Topical Issue Transcript – “The provision of Ambulance Services in Dublin” Dáil Éireann 25.01.17
Deputy Seán Haughey: Dublin Fire Brigade provides emergency ambulance services in Dublin city and county by arrangement between Dublin City Council and the national ambulance service of the HSE. The Dublin Fire Brigade has a proud tradition of providing this fire-based ambulance service in the capital.
International best practice indicates that combining fire rescue and emergency services greatly improves the response to a crisis. A total of 830 Dublin Fire Brigade firefighters are also trained paramedics. They are available to provide immediate emergency medical assistance and the benefits of this integrated service should not be underestimated.
The Dublin Fire Brigade has been providing the ambulance service in the Dublin area since 1898. Since that time, it has dealt with major emergencies in an efficient and professional manner including at the time of the North Strand bombings in 1941, the Dublin bombings in 1974, the Stardust fire in 1981 and the fatal bus accident on Wellington Quay in 2004. Dubliners are rightly proud of their fire brigade and ambulance service and hold the service in great affection.
There are indications that SIPTU and IMPACT will ballot Dublin Fire Brigade members for strike action over a failure to secure four additional and necessary ambulances for the service. The chief executive of Dublin City Council, Owen Keegan, has stated that he wishes to see a transfer of all call taking and dispatching for ambulances to the national central control centre in Tallaght. He has also stated that this has been agreed by the chief executives of the other Dublin local authorities and by the HSE.
In recent years, three comprehensive reviews have been carried out relating to the ambulance service. The HIQA report, published in December 2014, highlighted public safety issues arising from the fact that two ambulance services were operating in the same area. The report raised concerns about the existence of two separate control and dispatch processes and identified the need for greater clinical governance of both services. It called for an enhanced integration of service provision in the greater Dublin area. A joint review by the HSE and Dublin City Council of the Dublin ambulance service has also been completed. The independent Lightfoot review of the National Ambulance Service capacity was published. It is clear from all three reports that co-ordination and integration between the Dublin Fire Brigade and the National Ambulance Service is required. In addition, there are deficits in ambulance capacity which require significant investment.
Then Minister for Health, Deputy Leo Varadkar, informed the Seanad on 10 March 2015 that staff in the Dublin Fire Brigade would be fully consulted before any changes are implemented. Clearly, such consultation has not taken place. Dublin City Council recently passed a motion to the effect that the elected members in all the Dublin local authorities and on the regional assembly should be consulted about any proposed changes. During the same debate on 10 March 2015, the Minister, Deputy Varadkar, also clarified the position on statutory responsibility for the Dublin ambulance service.
The expert panel on the pre-hospital emergency care services in Dublin published its report in December 2015. The findings of this expert panel should be implemented as a matter of urgency as this report provides a mechanism to address operational inefficiencies and the issue of a fully integrated ambulance service in the Dublin area. The Minister should commence immediately, by way of the new governance arrangements set out by the expert panel, a process to eliminate the shortfall in the available capacity of the Dublin Fire Brigade to meet demand in order that the use of fire appliances to respond to ambulance calls is reserved for those calls that are clinically appropriate.
Funding should be provided directly by the Department and Dublin City Council for the operation of the ambulance service provided by the Dublin Fire Brigade and this funding should be increased to reflect the current costs of the service. The National Ambulance Service and the Dublin Fire Brigade should be given equal status and equal treatment regarding the operation of ambulance services in Dublin. The current dispatch functions should be retained by the Dublin Fire Brigade and the Dublin Fire Brigade should maintain control over its own clinical governance.
I understand that in the coming weeks the Department of Health and the Department of Housing, Planning, Community and Local Government will continue to engage with the HSE and Dublin City Council on any changes in service provision which may be proposed. The findings of the expert panel on the pre-hospital emergency care services in Dublin published in December 2015 provides a clear path to deal with problems identified in the various reviews carried out to date. The chief executive of Dublin City Council, Mr. Owen Keegan, and the HSE must not be allowed to make changes unilaterally to the existing arrangements and they most certainly should consult the staff and the unions involved. I fully support the retention of the delivery of Dublin’s ambulance service from the Dublin Fire Brigade call centre. This is in the best interests of the clients and patients and has the wholehearted support of Dubliners generally.
Minister of State at the Department of Health (Deputy Marcella Corcoran Kennedy): I thank Deputy Haughey for raising this matter. Dublin Fire Brigade provides emergency ambulance services in Dublin city and county by arrangement between Dublin City Council and the HSE. The HSE National Ambulance Service provides some emergency capacity in the greater Dublin area, as well as non-emergency patient transport.
