Overlapping ambulance services in Dublin provided by the National Ambulance Service (NAS) and Dublin Fire Brigade (DFB) are leaving the public at risk, according to a major report whose release was strongly opposed by Dublin City Council.
Both the DFB and the NAS, which share responsibility for 999 medical calls in the region, are failing to hit their targets for responding to the most urgent calls, the report commissioned by the Health Service Executive and Dublin City Council says.
Patients in Dublin are at potential risk from “suboptimal” ambulance provision in the capital by two overlapping State agencies, according to the report, which was commissioned in 2016.
The DFB failed to respond on time for between 27 per cent and 43 per cent of calls involving Delta (life-threatening but not cardiac or respiratory) emergencies, for the months under consideration in the report. The NAS failed to meet this target for between 29 per cent and 44 per cent of calls.
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With a failure to meet performance targets “a reality” for both organisations, current control arrangements for the DFB and the NAS “cannot be allowed to continue in their present configuration”.
While the failure of the NAS to meet targets can be partly explained by “the rurality issue”, this is “not a factor” for the calls handled by Dublin Fire Brigade, it says.
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“Significant extra resources are required, deployed in a very different way, if response times are to be optimised,” according to the report by former deputy Dublin city manager Derek Brady and former interim director of the NAS Martin Flaherty.
The Irish Times sought the report under Freedom of Information last year but was refused by the council. The decision was appealed and was refused again following an internal review. A subsequent appeal to the Office of the Information Commissioner resulted in the release of the document.
Issues around response times have persisted since the report was complete. Last year, barely a quarter of ambulances were being turned around at hospital emergency departments on time, The Irish Times reported, while 56 per cent of Delta calls involving life-threatening emergencies were not responded to within the target time.
The report was commissioned following concerns over delays in responding to emergency ambulance calls in the capital. The review was conducted by Mr Brady and Mr Flaherty. It was completed in September 2016 but never published.
Asked this week about the report, a DFB spokesman said “a number of initiatives and revised arrangements” had been implemented since the review was completed. A spokesman provided no details and acknowledged “outstanding issues” remained to be resolved.
A new structure involving the DFB, NAS, HSE, the council and the Department of Health and Housing, Local Government and Heritage has been set up and will have its first meeting this month, he said.
The NAS said there had been “a series of activities” to progress the recommendations of official reports, and that a group had been set up to progress outstanding issues.
The governance and financing of ambulance services in Dublin has been “problematic” over the last 20 years, says the report, with the DFB claiming it is insufficiently funded for the service it provides.
The report says the NAS control room should assume responsibility for call-taking and dispatch of all ambulances in Ireland.
Both organisations require “considerable improvement” and there are concerns about clinical governance in both.
“The NAS is the most appropriate national provider of ambulance services in Ireland and has the best strategic fit,” the report finds. As a result, the authors say their preferred option is for all ambulance services to be progressively transferred to the NAS.
But in view of “historical and current contexts”, they accept that another outcome could be for DFB to continue providing ambulances in support of the NAS through a service-level agreement.
The DFB rotates its staff across all vehicles but the report expresses concern that this may compromise the maintenance of complex skills needed to treat emergency patients. It says a “ring-fenced cohort of firefighter/paramedics” would be best placed to routinely staff the DFB’s ambulances. This would require at least 125 staff.
The report estimates the cost of providing a 24/7 ambulance in the DFB at €775,985 a year in 2013, compared with €604,632 for an NAS ambulance staffed with two paramedics.