Martin Daly: Praises Ambulance Service, Urges Faster Turnaround

Thank you for your presentation, very comprehensive, and I just want to recognise that the transformation of the National Ambulance Service in the last 20-25 years has been unbelievable as a community GP, moving from a point where we essentially had ambulances driven by drivers to a case where we now have a fully professionalised service, providing a whole suite of services in the emergency arena and in the subacute arena, because as we know, ambulance calls are made for cases and issues that would be better served by different pathways of care, and I know that there are initiatives within the National Ambulance Service to deal with that, and I'm reading some of them here. I also welcome to the development of those different pathways, the Clinical Hub Pathfinder, the Community Paramedic Service, the Alternative Pre-Hospital Care Pathways, and they've been very helpful to someone who's a rural GP on the ground, and acting as that bridge between primary care and constrained capacity sometimes in that sector, and the house calls that are done by a suite of people from the National Ambulance Service, depending on the priority. And that's all to be welcomed, and I think also the professionalisation of the service has been remarkable. These are highly skilled health professionals, and it is a, really, it is a privilege to work with them as part of a cohesive unit, and providing care in the community. Some of the things that have developed, and I'm conscious of time, and I'll give you time to answer, some of the things were the development of the community paramedic scheme, where a paramedic goes out, rather than sending an ambulance, because it is a valuable resource to send an ambulance to a thing, dealing with people in the community, looking for different pathways into a hospital sector if it's required, or back to the GP if also required. This is something I'd like you just maybe to expand upon. One of the issues in our own area is the turnaround times for ambulances, especially in the west-northwest area. That's not the fault of the ambulance service, but it is something that has been reported to me that it can take four to five hours in, and I'm not going to name the hospitals, but it can take four to five hours in some hospitals to turn around the ambulance. So for people listening to this, that means an ambulance arrives with a critically ill patient. They're kept up to four to five hours with their valuable resource of the healthcare professionals and the ambulance before they can hand that patient over. I wonder, would you be able to comment on that? Also, the issue around the advanced paramedics, paramedics issue, perhaps you could just expand a little bit on that. You did refer to it in your opening statement. And then in the north-west region, we know that there had been an expansion of training for us, but there was no additional funding in 2025, and you might expand on that also. Thanks very much again. Thank you. Thank you. So maybe just to deal with a number of those in turn. First of all, welcome the comments and the supportive comments in relation to the progress that's been made. In relation to the alternative pathways, I think that's really important. I know as a GP, you'll be aware of the changes that have been happening with enhanced community care and chronic disease and so on. And what we're trying to do, and our ambition, I suppose, is that community paramedics, that you would have one of those in each of our 96th community healthcare networks. We've trialled working with GPs in out-of-ores in the north-east and in Limerick this last winter, and we'll try and expand that. So I think that's a positive thing. On turnaround times, I think we fully acknowledge that work needs to be done there and that work is undertaken. You can see that we've invested in the service. I've set that out in the opening statement. I think to make it practical, or on average, we're trying to make 45 minutes in turnaround. And we're achieving that in some areas, we're not achieving it in others. We've been working very astutely with our regional colleagues. And one of the things we did is that we brought the KPIs that we're using now is both a KPI for NAS and a KPI for the hospital side, so that they work together. That's one. We have had liaison staff. We trialled that previously, and where that worked, it seems to have improved things very well. And we're going to try and look at that in future years. Is it a West-North-West issue in particular compared to nationally? No, it's across the board. In parts of, like, what I would say to you, if you're in Limerick, there's, on a busy day in Limerick, and all of us have seen that report that there's 200 plus, there's 100 ambulances coming in there, one every three minutes. They have a turnaround time of 38 minutes against our target of 45. Cork has improved significantly over 10 minutes in recent times. There's a requirement for improvement in some of that in the Western area. It is improving, it probably needs to improve more, and we need to work and support them in trying to achieve that. We have plans, as I say, in place. Significant progress is being made, but more needs to be done. In relation to the advanced paramedics and the paramedics, what I would say, again, based on the whole alternative care piece, there's two pieces. What I said in the opening statement is that we have 400 advanced paramedics, hugely valuable resource. We fully recognise that, and we are committed to continuing the training programme. However, we also want to make sure that we can align that better with where we want to, where the paramedics, they're not, we're not being able to deploy them to the locations that we really need them. The roles and responsibilities, dispute, if I call it that, which is underway. If we implement that, I think we'll be in a much better position to actually deploy that, and I've given a commitment in the opening statement, once we've that done, we will expand that service to a greater degree. I do also want to say, though, that we do want to prioritise community paramedics. As I say, if we want to have paramedics in each of the community healthcare networks and expand that, we do need to increase the training there. I might ask Cahill to just comment on the advanced paramedics as well, as that's, I think, an important, specific issue. Just to say we've less than a minute left. Okay. Well, one thing that may be of interest to, from your own background, is we're on community paramedics. We're working with the Irish College of General Practitioners to try and develop a shared vision for how community paramedics might work. We're very conscious of the challenges that general practice has now, and what's coming down the line, particularly in rural Ireland, and we think community paramedicine might be a key part of that solution. So, Dr. Jeremy Quinlan, Dr. Gary Stack, Dr. Alona Duffley, colleagues of yours, we've been working really well with those. We hope to have something by the end of this year on that, but I think would be very helpful for general practice in rural Ireland. That's great. Thank you very much. Thank you. Thank you.