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THE NATIONAL AMBULANCE Service has insufficient funding and staff to manage and maintain its fleet of almost 700 vehicles with some emergency ambulances being kept in service beyond the recommended age limit of five years.
A report by HSE internal auditors also revealed that funding for the replacement of ambulances operated by the NAS in 2023 is 50% below the required level.
It showed that the annual budget for ambulance replacement has remained static at €14.5 million since 2016, although the total expenditure in maintaining and replacing the fleet in 2023 was €32 million.
The audit concluded that it could only provide “limited” reassurance about the adequacy and effectiveness of the governance, risk management and internal control system for operating the NAS fleet of ambulances.
“There are weaknesses in the system of governance, risk management and controls which create a significant risk that the system will fail to meet its objectives,” it noted.
The audit added: “Action is required to improve the adequacy and/or effectiveness of the system.”
It highlighted how there were no reserve emergency ambulances at the time of the audit with no policy in place to address the issue.
In addition, no funding has been secured by the NAS to facilitate the environmental requirements for moving towards a sustainable fleet.
The audit noted that 15% of emergency ambulances – 45 out of 302 vehicles – were kept in use beyond the recommended age limit of five years with some retained in use for up to seven years.
Among the main findings, the audit highlighted how there were only five staff employed in the NAS’s fleet and assets department at the end of 2023 when it had been identified in 2021 that there would be a need for 19 posts by 2026.
One employee has responsibility for managing contracts for fuel, uniform and consumable contracts worth around €25 million, while another oversees €30-35 million capital funding.
The audit also identified a series of shortcomings and inefficiencies in the management of the NAS fleet.
It revealed that there is an incomplete listing of all NAS vehicles, while there were several maintenance contracts in place around the country which lack consistency in terms of pricing and service turnaround times.
The report showed that there was no complete listing of all breakdowns of ambulances last year.
HSE auditors said such insufficient oversight of the health of the fleet increased the risk of disruption to ambulance services.
They claimed the current practice does not facilitate oversight of expenditure for breakdowns for accurate budgeting and the tracking of frequent issues in specific vehicles and across the fleet.
However, the audit acknowledged that work was in progress on establishing a Fleet Asset Coordination Centre within the NAS which will hold real-time information on every vehicle including on repairs and servicing.
The NAS responds to over 400,000 ambulance calls each year and employs over 2,400 staff across 100 locations with a fleet of 675 vehicles.
Under Sláintecare reforms, it is proposed that the NAS will provide a monitoring service to other HSE fleet operators to support their procurement specification, regulatory and compliance requirements.
The NAS with its partners transport approximately 40,000 patients, coordinates and dispatches more than 800 air ambulance calls and completes 600 paediatric and neonatal transfers per annum.
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It’s sad when your GP asks you to make your own way to the Emergency Dept when you are seriously ill, as you would be too long waiting for an ambulance.
Recently I had to do that and when I was admitted to the ED there were at least four ambulance crews waiting to get their patients admitted and therefore could not go out on other calls. The system is buckled, not working and needs sorting out!!!
@Ollie Fitzpatrick: If you were able to get to the GP, why weren’t you able to get to the hospital? You obviously weren’t suffering from a stroke / heart attack / cardiac arrest / multiple traumatic injuries that the ambulance service is usually busy taking care of.
@stephen deegan: Actually I was suffering from an advanced state of one of the above!
My GP asked my partner to drive me to the hospital as the ambulance would take too long, which she did!! We were there in 15 mins….. The Ambulance would have been a lot longer!!!
@Ollie Fitzpatrick: So is there any difference in whether you went by ambulance or drove the 15 minutes to the hospital? You obviously were admitted before those people waiting in the ambulances outside. My point is that most people think that you will be seen faster if you go by ambulance, which is a myth. All patients are triaged the same way as if you walked in to the ED, with the exception of life-threatening emergencies like those I mentioned in my previous comment.Those people waiting in those ambulances which were being held up might have been able to make their own way to the ED, therefore releasing a vehicle for true emergencies. Our system is being abused because of this ‘seen sooner’ myth and that’s why ambulances are delayed on getting to the incidents that they’re supposed to.
