Dáil debates

Thursday, 5 July 2012

4:00 pm

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Labour)

I thank Deputy McHugh for raising this matter. I am responding on behalf of the Minister for Health, Deputy Reilly. The Deputy has raised the important issue of how we organise our health services to ensure we have safe and consistent treatment for patients throughout the country in a way that is affordable. This is being tackled through the clinical programmes and through the reorganisation of our hospital system and the establishment of our hospitals into groups. One of the issues which will be taken into consideration in the formation of hospital groups is the availability of services in Northern Ireland and any opportunities that exist for synergies. Decisions such as this will not be taken on a stand-alone basis. In the case of the development of standards for acute coronary care, the national clinical programme for acute coronary care syndrome has designed a streamlined approach to the treatment of all patients with the varying forms of acute coronary syndrome. It has also developed a standardised pre-hospital protocol for response, triage, treatment and transport of patients with these syndromes.

Every patient with an acute coronary syndrome should be diagnosed correctly and without delay and then managed according to the national protocol. Acute coronary syndromes are divided into three broad categories: ST elevation and myocardial infarction, STEMI, or full-blown heart attack; non-STEMI or threatened heart attack; and unstable angina. It is recognised internationally that STEMI's are best treated in a centre of excellence where the patient can be taken to a cardiac catheterisation laboratory and the blocked vessel opened. A primary percutaneous coronary intervention, PPCI, centre is a major cardiology centre that has at a minimum two cardiac catheterisation laboratories, at least five interventional cardiologists and 24 hour, seven day on-call staff including medics, nursing, technical and radiography staff. Given current resources these centres are placed in Galway, Dublin and Cork. The number of STEMIs per annum is small, approximately 2,000, and therefore the number on average that present to Letterkenny General Hospital is of the order of one every nine days.

The creation of hospital groups and trusts is at the heart of the Government's reforms of the acute hospital sector. It is integral to a stronger and more systematic process of performance management for hospitals while ensuring clinically safe and consistent services for patients.

In June the Minister announced the appointment of Professor John R. Higgins to work with the special delivery unit in the role of chairperson of a strategic board to assist the Department of Health in the design and establishment of hospital groups. As chairperson, he will have a key role in progressing the creation of hospital groups which, the Minister envisages, will be set up quickly on an administrative basis. Initial meetings with stakeholders, including meetings between Professor Higgins and each public hospital, have commenced and will continue during the summer. Representatives from Letterkenny General Hospital have been invited to meet Professor Higgins and the strategic board shortly as part of the consultative process and its inclusion in a specific hospital group will emerge from this process.

Following this process, hospitals will be allocated to groups on an administrative basis. Work will commence on governance and management frameworks for hospital groups, aligned to the recommendations of the HIQA Tallaght report. It is not anticipated that independent hospital trusts will be established until 2015, because much development is required in other areas, including universal health insurance and the underpinning legislation to create a comprehensive and robust system of efficient health care and safe patient care.

The need for a cardiac catheterisation laboratory in the north west is fully accepted. One important issue is to ensure that the potential for cross-Border patient flow in respect of acute services is exploited to the greatest extent feasible subject to the agreement of both jurisdictions. In this respect I am satisfied that the Minister has recently agreed a formal process for ongoing engagement with the Northern Ireland Department of Health and the Health and Social Care in Northern Ireland service and the terms of reference are being finalised. The decision on the location of the cardiac catheterisation laboratory will be made in the context of the establishment of hospital groups, taking into account the cross-Border synergies.

I commend the commitment of the Friends of Letterkenny General Hospital who, as Deputy McHugh has noted, have made a major contribution to service developments in the hospital and to the people of Donegal during this period. I thank him for raising the matter.

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