Brian Stanley criticises 'dynamic deployment' in ambulance service

You can raise much of the problems in our National Ambulance Service, and there are many problems. The staff are doing their best, but there are problems beyond their control. I am going to name out some of those. There are not enough staff or ambulances. We have approximately 1,500 staff. Scotland has more than double that, with a similar population. We have 675 operating ambulances within the service. Scotland has more than double that. There is a problem with so-called dynamic deployment. I really want to push you on this dynamic deployment. What that means is that ambulances can be sent anywhere. An ambulance based in Leish could be sent as far as Cork or Waterford, and are being sent that far. When they are almost at their destination, within a couple of miles of it, they can be turned back, because a local ambulance has got there a minute or two quicker. A crew can do 600 kilometres plus in a shift, and only pick up one or two patients. Recently, in Leish, where an ambulance crew was on, and only one ambulance crew was on, and one ambulance, the crew clocked in and were immediately sent to Oxford. Meanwhile, Leish was left without any ambulance. There was one ambulance station, and on a Monday and Tuesday night, there was only one ambulance on. An ambulance can take up to two hours or more to arrive within the county because of this, or not arrive at all. That is no fault to the staff. As I said, Monday or Tuesday night, only one ambulance can be on. That can be sent as far away as three counties, and that is actually happening. There is a recent death of a young person less than a mile from the hospital, and from the ambulance base, one ambulance base in the county, and there was no ambulance available to pick up that child. Two ambulances were on at that stage, and the two ambulances were sent out, and were gone to another county. We have less cover than we had 15 years ago in the county, despite the fact that the population has increased by over 40%, and it now stands for over 100,000. And to add to that problem is the problem with the rapid response vehicles. That is the cars with the advanced paramedics. There is less cover now. The operators of them did bring them home, and they would go, if they were called, whether they were on shift or not, they would leave from their home and rapidly deploy to the scene of an accident or an emergency. They are not now doing that because some genius decided that they had benefitting kind because they had this car with all the signs on it, and that they might be doing the shopping in it or something like that. Now, as a result of that, they are left at the base, and that extra cover is not there that was being done voluntarily by people. And then we have the staff shortage and retention problems because of burnout on top of all that. The Medical Times reported earlier this year the critical shortage of advanced paramedics is endangering life. And, yes, there are targets, and I have it here, replies to a parliamentary question I got recently. And in a life-threatening illness or injury situation, they have to reach that by 19 minutes. 18 minutes, 59 seconds to be exact. And put the only food in 45% of the time. So, I mean, if you set a target that low, of course you ought to leave it. Time is up, Deputy. Thank you. It's ridiculous. So, the question is, will you put an end to the so-called madness of dynamic deployment? Will you invest in more ambulances and increase the number of staff available? And will you step up recruitment immediately? Thank you, Tisha. Thank you, Deputy, for raising the issue. And look, at one level, the National Ambulance Service and pre-hospital emergency care has been transformed in the country over the last 20 years, in terms of the professionalisation of EMTs and of the whole response. And I think that has to be said, and there has been very significant investment in the service. In 2025, 8 million for new service developments for 180 additional posts in the service and increased capacity for aeromedical services. Like, total staff numbers now are at 2,430 as of August. That's a 25% increase since 2020. So, 502 extra people into the service. And 85% of that staff working in direct patient-facing roles. The issue of dynamic deployment is an issue that has arisen since the configuration was developed many years ago. And I, at a surface of, I can instinctively empathise with your point, because it does mean ambulances are travelling long distances and so on. And I think we have to respond to this in an evidence-based way. So, I do think, I'm not, and I'll talk to the Minister for Health and have further engagement with the National Ambulance Service and the professionals involved as to what is the optimal deployment of staff and ambulances and what's the best way to do it. In Dublin, for example, there's been a unique situation where you have the Dublin City Fire Service provided a very effective and efficient ambulance service for many, many years. And the HSE and themselves were arguing the task as to how to reform and configure. And my own view for a long time, if it's not broke, don't fix it in that context. And we should be open to examining what's the optimal way to deploy your resource. Now, many professionals will say what they're doing is the optimal way to do it. I think you're articulating a different perspective. I respect the points you're making, but I do think we probably need to look at this in a more evidence-based way. And perhaps your office committee could examine it in more detail on health. But the professionalisation of the service, the development of HEMS, for example, both in two services now, two dedicated helicopter emergency medical services, for example, all that significant expansion and is enhancing our response. And the key response, as you know, is an EMT or the first responder who's qualified and professional and can save lives. And to be fair, there's been a lot of very, very positive reforms, a lot of significant investment in the last number of years in this service. There has been issues, and the Oireachtas, members of the Oireachtas, from time to time, have raised the issue that we have raised. Now, Deputy Stanley. The issue is correct in relation to the investment, and I see the figures there, but you're not going to get the benefit of it because of the way it's configured at the moment. And just, you mentioned the word evidence. I'll tell you what the evidence is. You have a county left with no cover because the one ambulance is on cover has gone two or three counties away. That is not a situation that can be left to continue. And that's the way a leash is being left two nights a week, that that can happen. You have where somebody's injured or a life-threatening situation a mile or half a mile from the hospital. There's no ambulance to collect them because the two ambulances that are there during the day have been sent off somewhere else. I'm not arguing for them to be kept within a strict limit, but there does need to be a radius, Taoiseach. I raised this before. I raised the case of a farmer lying in a farmyard for two hours here a few years ago because there was no ambulance, you know, in the Clunasley area. There was no ambulance in Port Leash to go out to assist them. And what I'm appealing to you to do is that the officials will give you, they will give you answers and they will give you figures. They'll blind you with them. But you need to look at the reality of what's happening. And I'm spelling out the reality for you here in black and white. Thank you Deputy. It's a dynamic deployment and I'm asking you to review this dynamic deployment. The Government need to do it and invest in more ambulances and step up recruitment. Thank you, Taoiseach to respond. Yeah, but to be fair, like about 430,000 urgent and emergency calls in 2024. That's what we're talking about, the scale of this issue. With 32,000 calls increased, that's up above the previous year, 32,000 extra calls, 8% in 2023. And you've done the stats in terms of the performance is improving, 72.5% in 2023 to 73.2% against the 75% target for life-threatening cardiac respiratory arrest. We have to look at alternative care pathways as well. You mentioned the rapid response care. I've had experiences myself where that's been far more effective fast in cases that maybe didn't quite require an ambulance. But once you had the confidence of, you know, either a GP or a medic who can say, look, we can manage this in a certain way and get the person to a hospital. So we have to use the resource to be optimal. That's the objective. Thank you. Thank you. And one of the biggest issues has been torn over time. Thank you, Tisha. Hospitals in high times of high demand in emergency departments, for example. Thank you. And they're working on that in terms of improving that outcome. Thank you.