Dr. Patrick Owens:

I will answer in reverse order and start with the concept of effective catchment area. The first line of the report describes how the determination of any catchment area is a matter for interpretation, and that is true. The catchment area is almost a misnomer. What is important in any analysis of need is to identify the need of a given population. In a sense this report does things the wrong way around. What is needed initially is to identify the geographical area which feeds into UHW, to the south-east catheterisation laboratory service in this instance, and then apply normative data, which means to apply the percentages per million requiring angiograms, stents and pacemakers, and then work out what the actual need would be for that population. The value of doing it that way around is that the need is identified first. The need drives it. What has happened here is that the number of people who have had procedures has been counted but need has not been recognised. Delivery of service is recognised rather than the need for service delivery. The analogy I used several months ago was it is like trying to determine the number of people wanting to attend Croke Park on all-Ireland final day. What this methodology does in the report is that it counts the number of people in the stadium and concludes that is the number of people who want or need to be there. It completely ignores the fact that there are people streaming around shouting at touts and people in the pub watching the game because they know they will not get in. There is a need that is not being met, and a demand out there that is simply not being addressed because of the constrained nature of the service. The evidence for the constraint on the service is the fact that there was a 700-strong waiting list at the end of the year in which the report was done. This methodology cannot be applied to a constrained service; it simply is not logical.

Halfway through the report the logical inconsistency of that is borne out. Dr. Herity, having identified this catchment population, discusses briefly whether the activity carried out is consistent with that catchment population and finds that it is perfectly consistent. However, as he has determined the catchment population on the basis of number of procedures done, it is a completely circular argument that holds no water and is nonsensical. In fact, the only group of procedures upon which he did not make a judgment about the size of the catchment was pacemakers, which involves a separate technique we use in the lab. Not angiograms, not stents, but pacemakers. This was not used in his calculation of catchment. The pacemaker implant rate was far beyond what one would have expected for his calculated catchment. In other words, the strong implication is that his catchment area is a gross underestimate. The effective catchment area, therefore, is not correctly calculated. The methodology was never going to provide an accurate figure. It looks at the wrong thing. This should be a needs-based assessment, not an assessment based on treatment delivered.

There was another question on travel times. Dr. Doyle has carried out some independent assessments of the travel times from Waterford.