HIQA publishes review of pre-hospital emergency care services

Date of publication:

The Health Information and Quality Authority (HIQA) has today published its review of pre-hospital emergency care services in the Republic of Ireland.

The report, entitled Review of pre-hospital emergency care services to ensure high quality in the assessment, diagnosis, clinical management and transporting of acutely ill patients to appropriate healthcare facilities, sets out 12 specific recommendations and other opportunities for improvement which HIQA believes will increase the safety and quality of pre-hospital emergency care services that are provided by the HSE’s National Ambulance Service and by Dublin Fire Brigade.

Commenting on the publication of the review, HIQA’s Chief Executive Phelim Quinn said: “Last year we committed to delivering on a programme of assurance against the National Standards for Safer Better Healthcare to promote improvement in our healthcare services. HIQA has identified a range of challenges in the areas of operational efficiency, leadership, clinical governance, risk management and quality assurance. This report sets out areas for improvement within and across the National Ambulance Service and pre-hospital emergency care services provided by Dublin Fire Brigade, which relate to many aspects of service provision.

“In publishing the review report, we are calling on the National Ambulance Service and Dublin Fire Brigade to publish a joint action plan that will outline steps to improve individual and collective performance on all of the matters identified as a result of this review. Systems need to be put in place to monitor progress and performance against HIQA’s review recommendations. 

“As the acute hospital service moves towards a model of hospital groups, State-funded ambulance services should be fully included in this strategic planning process, and should operate as a clinical service embedded in the unscheduled care system, under the remit of the Acute Hospitals Directorate of the HSE. This should be central to the wider reconfiguration of hospitals.

“It is of serious concern to HIQA that current governance arrangements between the National Ambulance Service and Dublin Fire Brigade are disjointed, with inadequate quality assurance and accountability controls. As a matter of urgency, both services must act to ensure that there is a fully integrated ambulance service in the greater Dublin area. This should be underpinned by a binding service level agreement, which should include quality and performance assurance reporting mechanisms.

“This review notes the ever increasing numbers of calls for ambulances which occur throughout the country. At present, an emergency vehicle is dispatched to all calls, and patients are automatically transferred to hospital emergency departments. This is unsustainable, and contributes to delayed patient handovers at emergency departments. The model of care which requires 100% transporting of patients to emergency departments in all cases needs to be modernised, to include the potential for treatment or triage over the phone and also to provide for direct access to alternative care pathways, such as local injuries units.

“There is scope for significant improvement for patients in pre-hospital emergency care services. Many of the required changes that this HIQA review outlines can be achieved with strong leadership, effective performance management, staff buy-in and a detailed and strategic approach. By implementing the advice outlined in this review and its 12 crucial recommendations, the HSE and Dublin Fire Brigade can deliver sustainable and substantial improvements to the quality and safety of pre-hospital emergency care services across the State.” 


Further Information: 

For further information please contact:
Marty Whelan, Head of Communications and Stakeholder Engagement
01 8147480 / 086 2447623 mwhelan@hiqa.ie

Notes to the Editor: 

  • In accordance with the Health Act 2007 [section 8(e)], HIQA’s functions include, at the request or with the approval of the Minister for Health, reviewing and making recommendations as the Authority thinks fit in respect of health and social care services, to ensure the best outcomes for the resources available to the Health Service Executive (HSE).
  • In its 2014 Business Plan, HIQA undertook to commence a review of pre-hospital emergency care services in the final quarter of this year. Following a number of reported concerns, the Minister for Health asked the Authority to bring forward the review, which began last March. On 17 April last, the Authority published the assessment framework for the review, which described the standards to be reviewed and the sources of evidence that were necessary for an assessment of compliance with the relevant standards.
  • The purpose of the review is to provide assurance to the public that the following are in place:
    • clear strategic direction with implementation plans and control measures for the national service
    • effective governance and leadership arrangements at all levels within the service
    • clearly defined schemes of delegation
    • appropriate controls in place through service level agreements with third parties delivering services on behalf of the national service
    • appropriate quality and risk management arrangements
    • workforce is well organised, skilled and there is a culture of continuous improvement
    • the use of care pathways indicators, clinical outcome indicators and other performance indicators that the ambulance service is both safe and effective
  • The review used a combination of interview, document assessment and on-site review of services for assessment, diagnosis, initial management and transporting of an acutely ill patient to an appropriate healthcare facility.
  • The report contains 12 recommendations which relate to aspects of service provision in both the National Ambulance Service and Dublin Fire Brigade. Eight recommendations are of national significance, and are of importance to both service providers. The remaining four recommendations are specific to the National Ambulance Service and the HSE. It is expected that on foot of these recommendations, both service providers will formulate quality improvement plans that will promote improvements in the quality and safety of the State’s pre-hospital emergency care services.