicted but nothing was done. I hope the Minister of State can provide clarity and comfort to those in the Air Corps, as well as those who depend on the air ambulance service in emergency situations.

The Minister of State is welcome to the House. I wish to pay tribute to the Air Corps and the air ambulance service. They do the State significant service in difficult conditions. As noted by other Senators, many people walking around today would not be with us if it were not for the air ambulance service. I acknowledge the remarks of Senator Feighan on Roscommon and the excellent air ambulance service provided there.

We need a longer discussion on this matter. There is a basic level of service which the citizens of Ireland deserve. We owe them an integrated plan. A very interesting report on the successfulness of operations carried out by the HSE was published earlier this week. When a surgeon performs an operation at least 12 times per year, outcomes are far better and the patients have better chance of recovery and fewer complications. That holds true at various levels of expertise. I raised the issue of cancer outcomes on the Order of Business. It has been proven that centres of excellence provide better outcomes for cancer patients, those who have had a stroke and those undergoing an operation. If we wish for the public to have confidence in our services, they must know that they can be transported from their location to a hospital in a certain amount of time, whether by ambulance or helicopter.

I admire the Irish Community Rapid Response and the service provided by its charity helicopter. However, one must ask why it is necessary for a charity to provide that service. This is about the provision of a minimum standard. We must decide what that minimum standard is for those living in Donegal, Kerry, Roscommon, Mayo or elsewhere. It is that a very quick response commensurate with the seriousness of one's illness or accident is provided, whether by ambulance or helicopter. We need to sit down and see how to achieve that.

I will not be highly critical of any one service or Minister. The Sláintecare plan involves the roll-out of local services. Those who require the services of an acute hospital must be able to access it quickly and efficiently and that service must be provided by the State. A rapid response helicopter service provided by the Air Corps must be adequately resourced. Its staff must not be pulled off other duties but, rather, be dedicated to the service. There must be a sufficient staffing level. As we roll out Sláintecare and the centres of excellence, the public can have confidence that they will have rapid access to emergency services. I believe that is also the wish of the Minister of State.

In the dying days of this Government - I do not mean that in any nasty sense - there may be an opportunity to discuss the minimum level of service which we can guarantee, and then provide it. It should be provided by the State. We should not have to depend on the collection box and the good intentions and actions of members of the public who fundraise. We must tell citizens that there is a minimum threshold which we can and will provide. That is what they need and deserve. If this discussion kicks off that debate, this will have been time well spent.

I thank the Minister of State for attending. Perhaps in some way we can kick off this conversation whether in this House or not. We have to analyse the services provided, especially in rural Ireland. A rapid response helicopter service is a bare minimum. It has to be resourced properly, therefore, and if the Air Corps is providing it, it also has to be resourced properly.

Senator Feighan had indicated but unfortunately it was agreed that only group spokespersons would speak so I cannot ask him to come in. I call on the Minister of State to respond as there are no more group spokespersons to speak.

I have no issue with Senator Feighan coming in, with the agreement of the House.

It was not agreed on the Order of Business, I am sorry.

I did not use all my time.

The Acting Chairman could show flexibility.

Senator Feighan lives in the area. I believe we should let him speak.

Senator Feighan should go on and see what happens.

I could not overemphasise how important this service has been. Since 2012, hundreds of lives have been saved. Senator Humphreys summed it up correctly that these are men and women, brothers, sisters, mothers, fathers, sons and daughters around the country. I know how important this was. Before we had this service hundreds of people died unnecessarily. Due to the joined-up thinking of the Defence Forces and the Department of Health, working with the National Ambulance Service and advanced paramedics, this has been a wonderful service and I hope that we can iron out these issues on a cross-party basis to continue to provide this service. I would love this service to be provided not just in Cork and Athlone but across the island, bringing in our friends in Northern Ireland. We can do that, cross-Border and throughout the country. The Minister of State sometimes has issues to deal with and I know he will deal with them.

I welcome some of the Senators' comments. I recognise that Senator McFadden did not come into the House to start jumping up and down on this issue. She tabled a Commencement matter which I was able to answer. Senator Wilson spoke about lives being put at risk. Lives are not being put at risk because we have put a contingency plan in place to make sure lives will not be put at risk.

I should have said at the outset that I have never been dragged into this House previously, and I assure Senators I will not be dragged in to this House in the future because I have respect for them. When they say they are sorry for dragging me in, it says a lot about the personnel using that sort of language because this House is accountable to the people and, like any Minister, I am accountable to the people. The Leader asked me to come in and I have no issue whatsoever in responding to that request.

If Senators are making statements, they should always make sure they have the correct facts in front of them. Senator Craughwell has incorrect facts once again. The ICRR has two helicopters. One is based in Cork and will continue to be based there, the second will be based in Roscommon for four days a month between November and February.

I did not interrupt the Senator. I have manners.

I just want clarity.

