Official Report: Minutes of Evidence

The Chairperson (Ms P Bradley): I welcome Ms Roisin O'Hara, the interim chief executive of the Northern Ireland Ambulance Service (NIAS); Mr Brian McNeill, the director of operations in the Northern Ireland Ambulance Service; Mr Dale Ashford, the interim Chief Fire Officer of the Northern Ireland Fire and Rescue Service (NIFRS); and Mr Gary Thompson, Assistant Chief Fire Officer of the Northern Ireland Fire and Rescue Service. I am glad that I got that mouthful out of the way. It will be first names from now on. I do not know which one of you wants to do your presentation first. It is up to you; you decide.

Ms Roisin O'Hara (Northern Ireland Ambulance Service Health and Social Care Trust): Madam Chair and members, thank you very much for giving me the opportunity to come today to talk to you about our service and some of the challenges and pressures that we are experiencing. I hope to make some suggestions on how to improve things as we move forward. I have split the presentation into three areas. We will look at the workforce, our performance against our category A target, which is to have an eight-minute response to patients who have life-threatening conditions, and clinical performance.

We have a funded establishment of 1,287 and, out of that, just over 1,000 front-line staff. They are the staff who respond to the 999 calls and go out in ambulances or cars. They include the rapid response paramedics. In the last year, we had a big recruitment campaign and managed to recruit to 203 front-line jobs. That has put us in a good position to meet some of the challenges ahead this year and in coming years. Each year, we invest about £2 million of our budget in clinical training interventions. We spend a lot of time identifying with our clinical stakeholders the key aspects of that for our clinical staff, and we make that investment in them. I am pleased to say that, this year, in the first quarter and as we go through to the August figures, we appear to be on track to meet the departmental target for sickness absence, which is a 5% reduction from where we were last year. We are on track for that, although I have to say that sickness absence is still high in the Ambulance Service and is a priority for us. We will continue to look at that.

There has been some media attention on vacancies, particularly over the summer, and I thought that it might be useful to take a moment or two to talk about the recruitments that have happened and are ongoing. All the recruitments to our paramedic workforce and patient care services workforce have completed, and all the posts are either offered or in the process of being offered. We will be in the position very soon of having no paramedic vacancies and no patient care services vacancies. We still have about 61 EMT vacancies. Those details are correct as of today, because people will leave, retire etc, and that will shape every day. Sometimes, when we appoint a paramedic, we draw that person from our technician workforce, so that creates another vacancy when there is a career progression opportunity. At this point, we have about 61 vacancies in our emergency medical technician workforce. The recruitment processes are in progress, and some have completed. There has been a recruitment of qualified technicians, and the offers of employment are about to be made. We have two cohorts of EMTs planned for this year, which will bring in about 50 more EMTs in the current year. We are hopeful that we will be in a strong position with the workforce and its stability by the end of this financial year, and we hope to build on that.

I have outlined some of the key issues in the presentation. We still await the outcome of the job evaluation for our paramedic workforce — our rapid response vehicle (RRV) people — and our emergency medical technician posts. That process has sat outside the trust for a couple of years. We continue to press the job evaluation leads on the Department of Health (DH) side and the trade union side to bring that to a resolution, and we are hopeful that we will get to an outcome. The trust would like to have that process finished and our staff to know where that has landed through due process and in partnership. That is important to us all.

We are moving out now to develop a staff engagement strategy for the trust, and we are doing that, in the first instance, by starting staff engagement. We have met staff throughout the organisation on our new corporate plan, which is due to go live on 1 April 2017. We are using that as a springboard to talk to staff about what we do that is important to them, what success looks like to them and how we would measure and demonstrate what that success is like. This is a new type of process in our service, and, hopefully, through it, there will be some programmes, such as the health and well-being focus group that we have just implemented. It is a partnership group with staff, trade unions and management, and it is looking at some of the issues around that as part of staff engagement.

This year, we are also looking at a new programme of education. Historically, the national programmes that we used are all being reshaped. We have now moved out with new driving training for emergency response and ambulance driving. We are moving out with a new regulated programme for our emergency medical technicians, and, although we have no paramedic vacancies, we are using this year to look further at and establish opportunities for paramedic education. We are also in discussions with Department of Health colleagues on a university-type education. There are lots of options there, and we need to make sure that we get the right one for Northern Ireland.

I turn now to NIAS front-line activity and performance. It will be no surprise to the Health Committee that we have not met our category A eight-minute target for some time now. The last time we met it was in 2011. Last year, we achieved 53·5% of the category A target. However, we are getting there in an average of 10 minutes, and we do better in some areas. Again, it will be no surprise that, in the Belfast area — the big city area — it is an average of around eight minutes. Rural areas provide more difficulty in getting an ambulance to a patient within the eight-minute slot, but, in total last year, the service managed to get to patients in and around that 10-minute slot.

When we get to patients, our staff are very clinically sound. We have some very good clinical audit data that shows that we are up there with other ambulance services nationally and do a good job clinically. We remain committed to getting to the most clinically urgent patients as quickly as possible. Patients with immediate life-threatening conditions will continue to be our key priority, and we need to make sure that all our systems support that and get us to those patients.

We have had a lot of performance challenges from 2011-12, when we last met the target. The Northern Ireland population has increased by 2·1%; our demand for category A, which is our life-threatening demand, has risen by 23·1%; our performance has fallen by 19·2% in that period; our commissioned hours have increased by 7·1%; and our front-line workforce has increased by 3·4%. It would take me a long time to go into the detail of that, but there have been certain productivity gains, and, although we are not meeting the target — we would all prefer that we were meeting it — we have managed the significant increase in demand that we have been struggling with over that period. One example of that is that, during July, NIAS responded to 40 extra calls a day. That is a substantive number of extra calls for our staff to respond to in an average day. Some of the other challenges from that period were changes in the wider system. You will be aware that, if there are changes in some of the big acute hospitals, there could be an impact on the Ambulance Service. We have supported a lot of the Health and Social Care (HSC) service modernisation. There have been changes in Downpatrick, Lagan Valley, Mid Ulster, Omagh and Belfast City hospitals during that period, and we have managed to support those trusts and the service as a whole.

We have some issue with long hospital turnaround times. We believe that that equates to about six ambulances a day that we lose in handovers at hospitals. We are working with the hospitals and our commissioners and will continue to do that. We need to find a solution, but that is the reality that we are working with as we sit here today. We also experience longer scene times with patients due to enhanced care provision. In the clinical bit, I will talk about our alternative care pathways, but, when we start to treat people at home and leave people at home, that can prolong the time that our clinicians stay with a person, and some of that will have an impact. Winter has always been a difficult time for the Ambulance Service. You would think that it did not happen every year, but it does. It brings its pressures, particularly during heavy snowfalls and flooding. That continues to be a pressure for us.

Another thing is significant major incidents. Thank goodness, they usually do not land, as such. I will use the example of an airport alert. On a regular basis, our ambulances, RRV paramedics and officers have to go to an airport. Thankfully, none of the planes has actually crashed. It has never come to fruition, but a lot of our staff go to those major incidents, after which they have to regroup and go back to their day-to-day job. There is that dynamic as well, which is a performance challenge for us. Again, we are talking to Department of Health colleagues, to our commissioners and to other trusts; we are all part of a big system in trying to resolve some of those issues.

In terms of the priority service developments that, we believe, would help on that side of the house, we are keen to commence a capacity review. We have some support from the commissioners and from the Department of Health. We have benchmarked what happens, in particular, in Wales and Scotland. England is looking at its capacity and at some issues there. We are hopeful that we will get through procurement and be able to head out on a capacity review this side of Christmas. We are certainly hopeful that we will be able to go out by the end of October if we can get procurement finalised. That will then give us a better idea of what we can do best with the resources we have and what we need to meet the ministerial target. We can then start some discussions on the shape of the service, what we need from it and how we best deploy our staff.

I turn now to clinical performance and the priorities there. We are involved in and, indeed, chair the community resuscitation strategy implementation group. We work with stakeholders from all around the public sector, the public and our colleagues on a lot of the very good stuff that we are doing to move that forward. From an ambulance point of view, we have been involved in training staff in CPR and in the use of defibrillators, in creating more momentum around public access to defibrillators. We will be involved in October in Restart a Heart Day, when we hope to have a lot of media present and to use the events to interest the public. We hope that about 5,000 people will pay attention and learn how to use a defib to start a heart etc. We have also identified where a lot of the community defibrillators are so that, when you ring our control room to report a cardiac situation, we will be able to tell you where the closest one is, if that is of any use to you.

We have also commenced several first responder schemes. You may be aware of some of them, and a recent one involved my colleague here and our Fire and Rescue Service, which has been going well. I will let Dale give a little more input on that. We are doing a lot on that and are proud of our involvement. It is about collaboration with others and with the community to make a difference to people in need.

We have started primary percutaneous coronary intervention (PCI), which fast-tracks patients who need stenting and with cardiac issues to the cath labs. As you will be aware, there are two cath labs in Northern Ireland — at the Royal Victoria Hospital and Altnagelvin — and we have had very good success. Our clinical audit has shown that we are doing very well and meeting the targets that have been set for us. We also have a fast track to stroke services. Again, that is very positive and important for patient outcomes. I mentioned alternative care pathways. I will talk a little bit more about that, so we will park that for the minute.

Our medical director would never forgive me if I did not mention the electronic patient report form. We still operate a paper-based system, and we really need support to move it to an electronic basis. It would make such a difference to us, particularly in our clinical audit, to know a patient's outcome. Once we hand over to hospital etc, our data, in essence, stops. If there were an electronic link, we would have meaningful information, and it would help us when we think about our targets, patient outcomes, patient experience etc. It also provides for more synergy in the service as a whole. At this point, our ambulances will ring the ED and give a description, and the ED will put it in a book. If there were an electronic patient report form, that would all be seamless, and everybody could access the same thing. That is a priority for us.

I return to alternative care pathways. You will know that, historically, the Ambulance Service has been about responding to people in need, putting them in an ambulance and getting them to hospital as quickly as we can. The situation has changed. The clinicians and the clinical training that has supported our people has changed dramatically. We are now at a point at which we are looking at "Hear and treat", "Treat and leave" and "Treat and refer" models. Over the last two years, we have brought in 10 alternative care pathways in partnership with the other health and social care trusts. They are working well. There are new pathways for people who are diabetic and for palliative care. We have BCH Direct, whereby we can bring somebody who meets the criteria, usually an elderly person, straight through to Belfast City Hospital. I have been a personal user of that, and it worked very well. There is lots going on, and there are 10 new interventions. In 2015-16, 7,000 of our contacts did not go to an emergency department. Out of those, over 1,300 accessed some of the new alternative care pathways that have been set up. Others may have been "Hear and treat". We have GPs in control now. If it is appropriate, they will be able to talk to you and deal with your issues, ring you back and see whether the situation needs to be escalated up to an ambulance response or whatever. That is all working well. As long as that is appropriate — we believe that it is — that is good for patients and their carers. It is also good for the Ambulance Service because it releases a resource to go to the next person in need. That is very useful to us as well.

I turn now to the financial position. We have demonstrated sound financial management year on year and are predicting a break-even position at the end of March. I have to say, however, that finances continue to be a challenge, and we continue to work with our commissioners through the board and the Department in assessing future service delivery requirements. With more savings, I assume, coming on the horizon, it becomes a more difficult environment in which we can embed projects and transform etc. It is a pressure that we take seriously in trying to protect the front line when we make decisions.

I will finish with the key issues that I think are important for the Committee for Health to understand on where we see our priorities. We want to continue the development of being more patient-centred and have that as the focus of the provision of our safe, effective, quality care within our available resources. That is where our capacity review is extremely important. Advances in technology that can help with the clinical aspect of what we do are also important. We want to play a full and influential role in shaping and delivering healthcare in Northern Ireland. We are a small trust, but we are very important. You will see us on your streets, and we make a difference to the bigger trusts in what we can do and how we can work that system before it gets into a hospital. The other side of our business — discharges from hospital, keeping the system working and all that kind of thing — is also hugely important. Our emergency side of the house equates to 30% of what we do, so 70% of our work is not about the eight-minute response time. We do some of that extremely well, too.

