Éamon Ó Cuív (Galway West, Fianna Fail)
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Gabhaim buíochas leis an Leas-Cheann Comhairle. Tá mé cinnte go mbeidh an-spéis ag an Leas Cheann-Comhairle san ábhar seo.

Catherine Connolly (Galway West, Independent)
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Beidh an Teachta Ó Cuív in ann labhairt ar mo shon.

Éamon Ó Cuív (Galway West, Fianna Fail)
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Beidh mé in ann labhairt ar a son go cinnte dearfa.

Evacuations from islands happen all the time. They have always happened. We have improved ferry services, and there are lifeboats on some of the islands. We also have the helicopter rescue service, which is extremely important for the islands. However, the number of evacuations has grown rapidly as mass tourism has come to the islands. This is particularly the case when it comes to bike hire. Islanders will tell you observe that many people who have not cycled for a long time will hire bikes to get around. Unfortunately, a fair number of them come off and need to be taken off the island by boat, by helicopter or, in some cases, by plane to the mainland for treatment. The problem is that very few people are involved in accidents near the airstrip or the pier. This is also the case for those who get sick at home. All of these people have to be transported to the airstrip or to the pier. With the exception of Árainn Mhór in Donegal and Inis Mór - or Árainn, as it is more correctly known by locals - in the Aran Islands, there are no ambulances or vehicles for carrying patients on the other islands.

It is interesting that in 2023, the national ambulance service, NAS, received funding under the multi-annual integrated urgent and emergency care delivery process of Saolta, community health organisation, CHO, 1, community healthcare west, public health and the NAS. This was the only route the NAS could identify as being suitable when it came to obtaining funding. However, no funding was received via this route. It is not just the case that money is needed for ambulances; it is also required for the huge amount of work that goes into governance and safety.

Bhí an Leas-Cheann Comhairle agus mé ar na hOileáin Árainn le gairid. Bhí otharcharr breá ann. Is é an rud is mó a rachadh i gcion ort ná an traenáil a bhí faighte ag na hoileánaigh. The islanders received training in order that they would be able to handle patients according to the highest standards. This requires investment in the NAS training college and in operations staff who work with the island volunteers. A great deal of training needs to be done. In recent times, a new vehicle was put on Inis Mór, or Árainn, and another on Árainn Mhór in Donegal. This came out of NAS resources. The simple fact is, however that unless more resources are made available, the NAS does not have the resources required to provide an equivalent service on the other inhabited offshore islands that need it.

This problem might be resolved somewhat if matched funding could be obtained from the Department of Rural and Community Development, which has responsibility for the islands. It is my experience that when matched funding is provided, all sorts of other funding becomes available. One way or the other, this is needed. It is only when something goes wrong that people ask why an issue was not attended to a long time previously.

Colm Burke (Cork North Central, Fine Gael)
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I thank Deputy Ó Cuív for raising the very important issue of ambulance service provision on islands for residents and visitors. I am here on behalf of the Minister for Health, Deputy Donnelly, who, unfortunately, could not be here tonight.

As part of its planning for medical emergencies, the NAS has made significant investment in training and equipment for volunteers on our inhabited islands. Through the NAS community engagement unit, training and support are provided to emergency first responders, EFRs, on the islands, who provide an essential service to their communities. I am informed that five of the six islands located in the south west now have community first responder, CFR, groups. These include members who have been been trained to CFR and EFR levels. Furthermore, automated external defibrillator cabinets have been provided on all inhabited islands with year-round populations through local funding and funding under the NAS out-of-hospital cardiac arrest strategy.

Emergency medical support is provided to the islands by the emergency aeromedical services in the west and the north west and by the publicly funded helicopter emergency medical service in the south west. The Irish Coast Guard, IRCG, search and rescue service also provides essential support to the offshore islands and has made a number of volunteers active on Inis Oírr, Árainn, Inis Mór and Toraigh. These volunteers are available to support emergency responses, including the arrival and the departure of IRCG helicopters.

In the context of land ambulance services on the islands, I am informed that the NAS has supplied ambulances this year to Inis Mór and Árainn Mhór from its existing resources. As regards the other islands, the HSE and the NAS continue to explore ways to enhance services to the communities there. I understand that one issue about supplying ambulances is about making sure there are people on the islands who are trained to deal with the emergencies.

Turning to the service provided by the NAS more generally, I take this opportunity to acknowledge the commitment of the NAS in delivering access to patient care throughout the country. Last year saw record levels of activity, with nearly 400,000 emergency calls received. Activity to date this year is up around 11% on the same period in 2023. Despite this unprecedented increase in patient demand, national ambulance response time performance this year has shown improvement over the same period in 2023. Government investment in the NAS has also improved, with a budget of more than €247 million being provided. This represents an overall increase of 30%, or €60 million, since 2020. This increase in investment increased total NAS staffing at the end of August to 2,363, an overall growth in staff of 273 since 2020. Of these, approximately 2,100 are front-line-facing patient care roles.

