Billy Timmins (Wicklow, Independent)
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I appreciate that the Minister for Health is not available, but I hope that the Minister of State will pass on my points. County Wicklow may be the only county that has never had a general hospital. As a result, the area has historically been served by hospitals in Naas, Tallaght, Loughlinstown and, in some cases, the general hospital in Wexford town. This has led to a fragmented service, one that may not always have had the confidence of the public.

In recent years and in conjunction with the former Tánaiste, the area's elected representatives and I have met the HSE and the National Ambulance Service with a view to reconfiguring the emergency services in north-east Wicklow, moving them from Loughlinstown to St. Vincent's University Hospital. Sometime last week or the previous week, clinical directive 03/2014 was issued by the National Ambulance Service to the effect that the emergency services at St. Vincent's would no longer be available for people suffering cardiac arrest in County Wicklow and that they would be required to go to the nearest primary percutaneous coronary intervention, PPCI, unit. My understanding is that there are only two such units in Dublin - St. James's Hospital and the Mater hospital. This would result in an additional journey of 20 or 30 minutes, depending on traffic.

That this directive was made caused consternation locally, as did the fact that it was impossible to establish who had made the decision or its basis. Once again, no one in the HSE was responsible. How was this clinical directive issued and what was its basis? According to the directive, the service was to cease indefinitely with effect from 16.00 hours on 7 November. After the pandemonium and the hullabaloo that were kicked up, an amending directive was made to the effect that the service would be restored from this Tuesday onwards.

How did all of this happen? In any future reconfiguration, the PPCI unit in St. Vincent's should remain open to cardiac arrest sufferers in south Dublin and north-east Wicklow.

Aodhán Ó Ríordáin (Dublin North Central, Labour)
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I thank Deputy Timmins for raising this important matter. The national clinical programme for acute coronary syndrome aims to increase the percentage of ST-elevation myocardial infarction, STEMI, patients who get PPCIs by ensuring that patients are being taken to the right place, their treatment is standardised and processes are in place to ensure prompt investigation of all acute coronary syndrome patients. Under this programme, St. Vincent's University Hospital, St. James's Hospital and the Mater Misericordiae University Hospital operate as designated PPCI centres for the greater Dublin area on a 24-hour, seven-day per week basis.

The HSE has advised the Department that, unfortunately, a premature decision was taken last week to withdraw St. Vincent's University Hospital as a 24-7 PPCI centre without the normal notifications to relevant stakeholders. This resulted in a temporary suspension over last weekend of ambulance transfers to St. Vincent's for patients suspected of having STEMI. From 4 p.m. last Friday until 8 a.m. on yesterday, ambulances were instructed to take confirmed STEMI patients in the greater Dublin area to either of the other two 24-7 PPCI centres - St. James's Hospital and Mater Misericordiae University Hospital. The HSE has confirmed that three patients suspected of having STEMI who would have been brought by ambulance to St. Vincent's over the weekend and Monday were transported by ambulance to St. James's Hospital for appropriate treatment. All patients who presented directly to St. Vincent's with suspected STEMI were able to avail of PPCI in St. Vincent's 24-7, if deemed clinically necessary. I am happy to report that St. Vincent's resumed its 24-7 PPCI service at 8 a.m. on Tuesday, 11 November.

A redesign of the PPCI programme, particularly the out-of-hours service, is under way within the HSE. The HSE acute hospitals division, in collaboration with the acute coronary syndrome programme and the National Ambulance Service, will enter into discussions with all Dublin hospitals currently delivering PPCI with a view to devising the most effective and sustainable model of care for PPCI in the region.

Billy Timmins (Wicklow, Independent)
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Wicklow has an organisation called the community first responders. It comprises approximately 400 or 500 volunteers based in various locations who assist the ambulance service. When a call is received concerning a cardiac arrest, an ambulance may be dispatched from Townsend Street, but a local volunteer who has been trained to an acceptable standard is also called to the patient's location via a central number. It is a fantastic scheme, it is chaired by Mr. John Fitzgerald and it has been running for almost ten years.

A previous health Minister committed to rolling out the scheme countrywide, but that has not happened. Instead, it has taken off sporadically in some places. It requires little or no funding from the HSE. Will the Minister of State ask the Minister for Health to examine Wicklow's scheme with a view to rolling it out to areas, especially isolated ones, where emergency services are not available? A scheme was set up in Bray, a large town fairly close to Loughlinstown and St. Vincent's, nine or ten months ago and has already received more than 100 call-outs and saved lives around the county.

The Minister of State mentioned that a premature decision had been taken. This is where the difficulty arises. How was an individual able to make a decision to cease the service without going through the appropriate channels? The service would have been ceased indefinitely if not for the issue being raised. A system of accountability for establishing who is responsible for certain decisions does not seem to be in place in the HSE. This is unacceptable. While I accept that Deputy Ó Ríordáin is not the Minister, his reply was unsatisfactory. How are we to know that this situation will not recur if his reply did not outline the shortcomings in the first instance?

Aodhán Ó Ríordáin (Dublin North Central, Labour)
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The Deputy raises a valid point. I will be sure to relay to the Minister his concerns as well as Deputy Kelleher's two points about health issues in his constituency and those disadvantaged areas nationally with a higher proportion of people who suffer cancer. Deputy Timmins has raised issues and deserves a comprehensive response from the Minister concerned. I will endeavour to ensure that he receives it.