One thing that is very important to us — other ambulance services nationally are moving towards this — is to review targets not only to include meaningful response times but to include patient outcomes. Our target at the minute is about speed of response, which is hugely important if you are in a life-threatening position, but, if that is not the case, other responses are equally important, and patient outcome is equally important. We need to make sure that, when you are in an immediately life-threatening condition, we get you the right clinical resource and the right vehicle to take you to hospital. It is not just about dispatching anything to anybody. It has to be triaged sensibly, and the targets need to reflect that. I also have to say that, if we can get the targets right, I hope that the workforce will understand that they do a great job. They all work very hard in difficult circumstances. Hopefully, they will be able to see that when we report to the trust board and when we report through, because the other bits that they do will also be acknowledged and recognised.

I move on to the workforce. We have started discussions with Department of Health colleagues, and, hopefully, we will be embarking on a workforce review. It is some time since we did a strategic review, and we are very excited about and supportive of looking at a workforce review for the Ambulance Service in Northern Ireland.

Mr Dale Ashford (Northern Ireland Fire and Rescue Service): Madam Chair and members, thank you for the opportunity to brief the Health Committee on the Northern Ireland Fire and Rescue Service. Before I talk about some of our challenges and priorities, I want to provide a little bit of background, if I may.

NIFRS is, geographically, the largest service in Ireland and the second largest fire and rescue service in the UK. We have 2,200 employees, comprising operational and support staff. Our people provide a top-class service, operating from 68 fire stations. We are the only UK service with a European land border, and we have arrangements in place to facilitate cooperation across that border.

The role of the Fire and Rescue Service has changed significantly over recent years. We deliver a wide range of high-quality services to the public of Northern Ireland, including responding to fires, road traffic collisions and other emergencies, which include chemical, biological, radiological and nuclear incidents — thankfully, there are not, I am glad to say, many nuclear incidents — search and rescue incidents, serious flooding and serious transport incidents. We are proud of the consistently high satisfaction rating that we have received from the community of Northern Ireland. Nationally, the English fire and rescue service has moved into the Home Office, necessitating major changes in the national governance arrangements and the structure of the Chief Fire Officers Association. It is likely to affect national resilience arrangements, and we are engaging with national colleagues to ensure that we continue to play our role in the national resilience framework.

As a fire and rescue service, we face a number of challenges. The current corporate management team has faced and is addressing a number of issues, including modernising the service. We have looked at our operating model and are dealing with governance and infrastructure issues, all within a very challenging financial environment. A large proportion of our operational staff are retained community firefighters. Those men and women provide an excellent service to the communities they serve, but changes in demographics and the working trends in Northern Ireland present challenges in maintaining retained availability. We recently introduced an electronic monitoring system to help us to gain a clear understanding of availability on a 24-hour basis and to help us to inform operational and recruitment decisions.

Like most public-sector organisations in recent years, we have faced financial challenges. Our budget is currently a total of around £73 million. We face revenue budget pressure and are working through a savings plan to address that. In determining our efficiencies plan, we have based decisions on three specific criteria: public safety, firefighter safety and the well-being of our people. We compare well with our UK colleagues on value for money; cost per head of population is below the national average. However, we seek to introduce different shift patterns and a new crewing framework that will help us to make even better use of our resources. Our new operating model will be based on risk and will complement our integrated risk management plan (IRMP) to get the right resources in the right place at the right time. The effective introduction of the model will require us to recruit for 2017 if we are to manage overtime efficiently and deliver the service that we need to provide.

Capital priorities for this year include a new logistics support centre, for which enabling works are under way, and the development of our IT infrastructure, for which we are operating in partnership with the Business Services Organisation (BSO). The replacement of our incident command and control system is ongoing as part of a joint procurement with the Scottish Fire and Rescue Service. The process of modernising much of our service is likely to increase revenue costs in the future; for instance, the maintenance of the upgraded wide area network and improved infrastructure may be more costly than it is currently.

NIFRS is undergoing significant change. This is an exciting time, but it is not without its difficulties. Organisational structure reviews are at various stages of development for all the HQ directorates. Major work on the wider organisational structure is well advanced, and the first draft has been presented to the board. NIFRS makes service delivery decisions based on risk assessment, and that "resource to risk" approach has resulted in the proposed relocation of a number of our whole-time resources. We are looking at innovative solutions to enable us to provide our service in the most efficient way. We have progressed a long way with changes such as alternate crewing, and, by the end of the year, we hope to be well advanced in the implementation of our "resource to risk" programme. That will see us changing six stations from variable-crewed stations that operate on two watches, seven days a week, to more efficient day-crewed stations that are one watch, five days a week. We will also introduce whole-time day-crewed stations in Dungannon, Downpatrick, Strabane and Enniskillen, where a pilot is in progress. The introduction of four new whole-time stations will improve service delivery and make the best use of our existing resources.

We recently launched a consultation for our integrated risk management plan, which sets out the strategic direction for delivery of the service. New fit-for-purpose emergency response standards are being progressed and will go for consultation later this year. We are working with our colleagues in NIAS on our co-responding pilot in Lurgan, which will involve NIFRS and NIAS being mobilised simultaneously to certain categories of call — in particular, cardiac arrests and chest pains — in an effort to improve attendance times and patient care. That is part of an approach that has been endorsed nationally by the National Joint Council, and it supports the community resuscitation strategy that Roisin mentioned.

As well as the co-responding element, we are looking at wider collaboration with the Department of Health across a range of areas. They include upstream prevention in the wider sense — not just fire prevention — utilisation of our estate and looking at further opportunities for working together. A working group chaired by the Department of Health has been set up to take that forward. NIFRS has introduced a new people at risk strategy to ensure that our resources are targeted at those most at risk in our community. A key element of that approach is partnership working, and, from 1 April this year, we have signed 41 partnership agreements with statutory, voluntary and community organisations, including a number in the health and social care sector, to signpost vulnerable people and help to protect them from accidental fires.

We are statutory partners in the community planning environment with the new councils, and we play an active role in the policing and community safety partnerships (PCSP). That area will develop over the coming year and provide us with an opportunity to enhance our partnership working. It will also provide a platform for prevention interventions to help to ensure positive outcomes for the community. We are reviewing our youth engagement interventions and programmes to ensure the most efficient use of our resources. We recently signed a three-year agreement with the Prince's Trust to deliver a number of its programmes across Northern Ireland. We continue to deliver a very positive fire cadets programme based on the national model, but it is worth pointing out that delivery of those initiatives is entirely dependent on our ability to finance them from within our budget.

Our new training centre is at outline business case (OBC) stage 2, as part of the wider Northern Ireland Community Safety College programme. Approval has been given for the early works, and money has been secured. The design team for the enabling works has been appointed, and work should be under way during 2017 on the building of a new tactical firefighting facility, with completion of that phase by spring 2018. A significant amount of risk will be mitigated for us with the provision of updated training facilities in a real firefighting environment.

Overall, we are happy to report that there has been a reduction in emergency mobilisations. We have worked hard on the prevention agenda over the last 10 years, and the benefits are showing. In 2015-16, we responded to 22,458 emergency incidents, of which 3,200 were classified as major fires. It is worth pointing out, however, that there were 12 accidental fire deaths, which shows the need for us to maintain the emphasis on the prevention and protection agenda. We also rescued 561 people from road traffic collisions, and we continue to work with partner agencies to develop a new road safety strategy, which we plan to go to consultation with early next year.

Given the importance of the emphasis on prevention and protection work and our reducing budgets, we are looking for more innovative approaches, such as the use of volunteers, and increasing our partnership working to help us to achieve positive outcomes for the community.

The introduction of the Fire and Rescue Services (Emergencies) Order (Northern Ireland) 2011 required us to develop new capabilities to deal with flooding, serious transport incidents, urban search and rescue, and chemical, biological, radiation and nuclear incidents. The types of call that we get are changing. Climate change is having an effect, and we get more flooding calls now than we ever did. Rural firefighting is also a significant issue. We are called on to provide specialist technical services such as specialist rescue, flood, rope, collapsed structures etc, and there are emerging international security threats. The civil contingencies environment has also changed significantly with the introduction of the subregional emergency planning groups. We play an active part in those groups, as well as sitting on the Northern Ireland civil contingencies group.

As we look to the future, we will continue to explore more effective and efficient ways of working. We will continue to balance how we make savings and provide value for money against the very real need to invest in our personnel and infrastructure.

We are committed to seeking innovative solutions to service delivery, which will ensure that resources are adequately matched to the changing risk profile of our local communities. We are targeting our prevention and protection messages to ensure that we reach and protect the most vulnerable people. We see great potential in collaborative working and data sharing, which will bring real benefits to the communities we serve. None of that would be possible without the people who work for NIFRS. They are undoubtedly our greatest strength. I pay a personal tribute to all our people, who have fulfilled all their duties and have served their communities with the utmost dedication, despite some of the challenges that we face.

The Chairperson (Ms P Bradley): Thank you, Dale, for your briefing. I have a list: Ian, Trevor, Gary, Jo-Anne, Robbie, Paula, Gerry, Pat and Catherine. That is just for your information, folks. [Laughter.]

You have a full list of people who want a little bit more information or want to ask some questions. I have a few questions for both of you as well. I will start off with you, Roisin. It is about the challenges ahead. We know that all services in the health service have to adapt to whatever direction healthcare goes in the future. I know that that will pose great challenges for you. I was really encouraged to hear about the pathways. I imagine that those make such a difference to the backlog in our emergency departments.

Ms O'Hara: Yes. It can be built on and developed. We are very pleased with the evaluations that we have now in terms of the people who do not go to the ED, when it is appropriate that they do not, and are accessing treatment where they need to access it. We are very keen to build on that with our colleagues.

The Chairperson (Ms P Bradley): We talked about general electronic recording and information sharing in the last mandate. In your service, a really important facet of going to an emergency call is bound to be having that information and knowing the patient's history. Quite often, you would go to something after a member of the public has telephoned, so you would have no history whatsoever of what that patient may have. Electronic sharing, even more than recording, could be of great benefit for a professional service.

Ms O'Hara: It hits a range of areas for us. It is absolutely for that, but also in terms of our clinical education and supervision to allow the paramedic to quickly access the patients whom they have dealt with, reflect on their clinical practice and look at improvements etc. There are lots of ways in which that will improve our service, so it is a key priority for us.

The Chairperson (Ms P Bradley): It is quite disturbing that, in this day and age, the handover from the Ambulance Service to an ED is a piece of paper or is recorded in a book. You would have thought that, by now, there would be something a little bit more technical than that.

You talked about six ambulances being lost per day through the backlog, which, I assume, means that our EDs have not been able to do their handovers.

Ms O'Hara: I will get our director of operations to talk a little bit more about that particular issue.

Mr Brian McNeill (Northern Ireland Ambulance Service Health and Social Care Trust): It is still an ongoing issue for us. However, through the work that we have been doing with hospitals, we have reduced the longer queue times at hospitals. The days of two hours are now more of an exception than the norm. I recognise that the board has supported us in funding hospital ambulance liaison officers (HALOs) in the main hospital emergency departments. Those paramedic-qualified ambulance staff work with the team in prioritising patients coming in. They also work out ways collaboratively of trying to fast-track patients through and reduce congestion. That has had a very positive effect. The reality is that it is a symptom of general increase in demand. There is no quick fix; it is endemic throughout the whole of the UK. However, we are grateful; we have a very good working relationship with the EDs, so it is all about the patient and trying to resolve that.

You mentioned electronic patient report forms. That would be useful in terms of auditing those things and getting the evidence to support where changes could be made that would not adversely impact on the patient. There is no quick solution, but we are certainly looking at every conceivable way of addressing it.

The Chairperson (Ms P Bradley): Sometimes, some of the simplest innovative ways of working can make the biggest differences. I have worked in an ED department, and I know the value that is placed on you. I also know the absolute frustration where they want to get on with their job — to get out there and do their job — and that is being hindered. Progress has been made, and I really welcome that, but there is a lot to do.

Mark, did you want to come in on that point?

Mr Durkan: Is this problem particularly pronounced in any area, or is it general right across the North?

Mr McNeill: The "best-performing ED" — if I can use that term — is actually Altnagelvin because of the way that it is structured and the number of patients going through it. As you would imagine, the pressures are on the big EDs at the Ulster and the Royal.

Mr Durkan: Is there something that can be learned from the model at Altnagelvin?

Mr McNeill: It is really not that simple. It is to do with the number of people who present themselves, and we do not bring all patients to EDs, although some people think that we do. We have quite a lot of patients who self-present, and we are in competition with them. The area of demand-flow has to be looked at, and that would help, but there is no transferable solution.

