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 Header Item Topical Issue Matters
 Header Item Leaders' Questions

Tuesday, 9 December 2014

Dáil Éireann Debate
Vol. 861 No. 1

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Topical Issue Matters

An Ceann Comhairle: Information on Seán Barrett Zoom on Seán Barrett I wish to advise the House of the following matters in respect of which notice has been given under Standing Order 27A and the name of the Member in each case: (1) Deputy Dominic Hannigan - the need to include chartered engineers on the list of witnesses who can sign section 7 of a passport application; (2) Deputy Terence Flanagan - the processing of medical card applications in the primary care reimbursement service; (3) Deputy Billy Timmins - the way in which funding for greenways was allocated in May 2014; (4) Deputy Pat Deering - the need for signs on the M9 and other tourist services and facilities at St. Mullins in County Carlow; (5) Deputy Éamon Ó Cuív - the proposals that Teagasc has for its research station in Athenry, County Galway; (6) Deputy Peter Mathews - the need to intervene to secure deferred pensions for members of the Irish airlines superannuation scheme; (7) Deputy Paul J. Connaughton - concerns over the use of compulsory purchase orders on the Dublin to Galway greenway; (8) Deputy Noel Harrington - the future source for funding for community development under SICAP for the non-Gaeltacht inhabited islands of Hare, Bere, Whiddy, Sherkin, Long, Dursey, Inis Boffin, Inis Turk, and Clare; (9) Deputy Dessie Ellis - the impact of proposed increases in rents for council tenants; (10) Deputy Marcella Corcoran Kennedy - the proposed closure of Ulster Bank, Ferbane, County Offaly; (11) Deputy Billy Kelleher - the loss of routes and reduction of services at Cork Airport; (12) Deputy Derek Keating - the interface between the Health Service Executive and Dublin Fire Brigade and Ambulance Service; (14) Deputy Eric Byrne - the online appointments system at the Garda National Immigration Bureau; (15) Deputy Mattie McGrath - the plans to develop a fair commonage management plan for hill farmers; (16) Deputy Thomas P. Broughan - the need to review the methadone treatment scheme; (17) Deputy Michael McGrath - the loss of routes and reduction of services at Cork Airport; (18) Deputy Timmy Dooley - the delays in booking a national car test appointment; (19) Deputy Denis Naughten - the need to review the care and admission policy of acute psychiatric patients; (20) Deputy Clare Daly - the CIA report into rendition, detention and interrogation methods; (21) Deputy Seán Ó Fearghaíl - the position regarding the scheme to support national organisations funding; (22) Deputy Mick Wallace - the CIA interrogation methods report; (23) Deputy Robert Troy - the need to provide assistance and funding to services for the homeless at St. Martha's hostel for men and Bethany House for women, County Longford; (24) Deputy Ruth Coppinger - the recent revelation of abuse in care homes of people with mental disabilities; and (25) Deputy Patrick O'Donovan - the need for a review of the laws on speed detection cameras and the use of Go Safe vans on roads here.

The matters raised by Deputies Noel Harrington, Dessie Ellis, Dominic Hannigan and Timmy Dooley have been selected for discussion.

Leaders' Questions

Deputy Micheál Martin: Information on Micheál Martin Zoom on Micheál Martin Last week, there was a special "Prime Time" programme on the ambulance service. It monitored various counties and also looked at ambulance response times in Dublin. The programme was shocking as it showed interviews of staff and family members who made 999 calls, some of whom received appalling responses.

For example, one man explained how he rang 999 as his father had chest pain. Even though they could see the Wexford hospital from their own home, the ambulance took more than 50 minutes to arrive and unfortunately his father passed away. This man could not understand why ambulance control did not explain that there would be a delay, as he would have been able to drive his father to the hospital within a few minutes. When he queried this afterwards, he was told that people were not normally told there would be delays unless they asked.

