Ireland too rural for ambulances to meet response targets

Ireland is too rural to support an ambulance service to compare with the service in England and to meet official targets for response times, according to a confidential report.

Ireland’s “high rurality”, and the fact Irish people are less than half as likely to call an ambulance than people in England, means the cost of running the service in Ireland is significantly higher by comparison, the report commissioned by the Health Service Executive states.

The report questions the policy of the National Ambulance Service (NAS) of bringing all patients to hospital emergency departments and says many other countries adopt an initial “see and treat” approach to patient care instead of simply taking them to hospital. In England, up to 50 per cent of patients are dealt with in this way.

The report says Ireland’s ambulance is not directly comparable to English services. Even if fully resourced and operating to international best practice standards, the service “cannot possibly achieve” prescribed targets for response times.

Targets
Under these targets from the Health Information and Quality Authority (Hiqa), 80 per cent of Echo (potentially life-threatening) calls for emergency assistance are supposed to be dealt with by a first responder within eight minutes. Last year, in total just 26.6 per cent of such calls were responded to within this time. But in rural areas, just 6.6 per cent of calls were responded within the eight minute target time.

Lightfoot says Ireland’s much greater rural population has “major implications” for the ability of the National Ambulance Service to meet the same response times as its English equivalent.

In Ireland, 40 per cent of incidents are in a rural area, compared to 12 per cent in England. The report says the reason the number of ambulance calls per head in Ireland is only 40 per cent that in England may be down to easier access to GPs.

Pointing to the “very large gap” between current performance and targets, it says “because of the rural nature of the area NAS serves, we do not consider these targets are achievable”.

Drive times
In many cases, ambulance stations are not well located for the communities they serve. As a result, the average drive times in urban areas are nearly 10 minutes, compared to four minutes in high-performing services in other countries.

Providing extra resources would result in very little improvement in performance in rural areas, according to the report, which identifies 100 locations where less than one emergency call is made per week. It says solutions, such as back-up community first responders using a defibrillator are required.

Improvements would cost significant amounts of money; hiring an extra 290 staff would cost €15 million a year and take three years to implement. Even then, improved response times may not yield a commensurate improvement in clinical outcomes for the majority of patients who are not time-critical

From The Irish Times

http://www.irishtimes.com/news/health/ireland-too-rural-for-ambulances-to-meet-target-response-times-1.2063402

Carbon Lock-in

The assessment last week by the European Environment Agency that Ireland is set to fail to achieve its binding 2020 greenhouse gas emission reduction target comes as no surprise. At 20% below 2005 emission levels, the Irish target is the highest possible in the EU. This in itself is another fateful legacy of ‘Celtic Tiger’, as national targets were assigned based on relative wealth (GDP per capita). As we now know, Ireland’s wealth in the mid-2000s was largely illusory. The consequences now put the government in an unenviable bind of having to make the deepest cuts in emissions while also grappling with the aftermath of one of the deepest European recessions. The line coming from Minister Alan Kelly is that the 2020 target is simply unrealistic and unachievable”. Of course, in the continuous absence of any meaningful strategic efforts to reduce emissions, epitomised by the complete failure to enact a climate change law, it will continue to remain so. Despite the progressive rhetoric on climate change, to date there has been but paltry implementation of actual measures, with the bulk of any emission reductions largely coming as an unintended consequence of the recession.

Inaction on climate policy has been driven by the classic Irish persuasion of brushing inconvenient issues under the carpet, particularly when there are no immediate consequences for doing nothing. Unfortunately, this short-sightedness has only served to dig a deeper hole from which we must now get out of. For under EU law, further procrastination is no longer an option. From now, and each year to 2020, Ireland is under a direct and binding legal obligation to reduce its emissions in a linear fashion. This will not be achieved, and is likely to force the government to avail of flexibility mechanisms and to purchase compliance, such as buying expensive carbon credits. Furthermore, in accordance with the new EU Semester budgetary surveillance process, Ireland is required to achieve its national Europe 2020 targets, which also includes the 20% reduction in greenhouse emissions. The European Commission can issue annual Country Specific Recommendations (CSRs) and these could compel Ireland to introduce specific policy measures and, if necessary, impose financial sanctions. This may include, for example, environmental tax reforms, such as a significant increase in carbon taxes or other user charges (as was included in the 2014 CSRs for Luxembourg, for example). Similar to the current furore over water charges, such fiscal measures would obviously be extremely unpopular.