As we speak, the Air Corps is providing the service. There will be four days in the months of November, December, January and February when the EAS Air Corps will not be able to provide a service. When it is unable to provide a service, the community response helicopter will be in place and will be backed up by the Irish Coast Guard. The then Government put this in place in 2015 in line with the decision to establish the emergency air medical service when it said that if it us unable to accept taskings, the Irish Coast Guard will provide cover to the National Ambulance Service. People were looking for this service for as long as I can remember. The Fine Gael-Labour coalition Government in 2011 introduced this service and a memorandum of understanding was drawn up between the Air Corps, Defence Forces, Department of Defence, HSE and Department of Health. It was put in place in 2012 on a trial basis. It was successful in the intervening years and was put on a full-time permanent footing in 2015.

The most important issue is the safety of the people providing the service, including the pilots, Air Corps personnel, and the emergency services staff and patients on board. I could be mistaken but I am not sure that one Member mentioned that. I will mention it.

I apologise to the Senator.

I have emphasised the importance of providing the EAS service because of the benefit it provides to the local community, north, south, east and west. However, I have always stated to military management the importance of the safety of personnel in all areas of its work. It would be totally remiss of me if I did not take my responsibility seriously and think of the safety of personnel. When this came to my attention, I first engaged with the Departments of Health and Defence, the HSE, Air Corps, and military management. Following a recommendation that came out of those talks, we decided to approach the ICRR. We became aware that it had a second helicopter that was not in use. We asked it to provide assistance and it was confirmed to us that it would be able to provide assistance.

People might ask why this time of the year. There is a simple reason. Daylight hours are at their shortest and the statistics from recent years show that this is one of the quietest times, when we are least able to fly because of inclement weather conditions, including rain, wind, fog or whatever. A decision was made to do it because it would have the least impact on the citizens that I believed would be affected. Now that the ICRR is in place, this service will be as good as the service in the past. The only difference is the colour of the helicopter and, without being flippant, I do not think anyone will question that.

It will be based in Roscommon. If anybody has any understanding, they will know why it is not based at Custume Barracks in Athlone. That is a military installation. I confirm to the House the next four months expire, on 1 March 2020, this service will be back on a permanent footing.

I have never hidden behind the fact that we have challenges when it comes to pilots. That is one of the reasons that we asked the independent pay commission to look at the service commitment of the pilots, which was abolished back in 2008, and not by a Fine Gael-led Government, because of the economic downturn the country was going through at that time. The independent pay commission recommended that the service commitment scheme would be reintroduced and it has been under the high-level implementation plan that was put in place by the Government.

A question was asked about the EAS allowance. A claim had been made by the Representative Association of Commissioned Officers, RACO. That is being dealt with in the appropriate channels and it would be improper of me to comment on that here tonight because it is going through the appropriate channels. On all occasions, I have taken the military advice I have received. This is a temporary interruption and will be limited to four days per month over a period of four months. The EAS will continue and actions being taken now will ensure the long-term viability of the EAS provided by the Air Corps. I want to be very clear that the whole focus is returning the EAS to full capacity. The loss of 16 days of the EAS is regrettable, as I have stated, but it is necessary from the perspective of safety and governance.

There will be a training surge for new and additional pilots to service the EAS. We have the contingency plan in place with the ICRR and the Irish Coast Guard, which will co-operate fully with the National Ambulance Service. Two officers have recently been recommissioned. I am absolutely delighted that those people have come back in from the private sector and want to come back in as pilots with the Air Corps. People would accept that, of course, those two pilots who have come back in must undergo training and that is ongoing at the moment. I do not think anybody would accept that someone who is recommissioned in the Air Corps would reassume the duties they had six or seven years previously. That would be irresponsible of military management and the General Officer Commanding, GOC, in the Air Corps. Training must be gone through for people who have re-entered the Air Corps.

I hope I have outlined the issue. The most important thing is that lives are not being put at risk. There is an equally good service with the ICRR as what was provided by the Air Corps. I commend all the military personnel, pilots, personnel on the planes and paramedics involved with the EAS. These people have saved lives and will continue to do so. We are going to reassure the general public that this service will be back up and running from 1 March, except for four days in November, December, January and February. It would be irresponsible of me if we had taken this action in other months when there would have been longer flying days, better weather and everything like that.

Senator Humphreys asked why this service was not being provided at night time. There are safety reasons and safety concerns about landing, as pilots are aware, that must be taken into account.

It is absolutely fantastic that the ICRR is willing to step up to the plate. I compliment that organisation. There is a huge amount of voluntary organisations that run ambulances and helicopters right across Europe, including the UK, Wales, Scotland and all over the place. There are plenty of examples of them, so we are not unique. It is great that people appreciate our people and communities coming together to provide this service for the betterment of the people and their communities.

One question that was not addressed was how we cam guarantee a service when we do not know what pilots are scheduled to leave.

I must ask the Leader to-----

This is an important issue for the public. How can we guarantee something when we do not know? People are leaving every day.

We are moving on to the Judicial Appointments Commission Bill.

We are not going to get an answer to my question.