The Chairperson of the Committee for Health, Social Services and Public Safety (Dr Hendron): I welcome the opportunity to participate in this debate. The pressures faced by the Ambulance Service in meeting its responses times are of vital importance to all Members, their families and their constituents.

Every person in need of an emergency ambulance should expect equity of access to ambulance services. That means a speedy response time and proper equipment.

The improvement of service provision is of fundamental importance to my Committee. The Committee will have failed to do its job if it does not seek answers when a public body such as the Ambulance Service falls short of its key targets. I stress the admiration that my Committee and I have for the staff of the Ambulance Service, who do an incredibly difficult job extremely well with limited resources.

The Health Committee has considered the pressures faced by the Ambulance Service on many occasions. Most recently, Members examined the implementation plans of the Department of Health, Social Services and Public Safety for its strategic review of the Ambulance Service, 'Mapping the Road to Change: A Strategic Review of the Northern Ireland Ambulance Service', which sets out a phased programme of improvements to ensure that response time targets can be met in the future.

Committee Members also met recently with the chairperson and chief executive of the Northern Ireland Ambulance Service to discuss concerns about the ability of the Ambulance Service to meet, at the very least, the standards set for England, Scotland, and Wales. We should strive to meet not only the standards set in these islands but the best international standards. The public deserves no less.

We have heard that the Ambulance Service is not meeting its response time targets. Only 50% of calls are responded to within the eight-minute target time in the Eastern Board and Western Board areas, and the performance rate for the Northern Board and Southern Board areas is that only 46% of all calls are met within eight minutes.

Within those figures, there is considerable variability of performance across local government district areas. The problem affects rural areas hardest, especially remote areas. This problem was recognised by the Minister and her Department when she undertook the strategic review of ambulance services. The Committee welcomes the Minister's proposals to improve response times, and it will monitor their implementation to ensure that the Department acts without delay to improve services.

Fundamental to the problems facing the Ambulance Service are the resources needed to do the job. The lack of adequate resources affects the number of ambulances and crews available and their ability to meet the response targets. Only two thirds of the emergency ambulance fleet have paramedics on board. The public should expect a paramedic on every emergency ambulance. Funding also affects areas such as training, communications and morale.

However, it is not only about extra resources; it is also about the efficient use of existing resources. One example is the need for improved co-ordination of emergency ambulance services across the four health boards. The emergency co-ordination centre at Knockbracken Healthcare Park in Belfast handles work for the Eastern Board and the Northern Board. The centre should be used as a template for a regional emergency co- ordination centre, which would help the service to use its resources more effectively to meet targets.

Funding comparisons have pointed to a significant difference in the money available per head of population. Northern Ireland receives £14·50 per head, Scotland, £20 per head, and Wales, £22 per head. That difference must be redressed. The Minister's most recent bid, for £6·2 million to resource the implementation of the strategic review of the Ambulance Service in 2002-03, failed.

The emergency Ambulance Service is a cornerstone of the Health Service, and the public needs to be reassured that lives are not being put at risk due to the inadequate funding of this service. The service needs an adequate level of resources if it is to meet the performance standards, and the Health Committee will give its full support to the Minister in her efforts to obtain a fair proportion of funding for the Health Service and for ambulance services.

UNISON has sent a paper to all Members, and I want to highlight one point that is made in it:

I have made my final point on several occasions. Having been involved in primary care as a GP for many years, during all sorts of troubles, I have never known any ambulance driver to hold back in an emergency situation, no matter how much violence there was on the streets. I have great admiration for them.

I support the motion and commend Mr Fee for moving it at this time. For far too long the Ambulance Service has been regarded merely as patient transport and not as an emergency service, but the time has come when we must look on the Ambulance Service as a pre-hospital healthcare service. It will be an essential part of the review of acute hospitals. It is a healthcare provider that makes life better for patients in many different ways.

Emergency care can be influenced heavily in the pre-hospital phase. There is great talk about the "golden hour", but it is coming down to the "golden half-hour". In England and Wales it has been recommended that the time from when a call is received until the patient is at the door of an accident and emergency department should not exceed 30 minutes. According to the equality impact assessment of the Department of Health, Social Services and Public Safety, published in November 2001, the performance figures from some local government districts are: Carrickfergus 14%; Banbridge 18%; Limavady 30%; Moyle 33%; North Down 30%. And so it goes on. Is 14% an acceptable figure? I do not think so.

