Ciara Conway (Waterford, Labour)
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I thank the Minister of State for taking this debate. I am very disappointed to find myself here once again. This is an issue I have raised on numerous occasions in the Dáil Chamber and at the Oireachtas Joint Committee on Health and Children. It shows how important the issue is for the people of Waterford. Two years ago, I received a letter from the former Minister, Deputy Reilly, offering certain assurances to the people of Waterford and the south east regarding the health services in Waterford. This letter came after a winter of discontent in Waterford in which we saw thousands of people take to the streets, having come from all around the south east, to show that they were concerned about a possible downgrading of Waterford Regional Hospital, as it was known then. Their fear was centred, as it is centred now, around the Higgins report, which examined the reorganisation of hospital groupings. After a lot of fear, we were promised that this would make things better. I attended a lot of meetings, and at each of these Professor Higgins promised us time and again that what we had would be protected and services would be enhanced. We were told this would be a good thing for people in Waterford and the south east. The letter from the former Minister, Deputy Reilly, said that the establishment of hospital groups would enhance cardiology cover in Waterford. It went on to say: "[T]he increased flexibility of staff across the group will enable us to achieve our goal of providing cardiology cover at Waterford Regional Hospital 24 hours a day, seven days a week."

Two years on, we are no closer to that. Deputy John Halligan, who also represents Waterford, raised the very serious case two weeks ago of a man from Waterford who sadly and tragically died because the service was not available. A second cath laboratory to provide 24-7 cardiology services is needed. We were told at the time that we would get it. I now understand that a business plan is being put together and that this would cost €1.5 million, which is only a small amount in the context of the delivery of health services. This small amount of money would copperfasten services at University Hospital Waterford, UHW. We need an around the clock service. This requires provision of a second cath laboratory and the staff required to keep two laboratories open.

There are also shortcomings at the hospital in terms of dermatology services. It is worth noting that the south east has one of the highest rates of skin cancer in the country. Currently, there is no consultant dermatologist at University Hospital Waterford. One consultant is due to return from leave at the end of the month and interviews are taking place to fill other posts. This means that the people of Waterford now have to travel from the city to the South Infirmary-Victoria University Hospital in Cork to see a consultant. I will give an example in this regard. I was contacted by a distressed family whose mother is 79 years of age and is in a great deal of pain because of a very serious skin condition. She constantly breaks out in blisters which burst which, as one can imagine, is very painful. This lady, who is almost 80 years of age, is forced to travel to Cork to see a consultant for a five or ten minute consultation. This involves a four hour round trip journey for a fragile woman. It also places extra pressure on her family, who, because there is no transport available, have to take days off work to bring her to Cork, and all for a service that should be available in Waterford. Dermatology services at University Hospital Waterford have been reduced to one afternoon clinic on a Wednesday. This is not the vibrant future that was promised to the people of Waterford. The case I highlighted is only one of the less serious cases.

I invite the Minister of State, Deputy Lynch, to read last week's Waterford News & Starwhich outlines a truly awful case of a man who almost died because of a lack of dermatology services in University Hospital Waterford. A father of two whose skin was red and bubbling arrived in accident and emergency, where he spent 18 hours on a trolley and was misdiagnosed twice. As the doctors had never before seen the condition, a conscientious nurse faxed photographs of the man's skin to the Cork hospital. The consultants there took one look at them and advised that the man be sent to Cork immediately. The irony is that although there was a consultant dermatologist conducting his Wednesday clinic in UHW, the man did not get to see him. There were no ambulances available to take this extremely sick man to Cork as, he was told, access to the ambulance service required two days notice. This man, whose life was in danger, was then put in a taxi and sent to the Cork hospital. When he got there, he was told by the hospital staff that had he spent any more in Waterford hospital he would no longer be with us.

Kathleen Lynch (Cork North Central, Labour)
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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.

Ciara Conway (Waterford, Labour)
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I thank the Minister of State for her response. I take no pleasure in raising this issue time and again. I represent the people of Waterford, who feel like they are getting a shoddy deal. We were told at the time of the Higgins' report that one of the main requirements to secure services into the future was an increased population base. In regard to the case I highlighted of the elderly woman having to attend the South Infirmary-Victoria Hospital in Cork for a dermatology service, I was told on numerous occasions by the former Minister for Health, Deputy Reilly, and current Minister, Deputy Varadkar, that the consultants would travel to Waterford, because that makes more sense than frail sick people having to make a four-hour journey in great discomfort to avail of a service they are entitled to receive on their own doorstep. We were told that with the birth of these new hospital groups we would be able to attract the calibre of consultant that requires a big population base to ensure his or her skill set is maintained.

We were assured that through the provision of services in Cork, Waterford and in the other hospitals that they would have the necessary throughput of patients to maintain their skill set to a high standard in order that they could give the best service to the people of the south east. We were promised professorships and academic posts. Could the Minister of State please indicate the current position in that regard? I would welcome an update on the partnership between University Hospital Waterford and University College Cork, UCC. To be honest, the current situation is just not good enough. The hospital is called "University Hospital Waterford", which sounds good but it means nothing. We do not have what we were promised. I understand we are in a time of limited resources but as the economy starts to improve, the Labour Party must focus on the provision of public services. I will fight tooth and nail to ensure the people of Waterford and the south east get what they deserve. As a party in government we must make real decisions about where we want to provide investment. I, for one, will support investment in public services. Currently, nurses, doctors and care assistants are currently working to the pin of their collar to ensure service provision in University Hospital Waterford, but they need the Minister's support and that of his Cabinet colleagues to ensure we get the services that are so badly required in Waterford and the south east.

Kathleen Lynch (Cork North Central, Labour)
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The two new consultants will have an impact in terms of dealing with the needs of the elderly lady and the man with the rare complaint. Inasmuch as I can, I will do my very best to ensure the national recruitment service expedites those two appointments.

I will keep an eye on the business plan that is being prepared in regard to the catheterisation laboratories. Deputy Conway is correct in that when the hospital groups were being considered the reason Wexford, Kilkenny and all of the other areas were brought together was to provide the required population base, because it is important that consultants in particular specialties have the required throughput on an ongoing and continuous basis, as that is what makes them expert in their field. The people delivering the service in Waterford at the moment are doing an incredible job. The unfortunate difficulty is that they are not there for long enough and they are not there at weekends. As Deputy Conway correctly pointed out, as the economy improves we will have to examine the issues that directly affect people.