The Chairperson (Ms P Bradley): Thanks, Mark. I want to move on to workforce planning. In the last mandate, we looked a lot at workforce planning, and we know that there are many crises amongst various parts of the health service. You mentioned your workforce planning and said that there are now no paramedic vacancies.

Ms O'Hara: There are no paramedic vacancies, as we sit today.

The Chairperson (Ms P Bradley): How do you see your workforce as we go forward with the direction that we want to see health going? Will your workforce have to adapt or change? Is there any funding model that needs to be different?

Ms O'Hara: My gut feeling, at the beginning of this capacity review, is that if you looked at other ambulance services in Wales and the Republic of Ireland etc, you would find that their capacity reviews have indicated a need for more staff. We may well have just got to the point of having no vacancies and, if a capacity review indicates a requirement for more staff, may be back into a recruitment campaign in the new year. It will not stand still, but if we get to the point where we are at full establishment, then it is about the scope of practice and what we need in Northern Ireland, particularly in the paramedic workforce supported then by the emergency medical technician workforce. For example, when we look nationally at discussions on paramedic practitioners, we need to think of exactly what the need is for the clinician in the Northern Ireland context and start to develop towards that. Clinical interventions so rapidly change in advance, and we need to make sure that we continue to invest in the clinical skill set of our staff. It will also reshape in terms of the alternative care pathways and their roll-out. The more that we do on that, the more our paramedic clinicians will be in people's homes treating them; that will be a different dynamic for them. There are discussions going on about potentially having a mobile health unit, which would be an ambulance that could do other things, such as an ultrasound scan or an X-ray, but that is way in the future. They are just starting discussions around that, nationally. It would be nice not to be "firefighting", if I may use that expression.

The Chairperson (Ms P Bradley): We use the "firefighting" expression all the time.

Ms O'Hara: It would be good to have the workforce stabilised and be on a very sound footing to move forward, and we are, more or less, getting to that point.

The Chairperson (Ms P Bradley): Following on from that, I have a quick question, and then I will move on to Dale. You mentioned a 5% reduction in the sickness level, is that correct?

Ms O'Hara: Yes.

The Chairperson (Ms P Bradley): What is the percentage at present?

Ms O'Hara: It is in and around 10% — 9·6% or something like that — as of August. The interesting thing is that around 8% is long-term sickness absence. Without wanting to appear ageist — I am in that bracket — I know that the workforce is getting older. We do not have turnover. We find that long-term absence responds well to medical intervention, occupational health and all those sorts of things to try to work through it. The short-term absence is only about 2% to 2·5%, which is the part of the absence that you might consider that management of it might start to reduce it. However, we do have an issue. Our highest reason for absence is musculoskeletal, followed by stress, as you are probably aware from some of the recent media attention.

Musculoskeletal is a case in point. We are doing everything we can to make sure that our technology is right and that we have in place lifting aids, training and all that supports that for our staff. Over the last two years, we have started a fast-track physio service for staff who have musculoskeletal-type injuries, which is going very well.

On the stress side of the house, it is a difficult job. We are involved in some very traumatic cases. Our staff do a wonderful job in those situations, and we need to support them in relation to the stress that that might entail. It is not all work-related stress. Depression will be part of that, and the normal stresses of life like divorce, death etc will account for a portion as well. It is important that we prioritise that and have the support systems in place. We have counselling services available for staff as well.

The Chairperson (Ms P Bradley): OK. That is good.

Dale, we have talked on previous occasions. I know from being here in the last mandate that we did not get a lot of bother from the service. It was not one of the services that we had to continually monitor for x, y and z. The Fire Service just continued and got on with the job. Like the Ambulance Service, it just continued to do its job, but I know that you were under extreme pressures to do with the modernisation of the service. You mentioned your retained firefighters. Retained firefighters are what we rely on in the area where I live. There are issues, and you mentioned difficulties about retaining those retained firefighters.

What are your challenges looking ahead? I know that there are many challenges through the modernisation, budgets, cuts and everything else, yet you have all managed to keep going because you have a job to do and that is it. I know that it is the same in the Ambulance Service; that is how you look at things: "I have a job to do, and I am going to continue doing it". My question is just to look a bit more at your challenges and what you feel about those.

I will maybe talk a little bit more about the co-responding and how you see that working out. We spoke about it privately, but it would be good to let the public know how that is going to work. It sounds like a really exciting way of working.

Mr Ashford: Gary will talk more about the co-responding stuff. I will start off by saying that you are right that we face a lot of challenges. Budgets are difficult. Our budget has reduced significantly over the last few years. We are doing everything we can to modernise and change what we do to do that better, so that we make the best use of everything that we have. That is important.

Despite everything and no matter what happens, our people turn up and do a really good job. The public satisfaction rate that you see with the Fire Service is because of that. Our people carry on getting on with it, and I cannot commend them highly enough.

There are lots of challenges, particularly around the retained availability piece, because life has changed. These are the people who live in smaller towns that are not so busy. The truth of it is that we have not got that many fire calls for them to go to. The development of that is that people tend to work away from where they live and that makes them less available for us. That is a demographic change. There is not much we can do about that. It makes it much harder for us to get good retained people and to keep them.

I will get Gary to talk about the Gartan system, which has been a really helpful tool for us. Gary chairs our RDS steering group, which helps as well.

Mr Gary Thompson (Northern Ireland Fire and Rescue Service): We have 994 retained personnel in the organisation. We have 68 fire stations and, of those, 59 have a retained complement. Some are retained stations with one fire engine; some are retained with two fire engines; and some have a combination of the first appliance being old-time, 24/7 crewed, and the second being retained. Historically, our recruitment was based on establishment, so a two-appliance retained station would have had 20 personnel and a one-appliance station 12 personnel, and we would have just tried to manage those figures.

However, in reference to what Dale talked about, there are different challenges in different station areas. In rural areas, availability was different, irrespective of what your establishment levels were.

In March 2014, we brought in an electronic availability system that allows for all of our retained staff to text in by mobile phone when available and not available. There are two big benefits to that. The first benefit is from a dynamic mobilising point of view. As a service, we now know in our command room in our regional control centre exactly how many retained firefighters we have available right now at this very second, so that, if we need to mobilise in Ballyclare, let us say, we know how many firefighters we will have showing up and how many fire appliances we will get out. If we do not think that we have enough, we can immediately mobilise the right number of firefighters to resolve that incident effectively from neighbouring stations.

The second benefit of the system is that, because it is collecting historical data around availability, it allows us to analyse that data to see, based on availability as opposed to establishment, where we need to recruit. We have taken a new, targeted approach to retained recruitment. We have run two recruitment processes recently, and, as opposed to just saying that we will bring stations up to 20 or up to 12, we might now be putting some stations up to 22 or 23, because it is all about keeping people safe. It is all about getting appliances out the door of the fire stations. Other stations maybe have 17 retained firefighters and have really good availability and appliance response, and we are not bringing the numbers up. We are using the figure of 994 creatively across the workforce.

We piloted a new daytime-only retained model. This is totally new for the Northern Ireland Fire and Rescue Service. We find that, in most places, we do not have difficulties at night with retained firefighters being available. Weekends sometimes can be more difficult. The big problem is Monday to Friday nine-to-five; those days when somebody's primary occupation is taking them out of the local town. We used to recruit for firefighters to give 120 hours availability, but that is a big ask. Rather than trying to get new firefighters to come in at 120 hours and tying them in to weekdays, we came up with this new model of daytime-only contracts. In about 15 of our stations, we have now recruited two people specifically who will come in and be available Monday to Friday between 8.00 am and 6.00 pm. We have brought them in and trained them. They are now on the run. We have carried out an analysis since we put them in the stations, and availability in those stations has improved.

We are currently recruiting for 15 or 16 stations, and we are bringing 47 retained firefighters in, which will bring us up to about 980-something out of the 994. Again, that is all targeted, so it is a better return now with regard to where we are putting our resources to maximise appliance availability.

The Chairperson (Ms P Bradley): That is certainly much more positive than I remember from other briefing sessions to do with workforce.

I know that, with the budgets, some things are difficult. On the education programme, I think that you said that school visits and things like that were down 20%. I think that it is vital that we educate our children on the work that you do. I have spoken to you in the past about the LIFE programme. You also have the cadet programme, which is brilliant. I am really encouraged by that. I have attended a few of the pass-off parades of the LIFE programme at my local station in Glengormley. In fact, my son took part in one of them many years ago, and you know of that also. For him and his peers who took part in that, it was a very valued programme that made them feel very much a part of their community and that they were taking ownership of the area that they lived in. Do you see any further cuts in those community and education programmes?

Mr Ashford: We are in the process of reviewing all our youth education programmes. We really appreciate the value of LIFE. We think that it is a fantastic programme, and I have had nothing but praise for it. I have never had somebody come to me and say that it was not a great job. Everybody who has been involved has said that it is fantastic.

We now have to focus our resources where the highest levels of risk are. We know that, in terms of fire safety, certain people are most at risk. There are categories, and this is why working closely with other health colleagues is so important to us. Somebody who has lifestyle issues, such as alcoholics, drug users or whatever, those who live alone in a remote location and those over a certain age are most likely to be affected and be unsafe. We have to very much concentrate our efforts on keeping those people safe because they are the highest risk. That said, there are really strong benefits to be had from youth education, and we have seen some evaluation of that. It is difficult to turn that into pounds, shillings and pence, but some of the evaluation has been really good. From our own point of view, even getting young people to understand what we do and not see us a threat to them having fun has reduced attacks on firefighters. Attacks on firefighters used to be commonplace. They are very much the exception these days, which is a really positive step for us. We really value that process and want to do as much of that as we can.

We are in the process of reviewing everything that we do to try to find the most efficient and effective way of doing that. We have signed up to work with the Prince's Trust. We have had some great experiences with it over the past and have run a few team programmes and other interventions with it. We will continue to do that. We will also continue to look for other opportunities. The biggest opportunities are probably through partnership. I cannot afford to fund LIFE programmes any more, but there are people out there who probably can, and we need to take a more grown-up approach to things like sponsorship and getting support from other organisations. That will hopefully help us to do those sorts of things. There is a real benefit to the community.

The Chairperson (Ms P Bradley): I will bring members in now. I apologise; I spoke for a little longer than I intended to and asked a few too many questions. I had in my head that there was some information that I wanted to know. I still have some questions left, but hopefully the other members will cover that.

Mr Milne: Thanks to both services for the presentation this morning. It is nice to have you here. On a personal note, I would like to thank both services for the magnificent service that they provide to people all over the North.

Can you update the Committee on the air ambulance? When is that expected to be up and running, and are agreements already in place for cross-border cooperation?

Ms O'Hara: We have been working with all the stakeholders on getting the memorandum of understanding together. How will we go forward on it? The charity has been appointed. I think that the Minister has asked some questions of the Chief Medical Officer. We are awaiting that response before we step forward on it. I cannot go into any real detail other than to say that we are at the table, it is a very big priority for us, and we are moving it along as quickly as we can. Our medical director is leading on the memorandum of understanding on behalf of the trust, and he is working with the charity, Air Ambulance Northern Ireland (AANI), the aviation authority people, the Department of Health and our commissioners on that. We are very keen to get that moved on, but, at this point, it has not been finalised.

Mr Milne: On the news recently, there were reports of £700,000 or £800,000 to provide a landing pad on top of the Royal. Is there not a facility on the ground that would be much cheaper to land a helicopter on rather than reinforcing and going to that extreme?

Ms O'Hara: I will pass that one to Brian.

Mr McNeill: In the past, how we did business when we had the support of other aircraft was that an ordinary accident and emergency ambulance met the aircraft and transferred people to hospital. However, the calls that this aircraft would carry are time-critical, and it would be a much better experience for the patient and would improve outcomes if they were able to land close to the hospital.

I stand to be corrected on this, but the landing pad at the Royal, I believe, is an issue for the estates people who commissioned the hospital. It was not taken account of in this project. This is mostly about commissioning the actual helicopter, but I believe that it is being addressed. As Roisin said, there are still a lot of questions that have to be answered, and I believe that that may be one of them.

Mr Milne: As a matter of interest, how many people would you expect to carry in an air ambulance if there were multiple serious injuries?

Mr McNeill: Do you mean the capacity?

Mr Milne: Yes.