Standardisation of performance is necessary, taking rural and urban areas into account. It is easy to set times and to accept that the Ambulance Service is clinically meaningful. However, we must ask ourselves whether those times are operationally achievable. If they are not, we must ask ourselves how we can make them operationally achievable.

Modern technology is available. Have our ambulances been fitted with automatic vehicle location? It is easy to send ambulances to different locations, but if an ambulance is answering a call that is not an emergency and then has to be diverted to an emergency call, surely it makes sense that it should be fitted with an automatic vehicle location system. Satellite direction to homes is another absolute must for the future. How much time is lost because ambulances cannot find the exact location of an accident or a home where there has been a cardiac arrest?

I am glad that digital radio will be installed in ambulances. As Mr Fee said, there are many radio black spots in our country, but in order to have an ambulance service that can achieve the set times, there must be total coverage. That point is important. However, any equipment for ambulances should be properly tested in a Northern Ireland context before it is purchased.

I thank the Minister for her response, which I received this morning, to my question on stretcher beds. Many of the stretchers in ambulances are unacceptable, and it will cost a tremendous amount of money to replace them. Therefore, it is imperative that all equipment in ambulances should be properly tested before it is installed.

I also ask the Minister to take on board the difference between the retirement age of Fire Service personnel and ambulance personnel. The work of an ambulance crew can be heavy and stressful. Many ambulance personnel, when they reach the age of 63 or 64, find the work extremely heavy. They are unable to carry out the work as they should because their backs are being strained and so forth. In the Fire Service, one can retire at an earlier age.

I do not want to repeat many of the points that have already been made. Suffice it to say that the annual report of the Ambulance Service is correct when it states that this is a matter of life and death. Therefore, priority must be given to ensuring that the Ambulance Service is the best in the United Kingdom.

I support the motion in the name of Mr John Fee and welcome the fact that the motion has been tabled. It is an important matter that must be debated.

Health Committee members met the chief executive of the Northern Ireland Ambulance Service several weeks ago. Indeed, the Committee meets regularly with Ambulance Service staff, who highlight the problems that they face. The motion outlines not only the pressures that they are under but also the response times in rural areas. The Ambulance Service is under immense pressure at times.

Within the Health Service as a whole, we are back once again to the issue of resources. Much of the document 'Mapping the Road to Change: A Strategic Review of the Northern Ireland Ambulance Service' outlines the need for more funding and more resources. We must zoom in closely on those issues. The Chairperson of the Committee for Health, Social Services and Public Safety referred to the funding comparison per capita, where Northern Ireland is the lowest, followed by Scotland and Wales. I trust that the Department will take that issue on board, because it must be addressed.

Rev Robert Coulter raised the issue of the impact of acute hospital reorganisation. All those aspects and issues are most important, so that we get the Ambulance Service right not only for the needs of the people who will use the service but for the needs of the staff who are currently under immense pressure.

Delegations from the Ambulance Service have repeatedly made it clear to us that the funding allocation was totally inadequate to meet the needs of staff training, fleet replacement and prioritising investment within the service. Another major issue that was brought before us was the communications system, which also needs investment. When Committee members met departmental officials, we were glad to learn that, under the Executive programme funds, allocations have been provided for two key Ambulance Service developments in 2002-03. One of those relates to the introduction of digital trunk radio to improve communications between the Ambulance Service control, ambulances and hospitals.

An important issue for the Department to take on board is the possibility of examining the amalgamation of the Fire Service and the Ambulance Service. When the Committee met the chief executive of the Ambulance Service and his colleagues, it was stated that there was a need for a joint approach in relation to the communications of those two important emergency services. One needs to work with the other. The Department must examine the possible amalgamation of those services, in addition to the amalgamation of the communication services. That would help both organisations, and it would also help to address the emergency needs in our community. That would also help with the implementation of a rapid response scheme that would provide for faster responses to emergencies, particularly in rural areas.

In introducing this motion, Mr Fee outlined the needs of rural communities and the concerns and problems associated with response times. The amalgamation of communication services could be addressed to deal with that problem. Staffing and staff training were also outlined.

Violent attacks on Ambulance Service staff is one of the biggest issues that the service has had to face recently. Rev Robert Coulter referred to the retirement age of 65. Many staff have to work 12-hour shifts, coping with manual handling and stressful situations. The retirement age in the Fire Service is 55. Eight per cent of sickness absence in the Ambulance Service relates to exhaustion, back trouble, stress, violence and age-related problems. The Committee has been told by departmental officials that those issues will be taken on board. Those important staffing issues must be addressed immediately. A person of 65 years of age who has to deal with equipment in an ambulance can be under severe pressure, and the sickness rate proves that.

