I welcome the Minister for Health, Deputy Leo Varadkar, who has taken time from his very busy schedule to come here to respond to an issue raised by Senator Darragh O'Brien, Leader of the Opposition, last week. He has responded to the Leader of the House by coming here today.
Ambulance Services in Dublin: Statements
I welcome the opportunity to address the House and outline the changes proposed to ambulance services in Dublin.
First, I wish to clarify the position on statutory responsibility for the Dublin ambulance service. Historically, the Dublin ambulance service has been provided by Dublin Fire Brigade under fire services legislation. Statutory responsibility for this service, therefore, rests with Dublin City Council and consequently comes within the remit of my colleague, the Minister for the Environment, Community and Local Government.
That being said, I am a huge supporter of the Dublin Fire Brigade ambulance service and its crew who provide an excellent service for the people of Dublin. Our paramedic firefighters have a very long and proud tradition in the city and have rightly won a place in the hearts of Dubliners for that reason.
Response times are good. Training is excellent and clinical audits have been carried out for years. As my constituency is very well served by Blanchardstown fire station in Coolmine, I am well aware of the valuable services that Dublin Fire Brigade ambulances provide. Long may that continue and develop.
The National Ambulance Service is part of the HSE and statutory responsibility lies within the remit of my Department. In recent years staff at every level have put in a huge effort to transform the service. The service has evolved from being simply a transport service to a paramedic service, where advanced and often lifesaving treatment is provided at the scene and in the ambulance long before the patient gets to hospital. This is true throughout the country. A major programme of reform and modernisation of the service has been under way for some time and will continue this year. Response times for emergency Echo and Delta calls are improving, as are hospital turnaround times. I pay tribute to the staff and leadership of the service for these major advances in recent years.
Following the recent agreement between Dublin City Council and the HSE on changes in ambulance services, I want to be very clear that there is no question of any takeover by the National Ambulance Service of Dublin Fire Brigade. Dublin Fire Brigade will continue to provide ambulance services in Dublin, using its own vehicles and staff, and Dublin Fire Brigade vehicles will continue to support ambulance services, as needed. Only the structures around clinical governance of the service and call management will change. I have previously stated and I am happy to repeat today that I will not support a single fire brigade ambulance being taken out of service. However, the fact is that HIQA has identified serious patient safety concerns about the lack of co-ordination between the National Ambulance Service and the Dublin Fire Brigade. In its recent report HIQA highlighted the urgent need to address these issues. It is now proposed to establish a single point of contact and dispatch for all ambulance resources in the Dublin area and clinical governance of all Dublin ambulance services will be the responsibility of the National Ambulance Service medical director, Dr. Cathal O'Donnell.
These changes will mean that emergency calls in the future will go to one call centre in Dublin and not two. The dispatcher in that centre will be able to see every available ambulance in the region. The nearest available ambulance, whether it is a National Ambulance Service ambulance or a Dublin Fire Brigade ambulance, will be sent to the incident, which is not currently the case. The people of Dublin can therefore look forward to a more responsive service as the nearest ambulance to the scene will be dispatched. The changes will also mean that there will be uniform clinical standards, training, equipment and procedures, so patients will receive exactly the same level of care no matter which type of ambulance arrives. These reforms make sense and are good for Dubliners.
There has to be a better system than the current one. Currently, if Dublin Fire Brigade has no ambulance available, the call may, or may not, be transferred to the National Ambulance Service. Passing calls between two centres poses potential difficulties and calls can be delayed or fall between the two services. A patient can fall between two stools. This has to change.
I know that firemen may be concerned about the future but they need not be. Dublin Fire Brigade will continue to provide emergency ambulance services in Dublin and the staff will be fully consulted before any changes are implemented. I understand that on Friday last, it was agreed to set up a joint Dublin City Council-union group, under an independent Chairman, to move the process forward. This is welcome and I am sure the House will support it.
Dublin Fire Brigade has provided very well for the emergency needs of Dublin since 1898. However, no service can afford to stand still. A single contact and dispatch point for emergency ambulance calls is needed to address the safety issues identified by HIQA. I ask this House to set aside any sectoral interests and to put the people of Dublin first. Members should ask themselves what is best for the people of Dublin. In my view, clearly what is best for Dublin is an integrated call-taking and dispatch service.
