A commitment to delivering a top quality emergency service and a willingness to do so in a spirit of co-operation and partnership have been the hallmark of ambulance crews in Ireland in recent years. Their dedication to the service they provide and their level of professionalism must now be acknowledged and rewarded, says Joe O’Flynn, General Secretary of SIPTU.

No more EMT promises

THE LAST DECADE has been one of significant change in the ambulance serv­ice, principally in the wake of the publica­tion of the Strategic Review of the Ambulance Service in 1993. Many of these changes have been prompted by a natural increase in the demand for service.

Advances in technology and medical knowledge have facilitated some of these changes, while more have arisen out of belated increases in investment in resources — both material and personnel. But the biggest single qualitative change in the service was the implementation in of the recommendation to transform the old grades of driver and attendant into the new position of Emergency Medical Technician.

This change in approach arose prima­rily from the recognition that the speed and quality of response after a medical emergency — be it a road traffic accident or a heart attack — can have a critical bear­ing on the patient’s chances of survival. Effective intervention by ambulance per­sonnel may determine not only the sur­vival of the patient, but also the degree and duration of medical care required and the quality of life after discharge from hos­pital.

Emergency ambulance crews are at the frontline of medical care. It is now widely acknowledged that clinical inter­vention in the first hour, or shorter in case of cardiac arrest, can have a major influ­ence on a successful outcome. The timely intervention of an EMT is a critical part of this emergency response.

TRAUMATIC CIRCUMSTANCES

Furthermore, as the Strategic Review in 2001 also acknowledged, emergency ambulance crews often have to provide services in difficult and traumatic circum­stances. As far back as the mid l9BOs, ambulance personnel with a vision of what the service could and should be took this approach (i.e. providing modern equipment and developing skills to enhance the service, which in itself would lead to the recognition and rewards to EMT’s).

A pay increase of 25 per cent was rec­ommended by the Public Service Benchmarking Body. While this award was one of the largest to be recommended, I have sympathy with the argument that the Benchmarking Body did not go far enough. Indeed, considering the increas­ingly pivotal role that EMT’s play within the health service, if the re-organisation of the health service proceeds even remotely according to the approach mapped out in the Hanly Report, it was totally reprehen­sible that various armchair economists, commentators and business leaders should have waged a campaign to with­hold payment of the benchmarking awards.

Perhaps these lobbyists believed that they could change Government policy on this issue. But the Taoiseach stood by the agreement on benchmarking, which was an integral element of ‘Sustaining Progress’. To do otherwise would surely have been the end of the social partner­ship process.

On the issue of pay in the ambulance service, we are looking at unfinished busi­ness. The 25 per cent increase delivered through the first report of the Benchmarking Body should be seen as a down-payment with the expectation of further compensation to follow under any future review of public sector pay.

There is understandable scepticism about the implementation of the Hanly Report But if the central aim of the doc­ument — to rationalise the provision of health services in fewer major centres — is even realised to a partial extent, it is clear that it will place added responsibilities on the shoulders of the EMT’s. As patients are likely to be travelling further to reach acute hospital facilities, the role of the BIT in providing medical care will be even more pronounced.

Where ambulance staff still operate as drivers and attendants, the kind of stream­lining of hospital services being proposed in Hanly would not be possible. I believe a prerequisite for the introduction of Hanly’s proposals will have to include the extension of the service to provide air ambulance support, otherwise the public at large will simply reject the proposals and with very good reason. The level of support to enable EMT's to fulfil their role is still far from adequate- Issues remain in relation to further training as well as bet­ter organisation of the service.

LIFE AND DEATH SITUATIONS

Improving response times is critical. Yet ambulance personnel have now fallen vic­tim to the ludicrous unthinking application of traffic penalties in the course of responding to emergency calls. This would be laughable if we were not talking about potential life-and-death situations. Do these people have any understanding of the meaning of the word ‘emergency’? I sincerely hope that the authorities will see sense on this issue, not only in trying to meet the demands for quicker response times, but also to ensure the peace of mind of patients.

I am not sure that some bright spark in this or a future Government will not have a brainstorm about contract­ing out ambulance services as part of some wonderful notion about injecting com­mercial reality into the management of our health service. Indeed, in view of the fact that the private sector is already well estab­lished within the health service in Ireland with some small-scale private ambulance operators, the prospect of further privati­sation in the form of con­tracting out of services cur­rently within the public sec­tor is not so remote as might appear at first sight

And this private invest­ment is not being made out of any sense of altruism or concern for the public good. The bottom line, as always, is private profit for the golden circle and those with the vested interests. Already in this country, the Government has begun to highlight the need to pro­vide incentives for further private investment in the health service. The Minister for Finance already pro­vides tax breaks in certain areas, As the health crisis is allowed to worsen, the Minister for Finance is like­ly to speak of the need for even more public-private partnership initiatives in the health service

PRIVATISATION

Any private contractor would have to tender to provide services at no more than the existing cost, otherwise the whole exercise would be pointless (although that is not to say it could not happen anyway). So, if the contractor has to match the current spend and make a profit for themselves, they would have to save on administration, overheads or labour costs.

Any potential savings on administra­tive costs are unlikely to yield a big enough profit margin. They may shave some costs on overheads by cutting down on vehicle maintenance or by replacing ambulances less frequent, but such a strategy would be very risky since certain standards of vehicle reliability would undoubtedly feature as one of the terms of the contract and any slippage in this area could lead to its cancellation or non-renewal. So, where are they going to make the surplus profit? Will profit be made on labour costs, either by reducing staff num­bers and expecting you to do more, or by reducing your pay in real terms?

By working together, through the ambulance association and union, EMT’s can certainly make a difference for them­selves and their own working conditions, and can also make a difference in the qual­ity of the service provided to members of the general public.

(Joe O’Flynn. SIPTU General Secretary delivered his paper at the AAP’s Conference 2004).

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