Mr McNeill: I am not an expert on what craft has been specified. That is dealt with through the Association of Air Ambulances, but, in normal situations, it would be one patient. If you increase the capacity, you get into issues of how long it can fly for, whether it can go into day and night. There are lots of permutations, but I believe that it is one.

The Chairperson (Ms P Bradley): As that progresses, it will come through the Committee, and we will start to see the specifics and the memorandum of understanding on whether it will be fit for purpose. We need it to be fit for purpose. There is a lot of money being spent. It is a good question, but we will address it as we go along.

Mr Milne: I have a question for the Fire Service. Will you outline any difficulties with access to additional support or equipment that the Fire Service faces due to the natural barrier between here and Britain? You mentioned cross-border cooperation. Are there agreements in place for cooperation across the border?

Mr Ashford: On access to equipment and vehicles, we try to join up as much as we can with UK fire and rescue services, particularly on procurement. You will have heard me mention the fact that we are procuring our command and control system along with Scotland because when you join up, you get the benefits of scale and it reduces the cost of taking things forward. So, on procurement, we are doing everything that we can to make sure that we get the best value by going with the biggest group of people because, effectively, most fire and rescue services buy the same sort of thing. There may be a slight difference in some of the equipment and vehicles that we use, but they are more or less the same. So, we are doing everything that we can.

There is work going on. A lady called Anne Millington, who is the chief of Kent, is working on a national procurement group, and we are included in those conversations. So, I hope that what will come out of that is an even more effective way for us to procure equipment, vehicles and anything else that we need and save a lot of money, time and bureaucracy.

On the cross-border stuff, we have a long-standing arrangement with Donegal in which we provide fire cover for part of their county on a payment basis. They pay us for our services. With the necklace counties, as we call them, we have arrangements in place. This is early work that I started a couple of years ago in relation to a joint response, particularly on road traffic collisions. Basically, the set-up that we have is that, within a specified corridor along the border, if there is a road traffic collision, we both go because, at the end of the day, what matters is that the person who is stuck in the car gets attended to as quickly as possible. So we do not mind if we get there and find that the machine from Cavan has got there before us and is dealing with people. We have no issue with that, as long as we are both doing everything we can to make sure that people are safe.

Those arrangements apply in all the counties apart from Cavan. The MOU needs to be finished off for Cavan, but with the rest of the counties we have arrangements in place. We also have an arrangement whereby I meet all the chiefs from across the border on a regular basis a couple of times a year, and we look at issues that we share and we look for opportunities to do things together.

We ran a very successful project a couple of years ago called Driving Change, which was about a range of things, including road safety in the wider sense. It was about training our people to a higher level and doing joint training with crews from across the border. We also did some useful educational public relations work. We got youth groups involved, and the project was managed by Ian McQuitty, who did an excellent job of pulling everything together. Other things came out of it, such as conferences and joint learning, but the outworking and the long-term benefits are the MOUs that are being developed or are in place. Lots of good work is going on between us and all the border counties.

Mr Clarke: Roisin, can I take you back to the start of your presentation when you talked about the difficulties that you have with recruitment? I am staggered by that. I have asked questions over the years about campaigns that you had. You appointed people on temporary contracts, and then you went out to competition again. Where did the change come about?

Ms O'Hara: OK. We had x number of vacancies at one point, and about two years ago we moved onto a workforce stability programme. We put all our efforts into recruiting and appointing our paramedic, EMT and patient-care services workforces. A lot of our staff start in patient-care services and then when we advertise for a technician a lot of them go into that, which leaves vacancies. The temporary recruitments are not attached to a permanent post. They will allow for some capacity while people are going through training arrangements. For example, some of our staff who, perhaps, want to be successful in getting through the next training element, will have their job protected in the grade that they worked at substantially. That would be the only time that we would recruit temporary staff.

Mr Clarke: How much does it cost to train a paramedic?

Ms O'Hara: I do not have the details for the new programmes —

Mr Clarke: Roughly.

Ms O'Hara: — roughly I would say about £40,000.

Mr Clarke: That is what was in my mind too, from the question that I asked. Perhaps I can write to you about this, but I am sure that I have information going back a number of years that shows that people were employed and trained on temporary contracts for £40,000 —

Ms O'Hara: For a paramedic in training?

Mr Clarke: For EMTs and paramedics.

Ms O'Hara: EMTS? A paramedic in training would have been on a two-year training contract, after which they would apply for a post. We had a situation where —

Mr Clarke: I am sorry; can I stop you there? Why are they in a training programme and then applying for posts? Why are you not having substantive posts, training people and keeping them in employment?

The Chairperson (Ms P Bradley): Social work is the same.

Mr Clarke: I know, but two wrongs do not make a right.

Ms O'Hara: Absolutely. We have done the second methodology at times as well. It depends on whether there are any vacancies at the tail end of the training programme.

Mr Clarke: Well, you are saying today that there are 61 vacancies.

Ms O'Hara: For emergency medical technicians, yes.

Mr Clarke: There has been a trend in your department to train people and then let them go. You will spend £40,000 on the programme and then ask the person to apply for a job. Why not —

Ms O'Hara: I have —

Mr Clarke: — I am sorry; let me finish my point. Why not advertise the job for the vacancy, bring the person in and train them? If they meet the standard, they stay, and if they do not, they go.

Ms O'Hara: In essence, that is what we do. Now —

Mr Clarke: I am sorry for cutting in on you again. They were temporary, not permanent, contracts.

Ms O'Hara: There were student contracts for the paramedics in training. We had a situation about a year ago, I think, where some people were not successful or were on a waiting list for a paramedic post, and there were no posts for them to go into. They would have gone into permanent technician posts. They have now applied for the next vacancies that came up when the paramedic posts became available. They are now either in a paramedic post or about to be appointed to a paramedic post. We have not lost any of the investment that we put in.

When you are planning for the training of paramedics or technicians — and paramedics may go to university at some point as they do in other ambulance services nationally — there will be some attrition as well. When deciding how many to bring into the training school, it does not always equate to one to a vacancy either. At times, students will go somewhere else, they may go to work in a different ambulance service, or they may go to work somewhere else, or perhaps do a different type of degree, such as nursing, on top of that. It is complicated in the way it is done, but we are the only employer of paramedics in Northern Ireland, so we usually get to employ those whom we train at the end of the training.

Mr Clarke: I have met people from my constituency who went through the programmes and were not offered permanent jobs. Instead, they were encouraged to reapply for another programme. I will leave it there, because I do not want to labour the point.

On the issue of vacancies and stress, Brian, I think that you have been in the media a few time to defend the position. Is any of the stress related to the pressure that the people are working under and the fact that they cannot get days off because of the number of vacancies in the service?

Mr McNeill: Granting people's leave requests is certainly a pressure for us, as it is for any organisation, particularly at peak times, such as Christmas, new year and summer. We are a 24/7 organisation, as you can appreciate. We break people's leave into two big segments. Everyone in the organisation at the front line has rostered leave for wintertime and for summertime. We commit, no matter what is happening, to giving them that leave. On top of that, they have an element of casual leave. If someone needs the day off for a wedding or a birthday, that is how they use that leave. When they apply for that leave through our resource centre, we endeavour to grant 100% of the applications, but, because of the exigencies of the service and the need to provide cover, that is not always possible. So some people do not get the leave that they request.

Last year, because of the associated stress and anxiety, which you identified, we reviewed that process and committed to granting each station 10% of applications for casual leave. Most leave requests were for weekends, but our demand is greatest at weekends, as is our need for cover. Although we have a relief tier to support applications for leave, it does not support the demand, so we had to put in some sort of control to enable safe service. You are quite right that some people were frustrated and annoyed with that. On the issue of whether that has contributed to increases in stress, each case will be viewed on its own merit.

It is about getting a balance with efficiency. You talked about recruitment. We can only recruit whole-time equivalents to the funding that we have. We have to ensure that everyone that we recruit is used. So, we cannot use people during the summertime and not have work for them during the winter because they are not needed on the rota. It is a very difficult and complex thing. All I can say to you is that the capacity review will look at the hours that we need and when we need those hours over a 24/7 period. It will also look at the number of whole-time equivalents that we require to support those hours. Again, we will look at rotas and rosters. We have already brought in some innovative practice. For example, we did not have bank staff before this year, and we are very positive in our family-friendly policies. That adds to the competition for people who get casual leave.

Mr Clarke: I suggest that you are not. A paramedic whom I spoke to could not get leave to go to his uncle's funeral. I would not say that that is family-friendly. You get only one opportunity to attend a loved one's funeral, yet that person could not get leave. That was midweek, Brian, not the weekend, but they could not get leave. I have been in A&E departments on numerous occasions and the stress that the men and women in the Ambulance Service work under is horrendous, yet you go to the media to try to defend your department's position, but you do not take into consideration those on front-line service.

Mr McNeill: That is your opinion on the matter. I have given you my view on how we manage it.

Mr Clarke: That is my opinion, and it is the opinion of the staff who work in the service. I was looking at the statistics, and you are way beyond the targets that you have set for sickness levels. Some of that is down to how the people who work for you are treated.

Mr Middleton: Thank you for coming in today. I think that it was Gary who answered in relation to the pilot scheme in Lurgan. Maybe you mentioned this and I missed it, but how long will that pilot scheme last? Can you give us examples of where you are working, or could work, with the Ambulance Service and other services to co-respond? I read a story recently of where the Fire and Rescue Service rescued a gentleman in Belleek and provided the first-aid cover until the Ambulance Service arrived. That sort of work is very useful — it is life-saving. Can you give us an update on that?

Mr Thompson: I will deal first with the co-responding. Co-responding is a six-month medical emergency response pilot. It is nothing new in the UK Fire and Rescue Service; it is widespread across the water, but this is a first for Northern Ireland. The National Joint Council for Local Authority Fire and Rescue Services has approved pilots in England. There are about 40 schemes running there, and we approached each other to see if we could set up a pilot scheme. One of the first issues to be looked at is that, to add value, it would need to be zero cost for us; it cannot be an additional cost. Some retained stations in England went from 60 calls per annum to 600 calls. If we initially went out to retained stations every time, that would be a big increase in revenue costs. I identified our whole-time stations, where we already have personnel 24/7 who are being paid, and rural locations where we could hopefully work in partnership with the Ambulance Service and add value. We identified several stations and agreed to pilot in Lurgan first.

The pilot has been going for 11 days today and has dealt with 19 incidents. Morale in the station is good, and the two organisations have been working well on the ground. The Fire Service has got there just before the Ambulance Service on 50% of the calls; the Ambulance Service was there first on the other half. There has been good partnership working on the ground and good feedback from the station. The pilot will run for its six months. At the end, we will carry out a review of how it performed and then say whether we will move forward with the pilot in Lurgan on a permanent basis and whether there is an opportunity to expand it throughout the Province. It is a good example of the outcomes-based accountability in the draft Programme for Government in that we are providing better outcomes for the community that we serve at no extra cost through partnership working with public-sector organisations.

The other point that you raised was about rescuing people. If anybody dials 999, we just go out the door, whether the police are calling us, whether it is community search and rescue or whatever. We are no longer just a Fire and Rescue Service; we go to a wide range of call incidents, particularly search and rescue ones. Our urban search and rescue team often goes to people who are trapped and even to people who are missing.

Mr Middleton: That is very encouraging. Hopefully, we will hear in six months' time how exactly the pilot has gone. It is encouraging that we are falling into line with the rest of the UK and not just for the sake of it but on the basis of best practice. That is very good.

My next question is for both services in the sense that, unfortunately, we always hear of attacks on those who are responding to emergency calls. I notice from the report that the Fire Service has given that attacks on its firefighters and appliances are down by 46% from last year and that hoax calls are down 20%. That is a good thing, but we need to try to eradicate it totally. Unfortunately, the Ambulance Service is experiencing what I believe is a five-year high in attacks on ambulance personnel. Is the Fire and Rescue Service doing something that the Ambulance Service is not on education to make people aware of why they should not carry out such attacks? It is obvious to most of us; unfortunately, however, there is a small minority who see fit to attack our emergency services. Is there anything that we could do to address that situation?

Ms O'Hara: We have done collaborative work on that in the past, and you will have seen some of the TV adverts etc that we have worked together on. We have a very small resource in the Ambulance Service that focuses on community education, particularly primary schools and events at which we talk to kids, teenagers and young adults about the consequences of violence against staff etc. A subgroup of our health and safety committee, a partnership group with trades unions and management side, focuses on zero-tolerance work. What we find is that violence against staff is sporadic, difficult to plan for and to develop a strategy for. Zero tolerance is zero tolerance, and our staff are trained to carry out risk assessments, to calm and defuse, and how to operate in those environments to lessen the risk.

