999 delays over missing ambulances
Up to half of all emergency 999 calls in Dublin are delayed because there is no nearby ambulance, a report has found.
A nine-month investigation into the state of the ambulance service found that poor co-operation between the country's two main authorities meant paramedics were not getting to patients as quickly as they could.
It branded as unsafe the lack of staff in ambulance control centres and hit out at bosses for not recruiting enough paramedics to replace those who had left the service.
The 187-page review, carried out by State healthcare watchdog the Health Information and Quality Authority (Hiqa), also flagged concerns about the country's ageing ambulance fleet.
Almost a fifth are more than eight years old and paramedics are repeatedly warning about an increase in breakdowns.
Phelim Quinn, Hiqa chief executive, has demanded ambulance chiefs urgently publish a joint action plan to improve the service.
"It is of serious concern to Hiqa that current governance arrangements between the National Ambulance Service and Dublin Fire Brigade are disjointed, with inadequate quality assurance and accountability controls," he said.
"As a matter of urgency, both services must act to ensure that there is a fully-integrated ambulance service in the greater Dublin area."
Under the present system, ambulances in the capital are controlled by the Dublin Fire Brigade, while the rest of the country relies on the National Ambulance Service.
There is no integration and poor cooperation between the authorities means patients are not getting an ambulance as fast as they could if they worked better together, the report found.
The watchdog warned that Dublin Fire Brigade is regularly unable to cope with demand for emergency call-outs in the capital.
When this happens, it phones the National Ambulance Service to ask for help.
Hiqa said this arrangement takes up valuable time during a medical emergency, leading to delays in paramedics getting to the scene.
On some days, up to 50% of all emergency calls in Dublin are delayed for various periods because there is no ambulance nearby.
Last year, Dublin Fire Brigade was forced to call on the National Ambulance Service to step in with help on 26,920 occasions - or almost one in three of all calls it received.
But the national service could help out only in just over 8,000 of the calls.
For the remaining almost 19,000 calls, patients had to either wait for an ambulance to arrive from a long distance or their call was queued until paramedics became available.
It is estimated that around 14,000 emergency calls a year in Dublin are queued because paramedics are not available.
The investigation also flagged up problems in rural areas with finding the correct locations while ambulance "black spot" areas Tuam in Co Galway, Mulranny in Co Mayo, and Loughglynn in Co Roscommon remain without an ambulance.
Hiqa also said it was "significantly concerned" that the National Ambulance Service does not carry out reviews into whether patients are getting the best possible care.
It found bosses have yet to implement all of the recommendations from a report last year into the death of a patient after no ambulance was despatched to the scene.
A drop in the number of paramedics in the National Ambulance Service has resulted in a reliance on paid overtime or the dropping of ambulance shifts, the report found.
The watchdog called for immediate recruitment to replace lost staff.
Noting the service guidelines to replace ambulances over seven years old and with more than 500,000km on the clock, Hiqa said 47 of the 266-strong fleet were more than eight years old.
This has increased the inherent risk of emergency ambulance breakdown and staff have repeatedly complained about the rising number of mechanical problems with their vehicles.
Hiqa said more effective leadership and management is needed in the ambulance service at all levels.
It has drawn up 12 key recommendations for bosses to deal with the "significant" need for an improved ambulance service.
The watchdog has called on health chiefs to act on them.
Health Minister Leo Varadkar said the ambulance service has come on in "leaps and bounds" in recent years but many improvements were still needed.
"More ambulances could be on dynamic dispatch rather than being parked up and waiting for a call in fire stations, ambulance bases or hospitals," he said.
"A lot more needs to be done to improve turnaround times at emergency departments."
Mr Varadkar also insisted there was no need to bring everyone who calls out an ambulance to the nearest hospital emergency department.
The system was inefficient and in some cases it would be better if patients were treated at the scene, recommended to attend a clinic or even given advice over the phone, he said.
"Clearly these are big changes, and will require new training, protocols and a public education campaign, but it can be done," he said.
Mr Varadkar said the Hiqa report gives good guidance on how services can be improved in the medium term.
"It's clear that more investment will be needed to modernise the fleet and more staff will need to be provided in some areas, but Hiqa also makes it clear that existing resources are not being used to best effect," he said.