Dr. Niall Herity:

As I said earlier, I would not jump to the conclusion that provision of extra physical capacity would necessarily be followed by an increased number of patients travelling to that lab who are already being well supported and serviced in the lab, as for example, in St. James’s or Cork.

Can we talk about the question, which the Deputy said I had not answered, about clinical risks and safety as well as long waiting lists? I have a waiting list and pretty much everybody I work with has one too. I saw during the week that the number of people on waiting lists across the NHS in the UK has now risen to 3.5 million. It had been as low in 2007 as 2.2 million. Unfortunately, rising numbers of people on public hospital waiting lists is not a problem unique to Ireland. It is certainly a feature of life in the United Kingdom as well.

All of us would say we would prefer nobody was on a waiting list. It does seem to be a factor of where demand outstrips available capacity across the health care system. In terms of clinical risk, one can imagine somebody who has got a diagnosis of cancer and who is waiting for potentially curative surgery. The longer they wait on a waiting list, the greater their clinical risk. Undoubtedly, that would be the case and, accordingly, what happens for cancer patients is that they get clinical prioritisation. People with cancer do not wait a long time. There are certain standards and expectations which are typically met.

The people on my waiting list would be similar to those on waiting lists for procedures in Waterford, Cork, St. James’s or anywhere. These are typically people with suspected coronary artery disease who are awaiting a coronary angiogram, which is an investigative procedure and not necessarily a therapeutic procedure. A proportion of those patients will then go on to have a stent inserted or a bypass operation. These are not life-saving procedures. There is absolutely no evidence that people who undergo stent procedures or that most people who undergo bypass operations in the elective setting are actually at any less risk of having a heart attack or dying or surviving afterwards than if they had not done so.

A small number of people on my waiting list, and undoubtedly on waiting lists in Cork and Waterford, are at greater risk. I would particularly draw the Deputy’s attention to people with aortic valve disease, particularly severe aortic stenosis, structural heart disease or people with an adverse finding from a non-invasive investigation where we think they have multi-vessel disease. In those circumstances, we apply clinical prioritisation. I do not leave someone with severe aortic stenosis on my waiting list but bring them forward because I understand the benefit. Clinical prioritisation is extremely important.

One point which has not come up which I want to draw some attention to is that when I visited both cardiology services in Waterford and Cork, I was visiting them as part of the South/South West hospital group. Separately I met with the chief executive of the hospital group. I recognise that hospital groups, as they are constructed in the Republic of Ireland, are at a much earlier and less formed stage than hospital trusts in the United Kingdom. The point about any hospital grouping is that they provide a clinical opportunity. The opportunity they provide is that one gets a critical mass of capacity available across the hospital group to do, potentially, a better job for the patients across the group. When I met with the clinicians in both Waterford and Cork, it was clear to me that at that point they had not worked out the best way to pool their combined and greatly skilled resources to do the best job for patients. I understand that in the interim there has been work between the two sets of clinicians to make best use of that critical mass and the capacity across the hospital group. I am heartened and reassured that this has taken place. I do not believe it has threatened anybody.

What that means is that certain patients on the waiting list in Waterford, particularly, are now being offered their procedures in Cork. I am seeing that, however, as a short-term measure to address the large number of people on the waiting list rather than a long-term measure to somehow divert patients away from natural patient flows. In my report, I recommended that the capacity of the Waterford lab be increased from ten to 12 sessions. That was in recognition of the increased need for the catchment population. I am heartened to see the clinicians on the ground have taken up the opportunity to combine their resources for the benefit of patients.