Jack Chambers (Dublin West, Fianna Fail) | Oireachtas source

I am raising a matter which I consider to be extremely important and which impacts on patients who are waiting for a cardiac procedure called a transcatheter aortic valve replacement. This procedure involves the replacement of an aortic valve in a less interventionist way than by means of open heart surgery. The aortic valve is replaced by a cardiologist rather than a cardiac surgeon. The valve is replaced through a femoral or other artery instead of via open heart surgery, as I have stated. The reason patients require this type of cardiac intervention is that open heart surgery has been medically assessed as being inappropriate due to the underlying medical conditions of the patients involved. For example, some of them have quite severe cerebrovascular disease, renal disease, arterial disease, underlying respiratory issues or even haematological issues. They cannot get the required treatment via open heart surgery, which was the historic means to make a cardiac intervention. That is impossible for many patients.

This transcatheter aortic valve is the solution for the patients in question. Many of them, as I have discovered through constituency representations, are not getting the intervention they need and deserve. The situation, as it currently stands, at the Mater Hospital is an illustration of total and complete management dysfunction. It is an illustration of the complete dysfunction of the Ireland east hospital group and the short-sighted, irrational and clinically dangerous allocation of resources within our health service.

The information I have received is that there are up to 18 patients who are clinically unwell and sick. They are not clinically able for open heart surgery. They are assessed as needing this valve replacement in the Mater Hospital. They have complex medical and cardiac needs and time is absolutely of the essence. The barrier, however, to them getting their required intervention is not a staffing issue, an issue with theatres or an issue of bed capacity. We have the doctors, the nurses, the theatres, the hospital and the beds. We do not have one thing: the State, the HSE, the Department of Health and the Ministers will not provide funding for more than two valves per month. The consequence of that for many patients is that they are becoming clinically unwell and sicker. Their lives are at risk as a result of an unfair management practice.

The HSE - and, by extension, the Department and its Ministers - is refusing to fund more than two of these procedures per month within the hospital is because of the cost of the valve. Patients are left lingering for months, with their lives at risk and their health deteriorating. A rigorous, irrational and completely unreasonable budgetary approach to transcatherter aortic valves means that medical and health teams that are already in place cannot make the intervention they are paid to make. Why? It is because neither the Ministers nor the HSE, as the service provider, will provide funding for the necessary equipment. As a consequence, many of these patients are in our hospitals being managed medically because their underlying symptoms are worsening and they cannot get the valve. It is the most unreasonable and irrational method of allocating funds. I accept that the valve costs more than open heart surgery. However, it is regressive, in the context of our health policy, to limit the quantity of valves when we have the teams in place. We have spoken about recruitment issues in our health service. That is not an issue in this case. The staff are there to perform the procedures and have been telling the patients that they will perform them. They have the theatres but the HSE will not provide funding. I urge the Minister of State to address this issue.

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