David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I move:

That Dáil Éireann:

commends the tireless work of frontline paramedics and operational staff in dealing with increased demand without proportional resource increases;

notes that:

— 80 per cent of life-threatening incidents should be responded to by an ambulance within 19 minutes, as per the Health Service Executive's (HSE) own standards;

— average ambulance response times have lengthened by 50 per cent since 2019, by an average of 9 minutes, going from 18 to nearly 27 minutes, and up to 33 minutes on average in the South-East;

— State-wide response times for life-threatening callouts (Clinical Status 1 – ECHO: Patients who are in cardiac or respiratory arrest) within the 19-minute timeframe have decreased from 80 per cent in December 2017, to 76 per cent in December 2019, to 65 per cent in December 2022, and as low as 59 per cent in the West in December 2022; and

— State-wide response times for life-threatening callouts (Clinical Status 1 – DELTA: other life-threatening incidents) within the 19-minute timeframe have decreased from 54 per cent in December 2017, to 49 per cent in December 2019, to 30 per cent in December 2022, and as low as 19 per cent in Dublin in December 2022; and

further notes that:

— the National Ambulance Service (NAS) currently has cira 2,000 paramedics, and their workforce plan lays out a need for more than 1,300 more paramedics by the end of 2024, and a need to double the staffing composition to more than 4,000 by 2026;

— the NAS needs more than 3,000 paramedics in only four years to meet these targets and account for retirements and staff turnover;

— the NAS has warned that if these targets are not met, performance will continue to decline and the NAS will have insufficient resources to respond to the projected demand, and as a result, 19-minute performance would be considerably less than 40 per cent;

— only 209 new staff started with the NAS in 2022, of which 181 were patient and clinical care staff;

— since 2019, the National Ambulance Service College has commenced training for just 472 new recruits to the three-year Paramedic Studies programme, less than 160 a year;

— the NAS has said that "recruitment efforts are being surpassed by service demand", and Dublin Fire Brigade (DFB) have said "demand for ambulances is continually identified as being far in excess of DFB capacity"; and

— according to paramedics, as many as half or more shifts run into overtime, with 12-hour shifts often lasting 15 hours or more, leading to low morale and widespread burnout and occupation-related mental health difficulties among paramedics, which is damaging the attractiveness of the career and recruitment and retention in the NAS;

furthermore, notes that:

— in 2022, the average off-loads or hospital turnaround time in Dublin hospitals was 39 minutes, with 16 per cent of incidents having a turnaround time in excess of 60 minutes, according to DFB;

— in 2020, the comparable average turnaround time was 29 minutes with 6 per cent of ambulances experiencing off-load delays in excess of 60 minutes; and

— neither the HSE nor the NAS collate or report this data, as confirmed in a reply to parliamentary question 515 answered on 24th January, 2023;

condemns:

— the fact that the Government has not implemented the proposals agreed by Dáil Éireann on foot of a Sinn Féin motion on the NAS on 16th November, 2021, which the Government did not oppose;

— the failure of the Government and Minister for Health, Stephen Donnelly TD, to support our frontline paramedics to manage demand for emergency services and improve performance; and

— Minister for Health, Stephen Donnelly TD, and his Fianna Fáil and Fine Gael colleagues in Government, especially the Minister for Finance, Michael McGrath TD, and the Minister for Public Expenditure, National Development Plan Delivery and Reform, Paschal Donohoe TD, who chose not to provide the necessary fiscal resources in Budget 2023, which in turn is leading to burnout of frontline paramedics and has increased risk for patients due to increased response times; and

calls on the Government to:

— urgently publish a multi-annual capacity and workforce plan to meet the needs of the NAS and DFB to 2026 and 2030;

— urgently review the adequacy of the spatial distribution and coverage of the ambulance fleet, ambulance stations and rapid deployment points to ensure an equitable distribution of services across regions, reduce reliance on overtime and long shifts, and reach response time targets;

— provide more hospital beds to improve ambulance turnaround times and admit patients to hospital in a timely manner;

— rapidly advance specialist paramedic grades and expansions to primary and community services, in particular those relating to improved use of technology in hospital admission avoidance, community paramedicine, chronic disease management, and integrated care programmes for older people, to improve hospital avoidance and reduce the strain on emergency services; and

— expand mental health supports for the NAS and DFB workforce, including access to counselling and psychiatric services where appropriate, and address outstanding recruitment and retention issues which are a barrier to increasing employment.

