Dr. Tony O'Connell:

Nevertheless, as to what has happened since the Deputy raised this question at the previous meeting with the joint committee, a permanent consultant has commenced on 1 September and a third consultant has commenced on a temporary basis in August 2014 and, of course, there are other staff in the service. As the Minister stated clearly, to make investments such as a second catheterisation laboratory at a cost of €1.9 million with total revenue costs of €2.7 million for a 24-7 expansion, it is appropriate to draw up a business case to examine the benefits this provides. The service is addressing patients appropriately. The majority of patients within the existing nine-to-five arrangements certainly were not embarrassed by the planned maintenance that occurred on 13 August. There was no interruption to services, as additional sessions were put in place in the cardiac catheterisation laboratory to ensure patients were not disadvantaged.

Senator van Turnhout pointed out there has been a challenge in delivering cardiac rehabilitation throughout the country, and certainly a number of the rehabilitation co-ordinators believe the quality of service has been reduced. I am concerned about that and will meet the two relevant clinical programme leads tomorrow, that is, the programme for coronary care and the programme for cardiac failure. This is a long-standing appointment I have had with them, which will take place tomorrow, to sort out exactly what can be done about this within the current financial constraints. One comforting point noted in the written response is that there has been a highly successful development of the primary percutaneous coronary intervention, PCI, arrangements and, of course, one positive side-effect of this is that patients have their coronary ischaemia, that is, lack of oxygen to the muscle of the heart, corrected much faster. This means they are much less likely to have dead heart tissue, which results in them needing cardiac rehabilitation and experiencing cardiac failure. This is a highly positive spin-off from the great work that is being done by the clinical programmes. This does not mean we do not need any cardiac rehabilitation, as we obviously will, and I am keen to work with those two leads to make sure we do so in a way that increases the access of patients to those services.