Ireland 'too rural' for ambulance targets

The National Ambulance Service “cannot possibly” achieve prescribed targets for response times, even if it were fully resourced and operating to international best practice standards, according to a review ordered by the HSE.

The review questions the policy of bringing all patients to hospital emergency departments and says many other countries adopt an initial “see and treat” approach to patient care instead of simply taking them to hospital. In England, up to 50 per cent of patients are dealt with in this way.

Under targets set by the Health Information and Quality Authority (Hiqa), 80 per cent of Echo (life-threatening) calls for emergency assistance are supposed to be dealt with by a first responder within eight minutes.

In 2014, just 26.6 per cent of these calls in total were responded to within this time. In rural areas, just 6.6 per cent of calls were responded to within the eight-minute target time.

Rurality

The report says the service cannot achieve the target of responding to 80 per cent of life-threatening calls within eight minutes because of “the immense difficulties with rurality in Ireland”.

Even if it were fully resourced, it would be able to respond to just 60 per cent of calls within the target time. Improved response times could be achieved through better operational processes, additional resources and more use of community first responder schemes, but would have a “significant” cost.

Hiring 290 extra staff would cost €15 million a year and take three years to implement. Even then, improved response times might not yield a commensurate improvement in outcomes for the majority of non-time-critical patients.

‘Implications’

The report was carried out by UK consultancy Lightfoot Solutions, which says Ireland’s much greater rural population has “major implications” for the ability of the HSE to meet the same response times as its English equivalent.

In Ireland, 40 per cent of incidents are rural, compared to 12 per cent in England. The report says the reason the number of ambulance calls per head in Ireland is only 40 per cent that in England may be down to easier access to GPs.

Pointing to the “very large gap” between current performance and targets, it says “because of the rural nature of the area NAS serves, we do not consider these targets are achievable”.

In many cases, ambulance stations are not well located for those they serve. Average drive times in urban areas are nearly 10 minutes, compared with four minutes in high-performing services in other countries.

Providing extra resources would result in very little improvement in performance in rural areas, according to the report, which identifies 100 locations where less than one emergency call is made per week. It says alternative solutions, such as back-up community first responders using a defibrillator, are required.