Dáil Éireann díospóireacht -
Wednesday, 8 Nov 2023

Vol. 1045 No. 2

Saincheisteanna Tráthúla - Topical Issue Debate

Ambulance Service

Deputy Christopher O'Sullivan

I thank the Minister of State for being here to take this Topical Issue matter on the ambulance service in the west Cork area. The service is stretched and we urgently need extra ambulances to serve the people of the region. It is important that I explain the geography of west Cork. It is a huge area, bigger than most counties. For example, from the edge of Cork city to the Dursey Sound takes well over three hours to drive, and that is at a good speed. Travelling from somewhere like Clonakilty in the southern part of Cork to Macroom in the north takes well over an hour. It is a vast area. There are not enough ambulances to serve the area and provide safe outcomes.

There are five ambulance bases, in Clonakilty, Castletownbere, Bantry, Skibbereen and Macroom. Even at that, the service is stretched to its limit. The waiting times for ambulances are far too long. To compound that, because the National Ambulance Service, NAS, provides the service, these ambulances cover far more than the geographic region I have explained. Ambulances often serve Cork city and get stuck there, which means there is extra pressure on the west Cork area. Ambulances often serve Kerry. I have nothing against people in Kerry being able to avail of ambulance services, but that puts a serious strain on the service in west Cork.

I was contacted recently by a lady who called an ambulance for her daughter, which took three and a half hours to arrive. The House will have to bear with me in respect of the geography involved. The ambulance went from Cork city all the way west to Castletownbere, on the far west of the county, and then back to Skibbereen, for whatever reason. I am sure the ambulance service knew exactly what it was doing and had to travel that route for a reason, but that meant the woman's daughter was waiting for three and half hours for an ambulance, which is far too long. This is going to put lives at risk.

As with many parts of Ireland, there are islands off the coast of Cork. An islander rang an ambulance but the wait time was so long that the lady had to put her parent into the car, take the ferry and bring them to the hospital. It is not good enough. We need to increase the number of ambulances serving west Cork and the number of personnel. From a visit by the Minister of Health to west Cork this summer, my understanding is that an extra full-time ambulance with eight personnel was to be provided in Bantry to take the pressure off. That would be an amazing start, but we need to know when that will happen and when the personnel will be in place. Furthermore, when will there will there be more ambulances in west Cork? We need them desperately.

Minister of State at the Department of the Environment, Climate and Communications (Deputy Ossian Smyth)

I thank Deputy O'Sullivan for asking this question. I will answer it on behalf of the Minister for Health, Deputy Stephen Donnelly. The question relates to ambulance services in west Cork.

As the Deputy will be aware, the NAS serves the west Cork region 24-7 through a highly skilled workforce of intermediate care operatives, paramedics and advanced paramedics. There is a fleet of modern emergency ambulances, intermediate care vehicles and rapid response vehicles. There are 12 ambulance bases covering the entire county of Cork, of which four are in west Cork.

The NAS deploys these resources in the region dynamically, in line with international best practice. That allows the NAS to prioritise resource allocation to the highest acuity calls that require an immediate emergency response. The region is also served by a number of NAS alternative care pathways that include the Pathfinder see-and-treat service, the NAS national emergency operations centre, NEOC, the clinical hub hear-and-treat service and community paramedic and intermediate care services. The Pathfinder initiative launched in Cork in April 2023 to improve outcomes for older people by providing safe alternative care at home rather than in hospital emergency departments. On average, two thirds of patients seen by Pathfinder following a 999 call have remained at home rather than having to be brought to an emergency department. Pathfinder was launched in Kerry in 2023 and also serves west Cork.

An intermediate care service currently operates in the Bantry area of west Cork seven days a week. It provides low acuity inter-hospital patient transfer and discharge services to help preserve emergency ambulance resources in the region. A medical assessment unit, MAU, pathway for 112 and 999 patients is also permanently in place following a successful trial which involved Mallow General Hospital in 2020.

There is also further support provided by the Government funded south-west helicopter emergency medical service, HEMS, and the Irish Coast Guard search and rescue service. Since commencing operations on 16 February 2023, the south-west HEMS had carried out 328 emergency tasks by the end of September 2023.

