Over the past eight years, the number of people who died before an ambulance reached their location increased by an alarming 70%. Last year alone, 1,108 people died before an ambulance arrived on the scene. In one high-priority case, it took three hours and 15 minutes for an ambulance to arrive to a critically ill patient. I have raised the issues surrounding our ambulance service on numerous occasions during the lifetime of this Government. I have consistently highlighted the fact that the ambulance service is in a serious state of disarray. The centralised call-out system has failed. The service was much more effective and efficient when managed in regional hubs. There is now a national system which is poorly managed and co-ordinated. Many personnel in the system have lost confidence in the functionality of the system. It is not cost effective. There is massive wastage of funds due to poor logistical direction. The constant sustained pressure pushes crews to the limit of their endurance. They go to work not knowing what county or province they will end up in or what time they might get home. This has a demoralising effect on ambulance crews and their families. Frustration at the inability or unwillingness to correct repeated system failures has turned to disillusionment and anger among front-line workers. Many find it impossible to cope and are seeking to exit the service.

I have made numerous calls for a complete review of the service. In fact, a review happened, focusing on management structures, yet those findings were kept under wraps. Details of the report were subsequently obtained under freedom of information by Journal.ie. The findings confirm beyond doubt that every issue I and others in this House have raised was factual and verifiable, so much so that the report was deemed scathing in its criticism. It revealed that the ambulance structure is underdeveloped and under-resourced. Six areas were considered high risk or extreme risk. There was a keen focus on ambulance service staff, an area I have highlighted on a number of occasions in relation to paramedics. I relayed accounts of serious understaffing due to long-term sick leave, exhaustion and a lack of personnel to fill rosters. There were reports of exhausted paramedics travelling the highways and byways with their 12-hour shifts stretching to 15 hours or more, during which time they had no food breaks or downtime. Findings showed that up to 57% of shifts ran over designated finish times. The publication of this revealing report cannot be ignored, shelved or put on the long finger.

I thank the Deputy for raising this issue. Is ceist an-tábhachtach í. Over the past 20 years, there has been significant professionalisation of the entire area of medical technicians and the entire ambulance service. Much of that was informed by international best practice, such as in the development of the standards of training for emergency medical technicians, which replaced a different kind of approach prior to that. First and foremost, getting a qualified EMT to a scene is the best chance for a person to survive, as opposed to getting the person to a hospital perhaps 30 miles away - the first responder is key. That side of the transformation in the past 20 years though the Pre-Hospital Emergency Care Council, PHECC, has worked.

The other side is the centralisation of the call-out system, to which the Deputy referred, versus a regionalised hub approach. I will talk to the Minister about this again. Investment has increased continuously. In the National Ambulance Service it has gone up by 37% since 2019. The NAS has an allocation this year of €231 million and there are about 2,380 people working in it now, representing staff growth of approximately 447 since the end of 2019. That is a 23% increase in staff. There has been an increase in staff and investment and there are ongoing campaigns to recruit more qualified paramedics, student paramedics, emergency medical technicians and emergency call-takers. There is significant growth in demand for services, with 389,000 calls received in 2023. That is an increase of approximately 14% since the end of 2019. The National Ambulance Service states that its national performance for cardiac and other life-threatening call responses exceeds HSE national service plan key performance indicator, KPI, targets, showing improvements on the 2023 performance.

The HSE has stated that the National Ambulance Service dynamically deploys its ambulance resources in line with international best practice. It deals with higher acuity calls versus lower acuity calls and how they are triaged - it can change from lower to higher acuity between a call. It is worth having a review or engagement and perhaps a greater discussion around that so people understand what international best practice says in this situation as to the optimum model for the deployment of ambulances. I will discuss this with the Minister.

I seek a commitment that the complete findings of the report that is with the HSE be made public. I request assurance from the Government that failings identified in the report will be addressed as a matter of urgency. I agree that the shift towards first responders and paramedics has been a good one and works well. They are very capable and professional people. The problem is there are not enough of them, they do not get the support they require and, as a result, many are leaving the system. Recruitment and retention across the ambulance service are a major issue for a vital service. This has become an issue because the job has lost its appeal. It is a highly pressurised, stressful and tiring role. The ambulance service, if you will excuse the pun, is in need of resuscitation. The sooner we realise that and act on it, the better the results we will get. It requires political intervention to sort out the multitude of problems in the system. There is a huge level of anxiety and anger in the service. As was done in the mid-west recently, the regional model should be looked at again.

The report should be published. I will speak to the Minister for Health about the up-to-date position. I understand the report received significant media attention in one publication. If a report is commissioned by a service, it should be published openly by the HSE. As I said, the HSE's national service plan had various key performance indicators regarding purple calls, which are cardiac life-threatening, and red calls, which are other life-threatening calls, to be responded to within 18 minutes and 59 seconds. There is a load of data in that regard which indicates it exceeded those targets. There is a broader question regarding the incidences the Deputy outlined of excessive waiting times, people waiting far too long and what the optimum model is to deploy. The National Ambulance Service and HSE are clear that it is informed by best international practice. We need a rational discussion, at committee or some other level, to get under the bonnet of the issue and take on board what the Deputy said.