National Ambulance Service: Motion (Resumed) [Private Members]

The following motion was moved by Deputy David Cullinane on Tuesday, 28 February 2023:

That Dáil Éireann:

commends the tireless work of frontline paramedics and operational staff in dealing with increased demand without proportional resource increases;

notes that:

— 80 per cent of life-threatening incidents should be responded to by an ambulance within 19 minutes, as per the Health Service Executive's (HSE) own standards;

— average ambulance response times have lengthened by 50 per cent since 2019, by an average of 9 minutes, going from 18 to nearly 27 minutes, and up to 33 minutes on average in the South-East;

— State-wide response times for life-threatening callouts (Clinical Status 1 – ECHO: Patients who are in cardiac or respiratory arrest) within the 19-minute timeframe have decreased from 80 per cent in December 2017, to 76 per cent in December 2019, to 65 per cent in December 2022, and as low as 59 per cent in the West in December 2022; and

— State-wide response times for life-threatening callouts (Clinical Status 1 – DELTA: other life-threatening incidents) within the 19-minute timeframe have decreased from 54 per cent in December 2017, to 49 per cent in December 2019, to 30 per cent in December 2022, and as low as 19 per cent in Dublin in December 2022; and

further notes that:

— the National Ambulance Service (NAS) currently has circa 2,000 paramedics, and their workforce plan lays out a need for more than 1,300 more paramedics by the end of 2024, and a need to double the staffing composition to more than 4,000 by 2026;

— the NAS needs more than 3,000 paramedics in only four years to meet these targets and account for retirements and staff turnover;

— the NAS has warned that if these targets are not met, performance will continue to decline and the NAS will have insufficient resources to respond to the projected demand, and as a result, 19-minute performance would be considerably less than 40 per cent;

— only 209 new staff started with the NAS in 2022, of which 181 were patient and clinical care staff;

— since 2019, the National Ambulance Service College has commenced training for just 472 new recruits to the three-year Paramedic Studies programme, less than 160 a year;

— the NAS has said that "recruitment efforts are being surpassed by service demand", and Dublin Fire Brigade (DFB) have said "demand for ambulances is continually identified as being far in excess of DFB capacity"; and

— according to paramedics, as many as half or more shifts run into overtime, with 12-hour shifts often lasting 15 hours or more, leading to low morale and widespread burnout and occupation-related mental health difficulties among paramedics, which is damaging the attractiveness of the career and recruitment and retention in the NAS;

furthermore, notes that:

— in 2022, the average off-loads or hospital turnaround time in Dublin hospitals was 39 minutes, with 16 per cent of incidents having a turnaround time in excess of 60 minutes, according to DFB;

— in 2020, the comparable average turnaround time was 29 minutes with 6 per cent of ambulances experiencing off-load delays in excess of 60 minutes; and

— neither the HSE nor the NAS collate or report this data, as confirmed in a reply to parliamentary question 515 answered on 24th January, 2023;

condemns:

— the fact that the Government has not implemented the proposals agreed by Dáil Éireann on foot of a Sinn Féin motion on the NAS on 16th November, 2021, which the Government did not oppose;

— the failure of the Government and Minister for Health, Stephen Donnelly TD, to support our frontline paramedics to manage demand for emergency services and improve performance; and

— Minister for Health, Stephen Donnelly TD, and his Fianna Fáil and Fine Gael colleagues in Government, especially the Minister for Finance, Michael McGrath TD, and the Minister for Public Expenditure, National Development Plan Delivery and Reform, Paschal Donohoe TD, who chose not to provide the necessary fiscal resources in Budget 2023, which in turn is leading to burnout of frontline paramedics and has increased risk for patients due to increased response times; and

calls on the Government to:

— urgently publish a multi-annual capacity and workforce plan to meet the needs of the NAS and DFB to 2026 and 2030;