The level and extent of training must be improved. There is a shortage of paramedics, and an ongoing training programme for new staff and a refresher course for existing staff must be addressed.

Members will be strongly opposed to attacks on Ambulance Service staff, and all staff who work in the Health Service and the public sector. It is sickening to think that the people who need the service are at risk because of those attacks on staff that make the response times impossible to meet. Like other Members, I condemn the attacks on Ambulance Service staff.

When the Committee met the Department it learnt that money was being provided to deal with the raising of awareness in schools. The Committee was glad to learn that a pilot community education programme has been funded through the Department to raise awareness. Education programmes in schools will address the importance of the Ambulance Service and its work.

The Fire Service has an education programme in schools to highlight the importance and the need for that emergency service. About a month ago, concern was expressed to the Committee that there was no such programme available in the Ambulance Service. Members were glad to learn from the Department that that issue is being addressed, and we trust that it will have a positive outcome for the betterment not only of the Ambulance Service but also the whole community.

Fortunately, those attacks have stopped, and we trust that we will not hear of any more attacks on the Ambulance Service, the police, the Fire Service or any other people in the community.

Response times in rural areas are another major problem, and other Members have highlighted the issue well. Unfortunately, Northern Ireland is falling behind Great Britain in basic standards of service provision, fleet maintenance and training. That is due to a lack of funding, and it will affect our ability to meet the standards for response times to emergency calls. Our constituents deserve better, and the Ambulance Service deserves better. The service is working under extreme pressure due to a lack of funding, and the Department must address that issue not only for the sake of our constituents but also for Ambulance Service staff. We commend the staff of the Ambulance Service for working under such extreme pressures. We must represent them to the best of our ability. I trust that all the issues mentioned will be taken on board and that action will be taken on many of the concerns that have been raised. I support the motion.

On behalf of the Alliance Party, I want to put on record our thanks and appreciation to all members of the Ambulance Service who have served the entire community through years of murder and mayhem and who have been in the forefront of picking up the pieces, whether as a result of bombing, shooting, car accidents or other incidents. They have done, and continue to do, a superb job. As Mr Berry said, we hope that the recent and ongoing assaults on the Ambulance Service will cease immediately so that staff can get on with what they have been trained to do.

I hope that by having a debate on the Ambulance Service we will contribute to the overall well-being of everyone in the community and see co-operation between all those involved in the Ambulance Service. We are grateful for Mr Fee's motion.

The emphasis is on rural areas such as the Strangford constituency, which I represent. As I understand it, the eastern division is classified as rural and, therefore, must meet the performance standards for a rural area. The acute hospital services review recommends that there should be a significant increase in investment in the Ambulance Service. The Minister has endorsed detailed plans to secure improvements to the availability and quality of the Ambulance Service throughout Northern Ireland. We wish her every success in her endeavours.

I shall highlight some figures that emphasise the need to introduce a medical priority despatch system. Presently, calls to the Ambulance Service are not prioritised. Prioritisation has been introduced in all ambulance services in England, but not in Northern Ireland. The Alliance Party endorses its implementation here, starting with a pilot in the Eastern Health and Social Services Board area.

The targets in England for non-prioritised calls are the same as for Northern Ireland. Within each board area, 50% of all emergency calls must be answered within eight minutes. In the Eastern Health and Social Services Board area, 95% of all emergency calls must be answered within 18 minutes, and within 21 minutes in the other three board areas. The two regions compare similarly. Our four health and social services boards are not the best, but they are not the worst. In handling over 35,000 emergency calls, the Eastern Health and Social Services Board responded to 62·7% of those within eight minutes and 96·9% within the 18 minutes to 21 minutes target.

In order that the implementation proposals can improve response time, the new medical priority despatch system must be introduced. I appeal to the Minister and her Department to launch a public awareness campaign to emphasise the equality implications for patients in the new patient care services.

The strategic review implementation proposals go further than the exercise in England by establishing targets for local government districts. That decision is to be welcomed, and it will provide more detailed and honest figures and evaluations of performances. The Alliance Party supports any proposals that can get an ambulance to where it is needed in as short a time as possible and hopes that additional accident and emergency vehicles and crews will operate in outlying rural areas such as Saintfield, Killyleagh and Portaferry. Portaferry is at the tip of the Ards Peninsula, and anything that will reduce precious time in an emergency must be provided. I appeal to the Minister to ensure that those proposals are implemented as soon as possible.

I was pleased to hear the Minister say this morning that progress is being made on the all-Ireland air ambulance service.

