Ambulance study: Patients in the Dublin region are being put at risk by the lack of a single system for dispatching all emergency ambulances, whether by the health service or fire brigade.
The flaw is highlighted in an as-yet unpublished review of the command and control system currently in place for ambulance dispatch.
The review, seen by The Irish Times, states that communications between the fire service and health service personnel are often difficult and "do not support best practice in the efficient and effective dispatch of ambulance services".
Staff from both sectors came together under one roof to operate the fire/ambulance service control system in 1998 but "difficulties began to quickly emerge", it states.
The report, carried out by management consultant Conal Devine, states that the IT systems used by fire service and health service staff in the control centre were developed separately and are not compatible.
"The absence of a single integrated IT system for the dispatch of emergency ambulances in the region was identified as a fundamental obstacle by all parties. It was further accepted that an integrated IT system was a fundamental requirement for the safe and efficient dispatch of emergency ambulance services by both providers," the report says.
It goes on to refer to "a frequently dysfunctional system of ambulance dispatch" and to "damaging unhealthy competition" between the fire brigade and the health service when it came to running the ambulance service.
It concludes: "The existing parallel systems of ambulance dispatch in the Dublin area is not consistent with good practice and quality patient care. Furthermore, its continuation represents a substantive, identifiable, measurable risk to the patient population in the greater Dublin area."
It recommended that if the issues were not solved quickly, the Health Service Executive (HSE) should commission a risk management audit to assess the risks to patients from the continued provision of parallel unconnected publicly funded systems of command, control and delivery of emergency ambulance services.
Mr Devine recommended union negotiations on resolving issues be completed by the end of last month. They have yet to begin.
While both sides were asked to participate in the review, Siptu, representing the fire brigade staff, refused. Siptu branch secretary Paul Smyth said yesterday his members refused to participate because the terms of reference for the review, ordered by the health sector, were drawn up without consultation with the fire brigade staff.
He said the report was predicated on what was termed to be an agreement reached in 1995. But Siptu did not accept there was any agreement. It was just an arrangement, he said.
He argued that the command and control centre at Townsend Street in Dublin city centre was hugely effective. He believed the review was "fundamentally flawed".
John Moody, a fire service employee in the control centre, said he did not accept there were risks to patients posed by the current command and control system. The major risk to patients was the fact that there were too few ambulances, he said. He said Dublin fire brigade had 11 ambulances on the streets, the same number as it had 15 years ago, even though its workload had tripled. And he said whenever attempts were made to get the back-up of health service ambulances, they did not seem to be available.