EMISSIONS

So what is the scope for reducing emissions in the Ireland? Agriculture and transport together make up approximately 70% of all emissions for the purposes of the 2020 target. As part of its economic recovery plans, the government has been categorical in its position that emissions from agriculture will rise under the massive Food Harvest 2020 expansion plans. In fact, Ireland has been very active in arguing for special greenhouse gas accounting rules for agriculture. However, such rules, if they prove their worth, could not be introduced until at least 2022. As a result, in the short-term a disproportionate burden will have to be placed on the transport sector. A further unfortunate legacy of the ‘Celtic Tiger’ is that from 1990 to 2012 transport was the fastest growing source of emissions, increasing by 113%, mostly due to a threefold increase in the use of private cars. In 2009, the ‘Smarter Travel‘ policy was introduced and proposed that by 2020 car commuting to work should drop from 65% to 45%; alternatives such as walking, cycling and public transport should rise to 55% of total commuter journeys; and that future population and employment growth would predominantly take place in sustainable compact forms, which reduce the need to travel. This policy was a key component of the measures proposed to reduce Ireland’s transport emissions for the purposes of the 2020 target.

However, in the most recent draft ‘Investing in Our Transport Future’ policy document published by the Department of Transport in August, reality has bitten and these ambitious targets have now been abandoned. The report concedes that despite successive national policies which have had the consistent stated objective of promoting modal shift away from private cars and better integrating land-use and transportation, it must now be recognised that these policies have failed. As a result, given the diverse range and dispersed pattern of journey origins and destinations, there is now extremely limited potential for reducing emissions in the transport sector and “current spatial patterns remain very unfavourable to efficient and sustainable transport provision”. According to the report, even achieving widespread modal shift in our cities would yield little emission savings due to the short nature of such trips and the sheer scale of spatial sprawl and bloated commuter belts which have embedded car dependency. The report goes on to conclude that “reducing emissions from transport would require a transformation in the sector, relying on technological innovation and security of alternative fuels supply supported by enabling policies and widespread behavioural change”. What this in effect means is the extensive roll-out of electric vehicles. The government has a target of achieving 10%, or approximately 250,000 electric vehicles by 2020. There are currently around 250 in use. Worldwide there are only around 400,000.

The stored up costs of past planning failures just keep on giving and latest draft transport policy document reads as a pretty damning indictment of the spatial chaos that was allowed to take hold during  the ‘Celtic Tiger’ and the complete failure of the national policy to curb sprawl. Aside from the climate policy implications, as a consequence of the new budgetary realities, major questions are posed in the report as to whether Ireland can now afford to respond to these spatial patterns in terms of investment requirements and service provision costs. We are already seeing the implications of this with the recent decision by the National Transport Authority to approve a further increase in public transport fares.  Options being actively considered include reducing the size and/or level of performance of the funded road and rail network to a more appropriate scale (particularly rail due to its high fixed costs vis-à-vis passenger numbers) together with demand management through fiscal measures, such as road user charging based on distance and time. Clearly, the scope for such additional charges, infrastructure downgrades or service withdrawals is limited by realpolitikthe existing burden of taxation, the hardship being experienced by many families and high levels of household expenditure on transport, where people have no or inadequate access to more sustainable transport modes.

Until now the debate on Ireland’s greenhouse gas reduction targets has largely taken place in the abstract. However, the latest IPCC report this week has further firmed up the scientific evidence and the scale of mitigation required, and this issue is not going to go away. Likewise, the EU has recently agreed a post-2020 framework to reduce emissions by 40% by 2030, with national efforts again distributed on the basis of GDP per capita. Despite the recession, Ireland still has the fifth highest GDP per capita in Europe, guaranteeing a relatively high emission reduction target. In the coming years the unreality will have to end and the choices necessary to reduce emissions will come into sharp relief. None of them will be easy, inexpensive or without controversy. According to a briefing this year by the Department of Public Expenditure and Reform, in the absence of national mitigation, potential costs of purchasing compliance for the Irish Exchequer for the 2020 to 2030 period could have a cumulative total in the billions and there is cause for concern. Unfortunately, the fixed spatial legacy handed down by past planning failures has locked-in high fossil fuel use and entrenched car dependency which severely limits the choices now available and significantly increases the costs of mitigation options. In climate change policy jargon the ‘least cost principle’ would dictate that spatial planning practice and transport investment should be better and more firmly aligned. However, this lesson continues not to be learned – currently almost 50% of all new houses granted permission are for dispersed car dependent ‘one-off’ dwellings. It will be these same households that will bear the brunt of future transport cost inflation, downgrading of infrastructure and service withdrawals.