Unfortunately, we do experience violence. It is about the safe practice of our staff and supporting them. We have been asked to do some media work this week. I think that Brian is being interviewed tomorrow on that very point, and we are trying to get some staff who have been under attack to showcase their story and what it meant to them and their families. Hopefully, that will help to get the message out to the public. It is a very difficult piece of work to move forward, but we do prioritise it.

Mr Ashford: Perhaps I can add to that. Similarly, we have an education programme that goes out to primary-5 children, which we find to be of huge value. However, it is one of the things that comes under pressure as our budgets tighten. There is a series of cartoon characters, and the firefighters talk about them to educate children about different aspects of safety. We talk about attacks on firefighters, but we talk about attacks on everybody. We try to explain to young people the consequences of breaking the windscreen on a fire engine, ambulance or police car, and what it means when those vehicles are not available. That is why we try to get that across at an early age.

The picture is hugely improved from what it was. As a young firefighter, time without number I had to dodge bricks and all sorts of things that were being thrown at me, because we were seen as part of the establishment and therefore fair game. Things have improved hugely. I accept that there is plenty of room for improvement, and recent collaborative work with NIAS, and with the health sector as a whole, provides us with an opportunity to cement our achievements and to get that message out a bit further. What we have learned is that young people do learn. They do understand that they should not throw the stone because a windscreen costs £700, and that is £700 that we will not then have to pay for firefighters.

Mr Middleton: I agree with you, and that is an example of where cooperation between the two services brings benefits. Budgets for that type of education are ultimately small amounts of money that will bring huge savings in the long run, not only by protecting staff but by protecting the appliances.

I would like to raise another issue, again, unfortunately, in relation to Ambulance Service response times. I represent Foyle, which is quite a rural constituency. It is not the fault of the drivers, but trying to find addresses and get locations can be a problem. It was my understanding that there is a new system, either in place or about to be in place, in ambulances that will end in quicker responses. When I was on the council, we tried to encourage people to put numbers on their properties, which is important, but when you are out in a rural constituency sometimes numbers mean nothing; sometimes you have to get there by other means — coordinates or whatever. Can you give us an update on that?

Ms O'Hara: I will ask Brian to update you on that.

Mr McNeill: As the chief executive said in her presentation, it is important that we explore all technologies that can benefit our service, and certainly we have done that. We installed mobile data terminals in ambulances. In previous days, a call came in and was passed by radio to the crew, who depended on local knowledge. Those days have now gone, fortunately. The call is passed electronically to something on the dashboard that looks like an iPad , and it will identify the location of the incident and any details that we have on it.

When the call comes in, we can actually plot it from a gazetteer in the control room and can track the ambulance on its way to the call. If need be, we can give directions to it by radio. In fact, that mobile data technology is up for refresh. We have just had our business case approved for that. Hopefully, we will see the benefits of the enhanced technology over the last five years as we bring in the new system.

Mr Middleton: I think that that is welcome. As I said, it will certainly be to the benefit of waiting times. An audit of the Fire and Rescue Service was done fairly recently. You mentioned one of the issues being governance and that you are trying to restructure and all that. I will not go into it because it is in the report, and everybody can read it, but quite a few concerns were raised by the independent audit in relation to governance, finance, expenses and things like that. How far have you gone to address those recommendations?

Mr Ashford: We have a series of recommendations that we have been in the process of dealing with over recent years. To get an idea of where we were 18 months ago, we had something like 690-odd recommendations. We have pulled them all into a series of business improvement plans. Some of these go way back a couple of years. They are from external reports, our own internal audit and various things. We have pulled them into a series of business improvement plans, and we are working our way through them. We have made significant progress on that now. I had a meeting with the permanent secretary recently to outline how far we have got. It is important for us, because these things have been hanging around for a while and we need to get them cleared up.

To give an idea of the progress that we have made, a short while ago, we were sitting with something like 690 outstanding recommendations from various sources. By the end of this financial year, that will be fewer than 100, and 74 of those will be cleared up within the next financial year. I believe that we have made significant progress. We recognise the importance of that and that we have to keep the pressure on and keep things moving. We are in a different place. We have turned a corner on that.

Mr Middleton: I have just one last comment. Sometimes we can all be very critical. I just want to put on record our appreciation and thanks for the work that you do. Obviously, we are here sometimes to try to hold people to account, but we genuinely appreciate the work that you do. Thank you.

Mrs Dobson: Thank you for your presentation. Can I just reiterate what Gary has said? Your staff do an amazing job 24 hours a day. We are eternally grateful for that.

My first question is to you, Roisin. You gave us a positive message. Have you every confidence that the crewing crisis that you have experienced is behind you? Trevor made a few very valid points about morale, staff covering shifts and getting valuable time off, which is very difficult. We have all been approached by constituents who have told us about this very issue. Recently, I asked the Minister on many occasions whether the Ambulance Service fell short of a full complement of staff. She was not able to point me to an example of when that has happened. Can you enlighten us on when that has happened?

Ms O'Hara: As the presentation shows, we have 61 vacancies in our technician workforce at this time. I think that it is slightly complicated with regard to what you are looking at. Does that relate to dropped shifts? Does that mean that the public are not —

Mrs Dobson: You are bound to have data and information on when you did not have the full complement of staff. Surely you have records to show when that happened and on how many occasions that occurred. I am trying to tease out when that happened.

Ms O'Hara: Yes: if you are asking me in straight staff terms, we have 61 technician vacancies as we sit today.

Mrs Dobson: How many occasions were there when you did not have the full complement; when existing staff felt that they were under extreme pressure and have been trying to fulfil those duties?

Ms O'Hara: OK. For example, those duties would be filled at this time by staff doing overtime. That is the situation that you are describing, I suspect. That having been said, I would have to say that it is a big improvement from where we were two years ago. We would hope, with the two cohorts that are coming in this year, to be in a position where we are basically at full complement by this time next year.

Mrs Dobson: I am just trying to tease out occasions when you have not had full complement. Maybe the second part of my question will help you answer the first. Voluntary crews and private ambulances are taking up the slack when you do not have the manpower. I am trying to tease out, as Trevor touched on earlier, how many occasions you did not have the full complement of staff and voluntary crews and private ambulances picked up the slack.

Ms O'Hara: That, in essence, is when we would drop cover.

Mrs Dobson: Yes.

Ms O'Hara: I will pass over to Brian.

Mr McNeill: You are correct in your assessment. There have been many occasions when we have not been 100% compliant with contracted hours. That has been as a consequence of the vacancies that we carry and of sickness absence levels. There are many reasons, as in any organisation, for us not having the full complement of staff on any shift. The normal process —

Mrs Dobson: I take it that you have the data, Brian. Can you share that with the Committee?

Mr McNeill: Absolutely.

Mrs Dobson: We are all trying to tease out the issues because we have heard from crews who are feeling under immense pressure, and it would be good for us as a Committee to know on how many occasions that has happened.

Mr McNeill: We have a radio centre with a small team of a few people. Their job is to identify the vacant shifts that we know are coming up. They invite staff to work the overtime, but they also monitor the times when we are not able to cover the shift, and we have that information. I suppose —

Mrs Dobson: Is this still a regular occurrence?

Mr McNeill: It still happens. Absolutely. People may ring in tonight at the last moment who, because of sickness or caring arrangements, are unable to do their shift. Therefore we drop that shift.

To go back to Mr Clarke's comment, over the summertime at weekends, when people were requesting leave, we had a very high incidence — I am not going to hide it — of lack of compliance with cover. What do I mean when I say "high"? We would normally average around 80%; come September, we were up on 95%. It is a seasonal thing, as I said in response to Mr Clarke's question. The only way of eradicating it completely is to over-establish against the hours of cover that you are contracted to provide. We are constrained —

Mrs Dobson: Is that what you plan to do? Roisin said in her opening remarks that she hopes to be in a strong position with regard to the workforce by the end of this year.

Ms O'Hara: With regard to vacancy covered. That is not necessarily the same as shifts.

Mrs Dobson: The two tie in. Obviously, when you have vacancies, you do not have the manpower to cover the shifts; they are interlinked.

Ms O'Hara: Yes, but there are reasons for overtime that do not equate with vacancies. For example, if there was a long ambulance journey from one hospital to another, and it was at the end of somebody's shift, that person may have overtime.

Mrs Dobson: I understand. I am just concerned about potentially grave consequences if you do not have the cover, given the pressure that those crews are under, as Trevor articulated earlier.

Ms O'Hara: It is complex. What I am very clear about is that, this time next year, we will be in a better position than we have been in for some years, as measured by the number of vacancies in our front-line workforce. However, I have also mentioned capacity issues, and they will still be there. Then there are the activity increases, such as the 23% activity increase in our front-line, category A, life-threatening work. Those sorts of capacity issues will still be there, so there will still be a requirement for overtime at times. There will still be a requirement for staff to take time off at short notice. There will still be sickness absence etc. Absolutely, we hope to get to the position of not being in a vacancies crisis and of having more or less a full complement, but there are other dynamics.

Mrs Dobson: OK. Brian, back to your point, I am concerned about lack of cover and staff, and that is still occurring.

Mr McNeill: There are occasions when we have dropped shifts.

Mrs Dobson: And will you furnish the Committee with that in writing?

Mr McNeill: We can provide you with detail on that. But I will say two things. We, as the chief executive said, are committed to ensuring that we fill all our vacancies. When we have done that, there will still be dropped shifts as a consequence of other factors, such as sickness, other things that are unplanned and seasonal variation. Due to seasonal variation, we are starting to look at bringing in people on short-term contracts and part-time contracts to address that. We are getting to a better position. I acknowledge, first of all, my gratitude to staff who volunteered to work the overtime, because that helps, and also to the staff who do work the shifts when some other colleagues are not able to attend work, and the extra work that they commit to undertake.

Mrs Dobson: We are all grateful to staff, but they are under amazing pressure.

If an organisation raises money voluntarily to bring defibrillators into town centres, and I know local groups, such as the Lions Club in Banbridge, do amazing work raising funds for this, can the Ambulance Service provide appropriate training for them? How do you connect with them? There are so many people doing a fantastic job, raising money to buy them, but they need the training to support that. Can you do that, or are you doing that?

Mr McNeill: We do not provide that service. It would fall under the community resuscitation strategy, which has just been launched. There is work ongoing in relation to supporting communities. We do not actively provide that service. We are more interested in coordinating the response. We are keen that communities that do secure an automated external defibrillator (AED) let us know where it, is so we can put it on our system, and if a call comes in, we can direct the caller to it.

Mrs Dobson: So where would voluntary organisations and people in the community that are providing defibrillators find training?

Mr McNeill: There are various organisations, both commercial and voluntary, that will provide that service. It is not currently part of the service that we provide, but opportunities may present where we could do so, subject to support.

Mrs Dobson: The targets for eight-minute response have not been met since 2011, particularly in rural areas, as Gary touched on, and that is alarming.

Dale and Gary, thank you for your interesting briefing. I want to focus initially on your shift patterns and crewing framework. Again, that was touched on briefly. You say that those will allow you to make better use of your responses, but is it not true there has been concern from both the public and front-line officers, which culminated in the Assembly debating a Motion last January. Whilst proposing the Motion, I highlighted your letter, Dale, of December 2015 to the then Health Minister, and in your words:

You also wrote how this could lead to, in your words, "unacceptable risk levels". Can you outline what has changed in the nine months since you wrote that letter?

Mr Ashford: First, the letter looked at 5% and 10% reductions in our budget. That was not levied against us, and we were glad that it was much less than that. To some extent that has helped enormously. That said, it is still tight. We got a fairly small budget reduction this year of 1.5%, but that on top of the previous couple of years, where we also had budget reductions, all accumulates, and it becomes progressively more difficult.

We recognise, and you are quite right, quoting my letter, that the impact of a big cut made very quickly would have been very difficult for us to deal with. We would have struggled to provide the service. What is different going forward? We seek to do much better with the resources that we have. Now that is not going to mean we can afford any cut. For instance, I mentioned that we need to recruit next year, and we are having a discussion with the Department about support for that. Recruits cost money to employ, but they do not start reducing the overtime bill until you get them onto the fire engines. There is a pressure that comes with that. Our hope for managing our budget much better revolves around more innovative approaches to our crewing framework and our shift systems. I could try to tell you a lot more about that, but Gary has been doing all the work on it, so I will get him to elaborate slightly.