I am therefore pleased that following meetings between Dublin City Council and the unions, agreement in principle has now been reached on the integration of emergency ambulance call taking and dispatch. It has also been agreed that Dublin Fire Brigade will continue to be fully involved in emergency ambulance service delivery and there will be no diminution in such services. I very much welcome this development which will ensure that the people of Dublin get an even better ambulance service in the years to come.
I wish to share my time with Senators Averil Power and Mary White. I thank the Minister for coming into this House. We are restricted in the time we can speak on this issue. I raised this matter last week and I know that the Minister is personally supportive of the Dublin Fire Brigade ambulance service, as am I. There are a number of stations in my area of Swords-Skerries-Balbriggan. We all know the role of the Dublin Fire Brigade, its training and the fact that every crew member is a paramedic and many of them are advanced paramedics. We all know the work these crew members do. I do not doubt the Minister's bona fides as a supporter of the fire brigade. My concern about these changes relate to whoever may be the next health Minister or environment Minister.
I have a couple of questions for the Minister. At the moment, the HSE pays Dublin Fire Brigade approximately €9.2 million towards the emergency ambulance service for Dublin city and most of the county, including north County Dublin where I reside. This is from an annual budget of approximately €138.5 million. It represents just under 6.7% of the overall HSE budget for ambulance calls. However, over 40% of the calls go through the Dublin Fire Brigade ambulance service. It therefore provides serious value for money. This is my view. I am not sure and I am not convinced that when it goes under the control of the HSE that we will get the same service or value for money. This is my worry.
I will conclude on these remarks. After the recess, I hope the Minister will have more time to discuss this issue because I am very restricted in time today. I am pleased that a mechanism is now being set up between the Dublin Fire Brigade representatives, the unions, and Dublin City Council. However, I worry when people say there will be no diminution. I agree the Minister is saying this will be the case and I am glad of that. However, this does not change anything which happens in the future. If anything, we should be expanding what is done in Dublin with the fire brigade across the country.
Hear, hear.
We should be examining the possibility of a combined emergency medical services, EMS, system. We should be utilising all our fire brigade bases across the country and do what is done in Dublin. We should support that even more, do it across the country and work with the members of the HSE ambulance crew, who do a really good job. My issue is with management and not with the people on the street. This is something for another debate. My time is restricted and I do not want to delay. However, I would like to revisit this issue in the future.
Will the Minister commit that, subject to his schedule, we will, following the discussions, have a more comprehensive debate in a couple of weeks on the Dublin Fire Brigade ambulance service, the benefits of expanding this to the rest of the country, but properly resourcing and supporting it, as it provides an exceptional service to the people of Dublin city and county with exceptional value for money?
I welcome the opportunity to speak in this debate, albeit just for one minute. I came to the House last Tuesday and asked the Leader to schedule a debate on this issue because I was deeply concerned to hear the city manager had gone ahead and announced a major change to the service without the consultation that was promised initially. Like Senator O'Brien, I do not doubt the Minister's bona fides as a Dubliner and someone who is aware of the service Dublin Fire Brigade provides and I know he does not want to see an ambulance taken out of service. However, I share the same fears that this could be the start of cutbacks to the service.
I have seen television documentaries about the HSE service and the response times around the country. We get a far better service in Dublin. Our response times are much better because the fire brigade is involved. Given the management by the HSE of other areas, I am very concerned to see a working service being brought under the ambit of the HSE. I also saw internal HSE documents last year that indicated this was all about cost-cutting. That makes me worried for the future of the service. I echo Senator O'Brien's comments in that I would appreciate it if the Minister could make time available in his schedule at the earliest opportunity to come in and have a full debate on this vital service. It is one of our most basic services, to be able to respond to medical emergencies. Best practice internationally is for an integrated fire and ambulance service and anything that puts that under threat needs to be discussed properly in this House not decided on unilaterally elsewhere.