I support the motion.

I wish to place on record my personal appreciation, and that of my party Colleagues, to the Northern Ireland Ambulance Service for its dedication and professionalism in serving the entire community with impartiality and displaying great courage over many years.

It is appalling that there are those in society who are prepared to attack ambulance staff and other members of the emergency services as they carry out their duties. The attacks must stop, and the courts must deal adequately with those who are guilty of such disgraceful attacks. There are an alarming number of attacks on ambulance staff and other staff inside and outside hospitals. This escalating problem must be effectively addressed. In 2000-01 reported incidents of violence against ambulance staff totalled 71, in comparison with 43 in the previous year. It is vital that the general public supports the Ambulance Service and helps to eradicate the attacks.

The speed of response of ambulances to accident and emergency situations is critical at the time of a call and at attendance at the scene. There is concern, however, that some response targets are not being achieved. In the financial year 2000-01 two of the four health board areas - the Northern Board with 47% and the Southern Board with 42% - did not achieve the 50% target for accident and emergency ambulances to arrive at the scene in eight minutes. It is vital that, in emergencies, intervention and treatment for life-threatening conditions such as cardiac arrest begin as quickly as possible after the onset of the arrest. The targets of 95% of accident and emergency ambulances reaching the scene in 18 minutes for urban areas and 21 minutes for rural areas were not achieved in three of the four health board areas in 2000-01: the Northern Board with 94%, the Southern Board with 92% and the Western Board with 94%.

There were over 71,000 emergency calls in 2000-01, and the responses that were not achieved within the performance standard amount to several hundred in some areas. The times for each ambulance station over the quarter ending 31 December 2001 for response at the scene in eight minutes have a wide variance. In the Eastern Board area, the highest response rate is Ardoyne station at 71%, and the lowest is Downpatrick at 35%. In the Western Board, the highest response rate is Altnagelvin station at 59%, and the lowest is Castlederg at 37%. The Northern Board also has a large variance. The highest response rate is Antrim at 58%, and the lowest is Ballymoney at 32%. In the Southern Board, the highest response rate is Newry station at 53%, and the lowest is Craigavon at 30%.

It is clear that some response times must be improved and greater consistency achieved, particularly in rural areas. The necessary resources must be made available, and measures must be put in place to achieve the required improvements in response times as a priority.

I support the motion. It is important to examine what the Ambulance Service offers.

A wid be for pitten forrit ma consarn that, for aw the unanimous council uphauld for upsettin an ambulance ootstation on the Airds Peninsula, the Halth Meinister haesna setten oot onie plans for sicna ploy.

The Norlin Airland Ambulance Service haed an apen forgaitherin in the Strangford Airms Hotel in the Newtoun no lang syne for ti gae ower its propones for the haill Province an for the airt o Airds Burgh Council in parteiclar. It is clair that the Ambulance Service haes been in sairious want o siller in bygaen yeirs, gettin nae mair nor aboot £14 for ilk indwaller, an makkin compare wi Scotland an Wales the differ's neir £10 a heid. Deed, thir feigurs is e'en mair flegsum whan we tak the Fire Service. The Govrenment maun gie the dounhauden Ambulance Service the siller it's wantin that sair.

Airds Burgh Council haes been threipin for an ootstation on the Airds Peninsula thir 12 yeir, an that needcessitie haes cum til the fore as the population haes growne. The loanins o the Airds Peninsula is jaggit an nairrie, an the maist fek o fowk's bydin in the kintra an spreid oot. In the simmer the nummer indwallers fair gaes up, bi sae mukkil as 20,000. The tyme taen winnin til the steid o an accident in the laicher Airds Peninsula is up a lang wey, an the nummer lyfes tint haes growne flegsum.

I am concerned that, despite unanimous support from the district council - and I wear two hats for this - for the provision of an ambulance outstation on the Ards Peninsula, there have not been any plans for one under the current Health Minister or in the current Ambulance Service proposals.

We are here today to discuss rural needs in relation to ambulance provision. The Northern Ireland Ambulance Service recently held a public meeting in the Strangford Arms Hotel in Newtownards to outline its proposals for the Province as a whole and for the Ards Borough Council area in particular. The Ambulance Service has been seriously underfunded over the years, and we were given dramatic figures at that meeting. We spend only £14 per person, as much as £10 less than Scotland and Wales. When compared with the Northern Ireland Fire Authority, the figures were even more dramatic.