Counting the Cost of ‘Rurban’ Ireland

Ever since the collapse of the Celtic-tiger in 2008, almost every aspect of political, economic, social and environmental governance in Ireland has come in for some degree or critical retrospection. This critique has largely taken two forms i.e. to what extent did our governance contribute to the circumstances we now find ourselves in; and how can it be reformed to get us out of them?  For reasons which will need little explaining to regular readers of this blog, planning governance has quite correctly been fingered as a major cause of our current problems and since 2010, on paper at least, has been the subject of significant reform efforts.

One issue, however, which has clearly evaded any form of genuine rational analysis, has been rural settlement policy.  For decades, this political hot-potato has been gingerly fumbled by populist governments and manipulated as local political currency. The 2005 Sustainable Rural Housing Guidelines, which were intended to bring some clarity to what exactly the policy is, are a near perfect illustration of ‘win-win-win’ policy fuzziness leading to highly incoherent implementation across the country. According to Census 2011, the stock of ‘one-off’ dwellings in the State currently stands at 433,564 (26.3% of the total housing stock) with 417,094 (96%) located outside towns or settlements. Remarkably, one-quarter (104,000) of these dwellings have been constructed within the past ten years and since 2001 councils across the country have collectively granted planning permission for 174,000 new dispersed dwellings.  52% of the total stock of vacant housing units are located in rural areas.

While the number of planning permissions for ‘one-off’ dwellings has fallen from the heights of over 23,000 per annum in 2004, in 2012, 60% of all planning permissions in the State were for single dispersed houses.  This is despite the clear intention of national policy to direct new housing development into settlement centres. While it is true that this high proportion is as much to do about the collapse of the multi-unit development sector, the absolute numbers are, nonetheless, striking. Since 2010, 14,500 new ‘one-off’ dwellings have been granted planning permission as compared to 14,900 multi-unit houses and 11,100 apartments.

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The divisive debate over who should be permitted to self-build in the countryside tends to take place in abstract purity, completely divorced from both the public and private economic, social and environmental costs. Dispersal is considered a completely normal and benign feature of the Irish cultural landscape and recourse to statistics and facts will typically fall on deaf ears. Several intrepid commentators have from time to time poked their head above the parapet to question the wisdom of the spatial patterns taking hold across the country only to be instantly shot down with an emotive barrage of ‘anti-rural’ polemic.  While politically, this is certainly an issue best ignored in the customary Irish fashion, in official policy circles at least, the very serious cumulative problems and hidden costs presented by Ireland’s highly dispersed settlement patterns have long been acknowledged.

Now, without being directly attributed, this legacy is manifesting itself in contentious and costly disputes over such issues as the development of large wind energy and grid infrastructure projects; the closure of rural post offices, schools, pubs, hospitals and garda stations; rural cost of living, car dependency, lack of public transport and social isolation (and even drink driving laws); the challenge of an ageing society and the obesity crisis; climate change targets; septic tank charges; and deficient rural infrastructure, such as broadband and roads. These issues will no-doubt continue to become more acute as government pursues an austerity agenda in parallel with spatially blind productivist policies (e.g. National Renewable Energy Strategy, Grid 25, Food Harvest 2020). To date there has been no acknowledgement whatsoever that rural Ireland is a finite, congested and contested space where multiple sectoral policies are operating at cross-purposes and which simply cannot continue to accommodate the competing demands being placed upon it.

