David Stanton (Cork East, Fine Gael)
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I thank the Ceann Comhairle for selecting this issue. I also thank the Minister, Deputy Varadkar, for coming to the House to deal with the need for a specialist heart failure unit in Cork, an issue I have raised a number of times in recent weeks.

Last Tuesday, 15 December, I attended the launch of the report entitled, The Cost of Heart Failure in Ireland, which was produced under the auspices of the Irish Heart Foundation and presented by Mr. Brendan Kennelly of NUIG, who is a health economist. It makes for graphic reading. According to that report, the cost to Irish society of heart failure is €660 million per annum, which is a concern. The report also states that heart failure can be addressed at community level. The direct cost of heart failure to the HSE is €158 million. Some 90,000 people are affected and a further 160,000 have impending heart failure. Heart failure hospital admissions accounted for 8% of HSE inpatient bed days in 2012. The total annual bed days taken up for heart failure is more than 230,000 and the average length of stay is 11 days. The condition accounted for more than 40% of all cardiovascular disease bed days and 35% of inpatient stays during 2012. One in five people over the age of 40 will develop heart failure in their lifetime and it is set to become an epidemic due to an ageing population.

The report also estimates that nearly 4,500 patients are admitted to public hospitals with heart failure as their primary diagnosis each year,while heart failure accounts for 30% of all readmissions related to cardiovascular disease. Dr. Angie Brown of Irish Heart Foundationsaid at the launch that during 2012, 537 people had died as a result of heart failure. It is a huge health concern in Ireland and, worryingly, only 7% of people can identify the common signs of heart failure, with people often mistaking them for the signs of ageing.

There are currently 12 heart failure units operating across the country, six of which are located in Dublin at St. Vincent's hospital, Tallaght hospital, St. James's Hospital, the Mater hospital, Beaumont Hospital and Connolly hospital. There is also one heart failure unit in Drogheda, Wexford, Galway, Cavan, Sligo and Limerick. There is no heart failure unit in the south, which is the reason I have raised this issue today. Cork University Hospital provides a tertiary referral service for cardiology and cardiothoracic surgery to the southern region. I am told that there were to be two heart failure units in Cork, one in CUH and the other in the Mercy hospital but that this was put on hold in 2010-2011 to focus on the development of a unit in CUH. A limited heart failure clinic was established in Cork University Hospital in April 2008 from within existing resources. However, this service is verylimited in scopebecause of a lack of dedicated resources. It operates from the rapid access chest pain clinic, RACPC, located at level 3C, cardiac renal centre, CUH. Between ten and 15 follow up heart failure patients are reviewed per week. There is no dedicated inpatient heart failure service and no new heart failure patient referrals have been accepted to the clinic since August 2011.

Due to nursing and wider resource challenges and the negative impact the heart failure clinic was having on chest pain clinic activity and patient wait times, a dedicated heart failure service was a key priority of the HSE national acute medicine programme and the CUH service plan in 2011.I was advised by the HSE that the recruitment embargo prevented its implementation in CUH.How is it that opening of the units in other parts of the country were not affected by the recruitment embargo? As I said, there is no heart failure unit across the southern region. Will funding for various positions be made available or has such funding already been made available but was not spent? It would be a serious matter if that was the case. I would like an answer to that question. I understand that submissions on a heart failure unit have been made in respect of the 2016 service plan and that resources for a unit in CUH is the number one priority in this submission.

I was advised by the Minister recently that he is not in a position to commit funding. I reiterate that this is a very serious matter. The service could save money because many of these issues can be dealt with in the community. I look forward to the Minister's response and hope it is positive.

Leo Varadkar (Dublin West, Fine Gael)
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I thank Deputy Stanton for raising this subject and for giving me the opportunity to speak on it in the House. The tertiary referral service for cardiology and cardiothoracic surgery in the south is provided at Cork University Hospital, CUH. This includes extensive interventional cardiology services and a 24-7 cardiac catheterisation laboratory. In 2010, following an €85 million investment, the cardiac renal centre opened at CUH. This facility spans some 13,000 sq. m over six floors and was a very significant service development for the region. In 2008, CUH established a heart failure clinic. I am aware of the limitations of the current service. However, funding and service development priorities for the region must be considered in the context of the strategic plan for the south-south west hospital group. It will be up to the group to decide on its priorities for developments in the years to come.

