Dr. Niall Herity:

I will try to answer the questions in logical sequence because there was some overlap among them. However, I will first speak about my own background. I am an interventional cardiologist and I practise in this field of medicine on a daily basis. I have been an interventional cardiologist for about 25 years. The centre where I work, which is the Belfast Trust, is a very large interventional cardiology centre, one of the largest in the United Kingdom. In addition to being a full-time practising interventional cardiologist, I am also the clinical director of cardiology in Belfast. This means that in addition to considering the work I do for the patients who come to see me, I also have an overarching responsibility for ensuring the quality of care in the service, which is delivered not just in the Belfast Trust but for patients across the Northern Ireland region, which is the population we serve. As part of my work as the clinical director of the Belfast Trust, I have overseen the merger of some very large hospital services, namely, the Royal Victoria Hospital, Belfast City Hospital and the Mater hospital into a single entity - the Belfast Trust. I found many striking observations when I was considering not the merger but the grouping of the Waterford and Cork teams and the opportunities this provided. That is my personal background and experience.

In the context of how I came to be asked to undertake this work, the Department of Health in the Republic of Ireland made an official approach to the Department of Health in Northern Ireland to nominate somebody who was thought to be an expert in this area. It is was on that basis that I was asked to consider whether I would take it on. In doing so, I asked a few questions of myself, including: whether I had any conflict of interest - the answer to which was "Absolutely not"; whether I had the expertise and experience, or more importantly, was there anybody else in the health service in which I work who has more expertise and experience in this field and my judgment on that was "No"; and whether I had the opportunity or the time to take on this job for the Irish Government, the answer to which was "Yes, I could make the time given that it is such an important consideration". That is my background and how I came to be asked to undertake this work.

Many of the members have made reference to the British Cardiovascular Intervention Society, BCIS, as have I. The BCIS is a professional body. It is not constituted by the Government, rather it is a body representative of the interventional cardiologists across the United Kingdom. That includes England, Scotland Wales and Northern Ireland. I am a member of the BCIS, which has many hundreds of members, pretty much all of whom are interventional cardiologists. As part of its remit as an interventional cardiology grouping, it produces standards in the field of interventional cardiology, to which most centres in the United Kingdom will refer and will seek to comply. It is interesting that even since this report has come out, the minimum volume standard which had been, as was pointed out, set at 100 cases per year for the emergency workload has risen to 150. If I was asked does that have a legal background, I would reply that it does not. What it does have, however, is a professional background, namely, that it is the considered view of the expert professionals in this field that when undertaking high-stakes emergency work in the context of patients who are very sick and have acute myocardial infarction, those patients should be treated at centres that have high-volume services and the minimum in that regard has been set at 150 cases per year. It is described as an absolute minimum. The professionals in question point to extreme geographic isolation. In the United Kingdom and every other country, there are percentages and populations that live outside a 90-minute travel time to primary percutaneous coronary intervention, PCI, centres. My sense is that when they refer to extreme geographic isolation, they are not talking about mainland towns or cities but to people who live on islands or in other extremely isolated areas.

A few questions were asked about who I consulted as part of the six-week process. I visited University Hospital Waterford on 7 June. I gave notice that I was coming and I made no restrictions on who should be invited or who should attend. This was absolutely at the discretion of the team in the University Hospital Waterford. If it was thought that the most suitable people to attend would be patient representatives, elected representatives, journalists, clinicians and hospital managers, this was entirely at the discretion of the team from University Hospital Waterford and I placed no restriction on that. As it turned out, there was a very representative team and a very representative presentation was given. At the time, the views of the teams from both Wexford and South Tipperary hospitals were, in my opinion, well represented. I left with the strong impression that the teams from Wexford and South Tipperary hospitals were very satisfied with the support they get when they work in University Hospital Waterford, that they do very high-quality work there and that they would be more than happy to continue both this work and referring their patients to Waterford. I also placed no restrictions on how long I would stay. I arrived at about 10.30 a.m. and had it been necessary to stay until 10 p.m., I would have been happy to do so. As it turned out, the meeting finished in the early afternoon at the decision of the local team. Subsequent to that, I travelled back to Belfast, but I would have been more than happy and delighted to meet anyone from the local area who could have been invited along on that day to meet me.

The issue of the catchment area was raised a few times.