Seán Kyne (Galway West, Fine Gael)
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I thank the Office of the Ceann Comhairle for selecting this matter. As the Minister of State will be aware, yesterday was World Heart Day and it was fitting that in Brussels the heart failure policy network launched a policy toolkit to tackle heart failure. The aim of the heart failure policy network is to create a lasting network of politicians working with other stakeholders to lead significant policy changes to improve the lives of people with heart failure in Europe. Ireland has two representatives on the network, myself and Niall Johnson, the chief executive of Croí, the west of Ireland cardiac foundation, an organisation which undertakes excellent work in the region.

The Minister of State will already know that heart failure is a chronic condition that often requires inpatient hospital treatment. It occurs when the heart is unable to pump enough blood to meet the body's need for oxygen and important nutrients. The condition affects at least 15 million adults across Europe and one in five people is at risk of developing the condition. In Ireland, over 90,000 individuals live with the condition, which is responsible for between 600 and 700 deaths annually. Most important is the increasing prevalence of the condition, with thousands of new diagnoses each year. In fact, heart failure is the leading cause of hospitalisation among those over 65 throughout Europe and accounts for 5% of all acute hospital admissions. Unsurprisingly, this is a condition which has a huge negative impact on people's lives and on quality of life.

For too long heart failure has been the forgotten condition in health policies, despite the economic impact on health care and the terrible burden caused by people with the condition. However, we can change this and the policy toolkit provides ten priority actions backed up by clinical evidence and the views and experiences of patients and it sets out the economic case for change. We need to make heart failure a national health priority. We can do this by establishing a national strategy, increasing public and clinician awareness of the condition and investing in reliable data to support policy decisions. We also need to ensure timely diagnosis, which can be achieved by providing specific training for medical staff. We need to introduce multidisciplinary person-centred care which would include treatment plans that were consistent and available nationally, dedicated follow-up care with specific points of contact for patients and outpatient care to help avoid further hospital admissions. All patients with heart failure should be offered a personalised long-term care plan to help them manage their condition and we need to expand primary care to include medical staff trained in heart failure in order to facilitate care for people in their communities.

I welcome the work that has already been undertaken with the heart failure programme. The objectives and aims of that programme readily complement the heart failure networks and the programme is certainly going in the right direction. However, the most recent update of the programme was in 2012 and while some hospitals were taking part, they are mainly located on the east coast. I firmly believe that, with a renewed effort, we can successfully meet the challenges posed by heart failure. I attended the launch of the policy toolkit in Brussels yesterday and a wide variety of politicians and clinicians from across Europe were present. This is not an issue that is peculiar to Ireland but is common throughout European and the condition impacts upon some 15 million people. Patients from Italy and France who had suffered heart attacks and heart failure and who were not given any follow-up or long-term personalised care plans spoke about their conditions. There is a great need to develop the toolkit strategy and we have a marvellous opportunity to do so.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising this issue. He is correct about everything he said. It is not just an Irish problem, but, indeed, an international problem. Europe does well when member states do things together. World Heart Day was founded in 2000 to inform people about heart disease and its prevention. This year the theme is creating heart healthy environments. The day is intended to spread awareness that premature deaths from cardiovascular disease can be avoided if the risk factors, including tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol, can be controlled. I am sure the Deputy heard all about this yesterday. Healthy Ireland provides a framework that supports heart healthy environments. It includes strategies on tobacco and alcohol. The Department is currently revising its healthy eating guidelines and is developing an obesity policy and action plan, which will be finalised this year. The Department's Changing Cardiovascular Health: Cardiovascular Health Policy 2010-2019 was launched in 2010. Subsequent to that, the HSE established three key clinical programmes for acute coronary syndrome, heart failure and stroke.

Significant improvements have been made with regard to access to acute treatments for coronary heart disease and heart failure as well as the development of stroke units across the country. Heart failure, HF, is one of the major chronic diseases in Ireland today and is one of the commonest reasons, as the Deputy pointed out, for hospital admission in the elderly, often requiring a prolonged stay. It is recognised that integrated management programmes for heart failure, encompassing primary care and hospital services, can produce significant reductions in the need for hospitalisation and achieve better quality of life and outcomes for patients.

