Professor Ken McDonald:

Senator Rose Conway-Walsh and Deputy Margaret Murphy O'Mahony asked about the hospital service component of the national clinical programme, specifically the deficit in the Cork-Kerry region but also in the midlands. They asked what the cost would be of rolling out further hospital programmes. We estimate the cost for a single unit at somewhere in the region of €400,000 which would be recurring because it would be made up predominantly by staff costs.

In developing hospital frameworks we need to take cognisance of the need for integration of care services across primary and secondary care services. A component is the consultant's cost. We need to look at having a new model of consultant in the health care system, in which they would not just be a silo in the secondary care system but cross the divide and make the boundaries somewhat fuzzy as they worked closely with GP-led primary services. I am talking about an integrative care consultant within different specialties. This is critically important and, as we develop more consultants in the heart failure programme, I would like them to take on that responsibility in order that we can improve communication which has been a common theme of the discussion.

I was asked about the capacity of the health care system to roll out a project as innovative as virtual consultation, VC, given some of the difficulties we might have with information technology. I do not want to be flippant, but if something can be roadtested by me and it works, anyone can do it because I am not the most competent in using information technology. I have been very taken by the ease with which we can run a VC clinic with general practitioners. We do not need to be worried about its complexity, but we do need to be aware of the broadband issue as such consultations are critically dependent on the availability of broadband. I completely agree that we need to focus on fast-tracking its provision. We have the capacity to roll it out once we have the budgetary support to do so.

Senator John Dolan asked what were the ingredients of a prevention strategy and how we could layer them properly. That is critically important as we develop prevention programmes in whatever area, be it heart failure or stroke. It touches on the point raised by Deputy Billy Kelleher, namely, that there is a component of prevention which is the responsibility of the individual. We need to ensure everyone is aware of what he or she needs to do to keep healthy. We should not expect the Health Service Executive to provide everything. However, we also need to drill down into the population and find who is at super risk of developing immediate problems, whether heart failure or a stroke or whatever else. We can do this more effectively now than we could have five or ten years ago. It is the basis of the StopHF project to which I referred. The name suggests it is about stopping heart failure, but it also stops other cardiovascular diseases and prevents more cases of stroke than heart failure. It does this by taking people at risk and defining whether they are at super risk by a simple, straightforward diagnostic blood test. It should be universally available across the country. At a cost of between €15 and €20, it is remarkably powerful.

The prevention of heart failure strategy which is actually a prevention strategy for cardiovascular disease has been roadtested by Dr. Michael Barry and if something can get over the cost-effectiveness hurdle put in front of it, we know that it is robust. He has looked at and signed off on it.

He has stated it is a cost-effective strategy. Again, I encourage all of us to examine this thoroughly, not simply in respect of the national clinical programme for heart failure but also the chronic cardiovascular disease programmes in general.