An increasingly fractious relationship between Dublin City Council and the HSE over who should pay for the State's busiest ambulance service is revealed in correspondence dating from July 2010, released to The Irish Times under the Freedom of Information Act.
In emails between senior council officials, the HSE is accused of "short-changing" the local authority in relation to alleged arrears of more than €10 million accrued since 2005 for the ambulance service, which is provided by Dublin Fire Brigade (DFB) on behalf of the council.
The correspondence culminates in a letter from city manager Owen Keegan to the director general of the HSE, Tony O'Brien, dated November 22nd, 2013, in which Mr Keegan accuses the HSE of "refusing to abide by the terms" of an agreement reached 16 years ago as to how the ambulance service would be paid for.
The letter was sent three months before the announcement on February 27th by the HSE and the council of a joint review of ambulance services in Dublin city.
Charged with looking at patient-care and value for money, it is being conducted by former Dublin deputy city manager Derek Brady and former interim director of the National Ambulance Service (NAS) Martin Flaherty. It is is due to be completed by May.
'Long tradition'
Mr Keegan said in the November letter that while DFB had "a long tradition of service to the population of Dublin", having provided the ambulance service since 1898, the council could not continue to provide it where "DFB's capacity to meet Hiqa [Health Information and Quality Authority] standards is being undermined by factors outside its control".
He claimed the HSE was refusing to abide by long-standing agreements on payment, the current funding formula did not provide for reimbursement of significant costs incurred by DFB and agreement had “proved impossible” on a new service-level agreement.
Asked by The Irish Times last week about the alleged arrears with the city council, NAS director Martin Dunne said: "There are no arrears."
The emergency ambulance service in Dublin costs about €12 million a year, to which the HSE contributes €9.2 million out of a national ambulance budget of €134 million.
DFB takes about 40 per cent of all emergency calls in the State.
Although DFB has 12 ambulances stationed across its 11 fire stations (with two in Tara Street), it also has 22 fire appliances, each capable of carrying up to six paramedics.
Chief fire officer Pat Fleming says that up to 60 per cent of the most serious life-threatening calls in the city are responded to initially by a fire tender. He says this underlines the brigade’s need for three more ambulances, which it cannot afford to buy.
Despite a lot of work, he says, it has not been possible to reach a service-level agreement with the HSE.
Strike cover
HSE and DFB paramedics do work side by side in the city – the HSE has some emergency ambulances, although these are often deployed beyond Dublin, and both organisations have call-takers in the control room in Townsend Street. However, there have been reports of tensions between staff in the two organisations, said to date back to 1988 when then Eastern Health Board ambulance workers provided the city with cover during a strike by DFB.
The suspicion in the minds of some city council staff – that the HSE is trying to force integration and take control of the Dublin service by gradually starving the city council of adequate funding – is important in the context of the repeated failings of the HSE’s ambulance service outside the capital.
The HSE’s ambulances are failing to meet response-time targets, thousands of HSE paramedic shifts are dropped on a constant basis and resource levels mean that the nearest available crew may be up to 60km away.
By contrast, in Dublin, DFB never drops a paramedic shift on account of it having having a “minimum manning level”. Although short of ambulances, it has 22 fully crewed fire appliances as back-up which respond to a significant proportion of ambulance call-outs.
Its ambulances are dedicated to Dublin and cannot be despatched to emergencies outside the city. Although its response times need to improved, it is notable that no Dublin TD in recent years has raised concerns about the quality of the DFB service.
Private sector
People Before Profit councillor Brid Smith, who has met DFB paramedics in recent weeks to talk about their concerns, said she had never come across a group of workers "so committed to what they do, so proud of the service they provide". She would be "enormously worried if the people of Dublin were to lose this service to the poisonous hands of the HSE or the private sector".
Asked by The Irish Times about his intentions with regard to Dublin's ambulance service, Mr Dunne of the NAS said it would be inappropriate to comment while a review was under way.
