Report calls for fire brigade to run all Dublin ambulances

Responsibility for funding Dublin’s ambulance service should be removed from the HSE and taken over by the Department of the Environment, an unpublished report says.

It says Dublin Fire Brigade should retain full control of 999 emergency calls and dispatching ambulances in the city. Transferring these to the HSE’s National Ambulance Service (NAS) as called for by both Dublin City Council and the HSE, would “have an adverse effect on patient care”.

The report, a publication date for which has yet to be set, was commissioned by the council to address concerns highlighted by the Health Information and Quality Authority (Hiqa) in December last year.

The fire brigade provides ambulances in Dublin, while the NAS provides ambulances outside, with some overlap on the outskirts of the capital. Both operate their own call and dispatch centres.

Hiqa expressed “serious concern” about the “disjointed” relationship between the fire brigade and the NAS, which it said could delay ambulances.

“As a matter of urgency, both services must act to ensure that there is a fully integrated ambulance service in the greater Dublin area,” said Hiqa.

In response, the council – which manages the fire brigade – and the HSE said control of all ‘999’ calls and dispatching of fire brigade ambulances would transfer to the NAS. Clinical governance of Dublin’s ambulance service would also be taken over by the NAS.

Dublin City Council chief executive Owen Keegan later withdrew the plan, to allow consultation. A four-person panel, chaired by retired fire brigade chief fire-officer, Stephen Brady, was appointed to consider submissions from the HSE, the council, fire brigade management and unions.

Its report contains recommendations which will “present major challenges for all parties”, it says.

“If agreed and implemented they will provide a necessary framework towards addressing the concerns in the Hiqa report and achieving a first-rate clinically focused pre-hospital emergency care service.”

The fire brigade’s ambulance service is majority funded by the HSE through a service level agreement with the council. The council has for many years been dissatisfied with the allocation from the HSE.

“It is clear,” says the report, “. . . the historical funding arrangements have not been effective”. It says the fire brigade should be funded wholly by the Department of the Environment.

“This is necessary to ensure clarity regarding responsibility, control and accountability. Critically we believe this will encourage more effective service delivery for the patient and greater efficiency for the exchequer.”