I propose to take Questions Nos. 36 and 75 together.
My Department and the Department of Health, Social Services and Public Safety, Belfast, DHSSPS, commissioned a feasibility study and report on the costs and benefits associated with the introduction of a dedicated helicopter emergency medical service, HEMS, for the island of Ireland. The decision to commission the study followed a recommendation by a cross-Border working group on pre-hospital emergency care, one of a number of groups established under the North-South Ministerial Council to examine areas of North-South co-operation in the health field.
The report of the consultants appointed to undertake the study was published on 30 April 2004 and is available on my Department's website. The study identifies possible roles for a helicopter emergency medical service, HEMS, a primary response which will travel directly to the scene of an incident to take the patient to hospital or an inter-hospital response which is the planned, rapid transfer between hospital of patients requiring specialist care, escorted by skilled professionals. The study concludes that an inter-hospital transfer service would be the most appropriate in an all-island context. It indicates that this would involve significant capital investment and annual operating costs. The estimated cost is €12 million capital and €4 million annual operating costs for a single helicopter. Additional helicopters could be added with an additional annual cost for each aircraft of over €3 million.
A three-year programme of work would be needed to establish HEMS, including procurement of aircraft, identifying and constructing landing sites, developing cross-Border communications and control systems, producing service protocols and cross-Border management agreements, staff recruitment and training, and arrangements for integration with existing hospital and ambulance services.
An air ambulance service is currently provided for health boards by the Air Corps on a request and availability basis. The Air Corps provides this service subject to the nature of the mission, available aircraft and other operational commitments. Air Corps helicopters operate from airports and, where available and deemed safe, hospital helipads. Most transfers are airport to airport with onward transfer by land ambulance. The service is well regarded and appreciated by those in the health service who avail of it.
The reconfiguration of acute hospital services along the lines proposed by the national task force on medical staffing — the Hanly report — underlines the importance of having a well organised ambulance service capable of responding rapidly to the needs of emergency patients. While the study shows that a HEMS would have a part to play in providing improved response times, it is not a substitute for the emergency ambulance service.
My Department is exploring options in relation to HEMS development in light of the study. As part of this exercise, it has initiated discussions with the Department of Defence and the Department of Communications, Marine and Natural Resources. Policy on the development of emergency medical services in Ireland is set out in a number of documents, including Quality and Fairness — A Health System for You; Building Healthier Hearts, the Government's cardiovascular health strategy; the strategic review of the ambulance service 2001; and the national task force on medical staffing — Hanly report.
Funding provided by my Department in recent years has facilitated significant advancements in the development of the ambulance service in line with the recommendations of these reports, including a major upgrading in training and standards; the equipping of emergency ambulances with defibrillators and the training of ambulance personnel in their use; the introduction of two-person crewing; and an upgrading of the ambulance fleet and equipment and improvements in communication equipment and control operations.
The strategic review of the ambulance service 2001 report, which forms the basis for the development of pre-hospital emergency medical services into the future, identifies aspects of the current emergency ambulance service which need to be addressed to bring it into line with best international practice to ensure effective and quality driven practices. The review recommended an additional investment of €26 million up to 2006 in the ambulance service, and my Department will continue to pursue this as a priority.
The report recommends that the service be developed at a number of levels. Principal among the proposed developments are the elimination of on-call as a means of providing emergency cover, improved fleet reliability and the roll-out of the emergency medical technician-advanced, EMT-A, programme.
The elimination of on-call is designed to facilitate further improvement in response times. I was pleased to be in a position to provide funding in excess of €3 million in the current year to facilitate the continuing phasing out of on-call in a number of regions. This is a programme which I hope to be in a position to extend.
My Department also provided additional capital funding of €2.5 million in December 2003 to enable the boards and authorities to continue with fleet and equipment replacement programmes which are essential prerequisites for enhanced speedy and appropriate care.
In addition I announced policy approval for the development of the emergency medical technician-advanced, EMT-A, programme. Considerable work has been undertaken by the pre-hospital emergency care council in conjunction with my Department in preparing the legislation necessary to give effect to the introduction of this programme. Funding of €500,000 has been allocated to the council to facilitate the roll-out of the training element of the programme in the current year.
