Holly Cairns confronted the Taoiseach in the Dail over chronic ambulance understaffing and pay disputes, urging the government to drop preconditions and implement recommendations to protect patients and paramedics. She highlighted four-hour waits in Cork South West, a service running at 46% capacity and a call to double personnel by hiring 1,800 staff to end the crisis.
Overview of the exchange
Holly Cairns challenged the government on years of underfunding and the failure to recognise how the ambulance role has upskilled. She accused the government of expecting the service to run on workers' goodwill while paramedics provide near A&E-level care without commensurate pay or resources.
Impact on patients and rural communities
Cairns described the human cost: patients waiting hours for ambulances, and rural communities left vulnerable. She stressed that understaffing and proposed preconditions - reducing trained paramedics per crew and potential pay reductions - would worsen outcomes for patients.
Industrial dispute and proposed solutions
Cairns called for the government to drop preconditions and adopt the independent recommendations set out six years ago and supported by the Labour Court. The Taoiseach responded by defending past reform and urging mediation and dialogue between the HSE and unions.
Political consequences and next steps
The debate frames a wider confrontation over modernising pay structures, resourcing emergency services and resolving the strike. Cairns demanded concrete commitments from government; the Taoiseach reiterated a preference for negotiated settlements through the HSE and mediation.
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Thank you, Ceann Comhairle. These are workers who go above and beyond to do the most important work, who even volunteer after they finish work to provide that crucial emergency care. They spoke about how much they had to upskill over the years so they can provide better and faster treatment to patients, and how the evolving nature of their role has not been recognised by this or any previous government. Instead, these workers have been ignored for years. Taoiseach, not only are these essential workers badly paid, they are not adequately resourced. The service is so understaffed personnel numbers need to be doubled by hiring 1,800 workers. Is it any wonder the service is so stretched on the ground? Or that this is having very serious consequences for patients? In my own constituency, in Cork South West, I have been contacted by people who have had to wait four hours for an ambulance. Imagine that, seeing a loved one in serious medical distress and waiting for hours for an ambulance to arrive. It is horrific, it is the result of years of underfunding, and it is something people in rural Ireland have unfortunately come to expect. This is not the fault of ambulance workers who do their very best. The blame lies squarely with a government that expects an ambulance service to run on fumes and workers' goodwill. Taoiseach, it is outrageous this government has allowed things to deteriorate to where we are today. Ambulance workers on strike with the service running at 46% capacity. What does the government have to say to those people who have been fighting to resolve these issues for years? The bottom line is that staff in the ambulance service must be fairly paid and recognised for the essential and skilled work that they do. An independent report published six years ago has set out how that can be done. But instead of just implementing the report as recommended by the Labour court, attempts have been made to introduce preconditions which would see the number of trained paramedics in a crew go from two to one, and in some instances actually reduce people's pay. You couldn't make it up. This is not something that workers can or should agree to. This is now beyond a crisis, and this dispute must be brought to an end. Will the government commit to dropping those preconditions and adopting the McKean-Shaptree First of all, again, it was successive governments that invested and took the policy decisions to change the whole nature of the first responder sector. You just made a comment that no previous government ever did anything about this. Such an outrageous comment to make. No reality attached to it at all, but you seem to think you can come in and just say it. And that's grand. How do you think it happened? How do you think the Pre-Emergency Ambulance and Care Council was established? How was the first responder system developed? The professionalization of the whole area. And yes, all involved were fantastic in going with it and having the ambition to do it, but let's not throw away statements that no one cared a damn about it until now, until you got up to speak. That's ridiculous. And the bottom line is this. There was a genuine negotiations went on between the HSE and the unions. Unfortunately, even though they agreed and the unions agreed to put the proposal and recommended the proposal, which all of you ignore, you seem to be saying that no matter what people, you know, whatever is sought, just agree it, please. There's always negotiations in situations like this. We want to modernize. We accept it even further. We want to invest more. There is more funding on the table for investment. There has been very significant investment. Now, there are pressures on workers in that sector, of that there is no doubt. Reforms are important as well in public expenditure. We always can do things better, more efficiently and more effectively. What you seem to be saying is just forget all about reform, is what you're saying, and I don't think that's a sustainable position either. Neither did the unions, for that matter, and correctly so. So there's fantastic work being done on the front line. We affirm it. We want to get this resolved. There's only one way to resolve it, and that is through mediation, through dialogue, and I'm confident it can be resolved and that the issues can be netted out and we can get to a conclusion. Because there's been tremendous strides made, despite what you've said, in this area in my lifetime and certainly over the last two decades because of decisions to change policy, because of decisions to professionalize emergency medical technicians and to professionalize that entire service, and it's been very effective because it complements and supports the acute hospital service. In other words, the first responder is the key person to anybody whose life is in danger or to anyone who's in an accident, and the fact that we've professionalized that and that all those involved did the additional work, academic work and so on, and qualifications, is to their credit, and no one is disputing that. The state has accepted from day one that pay structures need to be modernized, and that was the subject matter of previous engagement at the WRC, which then concluded with very significant outcomes. And I outlined those earlier. Thank you. Now, Deputy Kearns. Thank you, Taoiseach. Time is up. Deputy Kearns. Taoiseach, I said this and no other previous government has acknowledged how much the ambulance service has upskilled in terms of their pay and conditions. So in the past 15 years, they've gone from essentially being a patient transfer service to providing what is nearly A&E-style services in any given situation, and their pay hasn't been acknowledged to be representative of that. That is the truth. They're on picket lines because of that. The reality is, Taoiseach and Minister, who's totting over at me, the reality is that paramedics are providing – they have the same responsibility as other medical professionals. They have the same amount of training as other medical professionals, and they are paid significantly less. That is fundamentally unfair. You at least have to recognize that. Then they're going in to a pay dispute, and they're being told that in order to get a pay rise, they have to accept that there will be a reduction in the number of trained paramedics in a crew, and because of the conditions around overtime, that some of their pay might be decreased. It is ridiculous. Will you answer the question in terms of will the government drop the preconditions around the pay? Taoiseach, to respond. First of all, Deputy, again, we're not going to negotiate paragraph by paragraph of an industrial relations agreement in the Chamber. Not feasible. We're not going to do that. But what I have said from day one is there should be dialogue. The HSE remain available for engagement with the trade unions on this matter. That is the sensible way to resolve this. Anybody involved in industrial relations over the years realizes that, know that. And by the way, we've long gone from the day when there's a ministerial intervention in every single dispute that could potentially arise. That day is gone. We have a very sophisticated way of resolving disputes. Experienced people. And yes, there has to be a will on both sides to resolve it. There is a will on the government side to resolve it. And I'm sure there is too on the union side. But people should enter into discussions and get into dialogue.
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