In recent years, three comprehensive reviews of our ambulance services have been undertaken: the Health Information and Quality Authority, HIQA, review, the independent Lightfoot review of National Ambulance Service capacity and the review of Dublin ambulance services, which was jointly commissioned by the HSE and Dublin City Council. The capacity review, published last year, examined overall ambulance resource levels and distribution against demand and activity. The review identified deficits in ambulance capacity, including in the Dublin area, which will require very significant investment to address. Implementation of the recommendations of the capacity review will require a multi-annual programme of phased investment in ambulance manpower, vehicles and technology. To this end, increased funding has been made available for ambulance services in the HSE national service plan 2017.
The HIQA report on ambulance services, which was published in December 2014, highlighted significant public safety issues arising from two ambulance services operating in the same domain. The report identified concerns around the existence of two separate control and dispatch processes, and also highlighted the need for greater clinical governance of both services. The HIQA report points very clearly to the need for enhanced integration of service provision in the greater Dublin area. In that context, the HSE is working closely with Dublin City Council, which is leading on this issue on behalf of the four Dublin local authorities to devise and agree the elements of a safe, sustainable, integrated and quality ambulance service for the citizens of Dublin.
The Minister for Health fully accepts that, in the interest of patient safety, we need the Dublin Fire Brigade and the National Ambulance Service to have a more co-ordinated and integrated approach to service delivery. To that end, discussions are taking place between officials of the Department of Health and the
Department of Housing, Planning, Community and Local Government. The Departments have requested a joint action plan from the HSE and Dublin City Council on service and governance issues.
The Dublin ambulance services review, which was commissioned in 2014, is focused on identifying a service model for the optimal provision of emergency ambulance services and patient care in the Dublin region, including service quality, patient safety and value for money. The review’s primary objectives are to determine the optimal model of ambulance provision, which ensures patients receive the highest standard of emergency response, and to determine the most cost-effective model of provision in future which ensures optimal value for money for the public purse.
I assure the Deputy that when the Minister for Health receives the review, a formal proposal for any changes to the services will be required to be submitted to both the Minister for Health and the Minister for Housing, Planning, Community and Local Government for consideration and approval. I convey the apologies of the Minister for Health, Deputy Harris, as he cannot be here this afternoon.
Deputy Seán Haughey: I thank the Minister of State for her response. This situation is becoming urgent. As I mentioned, there are indications that ballots are about to take place regarding strike action because of the inadequate ambulance service in the Dublin area. It comes back to the question of who provides the ambulance service. I speak this evening in defence of the Dublin Fire Brigade. It has been providing an excellent service. Dubliners are very proud of that service. It has a great tradition and its staff have great skills. I believe that is under threat. The chief executive of Dublin City Council, Mr. Owen Keegan, says that he wants no more to do with the governance of the Dublin Fire Brigade. He wants to hand the whole thing over, lock, stock and barrel, to the HSE. That would be a disaster. If we asked Dubliners who should run the fire and ambulance services, they certainly would not say the HSE. There is not much confidence in the HSE generally. As the saying goes, “If it ain’t broke, don’t fix it.” There are certainly problems that have to be addressed, but they can be addressed.
I want to come back to the issue of clinical governance. The previous Minister for Health, Deputy Varadkar, stated that it was the Department of the Environment, Community and Local Government, as it was then, that had responsibility for the Dublin ambulance service. Despite this, the Minister of State at the Department of Health is here this evening answering my questions and all my parliamentary questions were transferred to the Minister for Health. We need clarity on that. There are European court decisions in this regard which clearly state a role for the Department of Housing, Planning, Community and Local Government. I also want an assurance on consultation. No consultation took place between the staff and the unions on the HSE and Dublin City Council review. It is a recipe for disaster. There must be consultation with the elected members, the staff involved and the trade unions before any changes are contemplated, and not as a fait accompli. There must be consultation on this now.
Deputy Marcella Corcoran Kennedy: I assure the Deputy that I will certainly bring his pleas to the relevant parties on the consultation. Clearly, the people who are going to be most impacted by it need to be brought in as part of the consultation process. I do not think a top-down approach ever works, to be honest. I will most certainly bring that back to the Minister, Deputy Harris.
With regard to the considerations of the conclusions of the National Ambulance Service review, it is not yet possible to finalise the Dublin review until they are considered. Once the HSE and Dublin City Council have completed their consideration of the Dublin review, an action plan will be prepared to implement the recommendations of the three reviews of the ambulance service. The Deputy’s key point on consultation is very well made and I will certainly convey that to the relevant parties.