The Government has committed to provide a further increase in funding for the NAS in 2025. This will take the form of an additional 13%, or €33 million, and underlines the Government's continuing commitment to building further capacity in the NAS. Some €8 million in new development funding for 2024 will allow for the creation of 180 additional positions, including essential front-line paramedics, to build further capacity in the face of increasing patient demand.

I extend my gratitude to the NAS and its staff across the country for their commitment and dedication to patient care.

Éamon Ó Cuív (Galway West, Fianna Fail)
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One of the great frustrations of being a Member of this House are the padded answers that tell you everything except what you need to know and that address everything except what you addressed. What I wanted to speak about was the urgent need to provide funding to the NAS to enable it to provide ambulance services on offshore islands. This issue has been raised by the doctors who service the islands. In particular, it has been raised with me by the doctor who serves Clare Island, Inis Toirc and Inis Bigil. It has also been raised with me by the doctors on the Aran Islands and those who serve Inisbofin.

The Minister of State did not really provide an answer. Let us take the example of Inisbofin. Thousands of people go there every day during the summer and many hire bicycles. There are those who fall or trip. All sorts of things happen.

When there are large numbers of people in a place like that, things will go wrong, as well as islanders getting sick and having their own mishaps or needing attention.

If a person gets sick a mile or two away, it does not matter how well trained you are, there is no vehicle to transport them anywhere. People are doing things because they have to that are not according to standard. This leaves them in a vulnerable position. There is a full-time doctor on Inis Oírr. The training in question is great for having paramedics and so on. On Inis Oírr, however, a qualified doctor and nurse are on hand. They attend to these patients but they tell me that they have no physical way of transporting a person with broken bones or whatever in a safe way - in the only way we would accept on the mainland - as far as the helicopter, plane or boat service.

I thank the Leas-Cheann Comhairle for giving me an extra 30 seconds. There were only four real lines in the reply. Everything else was padding. Will the Minister of State indicate if it is intended to ensure that normal high standards will apply on the islands in the context of the evacuation of people from where they fall or where they are as far as the pier or the airfield?

Colm Burke (Cork North Central, Fine Gael)
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In fairness, the response I gave sets out clearly that there is emergency support in relation to the emergency aeromedical services in the west and north west.

Éamon Ó Cuív (Galway West, Fianna Fail)
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That is not the issue. How do you get to that service? How do you get to the airfield if the person lives or is located two miles away.

Colm Burke (Cork North Central, Fine Gael)
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As I understand it, the helicopter service is available. Earlier, I addressed the specific issue of emergency care on the islands and spoke about the significant increases in NAS resourcing in recent years. I also outlined the levels of additional investment in 2025 for the NAS following budget 2025. That is an increase of more than €33 million.

I will now mention the ambitious programme of reform the NAS has embarked upon in recent years to transform from a traditional patient conveyance service to an agile, fit-for-purpose emergency medical service. That is what the emergency services are doing. In order to meet the demands of our growing and ageing population, the NAS has developed a number of initiatives including community paramedics, increased capacity in the national emergency operations centre clinical hub, expansion of community first responder schemes nationally and development of a number of alternative pathways. These pathways, for instance, since October 2020 have treated more than 116,000 patients with 40% of patients not requiring subsequent treatment at hospital emergency departments. The programme of reform has also seen significant rise in Government investment with an increase of €60 million in the annual allocation since 2020. As outlined in budget 2025, there will be further additional funding to allow for expansion of these pathways and other essential initiatives throughout the country. The islands also need people who are trained to deal with and respond to emergencies.

Éamon Ó Cuív (Galway West, Fianna Fail)
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Doctors are trained.

Colm Burke (Cork North Central, Fine Gael)
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That has happened on some of the islands, but the programme is progressing. It is how they are responding to make sure that an adequate number of people are trained to deal with emergencies.

Éamon Ó Cuív (Galway West, Fianna Fail)
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The doctor tells me when he is confronted with somebody on the side of-----

Colm Burke (Cork North Central, Fine Gael)
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There is additional funding in each of these areas. The Deputy will have to accept that over the past four years that funding has benefited the islands. I outlined where ambulances have been provided to the islands.

Éamon Ó Cuív (Galway West, Fianna Fail)
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There are two. Inis Mór and-----

Colm Burke (Cork North Central, Fine Gael)
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It is progress that occurred in 2023. There will hopefully be further developments with the budget set out for the coming year.

Catherine Connolly (Galway West, Independent)
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I was lenient; we are over time. It is an important issue.