A whistleblower from the mid-west was interviewed. She said that ambulance crews from the mid-west were run ragged and "going without food for hours" trying to respond to patients because of a lack of ambulances. She is an emergency medical technician. She said: "There are still not enough vehicles to cover an emergency. If a plane crashed, there are definitely not enough ambulances for it." She also said: "The situation of late response times for ambulance call-outs in Limerick is serious. There wouldn't be a day that would go past that you wouldn't be stuck somewhere for an ambulance going 'Oh, God, we've no ambulances to send there'."

The Health Information and Quality Authority report published last week confirmed that ambulance calls continue to rise by about 10% per year.

An Ceann Comhairle: Information on Seán Barrett Zoom on Seán Barrett A question, please.

Deputy Micheál Martin: Information on Micheál Martin Zoom on Micheál Martin Worryingly, it also found that staffing in some control centres fell below the required safe levels.

Does the Taoiseach accept that ambulance response times are far from acceptable? What does he intend to do to address this situation? Does he accept that it is time for a fundamental review of how the ambulance system in the country is organised to ensure proper and effective ambulance response times in all areas of the country, particularly in rural areas?

The Taoiseach: Information on Enda Kenny Zoom on Enda Kenny The ambulance service over the years has always been one where controversy has raised its head on many occasions. I recall being on a health board many years ago and the clapped-out ambulance vehicles in many cases were a source of constant engagement at the meetings.

Since 2011, there has been a major programme of change to reconfigure how pre-hospital emergency care services are managed and delivered. Last year, there were 280,776 calls, 14,000 more than in 2012, which is a significant number. In 2011, there were no targets set for ambulance response times. When the Minister, Deputy Reilly, was in charge he raised the bar for response times. For 2014, a new target has been set for 80% of life-threatening calls to be responded to in under 19 minutes. The 2013 target was for between 68% and 70%. For the first time now hospital turnaround data are being collated on a national basis, which is important. That will allow an assessment of performance in the handover of critically ill patients in the system as a whole, in the response times and in the collection times. That will obviously allow for determination as to how the system can be improved. I accept it is not perfect by any means.

The HSE has acknowledged that at times of high demand with the emergency care system there is clearly a potential for delays in the transfer of patients from ambulance to emergency department and this results in delays in the release of ambulances from emergency departments and reduces the availability of ambulances elsewhere. That is why a national collation system has now been put in place.

There has also been a whole new further set of details on the ambulance emergency department framework. That clarifies the process of clinical handover, establishing where are the lines of responsibility . There is a €5.4 million increase in the ambulance budget for next year, which I think everyone will welcome. There will be 50 replacement ambulances next year, which I think everyone will also welcome. The DELTA and ECHO response times are improving, but the HIQA report recognises that patient outcome is actually more important than response times. The clinical audit will begin next year for the first time.

It is an evolution to a point where national data are now being collated. We have increased investment in the provision of new ambulances and in the collation of the data. Most important of all is the health of the patient.

Deputy Micheál Martin: Information on Micheál Martin Zoom on Micheál Martin The Taoiseach needs to stop referring to things happening "for the first time" because that is the classical political response to very serious issues. The HIQA report was quite clear that over a ten-year period, there was very significant progress in the training of emergency medical technicians. The whole pre-ambulance care council and so forth which was established more than ten years ago changed dramatically what had been happening prior to then.

The key point is that the lack of any strategic planning is now evident. Something has gone fundamentally wrong with the reconfiguration. What is the response to that person in Wexford who was within eyesight of the hospital and yet it took 50 minutes for the ambulance to get there? There are probably Deputies in all parts of the House who can instance cases where the response times were simply too long. The money that has been allocated for replacement vehicles had to be allocated because the HIQA report revealed-----

An Ceann Comhairle: Information on Seán Barrett Zoom on Seán Barrett A question, please.

Deputy Micheál Martin: Information on Micheál Martin Zoom on Micheál Martin -----that up to 47 vehicles were way beyond the seven years and 500,000 km criteria for emergency ambulances in the State.

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