I wish to raise the many problems in the National Ambulance Service. Staff are doing their best but there are problems beyond their control. I will outline some of those problems. There are not enough staff or ambulances. We have approximately 1,500 staff. Scotland, which has a similar population, has more than double that number. We have 675 operational ambulances in the service. Scotland has more than double that number.

There is a problem with so-called dynamic deployment, and I really want to push the Taoiseach on this. What dynamic deployment means is that ambulances can be sent anywhere. An ambulance based in Laois could be sent as far as Cork or Waterford. Ambulances are being sent that far. Sometimes they are turned back when they are within a couple of miles of their destination because a local ambulance has got there a minute or two quicker. A crew can do more than 600 km across a shift and only pick up one or two patients Recently in Laois, there was only one crew and one ambulance on call. When the crew clocked in, they were immediately sent to Wexford. Meanwhile, Laois was left without an ambulance. There is one ambulance station. On Monday and Tuesday nights, there is only one ambulance available. An ambulance can take up two hours to arrive at locations within the county - it might not even arrive at all - because of this. That is no fault of the staff.

As stated, only one ambulance is on call on Monday and Tuesday nights. That ambulance can be sent to destinations three counties away, which has actually happened. Recently, a young person died less than a mile from the hospital. There is, as already noted, the one ambulance base in the county and no ambulance was available to pick up that child. Two ambulances were on call at the time but both were attending calls in other counties.

We have less cover in the county than we had 15 years ago, despite the fact that the population has increased by over 40% and now stands at over 100,000. There is also a problem with the rapid-response vehicles in the county, namely the cars used by advanced paramedics. Again, there is less cover now. The drivers of those cars used to be allowed to bring them home. Regardless of whether they were on shift or not, if they were contacted, they would leave from their homes and rapidly deploy to the scene of an accident or emergency. They not doing that now because some genius decided that they had benefit-in-kind because they had cars with all the signs on them that they might be using to do the shopping or something like that. As a result, these vehicles are left at the base and the extra cover that people were offering on a voluntary basis is no longer there.

In addition to everything I have outlined, we have a staff shortage and retention problems because of staff burnout. The Irish Medical Times reported earlier this year that the critical shortage of advanced paramedics is endangering life. There are targets in this regard. I have them here. They were sent to me in the form of a reply to a parliamentary question I tabled recently. In a situation involving a life-threatening illness or injury, the target time for advanced paramedics to reach the scene is 18 minutes and 59 seconds. That is only happening 45% of the time. If you set a target that low, of course you will not meet it. It is ridiculous. Will the Government put an end to the madness of so-called dynamic deployment? Will it invest in more ambulances and increase the number of staff available? Will it step up recruitment immediately?

I thank the Deputy for raising this issue. At one level, the National Ambulance Service and pre-hospital emergency care have been transformed over the past 20 years in terms of the professionalisation of emergency medical technicians, EMTs, and of the level of response in general. There has been significant investment in the service. This year, €8 million has been allocated for new service developments, for 180 additional posts in the service and for increased capacity for aeromedical services. As of 30 August last, total staff numbers stood at 2,400. That is a 25% increase since 2020, meaning that 502 extra people have joined the service. Some 85% of those staff work in direct patient-facing roles.

The issue of dynamic deployment has arisen since the configuration was developed many years ago. On the surface, I can instinctively empathise with the Deputy's point because it does mean that ambulances are travelling long distances. We have to respond to this in an evidence-based way. I will talk to the Minister for Health and have further engagement with the National Ambulance Service and the professionals involved as to what is the optimal deployment of staff and ambulances and what is the best way to do it. In Dublin, for example, there has been a unique situation where Dublin Fire Brigade has provided a very effective and efficient ambulance service for many years. The HSE and the service were arguing the toss as to how to reform and reconfigure it. In that context, one view for a long time was "If it's not broke, don't fix it.".

We should be open to examining what is the optimal way to deploy the resources. Many professionals would say that what they are doing is the optimal way to do it. The Deputy is articulating a different perspective. I respect the points he is making, but I do think we probably need to look at this in a more evidence-based way. Perhaps the Oireachtas Joint Committee on Health could examine it in more detail. The professionalisation of the service and the development of two dedicated helicopter emergency medical services, for example, represents a significant expansion that is enhancing our response. As the Deputy knows, the key responder, namely an EMT or a first responder who is qualified and professional, can save lives. There have been a lot of very positive reforms and a great deal of significant investment in the service in the past number of years. There have been issues and, from time to time, Members have raised the matter to which Deputy Stanley refers.

The Taoiseach is correct about the investment, but we will not get the benefit of it because of the way the system is configured. The Taoiseach used the word "evidence". I will tell him what the evidence is. A county has no cover because the ambulance that is on call has to go to an emergency two or three counties away. That cannot be allowed to continue. That is the way Laois has been left on two nights each week. If a person is injured or is in a life-threatening situation only a mile or a half mile from the hospital, there is no ambulance to collect them. This is because the two ambulances that are there during the day have been sent somewhere else. I am not arguing for them to be kept within a strict limit, but a radius needs to imposed. I previously raised the case of a farmer who a few years ago was left lying in a farmyard in the Clonaslee area for two hours because there was no ambulance available in Portlaoise to be sent to assist him.

The officials will give the Taoiseach answers and will blind him with the figures they have available, but he needs to look at the reality of what is happening. I am spelling out the reality in black and white.

I am asking the Taoiseach to review this dynamic deployment. The Government needs to do it, invest in more ambulances and step up recruitment of staff.

To be fair, we are talking about 430,000 urgent and emergency calls in 2024. That is the scale of this issue. It is a 32,000-calls increase, or an 8% increase, on 2023. The Deputy has done the statistics. Performance is improving with 72.5% in 2023 to 73.2% against a 75% target for life-threatening cardiac or respiratory arrest. We have to look at alternative care pathways as well. The Deputy mentioned the rapid response car. I have had experiences myself where that has been far more effective and fast in cases that maybe did not quite require an ambulance once one had the confidence of either a GP or a medic who could say, "Look, we can manage this in a certain way and get the person to a hospital." We have to use the resource to the optimum. That is the objective. One of the biggest issues has been turnover time at hospitals at times of high demand in emergency departments. They are working to improve that outcome.

Before I call the next speaker, at the behest of Deputy Richard O'Donoghue, I welcome Greybridge vintage club to the Gallery.