@Ollie Fitzpatrick: I hope you’re recovered from your incident and are feeling better by the way.
@stephen deegan: I had a letter from my GP, which expedited mu triage, as I was a life threatening emergency. I was immediately admitted to the High Dependency Unit and ended up being hospitalised for a number of weeks. I am recovering at the moment, it’s a long process Stephen and I’m just glad to have come through it alive. Actually it was quite a frightening experience.
@Ollie Fitzpatrick: Get well soon.
@Ollie Fitzpatrick: It’s also a joke when a GP tells patients to go home, pack and bag, and call an Emergency Ambulance . Happens daily and much worse.
@stephen deegan: Will do Stephen, thank you for your wishes!!!
@Michael Cummins: I didn’t even get the opportunity to do that Michael. We were told to go immediately. Which we did!!
@Michael Cummins: Agreed. Some GPs and out of hours services are well able to abuse the system.
If they followed the UK system and sold off old fleet to private companies or volunteer groups or public at auction instead of destroying them in scrap yard they could recoupe some monies back . Shocking to see the graveyard of fleet in offaly
Just fire more money at it. It’s the health service, the management will know how to spend it in a efficient way, using best practice and get value for money.
Ah sure we can just increase the health budget even more……what would those inept turkeys running it like 30 billion maybe. Heres an idea why dont they they use the money from the sugar tax to help sort out the issues with the NAS. Oh wait silly me sure they have no clue where that money is in the health service black hole. And these are the same HSE with the nerve to ask for more taxes to be put on certain foods when the only unhealthy thing that needs checking round here is where the current 24 billion budget is being spent and how much of it is going on the wages of management and admin
My 78 year old mother fell and fractured her hip in 3 places, she also has dementia. She lives about 2 miles from the ambulance hub and 1 mile from the CUH (Cork’s main hospital) It took 4.5 hours for an ambulance to arrive. Obviously we would have brought her ourselves, but we didn’t want to move her just in case and she was also in awful pain. The service she got when they did arrive was outstanding and very caring but to wait that long given the circumstances was an absolute disgrace. The paramedic crews are amazing, but horribly understaffed. Thankfully my mother has made a full recovery from the fall.
A service life of five years Is that correct, then who gets it?
@Dan Murphy: Read the earlier comments and you’ll know!!
@Dan Murphy: they give them to the travellers of course
If the figures are correct, that equates to just 1.62 calls per day, per Ambulance… hardly heavy going…..
Spend some of the apple money we got, problem solved!
@AphroBeat:
Stop the waste would be more like it.
This going one way by design. Privatisation. We can look forward to a much reduced service in the future if that’s the case. Dfb is a really brilliant service as is NAS. I really hope I am wrong about the privatisation..
Was any benchmarking done against private ambulance’s level of service and efficiency?
@Pat Redmond: Two different services, Pat. Private ambulance services are staffed mostly by EMTs (6-8 weeks clinical training) and are used for low-acuity hospital to hospital transfers. NAS has a transfer service, (which is also available for emergencies) AND the primary emergency service which is crewed by paramedics (3 year degree) and advanced paramedics (3 year degree and 2 year masters). Benchmarking for education standards between public and private would be impossible.
That is incredible, Ollie, Left to rot, what sort of dopes would do that. They could easily get ten tears from them, and then give them to Poor countries, That’s disgraceful.
OUTSOURCE IT.
Sell bicycle shed.
It’s pretty clear that the current government-controlled ambulance system is not fit for purpose and the waiting times keep climbing every year. Along with the HSE as a whole, we need to privatise the ambulance system and introduce an Uber-style app system where hospitals complete with one another for the business of consumers who need to order an ambulance. This would also enable to view the routine of the ambulance in real time and judge which one they wish to book based on their current location. People would then be able to book and pay for whichever one meets their budget. If you want a basic ambulance like Uber Economy, you can book from the selection available and if you have more money, you should be able to book a more luxurious and premium one like Uber Comfort.
have your say