Joe McHugh (Donegal North East, Fine Gael)
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I welcome the Minister of State, Deputy Shortall. I acknowledge the role of the Friends of Letterkenny General Hospital in raising €500,000 of necessary funds towards a cardiac catheterisation laboratory in Letterkenny. The group intends to raise a further €700,000 to bring the total funding to €1.2 million. This represents a vast amount of fund-raising. This is an example of the positive effort of so many groups throughout the country. They are aware of what is needed in a particular area and they are willing to put their shoulder to the wheel.

The group is not working separately but in conjunction with management and consultants. This is not a separate fund-raising initiative. The United Kingdom NHS has pointed out that in 2015 there will be a significant deficit in cardiac catheterisation capacity in Northern Ireland. Letterkenny General Hospital has the only HSE-employed interventional cardiologist in the north west. Funding has been approved for a second cardiologist there. It has the capacity to build on an existing strength. The danger with cross-Border co-operation and all the associated challenges is not to acknowledge the strength of one particular hospital. Altnagelvin Area Hospital has its strengths and Letterkenny General Hospital has its strengths. There is a real opportunity here to build a critical service that will facilitate not only the population of Donegal or north Leitrim but also patients from Derry to Tyrone.

When we discuss cross-Border synergies and co-operation it is important to place a value on the existing strengths and capacities at particular hospitals. If there is an interventional cardiologist in Letterkenny, the only one in the north west, approval for a second cardiologist and community commitment and involvement in respect of fund-raising, then we should bring all of this together and tap into the goodwill. As legislators, we will not be rewarded in any way by the community if we bypass its wishes.

It is important to note the proactive role of the Minister with responsibility for health in Northern Ireland, Mr. Poots, and his close co-operation and working relationship with the Minister of State, Deputy Shortall, and the Minister for Health, Deputy Reilly. They have worked to analyse possible solutions in these straitened times. Perhaps in five or ten years time there will be a whole new landscape. Altnagelvin Area Hospital could work with Letterkenny General Hospital and Erne Hospital could work with Sligo Regional Hospital. We need to ensure at the beginning that the turf wars that have prevailed in hospitals and that will continue to prevail in future do not become the raison d'être of service provision. There is a capacity at Letterkenny General Hospital to provide this cardiology service. The team, the commitment and funding are in place as well as Government approval for a second cardiologist. We should honour this and we should be careful about how we move in the advanced co-operation between two hospitals on different sides of the Border. Everyone has the same overall objective, that is, to provide quality service for the people living in the north west.

Róisín Shortall (Dublin North West, Labour)
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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.

Joe McHugh (Donegal North East, Fine Gael)
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I thank the Minister of State for the extensive response. It is possible to read between the lines of what she has said. In fairness, the Minister of State is working within the realm of existing policy with respect to potential hospital trusts within this jurisdiction. From reading between the lines I detect an openness to considering cross-Border synergies. I have no intention of putting words in the mouth of the Minister of State. A really welcome feature of the response is that there is a broad vision not only for existing policy within the Twenty-six Counties but also for determining whether we can have some form of cross-Border co-operation.

I call on all stakeholders within hospitals - there is a lot at stake and that is why we use the term "stakeholders" - to examine the broader picture. There will be turf wars, suspicion, fear and misunderstandings, but there are opportunities. There is an opportunity to provide a high-quality service in the north west. Bearing in mind that Galway, Dublin and the southern region are facilitated, the response this afternoon implies the north west will be represented in some shape or form.

I know the Ceann Comhairle will allow me to digress a little on cross-Border co-operation. Yesterday was a significant historic day for North-South relations. The North-South Interparliamentary Association, which was set up yesterday, will be the first formal mechanism to allow communities and citizens, rather than politicians, north and south of the Border to lobby and campaign through a joint mechanism. The Ceann Comhairle is co-chairman with Mr. William Hay, whose family originally comes from Donegal. I have a personal interest in the latter's geographical connections. I congratulate the two co-chairmen, who have equal status, on their vision and for pushing forward this mechanism. It will help the Minister of State, Deputy Shortall, the Minister, Deputy Reilly, and all the other Ministers interested in cross-Border synergies to pursue realistic goals. I look forward to working with the Ceann Comhairle on the body and to continuing work with the Minister of State and Minister on cross-Border synergy.

Róisín Shortall (Dublin North West, Labour)
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The Deputy is absolutely correct that there is significant potential for a high level of co-operation between our health service and its equivalent in the North. Many of the possibilities are being explored actively. There is much potential for synergy. Just last weekend, I met two of my counterparts, Mr. McCann and Mr. Bell, on co-operation in respect of drugs and alcohol. We will be working closely in this regard. The Minister, Deputy Reilly, and I met Mr. Poots some months ago and the issue raised by the Deputy was very much to the fore. There is much potential and it is being pursued actively. I thank the Deputy for raising the matter.