The fact that ambulance response times have been deteriorating is not news: compliance with a 19-minute response target to the most serious calls has been declining for some time. However, the emergence of an internal report detailing the gravity of the situation gives cause for a more serious pause to consider how robust the service is, and raises wider questions about the nature of public service provision.
The HSE, which runs the National Ambulance Service (NAS), points to the arbitrariness of timed targets. It is true that they do not account for more important clinical outcomes which can be used to measure the effectiveness of the service. However, the measure cannot be entirely discounted. If time wasn’t an important factor in the efficacy of ambulance services, they wouldn’t put blue lights and sirens on the vehicles.
It is much harder to downplay the commentary in the report itself. It shows that demand for services is outstripping the capacity of the NAS to recruit, which “poses a serious risk to the ability of NAS to deliver urgent and emergency care services”. It outlines a “critical and immediate need to increase workforce capacity”, with the service struggling to plug the gaps left by those leaving with new recruits. In 2017-2018, new recruits equivalent to 13.6 per cent of the existing workforce started. In the 12 months to the end of March 2022, that figure was 7.2 per cent – showing the NAS’s capacity to refresh its workforce is diminishing. For whatever reason, the nature and organisation of the ambulance service means it is consuming its own workforce, who are suffering from burnout and pandemic fatigue.
Figures released to Sinn Féin show the service is reliant on a hefty overtime bill of €1.5 million a month to make ends meet. With no ready supply of paramedics other than those it trains over a three-year period, the service is also facing strategic shifts in its mission, being asked to develop more community-centred care along with the rest of the health service, in line with Sláintecare objectives. Doing this while trying to maintain the existing service, when it clearly cannot attract enough new staff nor retain those it has, is a fundamental challenge.
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In a country that struggles to achieve health outcomes matching the level of investment, and where healthcare remains one of the most febrile topics in political debate, the report should spur action among policymakers. Anywhere in the public service, creaking infrastructure undermines service provision, and in turn corrodes trust in the State itself. The stakes are particularly high in the health service, however, and the ambulance service itself goes to the heart of the contract that says: in their moment of greatest need, the State will be there for its citizens.