I again wish to express our deepest condolences to the Deputy on the death of Mary, his mother-in-law, and to the Fehilly and Crowe families. I also want to acknowledge the spirit in which he has raised these issues because at no stage did he criticise the men and women of the National Ambulance Service or our other first responders. Rather, he asked real questions, which he hopes will be addressed. I welcome the opportunity to address the House on behalf of the Minister, Deputy Carroll MacNeill, regarding the Deputy's request for information on the National Ambulance Service's capacity in the County Clare region. This year's allocation to our National Ambulance Service of €285 million includes €8 million in new service developments to deliver up to 180 additional posts, representing a significant increase on the 2024 allocation. As far as County Clare is concerned, the National Ambulance Service serves the county from bases located in Ennis, Ennistymon, Kilrush and Scarriff. These bases are staffed by a highly skilled workforce of pre-hospital emergency care practitioners, including paramedics, advanced paramedics and emergency medical technicians. In addition, the National Ambulance Service operates a fleet of modern emergency ambulances, intermediate care vehicles and rapid response vehicles from these bases. County Clare also benefits from the National Ambulance Service's national emergency operation centre clinical hub. It has five active community first responder groups operating in the county, as well as aeromedical support provided by the HSE helicopter service based in Rathcoole, County Cork, and the Irish Coast Guard search and rescue service from its base in Shannon. Patient demand for the National Ambulance Service continues to rise nationally and in the western region, which covers Clare. In 2024, there were nearly 430,000 urgent and emergency calls received from the public, representing an 8% increase nationally on the previous year. In the National Ambulance Service's western region, call volume similarly increased by 8%, or 7,781 calls, during the same period. Despite a significant increase in demand, ambulance response performance has improved nationally and in the National Ambulance Service mid-west region, including Clare, compared to its performance in 2023. The HSE national service plan sets out key performance indicators for cardiac or other potentially life-threatening calls to be responded to by ambulance in fewer than 90 minutes. In 2024, the National Ambulance Service's national performance for HSE key performance indicators, KPIs, was 73% against a target of 75% for purple calls, that is, life-threatening cases and 46% against a target of 45% for red calls, that is, calls to be responded to by an ambulance in less than 90 minutes. In the mid-west region, the National Ambulance Service's performance met the purple call KPI of 75% and exceeded the red call KPI of 49%. Performance in both call categories last year represents an improvement on performance in 2023. The nub of the issue is that, in line with international best practice, the National Ambulance Service deploys resources nationally - including in Clare - dynamically. This means that it prioritises resource allocation to the highest acuity calls, which require an immediate emergency response in direct response to patient needs. The National Ambulance Service's dynamic deployment means that Clare may also be supported by bases from neighbouring counties to ensure adequate coverage and rostering for emergency ambulances and rapid response vehicles.

Sentiment score: 0.18

As well as front-line urgent and emergency care, the NAS is also developing and expanding a range of clinically appropriate alternative care pathways to improve patient flow and reduce pressure on busy hospital emergency departments. The medical assessment unit, MAU, pathway for 999 patients introduced in Ennis Hospital treats patients referred by GPs, out-of-hours services, including Shannondoc, and National Ambulance Service paramedics. Last year, the NAS transported 430 patients to mid-west MAUs, including Ennis. I am pleased to inform the Deputy that the NAS plans to roll out additional community paramedics this year to various areas of the country. Community paramedics respond to low-acuity calls to facilitate more appropriate use of emergency care resources and enhance access to care for patients, contributing to more favourable health outcomes. I am informed that it is planned to include County Clare in this year's roll-out. I understand the point Deputy Crowe makes. We all have experience of situations where we have to call an ambulance, for example, for an elderly parent. It can be very distressing. I assure the Deputy that there has been no change to the National Ambulance Service roster in County Clare in recent months. It is important to put that on the record of the Dáil. There has been no reduction in service levels in County Clare. Triage is a very difficult situation. I compliment all those who work across the country as first responders. They do an amazing job. I also acknowledge Angela Coll for all her advocacy on healthcare in the Clare region.

