15/07/15 Senator Daly Speaks on Ambulance Services Provision

Senator Daly: I thank the Minister for coming to the House to respond to this issue regarding the national ambulance service, which is an issue in Kerry but also nationwide. It is about joined up thinking with regard to our national ambulance service and how the lack of that has affected Kerry, Cork and many other rural areas.

The epitome of the position was highlighted by a response from officials within the national ambulance service when they were withdrawing ambulances from west Cork. They told a local action group concerned about the effect of that in terms of life and death situations that was what they got for living in a rural area. Kerry was at the tail end of this process of reconfiguration or, as they like to call it, dynamic deployment, which is basically guessing where the next heart attack will take place – it is like Russian roulette when it comes to an ambulance service. In Kerry, fewer than 60% of the ambulances arrive within the 19 minute response time set by the Health Information and Quality Authority, HIQA, for emergency cases such as heart attacks, strokes and car crashes. The only way they will meet those response times is if they expand the length of time.

We are in a very rural area and we have seen ambulances being withdrawn. The Millstreet ambulance was withdrawn almost two years ago. That also covered a large part of east Kerry. Subsequently, one of the two emergency ambulances in Killarney was withdrawn and the strain on the system is evidenced by the fact that every month or so, there is a headline in The Kerrymanor Kerry’s Eyeabout how it took 50 minutes for an ambulance to get to Kenmare, Caherciveen or Dingle. That is complicated by the fact that when the ambulance arrives, and it is an excellent service because the paramedics are highly trained, it then goes to Cork where there could be a three hour wait just to have the patient admitted to Cork University Hospital because of a systems failure that has been ongoing in that hospital for years, which is amazing. That has been acknowledged by the Health Service Executive, HSE, and yet it continues.

This situation is costing the HSE more money because as the Minister of State will be aware, if stroke or heart attack victims do not get help immediately, their chances of recovery are greatly lessened. If they do not die their recovery takes longer, which means they tie up those beds in Cork University Hospital and throughout our national hospital network. There are also physiotherapy, speech therapy and other ancillary costs because the ambulance did not get to those patients in time.

There was a tragic case in south Kerry, which resulted in a fatality. The ambulance in Caherciveen was not available and there was not one available in Killarney. The ambulance had to come from Kenmare, which is nearly 50 minutes away. By the time it arrived, it was decided that the victim, who was suffering a heart attack, should go to Cork University Hospital. The helicopter was called from Shannon. It was now two hours after the initial call. When that patient stepped onto the helicopter he said, “I am in trouble, aren’t I?”, and he ended up dying on the operating table because the ambulance in Caherciveen had been pulled, as had the ambulances in Killarney and Millstreet. Tragedies are occurring as a result of these ambulances being withdrawn.

Next weekend Cork will play Kerry and we will have 40,000 people in Killarney, but there will be only one ambulance in the town. Killarney is unique because its population can double on any given weekend and yet it has only one ambulance. Very few towns can say their population will double on any given weekend and to have just one emergency ambulance in that situation is far from ideal.

I ask the Minister of State to look into that because not having ambulances available, and the cost of rehabilitation for those who do not get an ambulance in time, is costing the taxpayer a fortune.

Minister Lynch: I thank the Senator for raising the issue. I am pleased to be able to outline to him the current developments in pre-hospital services, both nationally and in the Kerry area, in particular.

The national ambulance service, NAS, has undergone a huge programme of reform and modernisation in recent years, and it is important to acknowledge that progress is being made. The Minister, Deputy Varadkar, recently officially opened the new national emergency operations centre in Tallaght, which allows the NAS to operate on a national rather than a regional basis. All calls for ambulance services for the Kerry region are now taken in Tallaght, and resources are dispatched from that centre.

Additional funding of €5.4 million has been provided this year to improve technology and clinical audit, and address gaps in service. Improved technology is facilitating better co-ordination of the national fleet, and that is improving control and dispatch performance.

It is important to note that the NAS is not a static service, but rather deploys its resources in a dynamic manner. This ensures that the nearest available and appropriate resource is sent to an incident. The NAS continuously evaluates its services in tandem with available resources and activity levels.

Kerry has 14 emergency ambulances and one rapid response vehicle. Seven crews operate on a 24 hours a day, seven days a week basis. The service operates from six ambulance stations in Tralee, Killarney, Listowel, Dingle, Kenmare and Caherciveen. Paramedics and advanced paramedics are deployed across the county, which ensures that practitioners with the appropriate skill level are located strategically to provide the best possible cover.

We are continuing to develop the intermediate care service, ICS, which transports patients between facilities, allowing emergency vehicles to focus on emergency calls. The ICS now carries three quarters of the non-emergency workload. In the Kerry area, two intermediate care vehicles operate from Monday to Friday, 8 a.m. to 8 p.m, and one operates on Saturday and Sunday from 10 a.m. to 7 p.m.

We are expanding the number of community first responders, CFRs, particularly in more rural and sparsely populated areas. These are volunteer groups in the community who are registered and trained to a certified standard. We now have over 120 teams operating around the country. Four of these teams are operating in the Kerry region and are linked to the national control centre. On receipt of an emergency call in a geographic area served by a team, the NAS computer aided dispatch system will send out a text alert to the group and simultaneously deploy a NAS resource. CFR teams are dispatched to persons with cardiac and respiratory difficulties. The responder may get to the scene before the arrival of the ambulance crew and will apply their training, thus increasing the person’s chance of survival. It is a great community initiative, which I fully endorse, and is a real case of helping thy neighbour. I have seen it in operation, and it is impressive.

We have also seen the establishment of the emergency aeromedical service, EAS, operated from Athlone by the Air Corps and staffed by NAS advanced paramedics. The EAS provides swift transfers of seriously ill or injured patients to appropriate hospitals. Over 1,050 missions have been completed since June 2012.

These are all significant achievements. However, the House can be assured that this Government intends to drive further improvements in our pre-hospital emergency care services, which will benefit the people of Kerry and those in the rest of the country

Senator Daly: I thank the Minister of State for her outline of the services. The main issue is the paramedics in Kerry will tell one there are simply not enough ambulances. It is not the case that they were not there before; they were and they were withdrawn. The emergency ambulance in Millstreet was taken away. The second ambulance in Killarney was taken away. Will the Minister of State ask for a report on how much it costs us to have fewer ambulances? If one tracks the patients going through the system, one sees the extra stay as a result of the ambulance not arriving in time costs money. Unfortunately, in some cases, it costs lives. It is a simple fact that if the ambulance does not arrive in time for a heart attack or stroke patient, or at a car accident, the outcome will be fatal in some cases and tragic for the family in the long run in other cases. The reply does not state we have fewer ambulances. We have dynamic deployment but the paramedics tell me they cannot be everywhere. If they are in CUH when a call comes in, and the next nearest ambulance is in Caherciveen, which is 40 minutes away, this will lead to tragic outcomes. I ask the Minister of State for an evaluation and impact assessment on how much it costs over a one-year period. As one can see from the reports, ambulances in Kerry do not arrive within HIQA’s guidelines and, therefore, the outcomes are tragic.

Minister Lynch: I know Kerry fairly well, as does everyone in Cork, not just from the clashes in Killarney but from holidaying there. Ambulances are based in Tralee, Killarney, Listowel, Dingle, Kenmare and Caherciveen. I know getting from Caherciveen along the coast road can be quite difficult at times and it is not a short journey. On paper, it looks to me as though there is extensive coverage, but I promise the Senator I will inquire as to whether there are particular difficulties. On paper, it looks as though there is extensive coverage.

Senator Daly: I thank the Minister of State.

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