A 70-year-old woman who has been hit by a car lies on the road for 50 minutes before an ambulance arrives. A woman who has choked on food is left waiting for half an hour after her husband calls 999. A 30-year-old man is left bleeding so long after being stabbed that a Garda car has to bring him to hospital.
These recent deaths, all tragic yet preventable, are the reason the ambulance service is under such scrutiny. The review just published by the Health Information and Quality Authority (Hiqa) is just one of a number of reports that have been ordered into what is without doubt an underperforming area of the health service.
With its heavy focus on targets and use of acronyms, the ambulance service can seem like a complicated beast to analyse. But it isn’t really. People need an answer to simple questions: Why are these delays occurring? Why isn’t the system hitting its targets? Is it properly resourced?
Diplomatic
The language of the Hiqa review is diplomatic and it pays due respect to improvements made in recent years, such as the increasing number of paramedics in the service. Overall, however, you don’t have to dig deep to find alarming verdicts about the lack of co-ordination, poor performance and failure to meet targets.
As in other areas of the health service, ambulance staff have been complaining for years about a lack of resources. Hiqa seems unconvinced; the report acknowledges the fleet is ageing, one in five vehicles is over eight years old, and acknowledges some isolated examples of unsafe staffing levels but it suggests major improvements can be made within existing resources. This "do it better" verdict may not find favour with staff, with Siptu members in Dublin Fire Brigade (DFB) already rejecting the notion that services can be substantially improved without greater funding.
The most alarming finding in the report relates to the lack of co-ordination between the brigade, which covers Dublin city, and the National Ambulance Service (NAS), which provides ambulances in the rest of the country, including Dublin county. On some days, up to half of the calls made to the DFB are delayed because demand exceeds its ability to respond. Of 81,000 calls to the service last year, 27,000 resulted in a call for assistance from the NAS. But only 8,000 of these calls were transferred, leaving 14,000 calls which were left in a queue. One in three of these calls was left unanswered for a potentially life-threatening period of time, up to eight minutes.
Collaboration
The report calls for close collaboration and shared service between the two services, but stop short of proposing they merge. Why? Because it wasn’t in the terms of reference for the review, according to Hiqa.
Almost as alarming is the response of the national service to its failure to meet targets for getting a first responder on the scene of an emergency within seven minutes and 59 seconds. It simply stopped publishing the data. The review shows how awry the service is here; in some life-threatening situation, only one in three calls is meeting the target.
The report says the public’s expectation of the ambulance service has to change. No longer can we expect to always end up in an emergency department, and some of us may be treated over the phone. Hiqa says it isn’t possible for rural areas to expect the same universally rapid response as might be expected in a city, a finding that won’t make it popular west of the Shannon.
This question is expected to be addressed more specifically in a HSE capacity review, which is nearing completion.