I thank the Minister for making time available. It is important that we debate this issue and that we refer to the recommendations of the HIQA report and act on them. The recommendation set out that the National Ambulance Service and the Dublin Fire Brigade must both address the operational inefficiencies identified and publish a joint action plan outlining proposed steps to improve individual and collective performance in call handling, address verification, dispatch, ambulance deployment, mobilisation, navigation and the co-ordination of calls between services. Another recommendation was that "[a]s a matter of urgency, both the National Ambulance Service and Dublin Fire Brigade must put the necessary corporate and clinical governance arrangements in place to provide a fully integrated ambulance service in the greater Dublin area. This should include a binding service level agreement, which includes formal quality and performance assurance reporting mechanisms". It was also recommended that "[t]he Health Service Executive and National Ambulance Service must immediately involve Dublin Fire Brigade in the National Ambulance Service Control Centre Reconfiguration Project to ensure a seamless and safe transition of services in Dublin". This is about providing a service that is not only efficient but also safe. The changes that have occurred are about getting everyone to work together.
Everyone here will join me in paying tribute to those who work in the ambulance service, both from the fire brigade side and in the National Ambulance Service. They are all committed to providing a comprehensive service. This co-ordination is necessary to make sure that we have the efficiencies that are required. The HIQA report clearly identifies that there were two different systems in place. The computer system was not the same and the whole process was different for both organisations. That is why this reconfiguration must occur. There has been a great deal of change over the past three to four years in the ambulance service across the country. There has been a great deal of improvement, which must continue. It now transpires that 70% of ambulances were released and able to respond to other calls within 30 minutes of arriving at the hospital and 94% within 60 minutes. It just shows that change has occurred and efficiencies are in place. This reorganisation is very necessary, but there must be full consultation and co-operation by all sides and every process that is required to get that co-operation must be put in place.
Cuirim céad fáilte roimh an Aire. De réir mar a thuigimse, tá sé i gceist na seirbhísí atá á shólathar ag Briogáid Dóiteáin Bhaile Átha Cliath a chur faoi scáth an tSeirbhís Náisiúnta Otharcharr. Caithfimid déanamh cinnte sa phróiséas seo nach bhfuil an Rialtas chun fáil réidh le cuid de na hotharcharranna ar bhealach indíreach. Tá imní ar ionadaithe ó Bhriogáid Dóiteáin Bhaile Átha Cliath. D'fhéadfadh aighneas tionsclaíoch a bheith ann de bharr go bhfuil an HSE ceapaithe chun dul i mbun na seirbhísí seo agus iad ag déileáil leis na glaonna éigeandála ar fad. Tá bagairt ann cheana féin go mbeadh stailceanna nó aighneas tionsclaíoch maidir le moltaí atá ann leis an leibhéal criúnna atá sa bhriogáid sin a laghdú aon trian cheana féin. Íocann an HSE €10 milliún leis an gcomhairle cathrach in aghaidh na bliana leis an 12 otharcharr a choinneáil ag imeacht i láthair Bhaile Átha Cliath. Creideann an HSE go bhféadfaidís é seo a dhéanamh ar bhealach níos saoire agus nach mbeadh an oiread daoine ag obair. Caithfimid a bheith cinnte san athrú seo nach ar son airgead a shábháil amháin atáimid á dhéanamh é seo. Tá sé sin fíor-thábhachtach.
Tá fhios againn go maith freisin go bhfuil deacrachtaí le soláthar an HSE ó thaobh otharcharr ar fud na tíre. Is rud é sin atá ag cur an-imní ar dhaoine, go háirithe ó thaobh na notharcharranna atá ag dul in aois agus in aois na mblianta. Ba chóir go ndéanfaí athrú ar otharcharr tar éis seacht bliana. Tá sé faighte amach go bhfuil 18% de na hotharcharranna éigeandála anois os cionn ocht bliana d'aois. Tá na seirbhísí otharchairr riachtanach trasna an Stáit, mar atá ráite romham. Nuair atá tionósc nó rud éigin éigeandála ag tarlú, caithfidh daoine muinín a bheith acu nuair a ghlaonn siad ar an otharcharr go bhfuil sé chun teacht in am tráthúil. Faraor, ní shin an scéal atá trasna na tíre. Tá caighdeán leagtha síos ag HIQA a dheireann gur ceart 80% de na glaonna a bheith déileáilte leo taobh istigh de hocht nóiméad. Ní tharlaíonn sé sin ach i gcás 26.6% de na glaonna. Sna ceantair tuaithe, is 6.6% de na glaonna sin a bhfreagraíodh taobh istigh den tréimhse ocht nóiméad sin.