— urgently review the adequacy of the spatial distribution and coverage of the ambulance fleet, ambulance stations and rapid deployment points to ensure an equitable distribution of services across regions, reduce reliance on overtime and long shifts, and reach response time targets;

— provide more hospital beds to improve ambulance turnaround times and admit patients to hospital in a timely manner;

— rapidly advance specialist paramedic grades and expansions to primary and community services, in particular those relating to improved use of technology in hospital admission avoidance, community paramedicine, chronic disease management, and integrated care programmes for older people, to improve hospital avoidance and reduce the strain on emergency services; and

— expand mental health supports for the NAS and DFB workforce, including access to counselling and psychiatric services where appropriate, and address outstanding recruitment and retention issues which are a barrier to increasing employment.

Debate resumed on amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"notes:

— the vital role played by the National Ambulance Service (NAS) in Ireland's public health service;

— the vital role played by the NAS throughout Ireland's response to the Covid-19 pandemic;

— that ambulance services have been experiencing a significant increase in demand in recent years with a record 389,764 emergency ambulance calls received from the public in 2022, a 6 per cent increase on the number received in 2021;

— that the Government invested a record amount of over €200 million in the NAS as part of Budget 2022, and this represented an overall increase in NAS annual funding of approximately €30 million since 2019, with a further record investment for the NAS being allocated as part of the 2023 Health Service Executive (HSE) National Service Plan;

— that NAS staffing levels have increased from 1,933 whole-time equivalent (WTE) in 2019 to 2,125 in 2023, a 10 per cent overall increase in WTE, with further expansion of this workforce expected in 2023;

— the significant progress made under the previous NAS strategy 'Vision2020', to commence the transformation of the NAS from a conventional emergency medical service to an agile and responsive mobile medical service, and to enable patients to be treated at the lowest appropriate level of acuity;

— the significant modernisation and development of the NAS operational fleet of vehicles, including critical care ambulances, emergency ambulances, intermediate care vehicles, rapid response vehicles and a range of specialised support vehicles;

— the establishment of a number of alternative care pathways, designed to treat patients at the most appropriate level of clinical need, in the right care setting, while avoiding the unnecessary use of emergency resources where there is no medical requirement;

— the development of the NAS clinical hub 'hear and treat' service at the National Emergency Operations Centre, the pathfinder 'see and treat' model of care, and the establishment of the NAS Intermediate Care Service, which undertakes low acuity inter-hospital transfers to help free up frontline emergency capacity;

— the expansion of the successful Medical Assessment Unit (MAU) pathway pilot project, first trialled in North Cork and Mallow General Hospital in 2022, to the MAUs in Ennis, Nenagh and Roscommon;

— that the MAU pathway results in patients receiving medical treatment in a hospital closer to their home, reduces patient presentations to emergency departments and releases ambulances more quickly to respond to other emergency calls;

— that the NAS has developed a Human Resources People Plan 2022 – 2025, to further support staff retention, and the overarching purpose of this plan is to enhance employee experience, optimise the NAS working environment and meet expectations of health policy in Ireland;

— the Department of Health and the HSE are working to finalise a new NAS strategic plan to 2031, and this plan will facilitate a strategic organisational redesign and continued focus on key priorities including alternative care pathways, specialist paramedic roles and progress towards meeting capacity requirements and performance targets; and

commends the NAS for recent improvements in response times, noting:

— the key performance indicator is for 80 per cent of all ECHO (life-threatening cardiac or respiratory arrest) emergency responses and 50 per cent of all DELTA (other life-threatening incidents) to be responded to within 18 minutes and 59 seconds; and

— the latest figures for January 2023 from NAS show that 77 per cent ECHO and 48 per cent DELTA were responded to within the target time; and acknowledges that certain parts of the country are not yet seeing the improvements in response times that are required, and commits to on-going support for the HSE and NAS in investment and reform, to ensure targets are met both nationally and regionally."

