Last week the director of the National Ambulance Service, NAS, felt compelled to outline some of the very serious challenges the service faces, including the fact it has an urgent need to recruit additional staff. Currently, recruitment efforts are being surpassed by service demands. We are told the scale of growth in demand for ambulance services is unprecedented and unexpected. Over recent days I have spoken to and received correspondence from paramedics in the midlands region and this reflects their experience. They tell me the service is now on its knees and that it is quite common that ambulance shifts are not covered due to a lack of staff. This is extremely concerning. The station in Tullamore has been closed for an entire day or night shift on a number of occasions recently. Previously this was unheard of. It is totally unacceptable. On top of all of this, despite the lack of cover in the midlands those available ambulances are regularly drawn into other areas. The Edenderry crews are regularly in Dublin, Kildare or the north east. The Birr ambulance crews spends most of its time in Tipperary or Limerick. The Portlaoise ambulances are frequently in Wicklow, Kildare or the south east. The Tullamore ambulance is then left to pick up the pieces in Laois, Westmeath, Birr and Edenderry. As one of the paramedics said to me, if a house was on fire in Portlaoise would we want the fire brigade to come from Dublin.

Despite the staffing crisis in the National Ambulance Service the Government has taken action that will, in all likelihood, significantly increase the pressure on it. I refer to the impact of extending nightclub opening hours. Allowing nightclubs open until 6 a.m., particularly in cities and major urban areas, is bound to have a knock-on effect on the already stretched ambulance services. It will certainly make it more likely that rural counties and rural ambulance-based services will be called into those areas and away from rural counties such as Offaly and Laois. Will the Minister consider pausing these measures to engage with the National Ambulance Service and health services and listen to what they have to say about the issue? They are important stakeholders. I want to be clear that while I fully support reform of our licensing laws for pubs and clubs, such reform should not bring about additional strain on vital national services such as the ambulance service.

It certainly should not make the working life of paramedics, such as those in Offaly and Laois, more difficult than it already is. Will the Minister outline the steps the Government is taking to increase recruitment and retention in the ambulance service? What actions will be taken to address the concern that ambulance shifts are not being covered in Laois and Offaly?

I thank the Deputy for raising an issue that is important to communities all over Ireland. The Minister for Health, Deputy Donnelly, is working closely with the head of the National Ambulance Service, Mr. Robert Morton, and they are now very much focused on the implementation of the national ambulance strategy. We have provided substantial additional resources to the NAS over the past couple of years. Record investment of more than €200 million was allocated to the service this year, an increase of approximately €30 million on that allocated in 2019.

When it comes to what we can do directly at the centre of government, we have prioritised the allocation of resources for the service. In the 2022 budget the service received its largest overall investment to date of €200.7 million, which included more than €8 million for an additional 128 staff, including paramedics, to address baseline capacity and strengthen clinical capacity at the clinical hub. The NAS staff complement, as of the end of September this year, is 2,032 whole-time equivalents. This represents an increase of 17% since the commencement of the previous National Ambulance Service strategic plan in December 2016.

Having said all that, I acknowledge the points made by the Deputy and that there have been instances where the service has fallen short of the standard we expect. This may well be for a variety of reasons, including vacancies, which the service is seeking to fill and for which an active recruitment campaign is under way. New investment is going into the rolling stock the service has as well as into upgrading bases. They are actively recruiting the professionals they need to provide the quality of service the Deputy and I, as well as all the people who we represent, expect.

Undoubtedly, response times have been impacted by high service demand, delays in patient transfers at busy hospital emergency departments and the continuing need for ambulance service crews to carry out necessary Covid infection prevention and control measures. However, where the standard falls short of what people expect, this should be made known to the authorities and a complaint should be made so that a learning can come from it. We all have experienced individual cases where the standard was not what we would have expected. That is not, as the Deputy said, because of the tremendous work of all of those working in the service. They are working in challenging and difficult circumstances and are doing the very best they can. I assure them, on behalf of the Minister and the Government, that we will continue to provide the resources they need to ensure the service is up to standard.

I thank the Minister for his response. I agree with him on one point in that the paramedics are doing an excellent job, but they are being put in an unfair situation. He did not address the deficits in counties such as Laois and Offaly where ambulance shifts are not being covered, for example. This is concerning and this is putting lives at risk, while also putting massive pressure on paramedics who were being pulled across the country into the east, south east, and Wicklow. The Birr ambulance crew has been called to counties Tipperary and Limerick. This is an unacceptable situation. The Government needs to take action, as does the Minister for Health, to address the situation at hand before something serious happens and lives are lost. Every ambulance station should have its shifts covered. While I accept there are issues around recruitment, which I am glad the Minister mentioned, will the Department of Public Expenditure and Reform support the submission made by the National Ambulance Service in respect of recruitment, which calls for the recruitment of an extra 192 student paramedics and the opening of a fourth campus in the south to increase capacity in the system?

Will the Minister support all of that? If he is to be meaningful and true to his word about taking action, surely that would be what the Government should be doing.

To be fair, the net issue leading to problems in certain cases is a lack of staff. It is not a lack of funding; the budget is there. The service is actively recruiting. It is bringing people in from other jurisdictions and trying to bring paramedics who qualified here and travelled abroad back to Ireland. However, there is a global shortage of paramedics and advanced paramedics. The service is doing all it can to make sure places are filled. Through the education system, the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, and the Minister for Health, Deputy Stephen Donnelly, are working closely together to ensure we have a pipeline of people coming through the education system with the training and skills they need so they can join the National Ambulance Service and fill the gaps that are there. It is the case that shifts should be covered and there should be a full complement of professionals at all times to provide the service to our people. We are conscious that this is a service that people only ever call on in an absolute emergency, very often at the darkest of moments of crisis in the life of an individual or family. That is why we will do all we possibly can to make sure the service is of a standard that people expect.