The national ambulance service is currently on the brink of collapse
By : a real ambulance driver
The national ambulance service is currently on the brink of collapse. The rosy picture painted by the H.S.E could not be further from the truth, staff are leaving in their droves due to recent savage cuts to wages, destruction of the work/life balance that every employee in the country strives for and radical changes to operations that were put in without any staff consultation and now that these very changes are found wanting, they are still being professed as a fix all by the H.S.E who’s ego won’t allow them to raise hands and start again. Here we will list some of the biggest problems in no particular order as they are all as important as each other in providing a healthy service across the country.
Staff levels: the service is currently 200 members under strength. This is due to a slowdown in recruitment (this is one of the few services that was never subject to any recruitment embargo). Staff are currently leaving to take up other roles either at home or abroad and when this is added to natural occurrences such as retirement the gap is too wide for anything but immediate recruitment. A number of years ago it was decided to ban all overtime and leave areas without cover but this has since been rescinded. Even with empty shifts being given out at an overtime rate there just isn’t enough staff to cover them.
Deployment: staff are being deployed on a national level now meaning that they can report for duty to their normal base of operations and be sent on to take up a role anywhere else. This leaves their normal base with fewer resources. Staff are also being deployed nationally once their duty has started, this leads to staff travelling massive distances under pressure to reach a patient and this leads to danger of accident, driver fatigue and delays reaching patients in unfamiliar areas. Recently it has been noted that crews can be sent to urgent 999/112 calls two and sometimes three counties away. This cannot be best practice in anybody’s mind
Pay cuts: the savage cuts forced on all public sector staff have devastating effects on members of the ambulance service. These cuts are a separate issue to what the service needs to address now as even though staff rejected all cuts there is a separate mechanism to reverse them and paying staff more right now will not fix the service that is suffering.
Fleet: the ageing ambulance fleet is undergoing modernisation however there are still vehicles being used that have between 400-500 thousand kilometres on the clock. These vehicles represent a huge risk to every road user they encounter and to every staff member and patient travelling in them. Replacing the engine has been common practice up to now but the chassis, wheels, brakes, suspension and other critical elements still hold this wear and tear.
HIQA response times: the target response times set out by HIQA are unachievable in rural Ireland. The service delivery standard should be measured by the outcome for the patient not how long it took to get there. Anecdotally if a patient passes away but the ambulance arrived within 8 minutes that is classed as a success.
Staff concerns: staff are being ignored on a daily basis regarding ideas and issues that are pertinent to them. When staff report incidents relating to safety and or aggression these documents are not followed up on and general can’t be found once submitted. The established unions that are supposed to fight tooth and nail for staff have ignoring them and allowing this situation to continue.
These are a list of concerns regarding the service the public receives however there are more issues that need attention.
Some solutions: immediate and prolonged recruitment. It takes 22 months to train a paramedic. Recruitment needs to begin now.
The current deployment model needs to be assessed for fitness to use and changes need to be made. Currently the system focuses on hitting targets and not patient care.
HIQA response times need to be ignored for the farce that they are and a patient focused outcome needs to be the new gold standard.
Continued modernisation of the fleet without using fleet budget for other purposes. A Consultation and steering group made up of staff, without union input as they already have their own processes needs to be in place for setting of policy and procedure. Where steering group agreement can’t be reached then the traditional union procedure can come into place.
There are a few positives that the ambulance service has got right in the last few years, patients who present with chest pain and are found to be having a heart attack by ambulance staff on arrival will always try to be transported to specialist cardiology surgeons within ninety minutes to have the blockage causing the heart attack removed, this has shown significant improvement in patient outcomes (regardless of whether the ambulance got there in 8 minutes)
National aeromedical service in conjunction with the Irish air corps has last year been made permanent due to the massive positive steps they have taken in rural emergency care.
Patients who present with symptoms of stroke are now transported direct to specialist stroke units once they present within a prescribed time.
These are all positive steps but the common denominator in these positive steps is dedicated well trained staff that continuously go above and beyond in a system that repeatedly lets them down.
Direct Democracy Ireland a national citizen’s movement fully supports members of the national ambulance service in their endeavours for service improvements and extends this support to all public sector workers particularly at the front line.