- (Minister for Health)

An Ceann Comhairle

I must now deal with a postponed division relating to amendment No. 1 to the motion regarding the National Ambulance Service. On Tuesday, 28 February 2023, on the question, "That the amendment to the motion be agreed to", a division was claimed and in accordance with Standing Order 80(2), that division must be taken now.

Amendment put:

The Dáil divided: Tá, 70; Níl, 58; Staon, 0.

Tá

Brophy, Colm.
Browne, James.
Bruton, Richard.
Burke, Colm.
Burke, Peter.
Butler, Mary.
Byrne, Thomas.
Cahill, Jackie.
Calleary, Dara.
Cannon, Ciarán.
Carey, Joe.
Carroll MacNeill, Jennifer.
Chambers, Jack.
Collins, Niall.
Costello, Patrick.
Creed, Michael.
Crowe, Cathal.
Devlin, Cormac.
Dillon, Alan.
Donnelly, Stephen.
Donohoe, Paschal.
Duffy, Francis Noel.
Durkan, Bernard J.
English, Damien.
Farrell, Alan.
Feighan, Frankie.
Flaherty, Joe.
Fleming, Sean.
Griffin, Brendan.
Harris, Simon.
Haughey, Seán.
Heydon, Martin.
Higgins, Emer.
Hourigan, Neasa.
Humphreys, Heather.
Kehoe, Paul.
Leddin, Brian.
Madigan, Josepha.
Martin, Catherine.
Matthews, Steven.
McAuliffe, Paul.
McConalogue, Charlie.
McGrath, Michael.
McHugh, Joe.
Moynihan, Aindrias.
Moynihan, Michael.
Murnane O'Connor, Jennifer.
Naughton, Hildegarde.
Noonan, Malcolm.
O'Brien, Darragh.
O'Brien, Joe.
O'Callaghan, Jim.
O'Connor, James.
O'Dea, Willie.
O'Donnell, Kieran.
O'Donovan, Patrick.
O'Dowd, Fergus.
O'Sullivan, Christopher.
O'Sullivan, Pádraig.
Ó Cathasaigh, Marc.
Ó Cuív, Éamon.
Phelan, John Paul.
Rabbitte, Anne.
Ring, Michael.
Ryan, Eamon.
Smith, Brendan.
Smyth, Niamh.
Smyth, Ossian.
Stanton, David.
Troy, Robert.

Níl

Andrews, Chris.
Bacik, Ivana.
Barry, Mick.
Berry, Cathal.
Browne, Martin.
Buckley, Pat.
Cairns, Holly.
Canney, Seán.
Clarke, Sorca.
Collins, Joan.
Collins, Michael.
Connolly, Catherine.
Conway-Walsh, Rose.
Cronin, Réada.
Cullinane, David.
Daly, Pa.
Doherty, Pearse.
Donnelly, Paul.
Ellis, Dessie.
Farrell, Mairéad.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Gannon, Gary.
Gould, Thomas.
Guirke, Johnny.
Healy-Rae, Danny.
Howlin, Brendan.
Kenny, Gino.
Kenny, Martin.
Kerrane, Claire.
Lowry, Michael.
Mac Lochlainn, Pádraig.
MacSharry, Marc.
McGrath, Mattie.
Mitchell, Denise.
Munster, Imelda.
Murphy, Catherine.
Murphy, Verona.
Nash, Ged.
Naughten, Denis.
Nolan, Carol.
O'Callaghan, Cian.
O'Reilly, Louise.
O'Rourke, Darren.
Ó Broin, Eoin.
Ó Murchú, Ruairí.
Ó Ríordáin, Aodhán.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Ryan, Patricia.
Sherlock, Sean.
Shortall, Róisín.
Stanley, Brian.
Tóibín, Peadar.
Tully, Pauline.
Ward, Mark.
Whitmore, Jennifer.

Staon

Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Pádraig Mac Lochlainn and Denise Mitchell.

Amendment declared carried.

Question put: "That the motion, as amended, be agreed to."

The Dáil divided: Tá, 71; Níl, 59; Staon, 0.