Mrs Dobson: I am interested because you may recall that, at the time, the Fire Brigades Union said:

That was quite a chilling assessment, so I am just interested in whether it was right or —

The Chairperson (Ms P Bradley): We did not have the cuts that were proposed, so that is why it did not happen.

Mr Ashford: Before I let Gary talk a little bit more about the shift systems, what I will say is that we have not closed any stations. We have been able to manage, but it is getting more and more difficult to do that. We still have the same number of fire engines available now as we had beforehand, and that is because of some of the steps taken. What I also will say is that, despite the difficulties we face, our proposals going forward are to increase the level of cover in four stations in Northern Ireland, and that is by taking a much more imaginative and innovative approach. As I say, Gary will elaborate a little bit more on that because he will do much better than me.

Mr Thompson: I think that probably a wee bit of confusion entered because we were already doing work on the new crewing framework. The integrated risk-management plan is all about making sure that you have the right resources in the right place at the right time. We had developed a new risk assessment methodology.

We have 67 defined station areas, and we had assessed risk in those 67 station areas. We looked at our resource allocation throughout those 67 station areas and then looked at proposing a new model. We were looking at how to have the right resources in the right place at the right time, how to be more efficient, how to crew better, how to utilise people when they are on watches and how to change how they do their training and get their leave so they do not need as many people on. We still provide the same level of service to the public because the safety of the public and our firefighters is our number one priority. That work was already going on, but it was going on through a risk-based and evidence-based approach; it was not budget driven. Dale's letter was entirely correct: the 5% or 10% cut would have been devastating and detrimental to our service delivery. However , the work that was going on was planned and risk-based. There was maybe a bit of confusion in and around some of the work that we were doing that was the right thing to do, and that risk-based work was getting mixed up in the cuts conversation.

Mrs Dobson: I just wanted an update, because it was quite a hard-hitting letter.

Finally, on the work undertaken by the Ambulance Service and fire crews to provide first response — I know that Gary touched on this — what training was provided to the officers for the pilot scheme in Lurgan in my constituency, which started, I think, 11 days ago? I think you touched on why Lurgan was chosen. Who will decide when the Fire Service will be the first responders rather than the Ambulance Service? I would just like to tease that out a wee bit more, as well as the joint ultimate aim of the six-month project.

Mr Ashford: Again, I will get Gary to elaborate on that mostly because it has been a feature of his work. What I will say is that there will never be a situation in which we respond instead of the Ambulance Service. There is co-response, so we both go together. This is about supporting the Ambulance Service, not instead of it. That is an important point to tease out. Again, Gary has led on most of that work, so I will get him to elaborate on it.

Mr Thompson: On the training, all the personnel used in the pilot — all the whole-time staff in Lurgan fire station — received what we call first person on the scene intermediate (FPOS-I) training. It was a full week's training, but we did it over two separate weeks, training up the whole station effectively, to be able to respond. We as an organisation have a contract in our road traffic collision strategy that says we will give trauma care and medical care when we arrive first at a road traffic collision. We had already determined that we as a service want our staff to be trained as first person on the scene intermediates, so that contract fitted in well with training up the whole-time complement at Lurgan station to be able to respond to medical emergencies.

As Dale said, being a community first responder — again, that name can cause some confusion — does not mean that we go on our own; rather, both services co-respond and go together. It is about trying to bring added value if you can get there quicker, because minutes or even seconds can make the difference to somebody's survival rate.

Mrs Dobson: Will it be assessed or rolled out after the six-month project?

Mr Thompson: Both services will do that. We will come together at the end of the six months. Our command room is capturing the data from every incident. All the details and the messages that are passed back are being captured, and we will probably carry out a mid-point review. At the end, we will determine whether it is something that we want to take forward. We have already set up a memorandum of understanding. There is no doubt that that is in draft form. We will tease out issues and go through the operation of the pilot to determine whether we will continue with it and whether it should be expanded throughout the service.

Mrs Dobson: There is a great team in Lurgan station doing that.

Mr Butler: OK, thank you. I am delighted to get in now. [Laughter.]

Mrs Dobson: I thought you would be in first.

Mr Butler: You will be glad to know that, obviously, some of my focus will be on the Fire Service, but I will start off with you guys. I will declare my interest and bias, which is that I was in the Fire Service until very recently.

Mr Durkan: Attacks have gone down since then. [Laughter.]

Mr Butler: Attacks have gone down, but the performance is the highest yet. [Laughter.]

I am glad that both organisations are here together because that is the way it should be. I am stating that now because there is something coming at the end for you in that regard. The first and most important thing for any front-line service is going to be patients — the clients or whatever you want to call them. I am a wee bit concerned about the issue of performance, which Gary touched on and Jo-Anne picked up.

In Belfast, you have cracking response times. You are hitting the eight-minute response time, and that is brilliant, but the worrying thing for me is that they also get to hospital quicker. In the rural areas, the reality is that we are not hitting the response time, and it takes longer to get to hospital. There is a level of care that you can expect and will receive, and it is excellent. It is a top-notch service. I worked with paramedics and EMTs many times. It is a fantastic service and something to be very proud of, but it is the poor relation.

I understand the business side of it. I just want to know whether there is anything specific that you are looking at to change that. The thing that worried me — the Fire Service will get the same question — is response times. I am very keen on response times. You talked about triage and call handling. Again, we have first-rate call handlers in both services, and triage is important for avoiding the nuisance calls and that type of thing. Patient-centred care has to be at the core of what we all do. What are you specifically going to do to improve attendance times and actual attendances in those places where, I think, the risk is greater?

Ms O'Hara: OK. I am going to pass this over to Brian, but I would link it very much to making sure that the targets reflect good patient outcomes and good measurement of patient outcomes in our targets.

Mr McNeill: The simple answer is this: change the target and make it a more meaningful target. Currently, we have a situation where, when a call comes in, we categorise it as red, amber or green. Red calls are potentially life-threatening situations, where we would send an ambulance or a rapid response vehicle (RRV) to deploy within eight minutes. You are quite right; even the 72·5% target has an inbuilt and inherent inequity in terms of the service. You are also quite right that Belfast gets a very good service. Not only are the hospitals closer and there is a quicker turnaround time, but a lot of the rural ambulances that come into the Belfast area have patients, and when they are leaving the area, and a call comes in, and they are the closest available, we will send them. That is where we are.

The difficulty is that we are chasing the eight-minute target, and, realistically, not all the patients whom we arrive at require an eight-minute response. As the chief executive said, we want to conduct a review. Currently, of the total 999 calls that we triage, 38% are category A targets. We want to review that. Your point is a valid one. There should be time-critical targets. When it comes to cardiac arrests or people who are not breathing or who are choking or drowning, there are certain specific calls that we need to get to in eight minutes or less. We need to build a system that will deliver on that. That will reduce the number of category A responses from 38% potentially to 10% of demand. That means, then, that we could look at more realistic targets for the other conditions such as chest pain, trauma calls and those types of calls. This is where we need people such as you to help us support and bring this in so we could have extended response times but within reason.

Services in Wales, Scotland and England have started work on this because they have realised that a target set in 1974 is outdated and is not what the system needed. Critical patients require time-critical response times, and that should be 100% across Northern Ireland. That reduces the pressure on the system and allows us to put in more meaningful outcome-based targets, as the chief executive said, for other specific clinical conditions. A good example of where we have achieved that without inequity is primary percutaneous coronary intervention. We have a centre in the Royal and a centre in Altnagelvin, and our obligation, when we worked with the teams in setting that up, was to have a patient there within an hour, no matter where they lived in Northern Ireland, and we have achieved 100% in that. That is a good example of a shift to designing a service around the needs of the patient rather than imposing an impossible target.

I go back to the issue of stress among staff. They are working harder, seeing more patients every day, spending longer with patients and spending time stuck in EDs without getting their breaks. Also, constantly chasing an unachievable target is very demotivating. We really think that the work on reviewing our capacity is important, and the next stage will be to make it more clinically focused and time-appropriate.

Mr Butler: I welcome your remarks, but I will keep a close eye on both services. Buzzwords are great. Everybody is into outcomes, and that is great. The Programme for Government is all about outcomes. However, actually, it is all about people: people care about getting care at that time and getting to hospital. I welcome what you say and, given my background, I understand it, but, at the same time, if it is not appropriate, I will be robust in challenging it. I understand the monetary, recruitment and establishment pressures that you guys are under, and there has to be a balance. You guys, given your seniority, have that responsibility.

You touched on stress, which has been mentioned a lot. The chief executive briefly mentioned an ongoing process in conjunction with the union to look at welfare and stress, particularly post-traumatic stress disorder (PTSD). Given the nature of the job and the scenes that the staff witness, that is bound to be prevalent. Will you give us a wee indication of what specifically is being done?

Ms O'Hara: When somebody exhibits PTSD in our service, we link through our occupational health services and provide the support that is required. In the widest sense of the stress that happens among our staff, the subgroup that I talked about has just started. It is a health and well-being forum that looks at ways in which we can support staff more and market more what we can do for them. The first meeting of that group was two weeks ago, and, from that, we issued a communication to all staff to remind them how to access confidential counselling, what is required within that and how it is there to support them etc. There is a little bit of trying to make it live again and reintroducing it to staff so that they are thinking about it. Do you want to add anything, Brian?

Mr McNeill: That group, which is primarily composed of staff from across the trust, will get together and develop a plan looking at things such as peer support, which is a very useful and quick way of dealing with issues in real time. There are also support services such as Carecall, as we mentioned. It is a big milestone for us to get that group together because, all too often, people finish a job and get their next job, and we have not accounted for what is needed to deal with their needs at that time. The engagement process that we are involving staff in will give us feedback on what their needs are and how we can best meet them.

Ms O'Hara: I will give an example of an intervention that we have introduced in our control room. Staff in the control room, as you will be aware, have to deal with some very distressing calls etc and stay with patients on the phone providing advice until the paramedic and technicians get to them. Over recent weeks, we got our Carecall people to come in and be available in the control room. That allows staff who have been dealing with the more distressing calls to take time out with a counsellor in situ and have some input. That is one of the examples that staff suggested to their managers. We are trying to support staff. We will use that as a test case to pilot and see whether it works for staff, whether it is useful and whether we can continue to roll it out.

Mr Butler: I have a third question, and I will let you answer it together, if that is OK. I will leave it to the end, and you can decide. I will give you a hint: it is about Desertcreat. I have a bias towards it because I was involved in the initial project. I will move on to the Fire Service.

Gary, you talked earlier about the lack of fire calls for retained firefighters. I am poacher turned gamekeeper, so I know that firefighter safety is a key priority for you. How do you propose to address that? Desertcreat, which we will talk about at the end, is coming up. In the interim — before that facility is there — what is the strategy for ensuring that firefighter safety levels are met? Does it involve a training strategy?

Mr Thompson: Thank you for your question. There is a training strategy at the minute. We can talk about our training facilities not being fit for purpose in light of Desertcreat, but that is a different conversation. We are very focused on the training of our staff. It is not so much about whole-time staff because they are there 24/7, so they do continuous training and drills daily. Retained staff, who are not always there, had a two-hour drill night once a week. That drill night is no longer a drill night because things have changed because of the paperwork that needs to be done and people's electronic/computer access etc. We now have safety-critical training days, and every retained firefighter must do 12 of those — it is non-negotiable. That is what we do in the retained world, and all staff in our complement of 994 will have to go through that. That is the bare minimum that we require for them to be trained adequately to keep them safe, and we are maintaining that.

Mr Butler: Do you see any pressure on those 12 days because of budgetary constraints? Years ago, there was pressure on the training budget, as there was across the service. For me, it is an absolute given that firefighter safety cannot slide.

Mr Thompson: There are pressures; there is no doubt about that. We had a two-pronged approach: training for retained firefighters and exercises, which is the validation of the competence gained through training. We had to put a moratorium on exercises because the money is not in the budget to do them. We have, however, tried to build the exercises into the safety-critical training days. Those days will be front-loaded with training for competence, and then a scenario-based exercise at the end will assess that. There are budgetary pressures, but we are not compromising on the training of our retained personnel.

Mr Butler: I had another couple of questions, but — this is not favouritism — I will not ask them, apart from the Desertcreat one, which I will wheel out now, because you have been sitting there for a long time.

