Ireland too rural for ambulances to meet target response times

Ireland is too rural to support an ambulance service to compare with the service in England and to meet official targets for response times, according to a confidential report.

Ireland’s “high rurality”, and the fact Irish people are less than half as likely to call an ambulance than people in England, means the cost of running the service in Ireland is significantly higher by comparison, the report commissioned by the Health Service Executive states.

The report questions the policy of the National Ambulance Service (NAS) of bringing all patients to hospital emergency departments and says many other countries adopt an initial “see and treat” approach to patient care instead of simply taking them to hospital. In England, up to 50 per cent of patients are dealt with in this way.

The report, by UK consultancy Lightfoot Solutions, is likely to spark controversy in rural areas, where there have been repeated rows over response times of ambulances in specific incidents.

The report says Ireland’s ambulance is not directly comparable to English services. Even if fully resourced and operating to international best practice standards, the service “cannot possibly achieve” prescribed targets for response times.

Targets

Under these targets from the Health Information and Quality Authority (Hiqa), 80 per cent of Echo (potentially life-threatening) calls for emergency assistance are supposed to be dealt with by a first responder within eight minutes. Last year, in total just 26.6 per cent of such calls were responded to within this time. But in rural areas, just 6.6 per cent of calls were responded within the eight minute target time.

Lightfoot says Ireland’s much greater rural population has “major implications” for the ability of the National Ambulance Service to meet the same response times as its English equivalent.

In Ireland, 40 per cent of incidents are in a rural area, compared to 12 per cent in England. The report says the reason the number of ambulance calls per head in Ireland is only 40 per cent that in England may be down to easier access to GPs.

Pointing to the “very large gap” between current performance and targets, it says “because of the rural nature of the area NAS serves, we do not consider these targets are achievable”.

Drive times

In many cases, ambulance stations are not well located for the communities they serve. As a result, the average drive times in urban areas are nearly 10 minutes, compared to four minutes in high-performing services in other countries.

Providing extra resources would result in very little improvement in performance in rural areas, according to the report, which identifies 100 locations where less than one emergency call is made per week. It says solutions, such as back-up community first responders using a defibrillator are required.

Improvements would cost significant amounts of money; hiring an extra 290 staff would cost €15 million a year and take three years to implement. Even then, improved response times may not yield a commensurate improvement in clinical outcomes for the majority of patients who are not time-critical.