25/02/15 Senator Daly speaks to the Seanad and Minister for Health Leo Varadkar on Health Services Motion

Senator Daly: I welcome the Minister to the House. Depending on who is doing the number-crunching, approximately 1 million people go through accident and emergency departments every year. There are several main issues with accident and emergency departments from ambulances, patient processing, staffing and step-down beds. From my experience of dealing with the ambulance service, I know the situation nationwide is dire when response times for 500 emergency calls are longer than the times recommended by the HSE. This has consequences. People are dying in Kerry because of their geographical position. More important, they are dying because of cuts to ambulance services. Before, two emergency ambulances were based in Killarney, one in Kenmare and one in Millstreet, which covered the east Kerry area. Now, there are just two ambulances covering the same area. That in turn means ambulances are pulled in from Dingle, Caherciveen, Tralee and Listowel to cover the gaps in the service in Kerry. It is death by geography.

The lack of emergency ambulance cover means when paramedics do arrive at a patient, the patient has already deteriorated to such a degree that he or she will spend longer in an intensive care unit, hospital and the step-down care facility. In some cases, they may never leave hospital. As the Minister knows, when a patient is suffering a heart attack, the longer it takes to put in the stent, the greater the likelihood the person will have an irreversible heart attack, will spend his days not being a productive member of society, or will die. We had such a case in Kerry where the Cahersiveen ambulance was not available and nor was the Killarney ambulance. It was out on call with the result that the Kenmare ambulance had to travel one hour and 40 minutes to see this man in south Kerry. When he was seen, they called the coastguard helicopter. He stepped into the helicopter and said that it was not good. The paramedic agreed with him and he died on the operating table in Cork. If he had been seen earlier and if the ambulance had been available, the outcome could have been different. We do not have enough emergency ambulances so we have people dying or having irreversible effects on the health, including heart attacks and strokes. There is an ongoing review and I take on board the point that the previous Government was in charge. A system where an ambulance is sitting outside an accident and emergency room with the patient inside on a trolley waiting for two hours for someone to say they will take him in is beyond belief. It means, for example, that the ambulance is not available in its home county to bring stroke and heart attack victims to Cork, leaving the service devoid of cover in Kerry. The same situation applies around the country.

The Minister has an action plan for stepdown beds. With regard to the 700 beds occupied in our hospitals and having them taken by people who should be in longstay care, there is an obvious loss of process. From the issue of the ambulance not being there to bring the critically ill patient to the hospital so they can get the treatment they need and do not have to go into long-term care, and the fact that ambulances arrive and are not immediately released, the process is not as it should be. This has been the situation for decades. Paramedics tell me they wait for hour for the patient be taken into accident and emergency units. That is a lot of equipment sitting there idle. It is not about money but about process and it can be fixed without throwing more money at the system.

Stepdown beds are about money. There are 20 beds in the Kenmare hospital available but we do not have the staff to take them from Cork University Hospital. Staff will be employed in the acute care hospital but not in community hospitals. Nursing homes are at full capacity. There are issues that can be solved by money but other issues must be solved by the processes currently in place, which are not working effectively. Tonight, 100 emergency ambulances are available around the country. If all 100 are out on call, no one wants to be the 101st victim of a car accident, a stroke or a heart attack because the ambulance will not be there when it is needed.

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