HSE can’t afford urgently needed changes to ambulance service

Urgently needed improvements to the ambulance service will have to be delayed because of a lack of resources, the HSE has admitted.

Longer target response times may be introduced for ambulances in rural areas compared to those operating in cities, it also indicated.

The HSE was responding to a review of the ambulance service which found evidence of consistent underperformance, poor co-ordination and unsafe staffing levels in some control centres.

The report by the Health Information and Quality Authority (Hiqa) criticised co-operation between the National Ambulance Service (NAS) and the Dublin Fire Brigade (DFB) and called on the two bodies to develop a joint action plan for better performance.

It highlighted the fact that 14,000 calls a year to the brigade are left in a queue while it tries to source an ambulance from the national service. Some are left waiting up to eight minutes and one in three experience a “potentially clinically significant and avoidable delay”.

The NAS aims to have a “first responder” on the scene of an emergency call within 7 minutes and 59 seconds in at least 75 per cent of cases. The best monthly result for ECHO calls, involving an immediately life-threatening cardiac or respiratory arrest, was 58 per cent. The best result for DELTA calls, involving other life-threatening situations, was just 34 per cent.

The report says the NAS has demonstrated consistent underperformance in the efficiency of call-taking and the processing of emergency calls, and this has contributed to poor response times to ECHO and DELTA calls.

Best monthly figures

The brigade’s best monthly figures saw it respond to 87 per cent of ECHO calls within the 7 minute 59 second target, and to 55 per cent of DELTA calls. Compared to response times in urban settings in other jurisdictions, this performance is relatively poor, says the report.

Meanwhile, at most one in three calls to the national service involving a non-cardiac or respiratory but life-threatening situation is responded to within the target time.

The HSE, which is carrying out its own review, said many of the recommendations made by Hiqa were already underway as part of a planned transformation programme to improve the ambulance service.

“Some of the reform initiatives are dependent on additional resources and a staged approach to implementation is therefore necessary,” said deputy director general Laverne McGuinness.

Siptu, which represents staff in DFB, flatly rejected the finding in the report that ambulance services can be substantially improved without greater funding being made available.

Minister for Health Leo Varadkar said the Hiqa review would act as a catalyst for further improvements to the ambulance services. More investment was needed to modernise the fleet of ambulances, he said, but existing resources could also be used better.

Lack of co-ordination

The review is critical of a lack of co-ordination between the NAS and the DFB and says they could do more to work with hospitals to address the problem of ambulance delays.

However, delays are a complex problem requiring a multi-faceted approach.

The Hiqa review says “it is possible” more ambulances and response vehicles may be needed, but there is also significant scope to improve services within existing resources.