On Desertcreat, we now have the right people in the room at the right time. I was on that project, and, putting my cards on the table, it was frustrating that the Ambulance Service was not there, although I do not know the reasons for that. The Minister's statement this morning said that the design team had been appointed and we were looking at a £45 million build project. On the back of the co-responding pilot in Lurgan, I assume that the Ambulance Service did not provide First Bike on Scene (FBoS) training for first responders. Is there any reason why discussions are not ongoing on why the Community Safety College will not have the right people in the right place, looking at the synergies, savings, increased training opportunities and the standards of response that the taxpayer should get?

Mr Ashford: Perhaps I will lead off and others can join in. Robbie, thanks for the question. I was with the Minister yesterday at the site. It is great that the design team has been appointed for the enabling works. They do not sound very grand, but they will take a lot of pressure off us because, hopefully, we will get our tactical firefighting training facilities very quickly. The prospect of a fantastic facility and all that it might bring is exciting.

The OBC 1 for the project was approved by the Executive, which gave us the approvals to take forward what we are involved in now. The design team will now develop the design of those enabling works. The next process that we have to go through is OBC 2, which is about the wider project. Roisin and I have had conversations, and there has been lots of talk in various forums about who should be part of this. In the process of developing OBC 2, we will look at the detail of everything, in line with any normal business case process. We will look at everything that is required, the strategic context and who might be involved. I would absolutely welcome the Ambulance Service getting much more involved in that development.

Involvement should probably be a little more widespread than that. Why stop at the Ambulance Service? We do a lot of work these days with voluntary agencies such as the Community Rescue Service and Foyle Search and Rescue. Other agencies may benefit from some of what we do in relation to command and control. A couple of years ago, I worked closely with colleagues in the Department of Agriculture and Rural Development (DARD), as it was then. We had a major incident in the spring blizzard, and they were very good. There has to be potential for us to look at the wider public service and at how we might develop all those capabilities. All of it will benefit the public in the long run.

Mr Butler: I agree with you, Dale. I see those other functions as complementary to the normal bread-and-butter service that you guys provide 24/7. I welcome that. There is nothing wrong with that. Roisin, what is your view?

Ms O'Hara: We had conversations in the very early planning stages. Our emergency planning officer was involved in discussing what the NIAS needs etc would be. We are a small trust and would be a small player. We are in discussions with the Department of Health about the education model for paramedics. You probably know that, in other ambulance services nationally, paramedics are mostly trained through university set-ups. The bulk of our training in our training school is the training of our paramedics and, subsequently, our technicians and that.

At this point, the activity that we would need to be a main player in Desertcreat is not clear, but I suspect that it is not at the level needed to be a key player. However, we are excited about shared emergency planning training. We would be keen on that, particularly given the opportunity that it gives for Northern Ireland to work in emergency planning. Quite often, our emergency planners go across the water to training events. It would be useful to have those here, and we would certainly want to use that facility, if we were able to, when it is up and running. In the OBC 2, we will continue to explore that and see whether it meets our need in any way.

Mr Butler: I encourage you to do so because a £45 million investment by any Department in any organisation is significant, and we need to get value for money. You referred to emergency planning and emergency responses on a grand scale to bigger events. There could be a lot of synergies, savings and benefits from the sharing of professional training.

Ms Bradshaw: Thank you very much for being here. This is some going, is it not?

My two questions are for the Ambulance Service. Earlier this summer, the Health and Social Care workforce census for the year ending 31 March 2016 was published. As a woman, I found it worrying that only 25% of your staff are women, 19% of your rapid response vehicle paramedics are women, and 18% of ambulance officers are women. Do you think that that is acceptable? Why is that happening, and what are you doing to address it?

Ms O'Hara: Is it acceptable? It needs to be reflective of society, so, ideally, we would see a change in that dynamic. Over years, we have seen a change in that dynamic. As to what we are doing about it, our recruitment is based on best practice, but, unfortunately, we seem to appoint fewer women than men to the workforce. Brian, I wonder whether you could come in to discuss that in relation to your workforce.

Mr McNeill: As Roisin said, we have attracted more women through our recruitment processes but not enough to uplift the percentage to a level that you would identify as being acceptable. The reason for that is not so much the nature of the work but the shift patterns and everything associated with those. As we start to review that and look at part-time working, it might become more attractive to females interested in joining us.

That said, it is fair to say that we have definitely made progress, not only in recruiting people to PCS and EMT paramedic posts but in getting to a stage where a lot of females hold senior positions as officers in the service and in training, which is very encouraging.

Ms Bradshaw: I am thinking about positive measures. I recognise the good practice and guidelines, but I am thinking about positively going out there.

Ms O'Hara: Yes, I do not discount that. We need to do more to welcome women into the workforce. Our trust board discussed that a while ago, and HR staff have been working with the Equality Commission on that, and we intend to roll out some of that work.

As Brian said, there is complexity in a 12-hour shift pattern that is largely full-time. Either Brian or I referred earlier to trying to look at new working practices through the capacity review.: different working and shift patterns that might make the situation different. Historically, the training for our paramedics and technicians has been residential. Obviously, that training is changing, so that whole environment will reshape, which might be more attractive to women.

I take your point that the under-representation of women is not appropriate or acceptable, and the trust will do something about it. We will make sure that women know that they are welcome and valued in the organisation. Reflecting what our director of operations said, women who join the organisation can have a very successful career, which is good for us. It is an issue that we will continue to work on.

Ms Bradshaw: Further to Robbie's point and a point that Ian made at the start of the meeting, a couple of weeks ago, I had a meeting with Helicopter Emergency Medical Services (HEMS) campaigners. The difference between what they advocate and an air ambulance is that rather than trying to get people to hospital as quickly as possible, they want people with a head trauma, punctured lung or other such injuries to be treated at the site. Would it not make sense, especially in rural areas, for patients to be packaged up at the roadside to mitigate the impact of injuries such as head trauma before they are transported, as opposed to doing the basics and taking them to hospital?

Ms O'Hara: The model is still under discussion, but the HEMS model involves having a doctor as well as a paramedic there.

Ms Bradshaw: That is my point. Why does that not happen for category A calls, especially where there is a quare distance to travel?

Mr McNeill: You just identified the reason: the complexity of the packaging. Our paramedics are trained to a certain skill level: enhancing that skill level would be expensive, and maintaining it would definitely involve recurrent expenditure. If our paramedics get to a scene and call for an air ambulance, they will sustain life and do what they can for the patient to the best of their abilities. However, on some occasions, it takes a doctor — a specialist air medic — to package and then monitor a patient. We were asked earlier about the suggestion of having a ground landing area and transferring patients. There are a lot of risks associated with taking patients out of a helicopter and putting them into a land-based ambulance to bring them to hospital. It is a science of medicine in its own right, and very complex equipment is associated with it.

Ms Bradshaw: I do not have the same issue as Ian has. I appreciate that, if they landed on top of the hospital, there would be a lift straight down into the trauma room, so I absolutely support the investment in the Royal in that regard. I am not saying that there should be a medic on every ambulance. My point is that 37% of calls are category A and there is a possibility that those could be triaged, so, as a model going forward with the reform of health and social care in Northern Ireland, would it not benefit long-term patient outcomes to look at having medics on board when responding to acute calls?

Mr McNeill: It would be, absolutely. That goes back to our workforce review and the associated education and training. That is most definitely something that we could look at.

Mr Carroll: Thanks for your presentation. I have a few points, mostly for the NIAS. I have been speaking to staff who said that, quite often, they get two category-A calls at the same time and have to pick which one to go to. That is an awful situation. Roisin and Brian, in your opinion, do we have enough ambulances on the road and enough staff employed in the service? Jo-Anne touched on the issue of private ambulances. Will you elaborate on how often they are used and how much they are paid to provide the service?

Your report refers to the £1·2 million of cuts made last year. Where were they?

Roisin, you said that population increase is one of the reasons why it is harder to reach the targets for category A calls. Do you not think that, given the scale of the increase in category A calls, funding needs to be increased, which means more funding for the service rather than less?

Ms O'Hara: We would not turn away any additional investment that came our way. Obviously, it would be very welcome. Have we enough ambulances to do what we need to do? If you mean meeting the ministerial target, the answer is that we are not able to meet that currently due to the complexity of issues that we have talked about around this table, and perhaps more. That will be highlighted through the capacity review, and there may be a story to tell about requiring more investment.

We worked through the financial savings completely outside the front line. We looked at equipment, administration and areas on our patient services side of the house to protect the front-line service. That is where we addressed our savings, and we have done that without any recourse to —

Mr Carroll: Sorry to jump in, but you said administration and what else?

Ms O'Hara: The budget for medical equipment etc and our PCS service are the areas that we took the money out of last year. We prioritise the front-line service, and we will continue to do that. You asked me so many questions that I have to ask you to remind me of them.

Mr Carroll: No problem. One was on private ambulances.

Ms O'Hara: If we get to the end of our capacity review, we will have some evidence and some science to give back to the Health Committee and others on the exact figures.

Mr Carroll: Is there a figure now for how often and how much?

Ms O'Hara: Sorry, I was still on whether the NIAS has enough ambulances. I will pass to Brian to talk about the use of private and voluntary ambulances.

Mr McNeill: I do not have a figure on usage at the minute, but I can get you it. Traditionally, we engage the voluntary ambulance services as the first option if the whole system is in pressure. That usually happens over the winter period. So, we would get a call, for example at midday in November, to say that the Royal needs to do 15 discharges to create capacity. With our available resources, we could not deliver that in the time they need it to be done. So, we would engage the voluntary services. They would come on board very quickly, and we would get patients moved to the appropriate facilities, and the whole thing would start to flow again. That is how they were used traditionally.

To go back to the earlier point when the question was asked about our compliance with shifts; when we knew we were going into a weekend where we may have been dropping a number of shifts, I made the decision to engage the voluntary and private services to come in and cover those hours as far as possible, and they would be allocated low-acuity work. They would be allocated routine jobs, such as moving patients between facilities, where it is basically more of a transport or mobility issue. That would release capacity for paramedics so that they could deal with the category-A calls. It would take some of the workload off them.

It has benefits in two ways. It is a very flexible way of moving resource levels up and down and is a very value-for-money way of doing so. It also enables us to support the voluntary services, because part of our major incident plan is that, in the event of something untoward happening, we would activate the voluntary and private services to come and support. So, this keeps them in our family. It keeps them practising what they do, and we know that if we call on them, we have formulated that relationship and they can deliver for us. So, it is just a way of delivering the service. Sometimes, some people look at the voluntary and private crews outside an ED or hospital and assume that we are engaging them all the time, and we do not. Quite often, the trusts have contracts in place with voluntary and private ambulance services, which is outside our remit. I know that this has been an issue for the Health and Social Care Board, which is now starting to look at it to see who is using them, how often they are being used and what way it is being regulated. That work is ongoing.

Ms Seeley: Thank you all for coming today and for staying here at this late stage. We appreciate that. I know it has been very trying. In fairness, a lot of my points have been covered, as you can imagine, so my questions will be more brief, but I am sure you will not complain. I will go to the Ambulance Service first. I put on record my thanks to all the staff in the Ambulance Service. Its staff work long hours, often with little to no breaks, and I know that this is the choice they make because of the fact that there are staffing issues.

The concern has been raised around sickness levels often being due to an inability to access time off, which is required for anyone's well-being. So, my question is around ambulance staff's relationships with the trust. What actions have been taken to harmonise that relationship, given that there has been a breakdown in relations over the last number of months and years?

Mr McNeill: The first thing I have to say is that when you refer to staffing issues as being the sole point of pressure, they are not. Staff have worked harder over the years, but that has been attributed to increase in demand. A 5% increase in demand every year is a big issue for us and our staff.

To improve relationships, we are trying to make the whole system work better for patients and staff. We would certainly admit that there are some, for want of a better terminology, "industrial relations issues" that need to be addressed. However, we have systems in place to address those issues and working groups to try to reach solutions.

A good example you have given is working long hours and not getting meal breaks. It is not that they do not get meal breaks because we decide not to give them, it is because the next emergency call is waiting for a response. Therefore, the question for us is whether we have enough staff, which is why we have pushed for a review of our capacity. The outcome of that will be, for example, whether we need adjust things if people are starting and finishing at the same time and require meal breaks at the same time. We are committed to doing what we need to do to make the service better for patients. In doing that, with reasonableness prevailing and a willingness from our staff and the staff I represent, we could make it better for them also, notwithstanding the support we will need from our politicians and the people who commission the service.

