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Ambulance Service Provision

Dáil Éireann Debate, Tuesday - 18 October 2016

Tuesday, 18 October 2016

Ceisteanna (16)

Louise O'Reilly

Ceist:

16. Deputy Louise O'Reilly asked the Minister for Health if he is satisfied that expenditure of over €19 million in the years 2012-15, inclusive, on private ambulance services represents value for money; if an investigation has happened on the reason some hospitals are outliers in terms of their use and spend on private ambulance services; the action he will take to divert public moneys spent on private ambulance services into resourcing and equipping the national ambulance service; and if he will make a statement on the matter. [30724/16]

Amharc ar fhreagra

Freagraí ó Béal (8 píosaí cainte)

Does the Minister think we are getting good value for money by spending €19 million on private ambulance services, €6.3 million of which was spent in 2015? Does he have any insight into why there is such disparity across the country, with certain hospitals relying very heavily on privatised services while others hardly use them at all?

The main role of the national ambulance service is to respond to emergency 999 or 112 calls. It also provides an interhospital transfer service through the intermediate care service.

There is a significant requirement for transfers of non-urgent patients for various clinical reasons, including transfers between hospitals, between residential and acute settings and transfers for diagnostic tests at other hospitals. In the context of the continued increase in demand for emergency ambulance services in recent years, there is a need to avail of private ambulance services to secure additional capacity for such patient transfers where required.

To this end, the HSE has put in place arrangements under a framework agreement, which provide for the utilisation of private ambulance providers. Public patient interhospital transports are carried out under this agreement.

Hospitals are permitted to seek patient transport services from other providers recognised by the pre-hospital emergency care council, where those included in the agreement are not in a position to provide the service required.

I am aware that acute hospitals have provided resources to the national ambulance service to facilitate the development of intermediate care services, and I welcome this. However, the reality is that there is an ongoing need for hospitals to have the flexibility to access private ambulance services where necessary and appropriate. The Deputy may wish to note that the HSE is reviewing public and private ambulance service provision. The review is expected to be completed by December 2016 and will answer the Deputy's question on value for money, as well as the question of consistency in deployment and policy around the country.

Since my appointment as Minister for Health I have met with the national ambulance service, NAS, and engaged with it on a broad range of issues including the various reviews of ambulance services which have been undertaken in recent years. I am therefore fully conscious of the need for a multi-annual programme of phased investment in ambulance manpower, vehicles and technology. In that regard, the Deputy can be assured that increased funding will be available to the national ambulance service for 2017. The detail of the improvements to be funded will be provided in the HSE's 2017 national service plan. Over the coming weeks my Department will work closely with its counterparts in the HSE and the national ambulance service to agree priorities in relation to the 2017 allocation.

I asked the Minister specifically whether he thought this represented good value for money and maybe I will get the answer in the next minute. Investing money in private companies will never improve our public health system. The Minister will be aware that national ambulance service personnel balloted for industrial action and that this was only averted on the promise of additional staff being recruited, specifically 461 paramedics. What is the plan for this and what is the budget allocation to ensure it is achieved? The Minister met with members of the Dublin fire brigade, whose members also provide a paramedic and ambulance service. Why do they not use a privatised service? There is no commitment on the Minister's part to the ring-fenced funding they have sought.

The HSE is carrying out a policy review and it will be able to advise me on whether these services represent value for money. It is about more than value for money. At the moment the service is essential. We need our public ambulances, our national ambulance service and Dublin fire brigade ambulances to pick up emergency cases and answer the 999 or 112 calls. In 2015, there were 308,000 calls to 999 and 112 numbers so there is a hugely increased demand. The ability of the national ambulance service to meet non-urgent patient care demands varies geographically. We try to make sure ambulances are used in urgent cases so that for non-urgent cases, such as transferring a patient from an acute setting to a residential setting, we will look at the use of private operators.

The Deputy is right that we need significant investment. An additional sum of €3.5 million will be allocated to the national ambulance service in 2017, the details of which will be set out in the service plan. I have had some very useful meetings with SIPTU on the Dublin fire brigade and the national ambulance service.

I have questioned the Minister a few times and my views on privatisation are well known. For those who do not want to listen, I repeat that we cannot improve the public health service by investing in private companies. It is very disappointing that the Minister says that we can. He also said the intention was to use more of these services, with €6.3 million in 2015 going to private providers outside our public health system to provide services national ambulance service personnel and Dublin fire brigade want to provide. These providers can give value for the money that is spent. The €6.3 million in 2015 shows that the amount going to private companies is going up, when it should be going down.

It might upset the Deputy to know that I agree with her on this.

It does not upset me. I just want to see the Minister do something about it.

I want to see investment in the public ambulance service and a reduction in reliance on private ambulance services. The Lightfoot report on capacity states that, even if we put in place all the extra ambulances and all the extra paramedics, we will still not have adequate provision in this country because of the geographic dispersal of our population. We need to invest in the national ambulance service and to provide it with more funding. This is why we are investing an extra €3 million in 2017, the details of which will be set out in the HSE service plan, but there are issues involved in supporting this service. Using private ambulances for non-urgent cases has a role to play and I want to keep our national ambulance service on the road to answer the urgent 999 and 112 calls.

The Dublin fire brigade brought up an important matter regarding how it is funded and I am due to receive a report on it, probably at the end of this year. I will have conversations with the Department of Housing, Planning, Community and Local Government in this regard as Dublin City Council currently funds it.

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