Léim ar aghaidh chuig an bpríomhábhar

Ambulance Service Provision

Dáil Éireann Debate, Tuesday - 1 April 2014

Tuesday, 1 April 2014

Ceisteanna (97)

Caoimhghín Ó Caoláin


97. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will take immediate action to increase the number of ambulances and the number of trained ambulance personnel to ensure proper emergency cover across the entire State in view of the dangerously inadequate ambulance service cover across large areas of the Twenty-six Counties at present; and if he will make a statement on the matter. [14989/14]

Amharc ar fhreagra

Freagraí ó Béal (24 píosaí cainte) (Ceist ar Health)

I ask the Minister to outline the immediate action he will take to increase the number of ambulances and trained ambulance personnel to ensure there will be a proper ambulance service in which citizens can have complete confidence in times of need.

I assure the House that the national ambulance service will continue to modernise and reconfigure its services to ensure emergency pre-hospital care is delivered in an appropriate and timely manner. In that regard, additional funding of €3.6 million and 43 staff have been provided under the national service plan for 2014. Including Dublin Fire Brigade emergency ambulances, our total fleet now numbers 534 vehicles. This represents an increase of 77 on the number of vehicles we had four years ago. I understand a number of emergency ambulances will be upgraded this year.

A significant reform programme is under way to provide a clinically driven and nationally co-ordinated system that will be supported by improved technology. Ongoing performance improvement projects include the single national control system, which is to be completed next year; the intermediate care service, which transports patients between facilities and allows emergency vehicles to focus on emergency situations; the move to on-duty rostering and the development of a national rostering system; and the emergency aeromedical support service, which flew 368 missions in 2013. One third of the latter involved time-critical transfers of ST segment elevation myocardial infarction, STEMI, heart attack patients to primary percutaneous coronary intervention, PCI, units.

I also draw the Deputy's attention to the three separate reviews of ambulance services that are under way. The Health Information and Quality Authority is examining the governance arrangements for pre-hospital emergency services, the HSE and Dublin City Council have commissioned a joint review of Dublin ambulance services to determine the optimal and most cost-effective model of ambulance services delivery for the city, and the national ambulance service is undertaking a comprehensive capacity review to determine the level of resourcing - in terms of staff, vehicles, skills and distribution - that will be required to deliver a safe and effective service now and into the future. These reviews will inform the development of a modern, clinically driven system, properly resourced, for appropriate and timely services to the benefit of patients.

We need fewer reviews and more action. That is the bottom line in respect of this matter. The "Prime Time" programme exposed the extent of the crisis relating to the ambulance service. That crisis is a direct result of cuts introduced under the stewardship of this Government and the one preceding it. Does the Minister share the huge public concern that exists with regard to the total inadequacy of the emergency ambulance cover available across huge swathes of this country? I refer here to the provision of ambulance services and the number of trained personnel and not to the quality of those working at the coalface within the ambulance service and who deserve great plaudits. Is it acceptable that ambulances often arrive too late and that people, including those I have known and who were dear to me, have died as a result? Is it acceptable that the target times set by HIQA are not being met? The times to which I refer have been changed and increased by the HSE. Is it acceptable that last year only one in every three people with life-threatening conditions was responded to by the ambulance service within the target times set?

I will address the specific issues. Since 2011 the HSE has been implementing response time standards on a phased basis in tandem with planned service improvement. In 2013 the HSE target for patient carrying vehicles to respond within 19 minutes was 70% for echo calls, that is, life-threatening cardiac and respiratory incidents, and 68% for delta calls, that is, life-threatening other than cardiac and respiratory incidents. For 2014 the target is 80% for both call types. It is important to remember that there have been over 1,000 extra calls per month in the past year. To say that we have been instigating cutbacks is utterly untrue. There has been a rationalising of control rooms towards one national system, which is ongoing. This is delivering improved technology to improve response times. The amount of investment in the past three years has been up year-on-year. In 2012 it was €128.7 million, in 2013 it was €135.1 million and in 2014 it was €137 million.

I assure the Minister that the points I have made are absolutely true. What we are seeking is an explanation of what the Minister is going to do about this crisis situation. Will he significantly increase the numbers of trained personnel and ambulances? When is he going to do this? What will he do in respect of HSE mismanagement of the service? This includes, for example, the scandalous use of rapid response vehicles as personal cars for managers. They are sitting outside their homes for long periods or in fleets at specific meetings that have been called having been driven there from different parts of the country and remaining for long periods out of service to the ambulance provision.

Is the Minister aware of the serious concern in the city of Dublin that the HSE is lining up to take control of the Dublin Fire Brigade ambulance service? This arises against the backdrop of a serious lack of confidence not only in the city but throughout the country in the HSE's capacity to provide a state-of-the-art and fully reliable ambulance service.

The people of this city do not want that change to arise. What can the Minister indicate to them about what he is going to do? When the Minister is citing figures he should examine the comparative situation in the North of Ireland and Scotland. He would find that we fall far short of those standards.

Again, the Deputy across loves to talk about crises and doom and gloom and has engaged in shroud-waving on several occasions.

The Minister should answer the question.

Sorry. I do not-----

He should answer the question without his nonsense. This is a very serious matter.

Deputy Ó Caoláin is not proving to be a very serious contributor if all he can do is shout instructions across the Chamber.

All the Minister can do is bluster his way.

There is no bluster.

He should answer the question.

No, sorry, Deputy.

Would you ask him to answer the question, a Leas-Cheann Comhairle?

Could we have order, please?

I will answer the question and I will keep the people informed of reality and the facts, not Deputy Ó Caoláin's bluster and shroud-waving. We have had quite enough of it over the years.

I am telling the Minister that any shroud-waving on my part is a result of the loss of a member of my family and it applies equally to all those who have experienced loss of life because of poor ambulance response times.

Good. I am glad that Deputy Ó Caoláin has acknowledged that it is shroud-waving.

This is a very serious matter.

I want order, please. The Minister to reply.

The response vehicle situation is currently being reviewed. I wish to inform Deputy Ó Caoláin again of some facts that do not quite fit the picture he likes to portray. Over 600 calls have been carried out this year already by those vehicles and over 230 of these were out-of-hours calls responded to by officers who had these vehicles at their homes and who were able to respond in an out-of-hours situation. That is what they are there for. I am not saying, no more than anyone in the service is saying, that the service could not be improved. We have these reviews to inform us of how to further improve the service to the benefit of patients and citizens. We will continue to do that.

Vehicles are important in themselves and ambulances are rather important too. Getting an ambulance to a patient is a priority. However, the core priority is getting treatment to the patient. There is a major emphasis now on the pre-hospital emergency care situation in order that the patient gets treatment and is stabilised as early as possible. This allows for them to be transferred to hospital in a safe fashion.