It is a big change; we are transforming. In my 31 years in the service and, as someone who has not had meal breaks, I empathise with what is happening on the ground. I see that we have gone through a very bad time but I believe that we are coming out the other end. There is a willingness from all of the stakeholders to see the organisation on a better platform. The chief executive has outlined some of the challenges and ideas they are putting forward, and I think it will deliver.

Ms Seeley: I have a wee side question around that. If staffing issues come out of the capacity review as being a problem — for example, not having enough staff or how staff are put on a rota — do you have the budget to recruit more people? Is there an issue with your budget that will stifle your ability to increase your staff?

Ms O'Hara: Our budget is static; it is our budget. If we were bidding for more money, we would do a business case that would go through to the commissioners. We are spending our money and we are largely spending it on front-line services; 80% of our staff budget goes on the front line as well. Depending on what comes out of the capacity review, discussions will have to be had and, hopefully, some business cases will have to be developed.

Mr McNeill: Perhaps we are being a little optimistic. Just last week, we committed to interviewing all the 320 people shortlisted from our last recruitment process. Should more funding become available, we are, at least, on the starting line.

Ms O'Hara: We will have waiting lists.

Ms Seeley: Did you mention when the capacity review would be completed?

Ms O'Hara: We are doing the procurement bit now and trying to get the approvals process in place. We hope to go out in late October/early November, as long as we get through the process. I am sure you are aware of how complicated the procurement process can be, but we are hopeful that we will get to the output of the capacity review in this financial year. That is what we are aiming for.

Ms Seeley: Thank you for your responses. Thank you to you two as well, and for waiting so patiently. I want to commend the cooperation that is going on in my, and Jo-Anne's, constituency of Upper Bann. Stephen Boyd kept me informed as it was progressing and updated me when it was due to go live. To support each other in that way has to be welcomed. One day it may come back and the Ambulance Service may be able to provide support. So, that has to be welcomed and commended and support has to be given to that.

My question is on the Fire Service and is similar to what Paula asked the Ambulance Service. It is about the lack of women in the Fire Service and the barriers against women possibly applying to the service. Maybe there is a perception that it is all about tackling fire, but your role has changed so much that women would be assets to the service, and I am sure you will agree with that. What actions are you taking to tackle and bring down the barriers that are stopping women from applying?

Mr Ashford: We have around 56 women at the moment, some whole-time and some retained. The issue comes up now and again whereby people ask whether women are suitable for the Fire Service . I use the same example all the time; Paula, I think I used it the last time we talked. At St. Paul's Cathedral in London, there is a monument to all the firefighters who were killed in the Blitz, and a significant number of them were women. To my mind, if women were good enough to die while putting out fires in what was probably the worst time in living memory then they are good enough to be in the Fire Service now. Every time we recruit, we try to do some positive engagement to encourage women to apply. In the past, perhaps shift systems and things like that were not the most conducive, but we do look now, depending on the situation, at flexible working practices whenever possible.

Another issue raised in a previous recruitment — we have not done any whole-time recruitment now, since 2011 — was the use of the multi-stage shuttle run for fitness testing, but we have taken that away. We are going to do fitness testing at a much later stage in the process the next time we recruit. We have also reviewed the aptitude testing process to make sure that it is fit for purpose and actually reflects what we need people to do.

For the next recruitment programme, it will be my plan — well, it will be Gary's plan now, because he will shortly be taking over from me — that we do as much positive engagement as we can. In the last retained firefighter recruitment process that we did, which was much more recent than the whole-time recruitment process, we got a good number of female applicants. Our target is to achieve 10% applications and 10% appointees, but we have never got near that. Currently, 2·9% of our whole-time workforce and 3·4% of the retained workforce are female. We recognise that there is a long way to go, but there is certainly a willingness among the corporate management team to try and address the imbalance.

The Chairperson (Ms P Bradley): Thank you. Catherine, just before I bring Mark in, can I remind members that we have quite a few statutory rules to rattle through and we need a quorum, so just bear that in mind. We will rattle through them as soon as we are finished here and I promise, we will get through them very quickly.

Mr Durkan: We expect a rapid response. [Laughter.]

I have to echo other members' appreciation to both organisations and for the heroic efforts of your respective staffs on the front line. I thought Gerry was going to go there when he started asking about the fleet and was talking about the number of ambulances, but I know that there has been an historical issue with the fleet — and some of it was "historical", to be quite frank; it was not deemed fit for purpose. I am just going back a couple of years. Have any of those issues been addressed? And, regarding the ambulances that you have; I know that there may not be enough of them, but are they all state of the art?

Mr McNeill: Thankfully, the answer to that question is yes. We have had a commitment to annual fleet replacement programme funding and all of our vehicles are less than five years old. They are state of the art and the equipment in them is the best you can get.

Mr Durkan: That is good; it was rapid, as well. [Laughter.]

I am aware of the work of both organisations, in conjunction with other statutory agencies, Departments, the Road Safety Forum and various partnerships around that. This mostly goes back to the Ambulance Service and when we were talking about the failure to meet response time targets, particularly in rural areas which have traditionally, statistically and historically the most dangerous roads. Over the past couple of decades, we have seen a huge reduction in the number of deaths on our roads but, sadly, over the past couple of years, we have seen the figures for deaths on our roads creep up again. Strangely, at the same time, the number of serious injuries on our roads has gone down, which would suggest that, maybe, the issue lies with the emergency services getting there or getting people to hospital on time. I know that I do not have to tell you guys, but there is such a fine line between life and death, and every second counts, literally; but there was a real anomaly in the figures. I am sure that your colleagues who work in that specific area could maybe explore it further.

Mr McNeill: This is a very complex question. My first thoughts on it are that trauma management is a very specialised business. I suppose that this is more of a plea; there is only so much you can do at a scene and in transporting the patient to hospital. That is why we have specialist emergency departments that are designated as trauma centres. Our staff are faced with some very difficult cases, going back to packaging the patient and transporting them to an ED. What patients need are specialist consultants and the specialist scanning and X-ray equipment to be able to deal with the multi-system trauma they have experienced. Quite often, as you have just identified, we will arrive on scene and the patient will be dead on arrival. If they are not, then the staff will do the best they can but they are very limited in terms of the complexity of cases.

Mr Durkan: I do not want to be critical of staff or the service but it is, possibly, indicative of just how stretched the service has become. You spoke about the increase in demand of 5% year-on-year. Could you expand on what you think that is attributable to? Occasionally in the newspapers we will see articles about the type of 999 calls that are received. A lot of people will look at them and laugh, because the way they are presented in the paper is almost as humorous articles but it is a very serious issue. There are people who make phone calls that waste time tying up resources. What more could be done in the education sphere? There are people who ring for an ambulance because they think that this is what you do when you have a headache. What more can be done to educate people about that? In the past we have talked about people turning up to A&E with toothaches and things like that.

Ms O'Hara: It seems that everything we are going to talk about is complex but there are all sorts of aspects to this. Some people will ring 999 because they have a need but not necessarily a 999 ambulance need. It is about making sure that we do not discount calls that are maybe not right for the Ambulance Service. We need a pathway for them. We also have spurious calls, and we are trying to work on those through our community education programmes. Some of our media campaigns, and social media, provide good opportunities as well. Is there anything else that you want to add, Brian?

Mr McNeill: There are a couple of factors on top of what Roisin has outlined. Sometimes, there is confusion about how to access health services. People see 999 as a quick process with a guaranteed response, and we may never change that perception. Public education will help, but I do not think that will ever make it change completely. We need to look at how we deal with calls and downgrade those that are not 999 calls through things we have put in place such as the directory of services. In our control system, we know where all the GP and dental services are. We would like to build on this so that when a call comes in as a 999 but is determined not to be such, it can be passed to another team that would manage it appropriately. That might take longer, but at least it will deflate the pressure on the system.

The other thing we have brought in is a clinical support desk. If a call comes in as a 999 but the issue is not life-threatening, we have GPs in our control room who can take the call. They can tell the caller that they do not need an immediate ambulance response and can then talk about the caller's needs. They can ask the caller to talk about their problem. It may be something as simple as a single mum with a few kids, one of whom has a spiked temperature in the middle of the night, and where she has no care arrangements in place in order to be able to take the child to hospital. The GP can talk the caller down, tell her what to give the child and undertake to ring back in half an hour. If the child gets any worse, the caller can ring the GP back first. These are ways of being able to address the demand issue.

Mr Durkan: I know that there are people who see arrival by ambulance as a sure-fire way of leapfrogging people who are sitting in the A&E waiting room.

I want to go back to the issue that Paula and Catherine raised about attracting females to join both services. What is sure to put people, certainly women, off joining the Ambulance Service is the increase in attacks on staff. Attacks on ambulance staff are very different in nature to attacks on Fire Service staff, which might involve young fellas throwing stones as you drive past. Attacks on the Ambulance Service are more attributable to you arriving in often combustible situations. You cannot really educate the public about that, although it might be reflective of wider societal problems.

I will touch on the Fire Service very briefly. I was chatting about the wasting of time, hoax calls and the amount of money or resources wasted when you have to respond to such calls. Bonfires always grab the headlines, but they take place on only a couple of nights a year. Gorse fires are always a big drain on your resources. Can you outline, off the top of your head, the cost of such things to you? There will be a financial cost and a potential human cost.

Mr Ashford: The cost varies. Gorse fires and rural firefighting are very difficult to predict. We had a really bad year in 2011, when we had our busiest day ever. I was in the command room on the busiest day in our history in 2011. That happened because of gorse fires, and we were completely stretched. Thankfully, it has never been as bad since then. The weather is a big factor, and it has not been that good for the last few years, which has definitely been in our favour.

Our guys have been doing a really good job in engaging with people to try to prevent these things. Largely, they are preventable. For whatever reason, people burn things in the countryside. If you make them aware of the consequences and what might happen as a result, they will usually listen and we can do something with that. We have seen a marked reduction in gorse fires over the last few years. The costs largely depend on where they are as well. A gorse fire on the Belfast hills will be attended by full-time crews, so we are paying them anyway. A massive gorse fire in the Mournes that goes on for two or three days will be attended largely by retained crews, which we pay by the hour. That has a much more significant effect on our budget. The work that has been going on has been very productive. People have been engaging. People involved in forestry, the local communities and the farmers have been talking to us, and, if we keep on that trajectory and keep engaging with people, this should become a much less significant problem for us in the future.

The Chairperson (Ms P Bradley): Thank you very much. I know it has been a rather long session, but I suppose it has been a double witness session. It is good to have you both together.

Before we finish, I want to tie a few things down to do with what Trevor and Jo-Anne highlighted to you earlier and some of the Committee's asks. Thankfully, Catherine asked about the capacity review. That will be around March, so we may get you back again just after that, if not before, or even around June to see what way it is going. I might have picked this up wrong, so you can tell me differently, but, through the capacity review, are the part-time hours, the shift patterns and stuff like that coming into effect?

Ms O'Hara: They will all be fed into the capacity review.

The Chairperson (Ms P Bradley): OK, so they will not happen until the capacity review takes place and will then be part of that process.

Ms O'Hara: Yes, the recommendations will come out of the capacity review.

The Chairperson (Ms P Bradley): Trevor and Jo-Anne raised issues to do with the dropped shifts and things like that. I believe that different shifts, especially part-time, could make a big difference there. We want to get a little bit of information back from you, Brian, on performance over the past year, whatever that might be, when that has happened. I worked in the health service for a number of years and I know that we rely on goodwill. It is the same with you. We rely on goodwill from anybody who works in that service, and I know that goodwill gets stretched to the point where there are sickness levels and things happen. Sometimes, accidents can happen because of those issues. We want to do whatever we can to help with those issues. That is the general feeling around the table. As long as we have the honest truth in front of us, we will do whatever we can to try to alleviate some of those pressures. That is what we want to do. If you can get some more information back to us, we can keep an eye on that. Once the capacity review is done, that will give us some real positive direction to alleviate those pressures. Is it fair enough to say that?

Ms O'Hara: Absolutely. We welcome your support.

The Chairperson (Ms P Bradley): OK, so could we get that back? Guys, thank you so much. It was good to see you again. It was a very informative session. And thank you, members, for bearing with us in all of this.

Mr Butler: I thought we were great. [Laughter.]