Speaking more broadly, I welcome the publication of the report, The Cost of Heart Failure in Ireland. This report advises on future policy and direction for heart failure services. As the report acknowledges, more than half our hospitals have dedicated inpatient and outpatient heart failure services. However, it also notes that these services are not distributed evenly across the country. The report's findings will inform the HSE's national clinical programme for heart failure in its work on service development. This work will build on its previous service developments. Integrated management programmes covering primary care and hospital services are very important for the successful treatment of heart failure. They can produce significant reductions in hospitalisation for patients and achieve better quality of life and outcomes.

The Department of Health's Changing Cardiovascular Health: Cardiovascular Health Policy 2010-2019 was launched in 2010. Following this, the HSE established three key clinical cardiac programmes, namely, the acute coronary syndrome programme, the stroke programme and the heart failure programme. Through these, significant improvements have been made on access to acute treatment for coronary disease.

The HSE's national clinical programme for heart failure aims to reorganise the way heart failure patients are managed by: identifying heart failure early, in the primary care setting or in general practice ideally; intervening early by supporting GPs in primary care; developing specialist care teams, so expertise is available at primary and secondary care level, to manage and prevent deterioration, including acute exacerbations and emergency presentations; and developing the heart failure cardiac rehabilitation service nationally, for self-management support to patients and secondary prevention of deterioration and complications.

It is intended that in 2016 there will be a national needs assessment of heart failure cardiac rehabilitation services. A significant amount of important work for patients living with heart failure has been done under the programme and I am confident, with the momentum that will be generated by this report, that this will continue.

David Stanton (Cork East, Fine Gael)
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The Minister might let me know, now or another time, if funding was available in the past for this particular unit and, if so, why it was not spent. If it was not spent, that is another story.

The Minister has admitted that this service in CUH is very limited. The whole of the south of Ireland does not have the kind of service that is available in Dublin and that is quite worrying. In the long term, this service would save money and, more important, lives. As I said earlier on, 90,000 people currently suffer from heart failure. Some 160,000 are at risk of impending heart failure. It is estimated that we will have more than 10,000 new cases of heart failure each year. Only 7% of people can identify the common symptoms of heart failure and one in four people with symptoms will wait a week or more to seek medical advice or will not seek medical advice at all. Some 84% of people have incorrectly thought people with heart failure live longer than those with cancer or who have suffered a heart attack or stroke. Heart failure causes more deaths than breast cancer and bowel cancer.

This centre is needed urgently in CUH to serve the southern region. Will the Minister use his influence and resources to set it up? It will, in the long run, save money and, more important, lives. I was amazed to learn that the whole south of the country does not have this service while other parts of the country do have it. There are six such units in Dublin. Why was it not done in Cork? More important, however, is that we should now get it done. I urge the Minister to make contact with the hospital group and to support it and give it what it needs to get the service established as soon as possible.

At the launch of the report, a heart failure patient spoke about the difference that the availability of a heart failure unit made to his life. This unit is in Dublin and is led by Professor Ken McDonald, who also spoke at the launch. This is something which should be done urgently. It is very important and it would save money and lives.

I thank the Minister for being here and wish him and the Leas-Cheann Comhairle a happy Christmas.

Michael Kitt (Galway East, Fianna Fail)
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Go raibh míle maith agat, a Theachta.

Leo Varadkar (Dublin West, Fine Gael)
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I do not know if funding was made available in the past or whether it was spent. If it was made available, I have not been so informed but it may have been some time ago.

The recruitment embargo no longer exists and some 4,000 staff were hired in the health service in the past year. We are not back to where we were but we are not far off it. At the rate we are going, we will be there in the next year or two. It is acknowledged that the heart failure clinic in CUH established in 2008 is very limited. It was established using existing resources and operates from the rapid access chest pain clinic in the Cardiac Renal Centre. I am told that between ten and 15 follow-up heart failure patients are reviewed each week.

As is always the case, health care always faces competing demands. The next Topical Issue concerns funding for stroke rehabilitation and the one after it concerns approving a medicine for a particular type of cystic fibrosis. It is never a case of whether to do something or not but rather opportunity cost and prioritisation. In the context of the budget for that particular region, it will be up to the hospital group to assess all of its different needs and priorities across the region, prioritise them and work out which ones will be done first. I have no doubt that all these things will be done in time but everything cannot be done now. I only wish it was so.

I acknowledge Deputy Stanton's particular interest in this issue. He has spoken to me about it privately on other occasions. I am sure it will be done but I cannot say exactly when. I return the compliment and wish him the best for the Christmas and new year break.