The HSE's national clinical programme for heart failure aims to reorganise the way heart failure patients are managed. Recent developments include structured services of acute heart failure. Such services have been established in 11 hospitals as national heart failure units. These sites have introduced a structured specialist hospital service for patients presenting with acute heart failure, including post-discharge follow up. They deliver an integrated service through the model of care developed by the national clinical programme for heart failure, which follows international best practice.

A new diagnostic clinic in the Gorey-Wexford-St.Vincent’s University Hospital Group provides direct access for general practitioners to specialist blood tests and echocardiography in the community with remote specialist advice on echocardiography results and specialist review of patients in the community when required. This improves access for patients to diagnostics and specialist advice. A heart failure integrated care demonstration project in the Carlow-Kilkenny region is planned to commence shortly. It will demonstrate integration between primary care, secondary care and the hospital group. This uses existing e-health technology and will strengthen patient self-care with enhanced nursing supports and training.

Co-ordinated care between primary and secondary care will provide rapid access to specialist opinion and will support identification of heart failure patients in GP practice. It will also provide specialist day care advice to general practice for rapid but non-urgent cases. Appropriate use of specialist advice and avoiding need for hospital and outpatient attendance has been a key target of this programme. Recognising that giving GPs access to senior specialist advice in a structured and timely manner will avert the need for OPD and emergency department referral, led to the development of a consultation service where GPs, practice nurses and specialist staff interact using web conference technology to discuss and manage cases collaboratively. This also allows simultaneous education for the health care professionals as they discuss relevant cases. I will deal with the Deputy's other questions in my supplementary reply.

Seán Kyne (Galway West, Fine Gael)
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I thank the Minister of State for her reply. I welcome the contents, particularly in the context of the national clinical programme for heart failure. The health failure policy toolkit can have a role in this. It has been rolled out across Europe and there should be liaison on this. I intend to follow up with the Department on this.

As the Minister of State has acknowledged many times, there is constant negativity around our health services and the negativity is so pervasive and persistent that it often overshadows and ignores the thousands of positive outcomes every day in every hospital and primary care unit. The negativity is bound to affect staff morale, etc. but it cannot be used to detract from the task before us. Ensuring the health service is efficient and provides timely, effective treatment is a mammoth task. I acknowledge the Department's role and the demands it faces regarding all illnesses and conditions. It is difficult to decide on how to allocate resources, particularly when there is constant strain on the national resources.

Under the national cancer strategy introduced by a previous Fine Gael-Labour Party Government in 1996 and its successor, which was published in 2006, cancer services have been transformed and, therefore, I hope a unified approach to heart failure can be adopted throughout the country and across Europe, which takes on board best practice and the best models. The health failure policy toolkit can work and there should be credit where credit is due. The strategy on cancer care under the former Minister, Mary Harney, has worked in many ways and has contributed to improved outcomes. Ultimately, the improvements in cancer outcomes have proven beyond doubt the positive benefits of the development and use of clear national strategies. I hope this can be done for heart failure. I urge the Minister of State to take on board the contents of the policy toolkit and development strategy for tackling this condition in conjunction with that has been planned and rolled out. As our population ages, this condition will become more prevalent and it will cause more serious issues, including financial problems, which will land on the desks of the Department.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising this significant issue. Three of the 11 hospitals involved are outside the greater Dublin region - Wexford, Cavan and Sligo. I agree with him there should be services in every significant area of population. I constantly say that the solution to overcrowded hospitals is within primary care and this is where this programme needs to go. This morning, we launched the diabetes in primary care programme, which will be delivered throughout the country in a primary care setting. It is about the management of a chronic disease and this is where the heart failure programme needs to go as well. That is where it is heading and we will increasingly provide for the management of chronic conditions in the primary care sector, of which HF will be one. I do not believe in the doomsday scenario, nor does the Deputy, but one must make one's case. If Healthy Ireland has an impact on how we live our lives and ensures we do not end up with heart failure because of alcohol abuse, tobacco use or inactivity, the future will be much brighter. However, a significant cohort will always end up with HF and we need to ensure they are managed in their communities where they feel most comfortable and where they are best known. The acute hospital should be a last resort.