Dr. Niall Herity:

The relationship between volume and outcomes is especially clear in the case of emergency procedures. The more procedures the centre performs, the more rapidly the difference in the likelihood that someone will die as a result of a primary PCI procedure diminishes. That is the key part. This is not about a single operator but the team in the catheterisation laboratory and the support services available to them. That is why the BCIS recommends that these procedures be undertaken in high volume centres with concentrated expertise. It is the performance of the entire team that determines the outcome. The relationships between high volume and better outcomes are absolutely clear in the case of this procedure.

On there being a single point of failure, it does happen. The impact of an emergency PCI procedure on daytime activity is far greater than it is on night-time activity. That is the reality for all of us. In the centre where I work there are eight catheterisation laboratories, all working full-time. What happens is that notice is received that a patient is coming. We have enough time to complete a procedure; we do not put the next patient on the table and wait for the next patient to arrive. That is how one deals with it. I thought the Minister of State was referring to a single point of radiological failure; in other words, a failure of the radiographic equipment. I made a specific recommendation that backup radiographic equipment be provided in the catheterisation laboratory in University Hospital Waterford, a recommendation also made by the BCIS.

On meeting Professor Higgins, it is not obvious to me that the chief academic officer of a hospital group is necessarily the person I would be going to, but I want to assure people that I read the Higgins report and made my own decision on whether I needed to consult him specifically about the matter.

I decided that he was not someone who would change the content of the report. However, I agree with his strategy, which is to build networks of hospitals in groups that will work together in a joined-up fashion in order to achieve the best outcomes for patients. I am heartened to see that that is happening in the south-south west hospital group.