Last week we learned of the tragic death of Vakaris Martinaitis, a two-year-old child, in Midleton. I offer our deepest sympathies to his parents and family. The circumstances surrounding this death have caused significant concern in the east Cork area because when a well-known neighbour rang for an ambulance, he was told there was no ambulance available to come to the scene. Indeed, no paramedic was dispatched to the scene either. I welcome the fact that the HSE has set up a review group to inquire into all the circumstances surrounding both the call and the fact that, ultimately, this child was transported to hospital in the back of the neighbour's car.

There was a similar incident in the town some weeks earlier when another young child drowned tragically. There are competing issues, but there was concern about the time it took for the ambulance to get to the scene on that occasion. Increasingly, we hear around the country that these are not isolated incidents. There are concerns across the country about the adequacy of the ambulance services and, above all, the response times of ambulances in emergency life-threatening situations in the midlands region, Galway, etc.

In Carlow some time ago it took seven hours and three ambulances to bring a minor footballer to hospital for treatment. A year earlier in Drogheda a man was left on the street for 25 minutes before being attended to. In March a garda was asked to drive an ambulance to Letterkenny General Hospital because no paramedic was available. In April 2012, it was revealed that almost half of ambulances dispatched on life-saving cardiac emergencies are failing to reach patients within the strictly set target time of eight minutes.

In February, the Minister for Health, Deputy Reilly, said he was going to abandon the national targets for the response times in dispatching ambulances in life-or-death situations. This came weeks after HIQA had increased its target for response times. The Minister has said he wanted to abandon all national targets. I do not know why he would even contemplate doing so. There are separate targets for first responders of emergency medical technicians who would be dispatched in advance of the ambulance and those targets are also not being met.

Given all of these incidents and episodes, I believe there is a fundamental need for a comprehensive review of our ambulance service. Is the Taoiseach satisfied that our national ambulance service is adequately resourced to deliver the service required? Do we have enough ambulances in place across the country? Do we have enough qualified emergency medical technicians in place? We all know about the golden hour in terms of early intervention and getting to a scene where life or death is at stake. It can be crucial in ensuring the survival of any individual caught up in such a situation. I believe there is enough evidence to suggest we all have reasons to be concerned about the adequacy of cover. We need more than just a review into a specific incident. We need reassurance from the Taoiseach that the Government is satisfied that the resources are in place to meet the requirements.

I wish to extend my sympathies and those of the Government to the parents of the young child who died as a result of this incident. I heard the radio report on the work done by Mr. Kevin Hennessy, a well-known neighbour of the child's family. These are always tragic cases and nothing we say or do here can bring back that child to his parents.

The incident has been escalated to the HSE's serious incident management team. Following preliminary inquiries into this tragic incident, the national ambulance service in line with the HSE incident review methodology, has commissioned an incident review into the fact that a 999 call was received at 14:00, 2 o'clock, on 6 May 2013 and how, in effect, that was managed. The review team has asked for a preliminary report on this as a matter of urgency to be followed by a full report. Obviously the national ambulance service's liaison officer liaised with the family.

As the Deputy is probably aware, emergency ambulances in east Cork are strategically deployed. In other words they are no longer tied to any particular station, but are employed where they are most likely to be required. In addition, county boundaries no longer apply. The nearest emergency ambulance responds regardless of its origin. There has been no loss for the national ambulance service in east Cork - in fact it has been enhanced. Previously paramedics were responding to calls after 20:00, 8 p.m., four nights a week from their homes as they were working on call. In 2012, this system successfully changed to an on-duty rota with paramedics rostered on duty 24 hours a day and seven days a week, and the on-call system was eliminated.

It is important to ascertain the true facts in so far as the handling of the emergency call was concerned. Let us get those facts accurately form the incident team.

In regard to other incidents around the country, the situation of the national ambulance service is constantly monitored and reviewed. When incidents such as this tragic one come to light, it is fundamental to ascertain what the response was and why that response was made in this particular case. I respectfully suggest to the Deputy that we should wait until we get the report from the HSE serious incident management team and - while it will not bring back the little child - we can then see how the 999 call was managed. Given the improvement in the situation with ambulance services in east Cork we need to ascertain why this particular situation followed through as it did.

We need to be very careful about using terms such as enhanced or improved services because there is no sense of that in the community affected. People are now very concerned about the next incident and what might happen because they just do not believe an adequate service is in place. Recent tragic incidents have brought them to that very sad conclusion. I have spoken to people on the ground and their concern is whether there will be an ambulance on time, if God forbid, another life-or-death situation occurs in the east Cork region.

The other incidents I outlined suggest that the Department and Minister need to ask some fundamental and hard questions about the adequacy of the service. We are hearing reports of overworked and stressed ambulance crews and that the ambulance service is at the pin of its collar to meet the demands placed on it. We may talk about the changes that occurred and so on, but clearly in many instances those changes are not working. I have instanced the research undertaken that indicated only half were reaching the targets set nationally. Those are not my figures - they are objectively ascertained figures that the Minister, himself, acknowledged more than a year ago. However, very little has happened since then to enhance or improve the situation.

The reports from Deputies in their regions indicate that the changes are not working. People do not experience an enhanced service by any stretch of the imagination. The service is not adequately resourced. We do not have enough emergency medical technicians. We do not have enough ambulances in place particularly where there have been significant demographic and population changes in recent times. We also have the issue of dispersed rural communities. In the light of what has happened, the Government should have a fundamental review of the adequacy of the service in order to be able to give genuine reassurance. People are very anxious and concerned about the adequacy of our ambulance service and whether it is fit for purpose. Does it have the resources in terms of personnel and ambulances to meet the level of demand that exists? I do not believe the people have that confidence at the moment and for good reason.

In the vast majority of cases the response of the national ambulance service is up to the standard that is expected. In this particular case a child fell from a window and died. As I have said, nothing will bring that child back. However, it is important that we ascertain the facts as to what happened after the 999 call was made at 2 p.m. It is important that we get the facts of the sequence of events that meant an ambulance was not dispatched when, I understand, an ambulance was available to deal with this particular incident.

When I said that services were enhanced in east Cork, I mean the ambulances are no longer tied to any particular ambulance centre and are enabled to travel to wherever the need is-----

That might be the problem.

Let us examine it.

That is what I am asking the Taoiseach to do.

Until 2012 paramedics were on call and answered calls after 8 p.m. from their own homes. This roster was changed and they are now on duty 24/7 which should, one would think, provide an enhanced service. I have no difficulty, when the facts of the matter come to light, with bringing it back to the House and letting everybody know.

In some cases only one ambulance is available at night, and if it is on one mission, it cannot be on a second mission.

I take the Deputy's point about the requirement for people to have confidence and trust in the national ambulance service, and from this perspective I have asked the Minister for Health to publish a general report on national response times and for a report from the high risk management team on this particularly sad case.