Dr. Niall Herity:

Maybe I will move on to talk about the catchment area which generated many questions. I direct members to figure 3.5 on page 19 of my report, which they should have before them. I want to take members through the method for calculating the catchment area of this cath lab. Figure 3.5 is so important because it contains the data that were provided to me by the team in Waterford itself. It shows that patients coming for cath lab procedures from the south east tend to fit into a fairly defined geographical profile. For example, a large number of patients come from Wexford, Waterford and Tipperary South, a smaller number of patients come from Kilkenny, and then a very small number of patients come from Tipperary North, Carlow and Wicklow. These data were a good start to make a calculation of the effective catchment population for this cath lab.

I now go back a page to table 3.4 which shows a separate data source looking at the patients coming for cath lab procedures through the cath lab in Waterford, broken down by county. The second column from the right shows that during 2015, a total of 346 patients attended any cath lab for a cath lab procedure. The majority of these people actually attended the cath lab in St. James's Hospital in Dublin. A proportion did attend University Hospital Waterford. The last column on the right shows that proportion was 6%. We then go to Kilkenny, a larger county with a larger population. A total of 458 people attended a cath lab, of whom the majority, 307, went to St. James's Hospital in Dublin, but a proportion, 26%, did go to Waterford. From Tipperary North, the vast majority of patients went to Limerick. A smaller number of people went to other centres listed, including 9% who went to Waterford. Then 53% of Tipperary South, 86% of Waterford and 69% of Wexford procedures were done in University Hospital Waterford. The value of this table is that it comes from a completely different source, the HIPE dataset. It shows a pattern that mirrors exactly the data demonstrated by the Waterford team. That is likely to validate the accuracy of both datasets.

I now go forward two pages to page 20 to show how this percentage calculation is applied to the 2016 census. The 2016 census report came out during the week I submitted the report. I deliberately held it back because I knew the report was scheduled. We were able to produce exactly up-to-date data on the population of this area. It shows that the overall population of the six counties, including Tipperary split into north and south, was 582,440. If we then break down the effective catchment population of each of those counties, Carlow, Kilkenny, Tipperary North etc., based on the percentage of patients who attended Waterford cath lab during the calendar year 2015, we found that the 6% for Carlow translated to 3,413, the 26% for Kilkenny translated into 25,771 and on down, giving a final effective catchment population of 286,147. That is the basis on which that catchment population has been arrived at.

Somebody mentioned private patients. I did not have any available data for the movement of private patients. In a mixed health care economy, as the Irish health care economy is, certainly there are private patients who move from one county to another and get treated in different places. However, these data specifically refer to the public hospital population.

There were questions about undue influence, interference and briefings. I received multiple documents and briefings as part of this process. I received briefings from as many sources as I thought was relevant, including published documents in the public domain, including Professor Higgins's report, briefings from the Department of Health, and briefings and presentations from local clinicians and consultants, the Health Service Executive and the acute coronary syndrome programme of the Health Service Executive. All this background information provided context for my review.

The other background information was the professional advice issued by international guideline groups, such as the American College of Cardiology, the American Heart Association, the European Society of Cardiology, BCIS that we mentioned, the Irish Cardiac Society and so on. All of these background documents and briefings provided context for my review and I took all of it into account. However, my conclusions are completely independent. They do not reflect any one or single aspect of that briefing or those background documents. Everybody I met was at pains to point out the independence of my position in regard to writing this report. Nobody tried to influence the process inappropriately. I am happy to have reached the conclusions I did and they remain my conclusions.

There was a question about the Minister's response to the report and the implementation or otherwise of the report. It is now a judgment for the Irish health care system, the Government, the Minister for Health and anybody else whether and how to implement the report. I do not have any views on that. I would not agree with the terminology that the report has been torn up. I do not think that is the case. I am not in day-to-day contact with anybody in the Department of Health or with the Minister, having submitted the report. It is now a matter for the Irish health care system to take forward.

Two people separately asked about the travel times from Cork to Waterford. They were taken directly from real world emergency ambulance journey times from Cork to Waterford which actually took place between October 2015 and June 2016. They are specifically referenced in the report. The number of journeys undertaken was relatively small at 15 to 20. The median journey time by a blue light ambulance carrying an emergency patient from Waterford hospital to Cork by road, not helicopter, was 88 minutes. That is where that figure came from.