Dr. Patrick Owens:

I will answer the Deputy's first question, which was potentially the easiest, on the 500,000 people, including children, who would not normally be included in the at-risk figures. The international standard is to express normative data, in other words, the number of heart attacks in a certain population and the number of stents required`, on a per million basis. I guess this reflects the fact that, historically, it has been easier to count totalities than to subdivide and count people aged over 40 years or whatever it happens to be. Incidence rates for myocardial infarction, the need for angiography and so forth are expressed in per million population. Hence, the total number of 500,000 is the number to which one would apply the normative data.

As far as two cardiac centres of excellence are concerned, I see the issue not in those terms but in terms of need. It is as simple as that. A centre of excellence is another phrase that is subject to interpretation. I consider it to mean a centre with a very strong academic cardiological pedigree. Cork has such a pedigree and that is great but the purpose of expanding the service in Waterford is not to set us up as a competitor but simply to deal with the work we have to do. It is worth pointing out at this point - this is particularly acute for Wexford and I am sure Dr. Buckley will speak to this issue - that Wexford is outside the South-South West hospital group, yet its activity funnels into the catheterisation laboratory for the south east in Waterford. This is one of the unintended consequences that have followed from the Higgins report in that the report identified University Hospital Waterford and South Tipperary General Hospital as being in one group, yet answering to the need of a much wider population that crosses borders. This is an incredibly messy solution but that is where we find ourselves. Professor Higgins identified it as a messy solution but one that required the service in Waterford to be developed to the point where the hospital could answer to the population.