Dublin’s ambulance crisis goes on because authorities are not trying hard enough

Concerns over the duplication of ambulance services in Dublin date back over 30 years.

Up to 2005, ambulance services across the country were delivered by nine different providers, resulting in a fragmented approach to the supply of emergency services.

From then, the National Ambulance Services was given responsibility for responding to 999 medical calls across the State – except in Dublin. It operates two national control centres in Tallaght and Ballyshannon – while Dublin Fire Brigade operates its own control centre from Tara Street.

In 2014, a Hiqa report found that up to half of all emergency calls received by DFB could be delayed because no ambulance was available. DFB sought assistance from the national service for one in three of all calls it received, but most of these were placed in a queue because resources were not available.

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Hiqa revisited the issue in 2017 when it found that, despite some improvements, a detailed plan for the delivery of emergency ambulance services in the Greater Dublin Area was still lacking. Delays in transferring calls between the two services had actually worsened, it found, due to increased demand.

Staff in the two organisations are on different pay scales and terms of employment. DFB staff are trained as firefighters and paramedics whereas NAS specialise as paramedics.

[ Dublin ambulance service leaving public at risk, report says ]

When no ambulance is available, DFB sends out a fire tender – this happens about 3,000 times a year.

Neither organisation is meeting performance targets. Eighty per cent of ambulances are supposed to be turned around – meaning ready to take another call after dealing with a previous one – in under 30 minutes. Last September, only 21 per cent of ambulances were. And whereas 80 per cent of calls were supposed to be responded to within 19 minutes, this was the case for 73 per cent of Echo (life-threatening cardiac or respiratory) calls and only 42 per cent of Delta (other life-threatening) calls.

Meanwhile, Dublin City Council and the HSE have been in a long-running dispute over funding. The council has claimed the HSE owes arrears for the provision of the service since 2007, with the figure increasing from €3.5 million in 2007 to up to €116 million this year, according to council figures.

In 2019, then Minister for Health Simon Harris said the call-taking arrangements in the capital, with two separate call and dispatch centres, represented “an unacceptably high patient safety risk” that could give rise to delays in the allocations of ambulances, “including in potentially life-threatening situations”.

He said at the time the issue was the subject of a mediation process between the council and DFB staff associations.

The council refused to detail the issues holding up the negotiations.

Faced with a threat to transfer part of the ambulance service to HSE control, staff at DFB threatened to strike.

The Covid pandemic then intervened, putting a stop to all talk of reform. The aftermath of the pandemic has seen record demand for ambulance services, which have continued to struggle despite increased resources.

[ Staffing crisis threatens ambulance response times ]

Despite the calls in multiple reports for services to be consolidated, there is no discussion of this issue. Dublin City Council refused to publish the Brady/Flaherty review of ambulance services in the capital – which comes down clearly on the side of consolidating service – and refused to release it under Freedom of Information. The Irish Times obtained the report through an appeal to the Office of the Information Commission.

Internally, we are told, a forum has been set up to discuss the matter but, years after reports criticised the duplication of services, it has yet to meet.

Some of the problems faced by the ambulance service, such as queuing at hospital emergency departments, are due to circumstances beyond its control. Others are not, yet the will to tackle them seems non-existent.