Of the expanding number of crises emerging from this Government the most life-threatening is the ambulance crisis. Two weeks ago “Prime Time” broadcast an excellent programme on the collapsing ambulance service. The details were shocking. In 2008 there were 320 ambulances in this State. Last year that dropped to 265, only 137 during the day and 113 at night. That is when the staff are there to drive them. In 2012, a total of 21,000 shift hours were dropped and 14,500 last year. The State has half the number of paramedics per capita compared to the North or Scotland. The National Ambulance Service is failing miserably to meet its Health Information and Quality Authority, HIQA, targets. Last year fewer than 30% of people with life-threatening conditions received an on time response. This compares with 75% in England and Scotland. Ambulance staff regularly have to go out on their own which leads to poor outcomes and injury to themselves. Gardaí are now being asked to go to emergencies and ascertain whether there is a need for an ambulance. These are people who may have had first aid training in Templemore 20 years ago and are now being asked to make a clinical decision on whether they must rush an individual to hospital in their cars or wait for an ambulance.

In the past 12 months I have received approximately 35 reports in my county of the ambulance being late for people in serious emergency situations. I reckon that other Deputies have heard similar reports. Seven of these people died. Will the Minister agree that a person dying for an hour on the roadside while waiting for an ambulance is unacceptable? Will he confirm his commitment to making sure these cuts are reversed? How many deaths will it take before the Government reverses the cuts?

This Government is determined to ensure people get medical treatment as swiftly, effectively and efficiently as possible. Since 2011 a major programme of change has been under way to reconfigure totally the way pre-hospital emergency care services are managed and delivered. In my three years as Minister for Public Expenditure and Reform the absolute resistance of the Deputies opposite to any change has been abundantly clear. They always talk about cuts, as if the measurement of inputs as opposed to outcomes was all that mattered. When this Government came into office in 2011, almost exactly three years ago, there were no targets set for the ambulance service. The Minister for Health, Deputy Reilly, has raised the bar annually for response times and for 2014 a new target of 80% of life-threatening calls to be responded to in under 19 minutes has been set. We are measuring it now. We did not know what it was pre-2011.

The emergency services in Dublin are provided by Dublin Fire Brigade through an arrangement between Dublin City Council and the Health Service Executive. The National Ambulance Service is working to modernise and reconfigure its service to ensure emergency pre-hospital care is delivered in an appropriate and timely manner. In particular a single national control system is being developed. That will be in operation next year. Significant change is happening. The review was expected to be completed in early summer but the timescale has now been revised in order to allow the results of the National Ambulance Service capacity review to inform the recommendations. We are having, regardless of Government, changes to what is happening on the ground. We are changing and reconfiguring the delivery model for health services to make sure the outcomes for people, their life chances, are better, so that when the first responder arrives treatment can start on the spot. That is what is important to people.

The Deputy should not always measure inputs in every situation, whether health or education or anything else and say the more we spend the better. Let us start measuring the outputs of our systems to ensure they are reconfigured, refined and improved to have a better quality of outcome for our citizens.

I am not sure the Minister heard me. I did discuss outputs. I indicated that 30% of people in life-threatening situations are receiving ambulances on time in this State, under this Government. That is an output. The Minister talks about change. There is change. Access to the health service is constricted at every level, including the ambulance service. The Minister also talked about what things are like on the ground: the "Prime Time" programme indicated what things are like on the ground. Despite the life-threatening absence of ambulances around the State, 60 senior management drive home, for their own purposes, in fully kitted-out ambulances worth €100,000. These vehicles lie mostly idle outside their houses for weeks at a time. We, the taxpayers, are filling their tanks. Taxpayers' money in this sector is intended to save people’s lives but it is being siphoned off to blue light senior managers on their way home.

This smacks to me of the culture of entitlement that was rife under the Fianna Fáil regime and is still coming to light with regard to the Central Remedial Clinic, CRC, and Rehab. Is the Minister happy that 60 managers drive home in fully kitted-out emergency response vehicles worth €100,000, and that those vehicles are not used for their intended purpose? Will the Minister admit this is mismanagement under the remit of the Minister for Health, Deputy Reilly? Will he commit today to making sure this does not happen in future?

In respect of outcomes, we need to have a system where we measure the quality of service to the citizen. At present if an ambulance responds to a life-threatening incident in under 19 minutes but the patient passes away, that is regarded as the ambulance meeting its targets. If the ambulance arrives one minute later and saves the life of that person and the person makes a full recovery that is recorded as missing the target. We need to have targets geared to ensure the impact-----

These targets take that into consideration.

-----of our health service on citizens. That is what the HIQA process that has commenced will do, measuring not only the time it takes to arrive but also the outcome, and what happens in the interim where ongoing advice is given to the caller so that the treatment can commence as soon as the call is made.

The Department of Health is reviewing the matter the Deputy raises about officers. We need to ensure that we have an open mind, and with the resources available, which the Deputy knows are and will be constrained, that we configure a service that is as efficient as we can make it, that takes account of best international practice and with a focus on the best outcome for the people who depend on our health service.