The National Ambulance Service of Ireland emergency service baseline and capacity review, commissioned by the HSE and carried out by Lightfoot Solutions UK, outlines how, even though the NAS is often compared to English ambulance services, it serves a much greater rural population than its English counterparts and there are only 40% as many ambulance calls per head of population as in England.
However, it has similar performance targets — including a target of an 80% response rate in eight minutes for Echo and Delta (life-threatening and potentially life-threatening) calls.
NAS deals with 480 emergency incidents a day, but according to the review: “Even on the assumption that NAS is fully resourced and operating to international good practice standards in all of its operational processes, the theoretical best achievable performance would be 64%.
“Our analysis indicates that it could only achieve an eight-minute performance of 60.6% across Ireland, compared to around 79% for a typical English service because of the immense difficulties with rurality in Ireland. This means that NAS cannot possibly achieve the Hiqa-prescribed target of 80% in eight minutes.”
Siptu health division organiser Paul Bell said the union had already written to Health Minister Simon Harris seeking an urgent meeting to discuss the review’s findings.
“We are looking to speak with the minister concerning what he intends to do to ensure the €25m necessary to fund the implementation of the recommendations contained in this report is made available,” he said.
The National Ambulance Service Representative Association said the findings of the review must be acted on urgently in order to avoid further tragedy as a result of lack of investment and the inability of ambulances to respond adequately to emergency incidents.
National chairman Michael Dixon said: “We have seen a number of adverse incidents in recent years that have resulted from lack of investment in the National Ambulance Service and the HSE insistence on defending response times that have now been shown to be completely unrealistic.
“The HSE and NAS can take no comfort from this independent review as paramedics on the ground, who are working under intolerable pressure, have warned of the inadequacies in personnel and equipment in the ambulance service but have been ignored while the HSE defended the service that has now been shown to be understaffed and under-resourced to meet the huge demands on it within the reconfigured hospital system.”
The review makes a string of recommendations, including that it should review the number and structure of the dispatch desks, operating processes, and the control room staffing arrangements.
Read the full report: www.hse.ie/eng/services/publications/NAScapacityreview.pdf
Response times varied across country
Figures from the NAS emergency service review give an insight into just how well ambulance services are performing in different parts of the country.
It shows that nationally, 68% of incidents in which an ambulance responded were emergencies, compared to 15% which were urgent incidents and 17% that were described as routine.
Regarding the number of emergency incidents by drive zones, 32% took place in a major urban area, with 28% in a minor urban area and 41% in rural areas.
Incidents coded either Echo or Delta involve life-threatening scenarios, while the review also looks at average response performances for both eight minutes and 19 minutes.
Regarding eight-minute response rates, Letterkenny, Tullamore, Tralee, Ennis, and Mullingar are the best performing minor urban areas, with Newbridge (which currently has no ambulance station), Stranorlar, Maynooth, Swords, and Enniscorthy at the other end of the scale.
Regarding 19-minute response rates, Kilkenny, Ennis, Letterkenny, Portlaoise, and Tralee are the five best-performing areas, while those with the poorest response rates were Gorey, Midleton, Newcastle West, Ballina, and Newcastle.
Dublin/Wicklow was the dispatch area with the best response average at 19 minutes, at 78.9%, but achieved only 23.4% for the eight-minute response rate. The rates for 8- and 19-minute responses elsewhere included 15.2% and 57.2% in East Kildare, 20.5% and 48% in the West, and 29% and 69.1% in the south.
Ambulances faced the longest average waiting time at Cork University Hospital, at 42.9 minutes.
Cavan General was the hospital with the shortest average waiting time, at 24.2 minutes.