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The dominant common-sense is that anyone who questions the wisdom of the unfettered right to build anywhere in rural Ireland is somehow ‘anti-rural’ and has a ‘pro-urban’ (i.e. Dublin) agenda. I would offer the counter-narrative that, far from maintaining local populations or providing an economic stimulus, it is in fact settlement dispersal which is a key driver of rural economic decline, out-migration, housing vacancy, isolation, higher costs for rural families and the under-provision of critical infrastructure, employment opportunities and public services, particularly in peripheral rural regions. Furthermore, the often phoney debate on this issue, reinforced by the popular media, assumes there are homogenous ‘rural’ and ‘urban’ spatial entities. I grew up and spend the most part of my life in a 1960’s ‘one-off’ bungalow. However, my parents, like great majority of my neighbours, are not rural. They instead would be more aptly classed as ‘rurban’, commuting long distances daily to work in urban centres. Data from Census 2011 is indicative of clear spatial trends towards acute counter-urbanisation and ex-urban sprawl where householders are electing to self-build in ‘rurban’ locations in search of larger family dwellings, higher quality affordable homes (unlike some of the disastrous build quality in urban locations), a rural environment and a perceived better quality of life close to kinship networks. Of the 417,094 ‘one-off’ dwellings located outside of designated settlements, 350,000 (84%) were located within 5 kilometres of a town. Just 1% of occupied ‘one-off’ houses did not fall within a 10 kilometres radius of any town in 2011, and the majority of these were built before 2001. These trends are tacitly supported by fiscal policies where ‘one off’ housing has always been an unspoken component of national housing policy and where the government has conveniently shirked its responsibilities in this area.

While the horse has largely bolted and our costly spatial legacy is now ‘locked-in’, I would argue that questioning settlement patterns of rural Ireland remains relevant and is entirely consistent with a ‘pro-rural’ agenda. The government’s decision to establish a Commission for Economic Development in Rural Areas (CEDRA) is explicit recognition that large parts of rural Ireland have been unequally affected by the recession. However, the diffuse spatial structure of rural areas and its impact on economic opportunity continues to be utterly ignored.  If we are ever to have a possibility of providing a counter-balance to the accelerating dominance of Dublin, Cork and Galway and provide some basic level of spatial equity then the challenge for regional planning is to deliver workable and socially acceptable alternatives to the current failed model of ‘one-off’ dispersal.

Ireland after NAMA

Ever since the collapse of the Celtic-tiger in 2008, almost every aspect of political, economic, social and environmental governance in Ireland has come in for some degree or critical retrospection. This critique has largely taken two forms i.e. to what extent did our governance contribute to the circumstances we now find ourselves in; and how can it be reformed to get us out of them?  For reasons which will need little explaining to regular readers of this blog, planning governance has quite correctly been fingered as a major cause of our current problems and since 2010, on paper at least, has been the subject of significant reform efforts.

One issue, however, which has clearly evaded any form of genuine rational analysis, has been rural settlement policy.  For decades, this political hot-potato has been gingerly fumbled by populist governments and manipulated as local political currency. The 2005 Sustainable Rural Housing Guidelines

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Post-Normal Planning: Developing Scenarios for Ireland’s Future

Ireland after NAMA

If there is one trait which should perhaps be the unique feature of planning and serve to distinguish it from all other disciplines, is its normative future-orientated agenda. In fact, planning has been singled out by futurists as a discipline where foresight and analysis of the future is most required – as nowhere in society are peoples futures mortgaged so far ahead as when local and national authorities make planning decisions, zone land and develop infrastructure. No matter how present focussed are current planning debates, the actual intent of decisions will unfold over decades. Decision-making in planning therefore cannot avoid addressing the future, and future generations. In this sense, we are all living our daily lives today with the locked-in, path dependent and largely irreversible consequences of past land use planning policy decisions.

While this may seem patently obvious, when I look around planning practice in Ireland today I see…

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Ireland after NAMA

In the UK, the government are looking to radically reform building standards and introduce much greater self-regulation of the construction industry.  Here’s how The Guardian open their story about such measures:

Regulations covering building standards, including fire safety and wheelchair access, could be torn up in a government plan to cut costs for the construction industry and boost the economy.  Ministers have ordered a wide-ranging review covering all aspects of building regulations, also including standards on energy efficiency. The review, which controversially includes the option of giving the building industry more scope for self-regulation, is the latest in a series of government initiatives intended to stimulate activity in the economy and drive job creation through investment in homebuilding.  Its aim is to prune regulations “significantly”.

Apparently costs to property developers and the construction sector are worth more than people’s health and safety and also the effects on the environment of…

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