Tá

Brophy, Colm.
Browne, James.
Bruton, Richard.
Burke, Colm.
Burke, Peter.
Butler, Mary.
Byrne, Thomas.
Cahill, Jackie.
Calleary, Dara.
Cannon, Ciarán.
Carey, Joe.
Carroll MacNeill, Jennifer.
Chambers, Jack.
Collins, Niall.
Costello, Patrick.
Creed, Michael.
Crowe, Cathal.
Devlin, Cormac.
Dillon, Alan.
Donnelly, Stephen.
Donohoe, Paschal.
Duffy, Francis Noel.
Durkan, Bernard J.
English, Damien.
Farrell, Alan.
Feighan, Frankie.
Flaherty, Joe.
Fleming, Sean.
Griffin, Brendan.
Harris, Simon.
Haughey, Seán.
Heydon, Martin.
Higgins, Emer.
Hourigan, Neasa.
Humphreys, Heather.
Kehoe, Paul.
Lawless, James.
Leddin, Brian.
Madigan, Josepha.
Martin, Catherine.
Matthews, Steven.
McAuliffe, Paul.
McConalogue, Charlie.
McGrath, Michael.
McHugh, Joe.
Moynihan, Aindrias.
Moynihan, Michael.
Murnane O'Connor, Jennifer.
Naughton, Hildegarde.
Noonan, Malcolm.
O'Brien, Darragh.
O'Brien, Joe.
O'Callaghan, Jim.
O'Connor, James.
O'Dea, Willie.
O'Donnell, Kieran.
O'Donovan, Patrick.
O'Dowd, Fergus.
O'Sullivan, Christopher.
O'Sullivan, Pádraig.
Ó Cathasaigh, Marc.
Ó Cuív, Éamon.
Phelan, John Paul.
Rabbitte, Anne.
Ring, Michael.
Ryan, Eamon.
Smith, Brendan.
Smyth, Niamh.
Smyth, Ossian.
Stanton, David.
Troy, Robert.

Níl

Andrews, Chris.
Bacik, Ivana.
Barry, Mick.
Berry, Cathal.
Browne, Martin.
Buckley, Pat.
Cairns, Holly.
Canney, Seán.
Clarke, Sorca.
Collins, Joan.
Collins, Michael.
Connolly, Catherine.
Conway-Walsh, Rose.
Cronin, Réada.
Cullinane, David.
Daly, Pa.
Doherty, Pearse.
Donnelly, Paul.
Ellis, Dessie.
Farrell, Mairéad.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Gannon, Gary.
Gould, Thomas.
Guirke, Johnny.
Healy-Rae, Danny.
Healy-Rae, Michael.
Howlin, Brendan.
Kenny, Gino.
Kenny, Martin.
Kerrane, Claire.
Lowry, Michael.
Mac Lochlainn, Pádraig.
MacSharry, Marc.
McGrath, Mattie.
Mitchell, Denise.
Munster, Imelda.
Murphy, Catherine.
Murphy, Verona.
Nash, Ged.
Naughten, Denis.
Nolan, Carol.
O'Callaghan, Cian.
O'Reilly, Louise.
O'Rourke, Darren.
Ó Broin, Eoin.
Ó Murchú, Ruairí.
Ó Ríordáin, Aodhán.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Ryan, Patricia.
Sherlock, Sean.
Shortall, Róisín.
Stanley, Brian.
Tóibín, Peadar.
Tully, Pauline.
Ward, Mark.
Whitmore, Jennifer.

Staon

Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Pádraig Mac Lochlainn and Denise Mitchell.

Question declared carried.

Cuireadh an Dáil ar athló ar 6.14 p.m. go dtí 9 a.m., Déardaoin, an 2 Márta 2023.

The Dáil adjourned at 6.14 p.m. until 9 a.m. on Thursday, 2 March 2023.

Dáil Éireann díospóireacht - Wednesday, 1 Mar 2023