In proposing this motion, I start by commending the tireless work of ambulance paramedics and those on the front line, many of whom I have spoken to over the last number of weeks in preparation for this Private Members' motion. We had a healthy discussion at the Joint Committee on Health with the National Ambulance Service and Dublin Fire Brigade last week. Some 80% of life-threatening incidents should be responded to by an ambulance within 19 minutes, per the Minister's, HSE's and HIQA's standards. The reality is that the average ambulance response times for life-threatening call-outs have lengthened by 50% since 2009, by an average of nine minutes, going from nearly 18 minutes to 27 minutes, and up to 33 minutes on average in the south east.

State-wide response rates within the 19-minute timeframe for the echo life-threatening call-outs, which, as we know, are for patients who are in cardiac or respiratory arrest, have decreased from 80% in December 2017 to 76% in December 2019, 65% in December 2022, and as low as 59% in the west of Ireland in December 2022. The State-wide response rates on time for the delta life-threatening calls, which are all remaining life-threatening calls, have dropped from 54% in December 2017 to 49% in December 2019 and 30% in December 2022 and, horrifically, as low as 19% in Dublin in December 2022. Dublin Fire Brigade was clear that the reason for this is a lack of capacity on one hand and, on the other, more lengthy wait and turnaround times at hospitals, with ambulances parked outside hospitals, waiting to disembark patients but being unable to because there are not enough beds.

The National Ambulance Service has about 2,000 staff. I have spoken to the Minister previously on this because we tabled a motion on this last year and recommended that the Minister and Government do certain things, which they simply have not done. As we know, we need to increase massively the capacity in the National Ambulance Service. The workforce plan that the National Ambulance Service has put in place states that it needs to recruit 1,300 more paramedics by the end of 2024 and that we have to double the capacity, which means an additional 4,000 staff by 2026. That is a huge increase that has to be met. The training places are simply not keeping pace at all. The National Ambulance Service stated, "recruitment efforts are being surpassed by service demand". We are not even standing still, never mind increasing the capacity, which we need to do. This is a critical area which the Minister is falling short on. We know that we need to double capacity over the next five years. It has been clearly set out in the capacity review. I do not see any of those targets realistically being met. When it comes to life-threatening call-outs across the State, average wait times are going up.

I mentioned the wait time for life-threatening calls in the south east. The average time last year was 33 minutes for the entire year, from when somebody makes a call to when an ambulance arrives. This includes those who are in serious cardiac arrest. The Minister will also know that the south east is the only region that does not have 24-7 emergency primary percutaneous coronary intervention, PPCI, yet it has the highest wait times for life-threatening calls for the National Ambulance Service. That is absolutely unacceptable and needs to be dealt with as part of increasing capacity in the service generally. The National Ambulance Service told us that the average off-load or hospital turnaround time in Dublin last year was 39 minutes, with 16% of incidents having a turnaround time in excess of 60 minutes, and that this was a substantial increase on previous years. When one looks at all the metrics and data, we are seeing people waiting longer and that capacity simply is not being put in.

The Minister needs to publish a multi-annual capacity and workforce plan. That needs to be matched with increased training places and a sense that we are actually going to achieve that plan, because the current plan, in my view, will not be achieved. One has to look at spatial and regional distribution and at the west, north west and south east, where wait times are particularly high. We know we need more beds in hospitals. It will certainly help if we can have more beds so that ambulances do not have to be parked outside hospitals for as long as they are. We need to advance rapidly specialist paramedic grades and to expand primary and community services. Finally, we also need to ensure that there are proper supports for those who are in the service, because the ambulance paramedics I speak to are overworked and doing much overtime. As the Minister knows, it is a stressful job, with difficult situations and difficult call-outs which they have to respond to. They deserve our support too. The Minister has to do much more on this issue.

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