Just one in four ambulances reach a life threatening emergency within the target time of 19 minutes in rural parts of the west of Ireland – by far the worst performing service in the country.
The first major review into the National Ambulance service (NAS) has found that it is not possible to achieve the current 80% response time target of eight minutes set by the Health Information and Quality Authority (HIQA) even with substantial investment due to the rural spread of the population.
Just under a quarter of ambulances meet patients within 19 minutes in rural west of Ireland and 5% are within eight-minute target for life-threatening and potentially life threatening cases. This is far behind the second worst service in the country – in the south west nearly 40% meet the 19-minute target – and the best performing services – the north east and the mid west had half of their vehicles reaching the standard.
However, with a significant increase in staffing levels and vehicles, as well as an upgrade in technology, that number of ambulances meeting the target in the west could jump to nearly one in two – or 47.3%.
Newly appointed Minister for Communications and Climate Change Denis Naughten said the report commissioned by the Health Service Executive (HSE) clearly acknowledged the scale of the problem across Galway, Mayo and Roscommon.
“These response times are by far the worst in the country and clearly show that urgent investment is now needed in both ambulances and staff in the West of Ireland,” he told the Connacht Tribune.
“While the response time figures prove what I have been pointing out for some years, the positive aspect of the report is that with investment we can see response times improve by 100%”
“I see this is a stepping stone – it’s not the full solution. It’s important we improve the service – even if we continue to lag behind the rest of the country.”
He would be working with the new Health Minister Simon Harris to implement the long list of recommendations in the report.
“I understand an additional 461 staff would be required to improve the service over and above the 148 staff positions which have been funded and trained – that’s in EMTs [emergency medical technicians], paramedics and advanced paramedics.
“The Department estimates that’s going to cost €25m which will take time as staff get trained up. Also required will be 71 additional vehicles at a cost of €10m. There will be additional resources provided in the forthcoming budget and HSE service plan. How many of those will come west I don’t know at the moment.”
The consultants found that the Irish ambulance services serve a much greater rural population than their counterparts in England and Scotland. Some 40% of incidents are in a rural location compared to 12% in a typical UK service.
However, there are 40% less calls per head of population within Ireland compared with the UK.
Martin Dunne, director of the HSE National Ambulance Service said the recommendations, once implemented, will improve pre-hospital emergency care services for patients which will in turn have a positive impact on the wider health services.
The report recommends setting up a clinical support desk to offer improved medical advice and services to patients.
Ambulances in the UK are now responding to about 7% of calls with telephone advice on self-care or guidance on alternative care pathways.
It also recommends an improved model for rural and remote locations with an extensive rollout of community first responder schemes, co-locations of paramedics with primary care professionals and continued use of the aeromedical services.
The consultants believe some ambulances should not to be maintained at specified static bases but “used in a more flexible manner that reflects the population needs”.
“Even on the assumption that the 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% [meeting the eight-minute performance target],” the report states.
“Our analysis indicates that it could only achieve an 8-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 8 minutes.”
Nationally 26% of ambulances are responding within eight minutes, while 67% are within 19 minutes – instead of 95% set by HIQA.
Over 1,500 additional hours are required to improve the response times for Echo [life-threatening] and Delta [potentially life-threatening] calls to improve performance from 35.7% to 51.2% in eight minutes and from 70.9% to 81.5% in 19 minutes.
The report found that the 18 ambulances in the west – with three more due to be commissioned – were responding to an average of 68 incidents per day – with four more regions of the country dealing with a greater number of medical emergencies.
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