2026-04-21

115. Deputy David Cullinane asked the Minister for Health the steps she will take to avert industrial action among ambulance workers, the steps she is taking to meet the ambition of the ambulance service's strategic workforce plan and if she will make a statement on the matter. [28517/26]

My question concerns potential industrial action by ambulance paramedics, particularly pre-hospital care professionals, which would include emergency medical technicians, EMTs, paramedics and others. They voted overwhelmingly to take industrial action, as the Minister knows, on 12, 19 and 26 May. I imagine that the last thing paramedics and EMTs want is to be on strike. A number of votes were taken in recent times, including one last year, on the roles and responsibilities changes that paramedics voted against, so clearly there are issues. These are votes of no confidence in the system and no confidence in action that should be taken being taken, so what is next? What action will the Minister take to avert industrial action?

I do not think anybody wants to be involved in strikes of any kind. That is not how we do things, which is why we have the very comprehensive industrial relations architecture we have painstakingly built over some time. The HSE and my Department have engaged extensively, constructively and in good faith, as have the National Ambulance Service representatives, for more than two years to address the issues raised within the National Ambulance Service. That engagement has taken place through the State’s established industrial relations machinery, including the Workplace Relations Commission, WRC, and the Labour Court, and within the framework of the public service agreement. A comprehensive and independently brokered set of proposals emerged from that process. These included significant pay improvements for staff, of between 3% and 14% on top of the 9.25% pay increases already provided for under the public service agreement. Crucially, those pay increases were linked to agreed reforms and I can go through some of the detail of those reforms, which would generate a more comprehensive ambulance response service for everybody and an easier working life. The HSE and my Department accepted the proposals and the subsequent Labour Court recommendation in full, and both SIPTU and Unite recommended them to their members at the time. The difficulty now is that the unions are seeking to secure all the pay increases while there has been a reluctance to deliver the accompanying reforms. Those reforms are essential because they deliver real benefits for patients and service delivery, including faster response times, more ambulances available through modern crewing arrangements, greater flexibility across the service, stronger assurance of ongoing regulatory compliance and the ability to treat more patients safely in the most appropriate setting.

The problem is that the National Ambulance Service is massively understaffed. I put down a parliamentary question to which the Minister's office responded a number of weeks ago. In 2025, the HSE target was to have 4,162 whole-time-equivalent paramedics working in the National Ambulance Service. The number for this year is 2,657. By 2026, the target was to have 4,780. The number is estimated to be 2,920 by the end of the year. By 2028, it is meant to be over 6,000. At best, we are going to hit 3,500. We are somewhere between 2,000 and 2,500 paramedics short of what we need. That is leading to burnout and fatigue, which is why there has been vote after vote where paramedics, EMTs and others have said that they have had enough and cannot take any more. As far as I can see, they do not have confidence in the management of the National Ambulance Service because clearly if there are votes coming back all of the time where they are voting against recommendations and for industrial action, there is a problem. The problem is burnout and fatigue and can only be fixed by more capacity and better resources. I appeal to the Minister to do everything possible to support our paramedics and avert industrial action.

It is important to acknowledge that there has been 30% growth in the staff of the National Ambulance Service, which is a larger proportional increase than the health service received overall. We have invested an additional €75 million in the service since 2022 and staff members have increased by 761 since 2022. The total workforce is now 2,500. Further investment planned for 2026 will deliver 21 extra crewed ambulances at peak demand. I understand that 134 of 168 posts have been recruited, so recruitment is progressing reasonably well so far this year. My overriding priority, of course, like the Deputy's, is the safety of patients and the continuity of the emergency services. It is important to discuss the reforms that have been suggested and agreed in the industrial relations architecture, and I can do that. However, we cannot just increase capacity anywhere without introducing reform as well.

The paramedics that I have spoken to, and I have spoken to many, are all in favour of reform, but they also want to know that the Government has their backs and is putting in place the capacity. The Minister is right to say there has been an increase in the number of paramedics, but the objective was to double the number of paramedics over a five- to six-year period because that is what was estimated was needed. I gave the Minister the figure that, for 2026, the target is 4,780. The Department and the HSE are telling me that, at best, it will reach 2,920. We are going to be somewhere between 2,000 and 2,500 paramedics short. In 2023, the Government cut the target response times for categories purple and red from 80% to 50% and from 75% to 45%, respectively, within the specified time period, but those targets are still not being met. The targets that were set are not being met in relation to response times, and the number of paramedics that we need is not being met. It is falling back on those paramedics who are in the system. They are clearly crying out to the Government, the Ministers and the HSE to say they are voting for strike action and voting no confidence in the management of the health service and the National Ambulance Service because they do not see the concrete actions that they need being taken.

I am very invested in resolving disputes, and that is why we put so much effort into the industrial relations architecture that we have. It is important to highlight some of the models of the proposed reforms under the agreement reached between union representatives and State representatives in those structures, for example, a modernised pay and allowance structure, which replaces a complex pay arrangement dating back to the late 1970s with a simpler, transparent structure aligned to wider HSE norms. It standardises overtime arrangements to HSE rates and incorporates rostered working requirements, including weekends and night working, to core pay structures. These are important reforms. It is important that we discuss reform in the health service because while we can set a target of 4,000, if we are at 2,500, the Deputy and I both know that we have to deal with the practicality of today. There are 134 already in place out of the 180 posts that were funded towards the end of last year. We are desperately trying to recruit into all parts of the health service. However, it is not a realistic conversation for the Deputy and I to say that we are going to go from 2,500 to 4,000 within six months. We have to recruit where we can, and implement the reforms to make sure that everybody is working in different ways, including in a much more modernised structure. We cannot stand over one that comes from a pay structure from the 1970s.