Caithfimid déanamh cinnte dá bhrí sin nach n-úsáidtear an próiséas seo ó thaobh an athbhreithniú le gearradh siar ar líon na n-otharcharr i mBaile Átha Cliath, mar atá feicthe ar fud na tíre. Sa bhuiséad malartach a chur Sinn Féin chun cinn, bhí muid ag moladh go gcuirfí dhá otharcharr breise ar fáil sna ceantair éagsúla sna ceithre réigiúin éagsúla. Tá an polasaí faoi láthair ag an Seirbhís Náisiúnta Otharcharr gach othar a thabhairt go dtí an ionad éigeandála sna hospidéil. Caithfimid beagáinín iniúchta a dhéanamh ar seo agus an modh "see and treat" a úsáidtear i dtíortha eile. Is rud é seo a d'fhéadfadh laghdú a dhéanamh ar an méid daoine gur gá a thabhairt go dtí na hionaid éigeandála sna hospidéil. Tá an gá atá léirithe ag HIQA maidir le tuilleadh comhoibriú a bheith idir na seirbhísí éagsúla tábhachtach ach caithfidh sé tarlú ar bhealach lena bhfuil na hoibrithe i mBaile Átha Cliath sásta agus lena bhfuil an tseirbhís agus an pobal sásta chomh maith céanna.
I will touch briefly on five points. I am not sure these are exact figures but I think Senator Darragh O'Brien said the HSE pays €9.2 million per year to Dublin Fire Brigade which accounts for 6.7% of the budget for the National Ambulance Service. On the face of it that would seem very little given that Dublin has one third of the population of the country. We must bear in mind that the vast majority of ambulance calls in Dublin, as is the case around the country, are not emergency calls. One needs to factor that into any of the budgets. If it is the case that Dublin Fire Brigade deals with 40% of emergency calls, it probably deals with 0% of non-emergency calls, so the vast majority of transport provided in Dublin by ambulance is provided by the National Ambulance Service. It is important to make that-----
They say emergency calls but I will not dispute it.
Most of the costs incurred by the National Ambulance Service are not emergency calls, they are inter-hospital transfer and transfer of neonates and transfer of patients and so on. That is the bulk of the work that is done. The difficulty in Dublin at the moment as identified by HIQA is that we currently have two call centres and calls are passed between Dublin Fire Brigade and the National Ambulance Service. There are problems with that and in my constituency there was a three hour delay in somebody getting an ambulance because a call was not passed on. That is not a satisfactory situation. Thankfully it was an alpha call, so it was not a serious emergency but it could happen that people do not get an ambulance because calls are not passed between the two call centres. That is not a satisfactory situation. It is also not satisfactory that the nearest ambulance is not sent. One might get through to the Dublin Fire Brigade and it might send its nearest ambulance which is ten minutes away but not the National Ambulance Service which is five minutes away. It is just common sense that we bring together dispatch and call taking, and there are differences in clinical audit. That is what we are trying to change. It does not mean that there will be any reduction in the number of Dublin Fire Brigade ambulances serving Dublin. That is not intended. I am happy to state that very clearly.
In terms of any cost cutting agenda, the budget for the National Ambulance Service will increase by €5.2 million this year. Most of that will be targeted at strengthening services in the west where there are gaps but if there is an agenda on cost cutting it is not coming from the HSE or the Department of Health. We are increasing the budget for ambulance services but what we want is efficiency. We do not want two vehicles turning up for an asthma attack when one is enough. We would rather those two were circulating separately picking up people much more quickly, so we want a bang for the taxpayer's buck.
There is a separate dispute involving Dublin Fire Brigade and crewing levels. That does not involve the HSE or the Department of Health, but is a matter between Dublin City Council and the unions and I am not going to get involved in that.
I am happy to engage in a future debate on ambulance services whether in Dublin or in the country as a whole because we are due to get the national capacity review on ambulance services quite soon and also the review on Dublin services in particular, so it would be opportune to have a longer debate, as has been suggested by Senators, at a later date.
I thank the Minister for coming to the House on the matter raised by Deputy Darragh O'Brien last week. We appreciate his speedy response.
Sitting suspended at
5.10 p.m. and resumed at 5.15 p.m.