Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I will first address the Deputy's last concern regarding dermatology services. There are three approved permanent consultant dermatologist posts at UHW. As rightly pointed out by the Deputy, one consultant is currently on maternity leave but is due to return to work on 25 March. Interviews to fill the other two posts were held on 25 February and two successful candidates are currently being processed by the national recruitment service. University Hospital Waterford is optimistic that contracts for these posts can be agreed in the coming months. I will do as much as I can to ensure this is done as speedily as possible. I do not propose to repeat what the Deputy said in regard to the special arrangement with the South Infirmary-Victoria University Hospital, Cork, for urgent dermatological referrals. The two new posts at UHW, when filled, will have a significant impact on services. I will do my best to ensure the process, including vetting and so on, is completed as quickly as possible.

I thank the Deputy for raising the issue which I assumed to be in relation to cardiology services in Waterford. The report on the establishment of hospital groups as a transition to independent hospital trusts noted that the cardiology service at University Hospital Waterford, UHW, should be extended. The hospital's regional cardiology interventional suite opened in 2008. In 2012, the suite was identified as the designated primary PCI centre for the region, under the national clinical programme for acute coronary syndrome. Its services cover Waterford, Kilkenny, south Tipperary and Wexford. The centre currently has one catheterisation laboratory, which operates five days a week and incorporates a dedicated six-bed cardiac day ward. Staffing includes three consultant interventional cardiologists based at Waterford and two visiting consultant cardiologists from Wexford and south Tipperary, who work there one day a week. I understand that a business case, prepared by UHW, for the development of a second catheterisation laboratory and a 24-hour PCI service, is under consideration within the south-south west hospital group. The development of a second catheterisation laboratory is, I believe, considered a priority within the group.

In regard to the suggested extension of the PCI service to a 24-hour service, for any complex acute hospital service, a key criterion for deciding whether a 24-hour service should be provided is whether there is a sufficient volume of appropriate activity to ensure safe provision of the service to patients. Without sufficient throughput of patients, staff engaged in the service will not be able to maintain their skill levels. This could put patients at risk. lt is my understanding that under the acute coronary syndrome programme to be viable, a 24-7 PCI service must serve a population of 500,000 to 1,000,000 people, which requires at least six interventional cardiologists to staff the necessary roster. It is worth noting that the acute coronary syndrome programme is of the view that the current population base covered by UHW does not provide for a viable 24-7 service. I am aware that the consultants currently providing the existing service have indicated their willingness to work extra hours to facilitate the extension of the current nine-to-five service, and I welcome their commitment. However, this would also require the provision of additional specialist support services provided by radiographers, nurses and cardiac technicians, with considerable additional revenue costs. I take on board what the Deputy had to say in relation to the extra cost. A review of PCI services in Dublin is due to be completed shortly. On completion of that process, PCI capacity and requirements in areas outside Dublin, including Waterford, will be examined. Any decision on further provision of PCI services in any region will be based on the best interest of patients, evidence on the volume of clinical need, the quality and safety of the service that can be provided, the ability to staff it safely and the resources available.

I know that my response in relation to additional cost is cold comfort to the Deputy. I will find out exactly what is the additional cost. It is hoped that following the review of the PCI services we will be able to progress the case highlighted on numerous occasions by the Deputy. It is not that we are ignoring it. Patient safety is paramount. When the Deputy highlights cases of people having died for lack of a service that must also be taken into consideration.

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