The Government, and the Department, must take steps to provide the funding that the hard-pressed Ambulance Service is desperate for. For 12 years Ards Borough Council has pressed hard for an outstation on the Ards Peninsula. It knows the needs and tries to reflect them. That commitment, and the need itself, has grown as the population has increased. The roads of the Ards Peninsula are, by nature, twisty and narrow, and the population is predominantly rural and widely spread. In the summer, the population grows by as many as 20,000 people, so it takes even longer to get to an accident on the lower Ards Peninsula, and that could result in a dramatic increase in the number of deaths.

It seems that the major reasons for the inability of the Ambulance Service to upgrade and provide better and more efficient services are money and manpower. As the problem continues and the Ambulance Service in the Province falls further behind, it could well be time to consider some short-term assistance. There is an organisation called ProParamedics, which is a professional, experienced group that is willing and able to assist. It has trained and expert staff, who already assist at a number of venues in the Province. It has come into being because the Ambulance Service and St John Ambulance - a voluntary group - have not been able to assist due to financial and manpower restrictions. Staff resources are already being squeezed.

I request that ProParamedics be fully considered if substantial manpower and funding are not made available immediately. It says that it can offer a service at a much better and competitive rate and be there within the prescribed time to meet all emergencies. It is available. Even if full training took place today for Ambulance Service personnel, they might not be ready to take up their posts right away.

Problems are further exacerbated because ambulances are able to take only one injured person to hospital at a time; in serious accidents the numbers of ambulances needed increase greatly. The pressure is on the Ambulance Service, and a fair and positive response for outstations or rapid-response units must take place - not, as we have been told, at a predetermined location; there has to be a full and fair look at the entire Province.

I call on the Minister and the Ambulance Service to create a rapid-response centre and outstation on the Ards Peninsula, which has already been justified by its needs. The outstation or rapid-response method could work effectively for the peninsula, perhaps working out of the health centre in Kircubbin. Again, I put that forward as a suggestion. It would be a clear and direct way of trying to help. There is a centre there that could be made available, and it could well be the outstation or rapid-response centre for the peninsula.

It is, therefore, disappointing that the commitment we sought from the Ambulance Service for the outstation has not been forthcoming. Perhaps the Minister can confirm that no decisions have been made, that nothing is predetermined, and that the outstation for the Ards Peninsula is still in the running. The Department said that there would be three pilot schemes for the Province but suggested that other places would probably be chosen. On three occasions it mentioned three places: the Sperrins, the Glens of Antrim and Fermanagh. I am not saying that any of those locations should not get the outstations, but the Ards Peninsula needs one more than most.

The outstation is crucial for people there. It is imperative to ensure a shorter response time for accidents and injuries, and I implore the Ambulance Service and the Department to review the situation and ensure that there is a pilot scheme for the Ards Peninsula. So far they have failed to deliver any sort of assurance to elected representatives. There is still time, and opportunity, to ensure that the Ards Peninsula gets its much needed and long overdue ambulance provision. Time, effort and need demand it.

Go raibh maith agat, a LeasCheann Comhairle. Gabhaim buíochas leis an Uasal Ó Fiach as an ábhar seo a thabhairt os comhair an Tí. D'éist mé go cúramach leis na tuairimí a léirigh Comhaltaí agus tá áthas orm deis a bheith agam sa díospóireacht seo na fadhbanna atá ag an tSeirbhís Otharcharr a mheas. Is cuid dhílis na seirbhísí sláinte agus pearsanta sóisialta í an tSeirbhís seo, agus tá gá le soláthar éifeachtach éifeachtúil otharcharr má tá beo go leor daoine gortaithe agus breoite le sábháil gach bliain.

I thank Mr Fee for bringing this matter to the House. I have listened with interest to the views expressed and welcome the opportunity that the debate has provided to consider the problems facing the Ambulance Service, which is an integral and important part of health and personal social services, as has been stated in the debate. Efficient and effective ambulance provision is essential if the lives of many injured and sick people are to be saved each year.

The key performance measure for the Ambulance Service is its ability to meet clearly defined response standards. The current targets for the service are to respond within eight minutes to 50% of all emergency calls, to respond to 95% of all emergency calls within 18 minutes in the Eastern Board area and within 21 minutes in all other board areas. As has been made clear these standards are met only in the Eastern and Western Board areas, and within them there is considerable variation in performance. It is no coincidence that the areas in which the Ambulance Service fails to meet current response targets are mainly, though not exclusively, rural areas.