Sentiment score: 0.12

I thank Deputy Ó Murchú very much for raising this important issue to specifically discuss the care of children with autism who also have mental health issues. In addition, I acknowledge the Deputy's constant advocacy in this area. We have had many exchanges and discussions on trying to provide services. I acknowledge the case of the young person he mentions, whom he also mentioned last week in the Dáil. As the Deputy is aware, our child and adolescent mental health services are for those aged up to 18 years and who have a moderate-to-severe mental health difficulty. Access to CAMHS is on the basis of prioritised clinical assessment. All referrals to CAMHS are assessed by a multidisciplinary team. Approximately 2% of children and young people require support from this specialist service, with more than 90% of the mental health needs of younger people being successfully treated in a primary care setting. I acknowledge that there are children and adolescents with complex care issues who may present, for example, with a moderate-to-severe mental health difficulty in addition to presentations such as an intellectual disability or autism. While the needs of children with autism are often best met by HSE primary care and children's disability network teams - the CDNTs - where a child or adolescent presents with a moderate-to-severe mental health difficulty, regardless of whether the child also has autism, it is the role of CAMHS to provide appropriate multidisciplinary assessment and treatment for the mental health difficulty. In plain language, a young person who receives support from CAMHS normally has a primary mental health diagnosis. Then, there can be a secondary diagnosis for autism or other condition. I agree with the Deputy that there is no doubt it is a challenging area for many families of children who have more than one diagnosis. Sometimes, they might be refused entry to one service while they are on a waiting list for another. On Monday of this week, I visited three different CAMHS teams in the south of the country as part of a process whereby I am currently visiting CAMHS teams. It is interesting to hear that the presentations have changed. Almost 55% of all presentations are linked to ADHD, but a big percentage of presentations are also linked to autism. Prior to this, there was a lot of depression, anxiety, self-harm and suicidal ideation, but there has been a definite swing towards ADHD and autism. It is important that we prioritise the area more. When information indicates that there is more than one HSE service that could best meet the needs of the child or adolescent, consultation should take place to determine which is the most appropriate service or whether a joint approach to assessment and intervention is indicated. In order to ensure a person-centred pathway to meet the needs of children with a complex disability and their families, the HSE and Tusla have a joint working protocol to promote best outcomes for children known to either one or both agencies. There is strong collaboration to ensure the needs of these young people are met. Lots of parents come to me as well with the same situation. They feel their child probably does not sit in either service but they need the support of both. That is where it is becoming problematic. It is an area we are focusing on because we need to. When CAMHS teams were set up originally, autism was not as significant an issue as it is now. A Minister of State, I will put a strong focus on that to support those families because all they want is a pathway. I acknowledge that today is World Autism Awareness Day.

Sentiment score: 0.20

I am determined to make further progress through the national office for child and youth mental health in the HSE, which has developed a new youth mental health action plan, published in February. This three-year plan for comprehensive reform across all youth mental health services sets out a roadmap to ensure all children and families have the pathway we have discussed. The new action plan aims to enhance integrated care across youth services, including supporting children and young people who have co-existing neurodevelopmental and mental health needs, which is the area we have been talking about. I checked out the mental health with intellectual disability, ID, team last week after the Deputy raised it in the Dáil. Mental health ID teams are a little different from CAMHS. They are multidisciplinary and might have nine to 12 positions. Across the board, mental health and ID teams are led by consultant psychiatrists who can deal with psychiatry and intellectual disability and it only takes four members of staff across the team. My understanding is that the consultant is in place and the auxiliary staff are being recruited at the moment. However, I understand the urgency of this area. What I have tried to do in the past five years with the 44% increase in all the various budgets is to build incrementally. There are two new mental health ID teams this year, along with two eating disorder teams and four ADHD teams for adults. They are being built incrementally. The pay and numbers strategy will not be an issue because these posts are ring-fenced.

Sentiment score: 0.21