Regarding ambulance services more generally, the Government has invested significantly in the NAS in recent years. Record investment of over €219 million has been allocated to the NAS under the HSE 2023 national service plan. This represents an overall increase of approximately €50 million from that which was allocated in 2019. This unprecedented level of investment has allowed for the NAS to undergo an enormous programme of change and reform recent years, continuing a transformation from a traditional emergency ambulance service to an agile mobile medical service.

As a direct result of this investment, the NAS workforce has also grown substantially, with an increase of 32% in total staff numbers since December 2015. As well as the significant increase in staff numbers, the NAS has also made major advancements in the way it delivers patient care. For example, building clinical capacity in the national emergency operation centre in Tallaght allows the NAS to assess and treat many patients at the lowest appropriate level of acuity, resulting in a better experience for patients and a more efficient use of resources.

I extend my sincere thanks and gratitude to the staff of the NAS and all of our ambulance services for their commitment and dedication to patient care in west Cork and throughout the country.

Deputy Christopher O'Sullivan

I thank the Minister of State. It is important that he mentioned the Government-funded air ambulance helicopter service. It is an extraordinary service, which ran on voluntary donations and charity fundraising for years. It is important that the Government is now backing it because without it we would be in dire straits. Even with that addition, it is still not enough. There are still parts of west Cork that are not being served properly by an ambulance service. We need to bolster the service. We need extra ambulances and staff.

I want to thank, from the bottom of my heart, the staff of the ambulance service for their extraordinary commitment and passion. However, they are experiencing burnout and are stressed and under severe pressure as a result of the workload and the lack of support and personnel.

That is why what I request is so important. I am not sure whether the Minister of State has the answer today but I would love one as quickly as possible on when the full-time ambulance with eight personnel announced for Bantry during the summer will be in place. Have the personnel been recruited? When can we expect to see the new ambulance up and running? I thank the Minister of State.

Deputy Ossian Smyth

I thank the Deputy. I do not have the specific answer for him but I will ask the Minister, Deputy Donnelly, to get him an answer on the question of an additional ambulance with eight staff located in Bantry. I thank him for acknowledging the success of the helicopter emergency service. He does recognise that this is not just about the number of ambulances providing a good emergency call-out service as the approach also involves considering how we can treat people before an ambulance arrives, particularly when such long distances must be covered.

With regard to some programmes, a large proportion of people, or even a majority, realise they do not need an ambulance and can be treated at home. The community first-responder programme has been important. There were 30 teams two years ago and there are now 39 across Cork. They provide services like cardiopulmonary resuscitation and defibrillation and in many cases help to sustain patients. Not all of the investment should go towards additional ambulance services. As far as possible, we want to make sure people survive their emergency event and get the best treatment as soon as possible through the correct care pathway. It would be crazy not to use remote services. If we can provide a service over a video or audio link that can keep a patient alive or give him or her a better outcome, we definitely should put resources into it.

The Deputy is aware that paramedics’ skills are now far beyond those that they would have had some years ago, when they were mostly driving and lifting people in and out of ambulances. Paramedics now have many qualifications to obtain and they can give considerable care in the ambulance or on site on arrival. I will come back to the Deputy on his specific question. I acknowledge that he needs an answer.

Flood Risk Management

Deputy Ruairí Ó Murchú

The fact is that we had absolutely devastating rains in north County Louth and Dundalk. As bad as they were, they could have been worse, which was the fear of everybody. When I submitted this issue for debate, I was not sure what Ministry to include because I have questions for the Department of Public Expenditure, National Development Plan Delivery and Reform on the OPW and flood defences and questions for the Department of Housing, Local Government and Heritage on local government and its operations, and also on the entire issue of drainage schemes, a very particular issue that I will deal with in respect of Dundalk. Obviously, the Department of Transport has responsibility in that a large number of roads and bridges have been destroyed. Carlingford and parts of the Cooley Peninsula have been absolutely devastated. People are going through the rack and ruin of what are their homes and businesses.