The implementation plan and the strategic review of the Ambulance Service contain a series of measures to reduce the differentials between urban and rural areas, to improve overall response times and to improve the quality of responses by the provision of enhanced staff training. The plan sets out clearly the need for fundamental investment in the service if it is to make these improvements, and it is specific on what is required and the likely costs. Several Members took up that point.

However, there has been, and continues to be, significant investment in the Ambulance Service - over the last three years, over 100 new vehicles have been put on the road. Significant investment has been made in new equipment and in the training and development of staff.

One of the recommendations of the implementation plan is that there should be additional response points for accident and emergency ambulances to enable the travelling time to incidents to be reduced. Four additional response points are on stream, and more are planned.

The recommendation of the strategic review for 20 more locations was not supported by any statistical information. The issue is revised and revisited in the proposed implementation plan, based on computer-modelling of locations and response times. I can confirm that 11 additional locations are proposed and that consultation meetings have already identified alternative locations based on local knowledge.

I am also pleased to confirm that, as well as additional resources for the coming year, an additional £300,000 will be made available next year to begin the medical priority despatch system - a protocol which will help ambulance control staff to determine whether an incident is life-threatening and thus use existing resources more effectively; to improve the 24-hour on-call arrangements for responses to major incidents; to put in place measures to address problems with attacks on ambulance staff, including a trial programme to help prepare crews to deal with potentially violent situations; and a pilot community education programme for children and young people. That is on top of the additional £1 million already available to the Ambulance Service for 2002-03 for training and developing paramedics and other staff.

I have also secured a total of £3·2 million for digital trunk radio systems and rapid responder schemes, £1·1 million of which will be available to the Ambulance Service in 2002-03. The introduction of digital trunk radio provides for clearer and more secure communications between ambulance control staff and the other emergency services and will have many benefits in relation to the quality and timing of responses to emergency calls.

In that respect, I noted the points that Mr Berry made about closer communication systems and working together. Recent discussions and work have focused on closer co-operation between the Fire Service and the Ambulance Service. That is one of the reasons why the two services were put into the same Department - the Department of Health, Social Services and Public Safety - when the new arrangements were made.

I note with some regret that Mr Berry kept talking about what he had heard from departmental officials when he was quoting the responses that I had given to him face to face, when I met with him and his Committee colleagues in order to discuss budget proposals. Given that I had the professionalism to provide those responses, I hope that after this morning he will remember that they came from me.

The rapid responder schemes will have a particularly important role in improving the response in rural areas. There will be four rapid responder four-wheel drive vehicles - one in each of the board areas - each driven by a paramedic. Those vehicles will be situated in areas where the response times are particularly poor because of rural isolation or poor road networks. In addition, plans have been developed for pilot first responder schemes in rural areas, under the remit of the North/South Ministerial Council (NSMC). Those schemes will train people from the community in basic life-saving skills, so that they can provide support in the vital minutes that it takes for an ambulance to arrive on the scene.

Although I have concentrated on speed of response, which is of obvious significance, simply improving response times will not improve clinical outcomes for patients. Increasingly, the focus has been turning towards the quality of care that Ambulance Service personnel provide before a patient arrives at hospital. Recommendations in that area include improvements in training and development and the introduction of clinical audit procedures and systems. Ambulance Service is continually examining ways to improve the quality of service that it delivers. Over the past three years I have been able to make over £3 million available for Ambulance Service modernisation. I have also secured over £3 million with which to improve Ambulance Service communications and to pilot rapid-responder schemes.

The provision of those measures - the additional ambulance locations, the rapid-responder schemes, the introduction of first-responder schemes and the strategic deployment of ambulances - as identified in the implementation plan, are measures specifically designed to improve response times in rural areas. However, the extent to which various measures can be initiated - including the provision of paramedics - depends largely on the availability of the additional resources. The Chairperson of the Committee for Health, Social Services and Public Safety has already mentioned that my most recent bid was not met. However, I assure Members that, as they requested this morning, I will continue to bid for resources for that important aspect of my Department's services. The issue of roads was raised this morning. However, it is not within my remit and is a matter for the Minister for Regional Development.

Public consultation meetings took place in locations with the poorest response times in each board area. As part of the consultation process departmental officials offered to meet with any group wishing to air their views in that way. Several meetings have taken place in response to such requests. Those are continuing, even though the formal end of the consultation period was 15 February 2002. A request from Newry and Mourne Health and Social Services Trust was made at the end of last week. Arrangements are currently being made for that meeting.

