Last week, a woman in her 60s died in an ambulance on the way to hospital. Two hours before this woman died, an ambulance was en route to transport her to hospital. In this case, the ambulance, on its way to the critically ill woman, was stood down and was diverted to care for a man with a back injury. When the paramedics arrived, the man walked out of his home and stepped into the ambulance. When a crew eventually arrived for the woman, she was carried out of her home by stretcher. This was the last time that she saw her home. The description given of the man's injury pushed him up the priority list and pushed her down. He ticked more boxes on the ambulance service's emergency scale. This is a preprogrammed computer system that determines patient priority. It is a computer that decides based on a tick in a box how urgently an ambulance should arrive. If an ambulance is on its way to a call, it can be stood down and diverted to just about anywhere, whether another town, another county or even another province.

For example, a recent shift from the Thurles ambulance base started at 8 p.m. That night crew was dispatched from Thurles to Nenagh, then back to Cashel. The next call was to Ballingarry and they were then sent to Tullow, County Carlow, diverted to New Ross and from there to Gowran and Thomastown. They were then sent back to Carlow town. This involved seven and a half hours of non-stop driving and only one patient to be transferred to hospital. While all this frantic driving was happening, Thurles was left without a service.

This situation is being replicated every week as Tipperary ambulances are diverted to other regions. Last week, for example, the south-east region operated at 50% capacity due to long-term sick leave, exhaustion and lack of staff to fill rosters. Exhausted paramedics rush along the highways and byways of Ireland, their 12-hour shifts stretching to 15 hours and more. They have no food breaks or downtime. A recent study showed 50% of shifts run over their designated finish times. This is dangerous and unsustainable. Social media recently highlighted an ambulance crew who went off the road through fatigue at the end of their shift. Paramedics across Ireland feel ignored and frustrated. Many suffer from burnout and anxiety and morale is at an all-time low. An independent review of the ambulance service is urgently required. It needs to be conducted from the bottom up and carried out without delay.

I thank the Deputy for raising this issue. The concept of a national ambulance service has been developed for a number of years. I am told and have checked that dynamic deployment allows staff in the HSE's national emergency operations centre in Tallaght to see all available resources and prioritise allocation to the higher acuity calls that require an immediate emergency response. Judgment calls are made through a system as to which is the most severe incident and ambulances are then deployed.

That model represents international best practice. It has been highlighted by HIQA as a way to improve response time and national ambulance service performance generally. That said, we hear repeated concerns from Deputies and public representatives locally about situations that have emerged in their localities. It is always important to review how a system and service operates. In 2021, the service received an additional €10 million. For 2022, an additional €8.3 million on top of that is being allocated to modernise and build up the capacity of the service.

There is an acknowledgement in the service that lower acuity calls - in other words, calls deemed to be less serious - have longer waiting times but in the sad case the Deputy has articulated, it seems the woman did not meet those metrics on the face of it, but actually was in a much worse condition.

The service has provided huge backup and been involved in the Covid response. I thank them for that; they have performed heroically throughout the pandemic. Redeployment of approximately 45 paramedics from Covid-19-related work back to emergency ambulance duties is under way. A further 80 paramedics are due to graduate from the National Ambulance Service College this quarter and 200 student paramedics are at different stages of the programme.

There is a strong focus on getting the additional staff in place but the Deputy's point is about a wider review of the idea of the national service with national redeployment, as opposed to having people located in different stations around the country. The professionals and experts in the field of emergency care are of the view that the current service is better in terms of outcomes but the experiences the Deputy has outlined deserve to be put before the National Ambulance Service team and the HSE with a view to feeding into and getting a better service and better outcomes for people locally.

There is just one further point. The community first responders scheme is important as well, and that needs to be grown again. It was stepped down a bit due to Covid, but that also needs to be reactivated, strengthened and expanded.

I do not think the Taoiseach or anybody in the Government has the full facts regarding what is happening. For example, ambulances are criss-crossing the country. You do not have to be a genius to know that this is not efficient or cost-effective. I will give the Taoiseach another example. It has happened in recent weeks that an ambulance was sent from a base in Kenmare to Waterford. An ambulance that left Kenmare, arrived in Waterford and did a call in Clonmel on the way back. It left Clonmel for a three-and-a-half hour journey and arrived back at its base late at night. The crew on board had done a 15-hour shift. There is nothing logical about that. It is ridiculous and it needs to be addressed.

The Taoiseach must throw open the doors of the National Ambulance Service and scrutinise it. We can no longer turn a blind eye to what is happening. The current system is failing both paramedics and patients. Together with an independent review of the service, we must also scrutinise the doctor-on-call system and look at the limited number of services provided at local injury units. The entire system is a total fiasco. Ambulances are waiting around with patients in them who cannot get access to hospitals and there are other patients waiting for those ambulances to arrive. A delay in ambulances means a delay in patient services, and that must be addressed.

I will relay this matter to the Minister for Health, Deputy Donnelly. I will discuss it with him, the CEO of the HSE and the head of the National Ambulance Service. It would also be useful it the Joint Committee on Health received a presentation from the National Ambulance Service. I do not know if that has happened, but it would be very useful. It would be an opportunity for Deputies and Senators to present their perspectives and relay the experiences of constituents and people on the ground. There is a lot in what Deputy Lowry says, but we need to hear the overall perspective on what is the optimum model for the provision of emergency care and emergency medical practitioners. This is a key service in terms of those who provide it being first on the scene. A professional paramedic can be critical in terms of the outcomes for any person and must also make the right decisions on the spot.