I commend the community for all the work it did, even the mitigation work in parts of Dundalk, particularly the part I am from. In fairness, I have to commend the considerable work done by members of the fire service, members of the county council and many others, but there are questions about how we respond to issues like this. There are huge gaps.

We welcome the humanitarian assistance scheme and the emergency business flood relief scheme. We need to ensure there are flexibilities because, as I met people, particularly with Councillor Antóin Watters, I found more anomalies and more questions. In fairness, we have a fair bit of information flowing freely back to us but we just need to ensure we are looking after people.

There is a request for a scheme for farmers whose lands have been damaged and whose feedstock has been destroyed. I raised this with the Taoiseach and also the Minister for Agriculture, Food and the Marine, Deputy McConalogue. We do need some sort of relief scheme delivered. As I said before, there are still people who cannot get to their homes because roads and bridges have been destroyed. As quickly as possible, the repair work has to get under way.

Let me refer now to the big piece of work. It was brought up by several councillors, particularly Councillors Antóin Watters, Edel Corrigan and Kevin Meenan. Councillors from every party across the Dundalk municipal area and north County Louth brought up all these issues at a meeting yesterday. The OPW is to be met by the council concerning flood defences and anything else that needs to be done. While people are talking about the need for works to repair their houses and businesses, they are also saying they need mitigations dealt with. There are question marks over actions that were carried out around drainage and legacy issues. Huge parts of the estate where I live in Dundalk were under water. While some people unfortunately got flooded, there was a fair amount work done to hold back the tide, for want of a better term. However, in real terms the only thing that saved us was the fact that the Tuesday night rains were not as significant as they could have been and storm Ciarán passed us by. Cluan Enda, Bay Estate, Greenwood Drive, Avondale Park, Meadow View and all the areas off Avenue Road and between Red Barns Road and St. Alphonsus Road in Dundalk flood regularly during normal times. What that tells me is that there is an issue concerning the combined system that deals with storm water and sewage. We have a pump station that Irish Water is responsible for but that is run by EPS Water, a subcontracted company. We need to have a major assessment of north County Louth and what can be done by way of mitigation, but we really need to consider that Dundalk cannot deal with these issues regularly, which means that times like these represent an absolute disaster. We are very close to one.

Deputy Ossian Smyth

I thank the Deputy for raising the important issue of the recent flooding in north Louth and Dundalk. It is of both local and national importance. I appreciate and fully share the Deputy’s concern for the communities and businesses affected by last week’s flooding event.

I am answering this question on behalf of the Minister for Housing, Local Government and Heritage, Deputy Darragh O’Brien, but his Department has no function in regard to flood relief infrastructure. I have been informed by my colleagues in the OPW that following the flooding experienced in Louth last week as a result of heavy rainfall, the OPW and Louth County Council are working to progress flood relief schemes to protect at-risk properties in north Louth and the Cooley Peninsula from such events in the future. The OPW has primary responsibility for flood relief schemes. I understand that assistance is being provided to those affected by the flooding through the humanitarian assistance scheme administered by the Department of Social Protection and the emergency business flooding schemes for small businesses, sports clubs and community and voluntary organisations administered by the Department of Enterprise, Trade and Employment.

On associated wastewater and storm water infrastructure, the Deputy will appreciate that, since 1 January 2014, Uisce Éireann has had statutory responsibility for all aspects of water services, including the planning, delivery and operation at national, regional and local levels. The prioritisation and progression of individual projects are matters for determination by Uisce Éireann. Uisce Éireann is held to account in this role by the Environmental Protection Agency, EPA, as the environmental regulator. The EPA recently released its urban wastewater treatment report for 2022 and this highlights that, while many challenges lie ahead, Uisce Éireann is making progress and improving compliance. The draft river basin management plan reports the number of water bodies showing that the actual impact from wastewater has now decreased.

Uisce Éireann has informed me that investment is continuing in wastewater infrastructure in north Louth and Dundalk to support future growth and development, meet current demand and support the protection of the local environment, with upgrade works ongoing on wastewater treatment in Drogheda and the preparation of a drainage area plan for north Louth to identify drainage problems impacting the public and the environment followed by the identification of solutions to remedy these.