In relation to the question about ambulances being used as a taxi service, the strategic review report highlighted the inappropriate use of accident and emergency (A&E) vehicles in the transport of patients to and from hospital appointments. The proposed separation of the management of A&E and patient care services (PCS) and further investment in the A&E and PCS fleets will ensure that A&E vehicles will not be diverted away from emergency calls.

The Ambulance Service is also aware of the need to make the public aware of what the medical priority despatch system will be, and it will introduce a public awareness programme. The Department will provide appropriate support to ensure that public concerns about the medical priority despatch system are addressed effectively.

Bob Coulter mentioned the retirement age for Ambulance Service personnel. That is not locally negotiated but is carried out in England as part of the normal negotiations on pay and conditions of service.

Violence against ambulance staff is of great concern to us all. The Ambulance Service has been in discussions with staff-side representatives about the measures it could take to minimise the risk to ambulance crews. I will meet representatives from UNISON to discuss that issue in the near future. In the meantime, my officials and Ambulance Service management are looking at initiatives to better protect staff and preclude further attacks, such as more robust windscreens in vehicles and community education projects, which I mentioned earlier.

Direct comparisons with response times of other ambulance services are not possible. The performance of GB services is measured on the basis of emergency calls categorised by level of urgency, and GB ambulance services are required to respond to 75% of life-threatening - or category A - calls within eight minutes.

The recognition of the Ambulance Service as an emergency service was mentioned. Ambulance services are provided to ensure that people who are ill can access health services under the provision of the Health and Personal Social Services (Northern Ireland) Order 1972. The accident and emergency ambulance service is generally perceived as an emergency service, but my officials are investigating what benefits, if any, would result from formally recognising it as such.

As regards regional funding, the proposed new commissioning arrangements are intended to result in a co-ordinated, corporate approach to the development of the Ambulance Service. Health and social services boards currently negotiate with the ambulance trust individually. The new model is based on a single commissioning group, including representatives from the four health and social services boards. Through that group, new service developments will be agreed on a regional basis.

Important though the recent and planned investments are, as is the work that we have taken forward to date, they fall short of the full implementation plan. There is a significant additional cost to implementing all measures proposed in the plan. For example, to achieve a 50% response rate to all emergency calls in all board areas within eight minutes will require a recurrent minimum allocation for ambulance services of £3 million a year.

To meet other more ambitious response time targets, additional funding of £8 million a year would be required for the first two years, with a minimum of £5 million a year thereafter. That is against a background of a limited departmental budget and the continuing pressures across the whole spectrum of health and personal social services. Therefore the speed at which improvements can be achieved will depend on the level of additional funding available. The Chairperson of the Committee for Health, Social Services and Public Safety referred to the fate of bids that I made this year.

Responses to the consultation on the implementation of the strategic review are being collated and evaluated. I will, in due course, feed the key messages from that back to Members. However, on the basis of the consultation so far, people clearly have genuine concerns about the need to improve the Ambulance Service, and response times in particular. In that respect, I welcome today's debate on those issues.

Significant investment in additional ambulances and crews is required to improve response times. I have sought every opportunity to provide additional funds for the Ambulance Service and will continue to do so. Indeed, I will continue to press and to take every opportunity to try to secure and provide additional funds for this vital service. I recognise that, even in these times of pressure on services overall, the Ambulance Service must be seen as a key element in providing effective and equitable healthcare for everyone.

Go raibh maith agat, a LeasCheann Comhairle. I too commend Mr John Fee for moving this motion, and I will add to the reasons outlined by my Colleague, Barry McElduff, for moving an amendment to it. I also take the opportunity to commend and thank the Ambulance Service staff for their years of hard work and dedication and to point out that the level of attacks on staff has increased and must stop. The Committee for Health, Social Services and Public Safety discussed the matter last week.

The debate was mature and informed and covered the issues faced by the Ambulance Service. I agree with John Fee that the ring-fencing of money must be examined and that the Ambulance Service cannot develop without a proper budget and funding, and I will come back to that later. The basis of the amendment is that many of the services in the Department of Health, Social Services and Public Safety cannot operate without long-term strategic funding.

I agree with the many Members who referred to the poor response time in rural areas. We must compare that with the time taken to respond in urban areas. With regard to a joined-up, collective approach, I commend the Minister for Regional Development for his presence throughout most of the debate. I hope that he and his officials will read Hansard closely and take note of what has been said about the roads infrastructure.

The Health Service has been underfunded for years. Sadly, it has reached a stage where money is scarce and different parts of the sector are fighting each other for it. That must be examined. The need for £57 million to build a new cancer centre was discussed as recently as 5 March. Earlier today we spoke of additional money for free care of the elderly. We have talked recently about money needed for children's services, community care, the acute sector, the Fire Service and the Ambulance Service. One is no more important than the other, but the list is endless, and I apologise if anything has been missed.

