John Halligan (Waterford, Independent)
Link to this: Individually | In context | Oireachtas source

3. To ask the Minister for Health further to Questions Nos. 246 and 249 of 18 December 2013, if he will provide a guarantee that 24-7 cardiac cover will be introduced at University Hospital Waterford, UHW in the lifetime of the Government; his views that this service has been promised since 2010; the infrastructure that is currently lacking at the hospital, which prohibits the introduction of a full-time service; the plans his Department has to increase the staffing complement of consultant interventional cardiologists from its current three to six to operate a 24-7 unit; if funds have been ring-fenced to provide for this additional staffing; his further views that there is a sufficient level of care being provided to cardiac patients between the hours of 5 p.m. on Friday and 9 a.m. on Monday in the hospital; his views that no deaths will occur as a direct result of the lack of experienced cardiac cover at the weekends; the outcome of the Health Service Executive examination into options for the location of the long-awaited catheterization laboratory within the hospital; and if he will make a statement on the matter. [8166/15]

John Halligan (Waterford, Independent)
Link to this: Individually | In context | Oireachtas source

Can the Minister finally guarantee that 24-7 cardiac cover will be introduced at University Hospital Waterford in the lifetime of the Government, as promised since 2010? What infrastructure is currently lacking at UHW that prohibits the introduction of a full-time service? What plans has the Department to increase the staffing complement of consultant interventional cardiologists from its current three to six, to operate a 24-7 unit?

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

University Hospital Waterford's regional cardiology interventional suite opened in 2008 and serves a population of almost 500,000 people. 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. Staff include three consultant interventional cardiologists based at Waterford and two visiting consultant cardiologists, from Wexford and south Tipperary, who work there one day a week.

Having 24-hour emergency PCI cover requires, as a minimum, two cath labs on site. As for any complex acute hospital service, a key criterion for deciding whether a 24-hour PCI 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 volume, the number of staff required to man a 24-7 roster will not be in a position to treat the number of patients needed to maintain their skills.

A review of PCI services in Dublin is due to be completed shortly. On the completion of that process, PCI capacity and requirements in areas outside Dublin, including in Waterford, will be examined. Any decision on further provision of PCI services in any region will be based on the best interest of patients and on 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.

John Halligan (Waterford, Independent)
Link to this: Individually | In context | Oireachtas source

I am not happy with the Minister's reply. This Government and former Minister committed to a 24-7 service. The cath lab is open from Monday to Friday until 5.30 p.m. and, despite the fact that Waterford is one of the busiest regional hospitals in the country, it closes at the weekend. Lives are being lost. I was recently in contact with the Minister's office concerning one of these lives. The person is Andrew Doherty, who was admitted to the cardiac unit in Waterford last October for ten days. During that time, he had two stents implanted and was transferred to the medical ward for surgery. He began to feel chest pains on Sunday afternoon, but no doctor was called or consultant informed about the change in his condition. As it was the weekend, the cath lab was closed. The family was told not to worry and that he was having a panic attack. Mr. Doherty passed away that night, and a junior doctor whom I contacted told his wife he did not know the man's history and could do practically nothing until the consultants returned on Monday morning. Why is the Minister talking about volume when this is about people's lives? Perhaps one life can be saved over a weekend. The Minister made a cast-iron guarantee to the people of Waterford. Some 15,000 people marched on the streets of Waterford two years ago. After the march, the then Minister for Health promised a 24-hour service. Now I am looking to hear a yes-or-no answer. Will the service be provided before the end of the current term? If not, there will be another 15,000 people on the streets of Waterford shortly.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I do not know the details of the case to which the Deputy referred.

John Halligan (Waterford, Independent)
Link to this: Individually | In context | Oireachtas source

I sent the details to the Minister.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I do not have access to patients' files and I doubt Deputy Halligan does either. I think it inappropriate to raise such cases in the Dáil unless the Deputy has full access and expert knowledge of the case. I do not know whether that is the case. I may be incorrect, but at any given time in University Hospital Waterford there will be a consultant physician on call, if not a consultant cardiologist. Why the person was not called in a particular case, I cannot say.

I can guarantee that one thing that costs lives is the setting up of any specialist service that is not adequately staffed and does not have an adequate throughput to ensure quality and to ensure that those providing the service are able to keep their skills up to date. We have already seen this with cancer services, which is why they had to be centralised. In order to be viable, a 24-7 PCI service must serve a population of 500,000 to 1,000,000 people and it must also have at least six interventional cardiologists to provide a 24-7 cover rota. The most obvious first step in the improvement of services in the south east and Waterford is that the hours of the existing cath lab be extended, perhaps from 8 a.m. to 8 p.m., covering Saturdays and Sundays. It is important to see whether the three cardiologists are able to cover the rota. We have had problems in other parts of the country where consultant cardiologists are unable to cover the rota. It is a much greater patient safety risk.

John Halligan (Waterford, Independent)
Link to this: Individually | In context | Oireachtas source

The cath lab is closed from 5.30 p.m. on Friday until Monday. The Government prepared a business plan in the 2015 Estimates which stated that University Hospital Waterford needed an additional three consultant interventional cardiologists to enable the lab to operate on a 24-7 basis. The hospital recently sought funding for these, and the total revenue cost, according to the Government, was €2.7 million. We are now being told that the cost benefit analysis must take place again. The Government has already done a business plan. The former Minister for Health put together a business plan and categorically told the people of Waterford that the 24-hour service would be guaranteed. I met him in the hospital. The Minister is now saying that it may be, that he is not too sure, and that it probably will not be.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

It is not standard practice for the Government to do business plans. Maybe it was done by the hospital group.

John Halligan (Waterford, Independent)
Link to this: Individually | In context | Oireachtas source

The Government supported it. The former Minister supported it. I am sorry for cutting across the Minister. This is a very serious issue.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I will answer the question if I am not interrupted.

John Halligan (Waterford, Independent)
Link to this: Individually | In context | Oireachtas source

I apologise.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am not aware of the preparation of any business plan by the Government. Business plans for services are generally done by a hospital, a hospital group or the HSE. To ensure that lives are protected, it is important that any specialist service has adequate throughput, which means enough patients and in sufficient volume to ensure quality, critical mass and specialisation. It must also be adequately staffed. The first step in Waterford is to extend the hours of the existing cath lab, because any new cath lab will take time to build. There are currently three cardiologists. If six people can cover a 24-7 service, surely the existing three people can cover a 12-hour service seven days a week. As the Deputy should know, if he does not already, there is great difficulty in hiring cardiologists and being able to cover rotas in the way that people expect. If a rota is not covered, this results in a greater patient safety risk. An unsafe service is not a good thing. We want people to have a safe service, and it is better that people travel to obtain a safe service than have an unsafe service close by.