Last week, there was a special "Prime Time" programme on the ambulance service. It monitored various counties and also looked at ambulance response times in Dublin. The programme was shocking as it showed interviews of staff and family members who made 999 calls, some of whom received appalling responses.

For example, one man explained how he rang 999 as his father had chest pain. Even though they could see the Wexford hospital from their own home, the ambulance took more than 50 minutes to arrive and unfortunately his father passed away. This man could not understand why ambulance control did not explain that there would be a delay, as he would have been able to drive his father to the hospital within a few minutes. When he queried this afterwards, he was told that people were not normally told there would be delays unless they asked.

A whistleblower from the mid-west was interviewed. She said that ambulance crews from the mid-west were run ragged and "going without food for hours" trying to respond to patients because of a lack of ambulances. She is an emergency medical technician. She said: "There are still not enough vehicles to cover an emergency. If a plane crashed, there are definitely not enough ambulances for it." She also said: "The situation of late response times for ambulance call-outs in Limerick is serious. There wouldn't be a day that would go past that you wouldn't be stuck somewhere for an ambulance going 'Oh, God, we've no ambulances to send there'."

The Health Information and Quality Authority report published last week confirmed that ambulance calls continue to rise by about 10% per year.

A question, please.

Worryingly, it also found that staffing in some control centres fell below the required safe levels.

Does the Taoiseach accept that ambulance response times are far from acceptable? What does he intend to do to address this situation? Does he accept that it is time for a fundamental review of how the ambulance system in the country is organised to ensure proper and effective ambulance response times in all areas of the country, particularly in rural areas?

The ambulance service over the years has always been one where controversy has raised its head on many occasions. I recall being on a health board many years ago and the clapped-out ambulance vehicles in many cases were a source of constant engagement at the meetings.

Since 2011, there has been a major programme of change to reconfigure how pre-hospital emergency care services are managed and delivered. Last year, there were 280,776 calls, 14,000 more than in 2012, which is a significant number. In 2011, there were no targets set for ambulance response times. When the Minister, Deputy Reilly, was in charge he raised the bar for response times. For 2014, a new target has been set for 80% of life-threatening calls to be responded to in under 19 minutes. The 2013 target was for between 68% and 70%. For the first time now hospital turnaround data are being collated on a national basis, which is important. That will allow an assessment of performance in the handover of critically ill patients in the system as a whole, in the response times and in the collection times. That will obviously allow for determination as to how the system can be improved. I accept it is not perfect by any means.

The HSE has acknowledged that at times of high demand with the emergency care system there is clearly a potential for delays in the transfer of patients from ambulance to emergency department and this results in delays in the release of ambulances from emergency departments and reduces the availability of ambulances elsewhere. That is why a national collation system has now been put in place.

There has also been a whole new further set of details on the ambulance emergency department framework. That clarifies the process of clinical handover, establishing where are the lines of responsibility . There is a €5.4 million increase in the ambulance budget for next year, which I think everyone will welcome. There will be 50 replacement ambulances next year, which I think everyone will also welcome. The DELTA and ECHO response times are improving, but the HIQA report recognises that patient outcome is actually more important than response times. The clinical audit will begin next year for the first time.

It is an evolution to a point where national data are now being collated. We have increased investment in the provision of new ambulances and in the collation of the data. Most important of all is the health of the patient.

The Taoiseach needs to stop referring to things happening "for the first time" because that is the classical political response to very serious issues. The HIQA report was quite clear that over a ten-year period, there was very significant progress in the training of emergency medical technicians. The whole pre-ambulance care council and so forth which was established more than ten years ago changed dramatically what had been happening prior to then.

The key point is that the lack of any strategic planning is now evident. Something has gone fundamentally wrong with the reconfiguration. What is the response to that person in Wexford who was within eyesight of the hospital and yet it took 50 minutes for the ambulance to get there? There are probably Deputies in all parts of the House who can instance cases where the response times were simply too long. The money that has been allocated for replacement vehicles had to be allocated because the HIQA report revealed-----

A question, please.

-----that up to 47 vehicles were way beyond the seven years and 500,000 km criteria for emergency ambulances in the State.

They had long passed those criteria and still had not been replaced and will not be until next year. We welcome that fact, but it is too late and shows a lack of proactivity. The report, which backs up the "Prime Time" programme, says that EMPs are not being adequately trained, there is a lack of strategic planning, and quality assurance of clinical care is limited.

We are over time. The Deputy should put his question.

It also strongly criticises the issue of ambulance capacity being lost due to the delay in handing over to accident and emergency departments. It is not just a question of saying that it is far from perfect. There are serious issues which are crying out to be addressed-----

Yes, I know.

-----in terms of the reconfiguration and the move to centralisation. Would the Taoiseach accept that something has gone wrong concerning people's access to ambulances and the response times.

Yes. I accept that it is not perfect and that there are serious issues, but they are being addressed by the Minister. I think the Deputy accepts that a €5.4 million increase in the ambulance budget next year is important. That is recognised by the Minister and it is now in place. Some 50 replacement ambulances will be provided. These are brand new ambulances. I had an opportunity quite recently to deal with a private company on the issue of a number of new ambulances and their facilities are absolutely first class.

But it is the public sector that should have them.

Yes, I understand. The former Minister for Health, Deputy Reilly, brought in targets for the national ambulance service whereby, when a life-threatening condition occurs, a patient-carrying vehicle should be on the scene within 19 minutes for 80% of those calls. That does not actually deal with the problem, however.

Like most of the things he brought in.

I will tell the Deputy why. Target times are only one element of an ambulance service. At present, if an ambulance responds in under 19 minutes to a call in respect of a life-threatening situation and the patient unfortunately passes away, that is recorded as an ambulance meeting its target. On the other hand, if an ambulance responds in 20 minutes to a call in respect of a life-threatening situation and the patient makes a full recovery, it is recorded as an ambulance missing its target. The determination of times, therefore, does not give a comprehensive response, although it is one element of it.

Whose fault is that?

The emergency aeromedical service support was a 12-month pilot project between the NAS and the Air Corps providing dedicated aeromedical support for the NAS in the west, specifically where roads were poor and land ambulance transit times were more severe. A review of that project found that a clinical need exists for the service.

Thank you, Taoiseach. We are over time.

It recommended that it be established on a permanent basis. The 2015 HSE plan includes a specific target for turnover at hospitals for the first time, so that is an improvement. We also have an air ambulance for the midlands and the west, which is important. It is not perfect but the air ambulance for the midlands and west is now in situ, which is a big improvement in terms of access and travel times for hospitals.