Health was made a priority in the Programme for Government, and that fact must be addressed. The Executive have said that they will deal with health as a priority, and it must be impressed upon them that proper long-term funding is necessary. It is sad that lives are at risk if the Executive do not commit resources to resolving the matter.

I thank the Minister for her attendance at the debate and for the statement she made earlier regarding North/ South co-operation. The all-island accident and emergency service mentioned earlier today is an example of that. That service would improve the situation in the border counties.

With regard to the point about the infrastructure, the Department for Regional Development appealed to the goodwill of farmers concerning the gritting of roads. That collective approach and response solved some of the problems.

I agree with the Chairperson of the Committee for Health, Social Services and Public Safety that it is important for the Ambulance Service to meet response times. It is pointless to specify such times if the will to meet them is not there, but its absence is again linked to underfunding.

I agree with Joe Hendron that the Committee welcomes the Minister's proposals to improve response times. As he says, health boards must co-operate to improve the response times of ambulances. He also pointed out that the Minister had made a bid for £6·2 million for the Ambulance Service. That bid was not approved by the Executive. Again, I must ask whether that demonstrates that health is a priority for the Executive, because it does not seem so to me.

I agree with Bob Coulter that the Ambulance Service is sometimes seen as a personal bus service or patient transport service. I also agree that we must consider the retirement age for ambulance personnel and take on board the Minister's comments. The Committee must look at that closely, because it is decided and negotiated in England.

Paul Berry mentioned the need for more funding and resources. As a fellow member of the Committee for Health, Social Services and Public Safety, I support him. We are all aware of the lack of funding for the service, and we should not have to decide to fund certain provisions to the exclusion of others. Like Paul Berry, I welcome the Minister's announcement of the setting-up of the education scheme to tackle the ongoing attacks on Ambulance Service personnel.

I agree with the Minister that the Ambulance Service is an important part of the remit of the Department of Health, Social Services and Public Safety. She said that in most cases, the Ambulance Service fails to meet its targets in rural areas. The problem must be tackled urgently. The Minister highlighted the additional investment, which resulted in around 100 new vehicles and new equipment. Some £300,000 has been allocated to the dispatch system. I welcome that as a positive step forward, but I do not think that it is enough, even taking on board the constraints with which the Minister is faced. Everyone who has taken part in this debate has shown that there is a problem of underfunding.

I thank John Fee for ensuring that the motion reached the Floor of the House. I am pleased that there is general agreement that adequate funding is crucial to improving, not only ambulance response time, but the service as a whole. I hope that all parties will continue to support the Minister in her efforts to obtain adequate funding for the service.

I thank the Minister for taking time to come here today and for her fairly comprehensive overview of what is happening in the Ambulance Service. I also thank Members for taking part in the debate. We are all singing from the same hymn sheet, so I will not go over all the details that have been discussed.

The Minister talked about providing equitable healthcare for the whole community. That is basically what the debate is all about. Under various pieces of legislation we have made it illegal to discriminate on the grounds of age, gender, political or religious views, disability or sexual orientation. We should probably have written into the legislation that there must also be equity between rural and urban dwellers.

When I tried to make that point to a senior health board official, he insultingly and facetiously said that he supposed that I wanted an acute hospital in every village in south Armagh. My response is not publishable. However, the thrust of it was that I did not, but that if we could not have acute services on everyone's doorsteps, we would have to rely on the people who provide the ambulance, GP and primary care services in those communities.

In my area, certain acute services have been removed from Daisy Hill Hospital and some hospital services have been closed in Armagh. GP out-of-hours schemes have been created that have reduced the number of GPs available at weekends and evenings. These schemes rely on the Ambulance Service as a back-up. In that context, the Executive as a whole must make the Ambulance Service a priority.

It is also for that reason that my Colleagues and I will not oppose the amendment - if it gets the Executive's attention, so much the better.

There is a remarkable urgency about this, because a great deal of consultation is necessary, and the proposals and the implementation strategy must be tested against various models. Nonetheless, this issue should have priority over all others.

The Minister has said that this issue will be examined. As with the Fire Service and the Police Service, the Ambulance Service should be a discrete, stand-alone centrally funded emergency service, and the sooner we achieve that the better. I thank the Minister and Members for their attendance and comments.

Question, That the amendment be made, put and agreed to.

Main Question, as amended, put and agreed to.

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