As part of budget 2024, the Minister secured funding of €1.6 billion to support Uisce Éireann in delivering water services. This overall investment will deliver significant improvements in our public water and wastewater services. The national development plan commits to almost €6 billion in capital investment, to be undertaken by Uisce Éireann from 2021 to 2025, and over €4.5 billion will be voted Exchequer funded in respect of domestic water services.

This sustained investment will improve capacity, performance and, in particular, the resilience of water services. Many serious challenges will remain, which will take investment. The EPA has identified the priority areas where Uisce Éireann should target its available resources to deliver improvements where they are most needed and will bring the greatest environmental benefits.

Deputy Ruairí Ó Murchú

I raised this issue with the Department of Housing, Local Government and Heritage rather than the Office of Public Works because I get that this is not the last time I will do so. What the Minister of State has told me is brilliant but we need a timeline for the drainage area plan.

To speak specifically about Dundalk, at this point we cannot get rid of storm waters following regular heavy rainfall. That tells me we have not made an allowance for new estates and we want to see even more estates built. We have also not allowed for new businesses and factories, all of which are very welcome.

My estate cannot get onto a line that goes to a pumping station, so the water literally lies in the estate. If we were to have further rain or the rains they had in the Cooley Peninsula, the estate would be destroyed. Councillor Antóin Watters and I covered a huge area. The Turf Road in Edentubber was ripped away but at least works are being planned for that. There is also Deerpark in Ravensdale and Ballymakellet. Businesses across the board in Carlingford are affected, including Ma Bakers, the Four Seasons, the Carlingford Arms and the equestrian centre. There is huge devastation. I thank the residents of Trinity Close, whose homes have been destroyed. Bridie McGeown allowed me to use her house to do an interview with RTÉ. Fiona and Brendan also fed me when I would have expected to be given short shrift. Lurgan, Piedmont, Benagh, Lordship, Rathcor, Grange and some other places are still dealing with this type of flooding. Everyone is pointing out changes with regard to drainage systems, culverts and so on. We really need to look at this.

There is an issue with Louth County Council. In 1982, there were, I think, 163 council workers, whereas now the number is around 28. A huge amount of work has been done but we need to have a central hub. At times we need to pull in other State agencies. People have asked if we need the Defence Forces. As I have said, we got lucky this time but we could be waiting for doomsday because all it would have taken was one more night of rain.

Deputy Ossian Smyth

As the Deputy rightly identifies, the OPW is not the only agency or organ of State responsible for dealing with flooding. It does flood prevention works but Uisce Éireann is involved in making sure there is sufficient drainage, in particular for new housing, as the Deputy pointed out. We have a massive housing programme, so we needed a lot of investment in Uisce Éireann. That is why it was given €1.6 billion this year for investment purposes. When all else fails, there are compensation payments for businesses and individuals. However, it is well recognised with flooding that it costs a lot less to do the preventative work than it does to compensate people after the fact. For this reason, it is important that we continue to invest at that level. With a growing population and a massive increase in our housing programme, we need a commensurate increase in the amount of investment in our water drainage facilities. The programme for Government commits to funding Uisce Éireann's capital investment plan for drinking water and wastewater on a multi-annual basis instead of year by year for this reason. The delivery of the funding project has been committed to in Project Ireland 2040. The national development plan commits to almost €6 billion of capital investment to be undertaken by Uisce Éireann until 2025.

Uisce Éireann has established a dedicated team to deal with representations and queries from public representatives. The team can be contacted via email at [e-mail] or by telephone on a dedicated number at 1890 578 578. Uisce Éireann will share with the Deputy its plans for investment in wastewater treatment in north County Louth and Dundalk. If he is not happy with what he hears or has other suggestions, he should contact either my office or that of the Minister for Housing, Local Government and Heritage.

Deputy Ruairí Ó Murchú

We will do that. We need an assessment alongside the catchment flood risk assessment and management, CFRAM, and everything else.

Cuireadh an Dáil ar fionraí ar 9.34 a.m. agus cuireadh tús leis arís ar 9.58 a.m.

Sitting suspended at 9.34 a.m. and resumed at 9.58 a.m.