Tony McLoughlin (Sligo-Leitrim, Fine Gael)
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I thank the Ceann Comhairle for selecting this important matter for discussion. I am seeking clarification of the Health Service Executive's plans to deliver a fixed cardiac catheterisation laboratory at Sligo University Hospital in 2017. I have had previous discussions and correspondence with the Minister on this matter, which is of the utmost importance to people in the north west, including those I represent in the constituency of Sligo-Leitrim. A quick glance at a map of Ireland illuminates how people living in the north west are being left behind in terms of access to this life-saving cardiac service. The major question at issue when a person presents at a hospital with an urgent cardiac arrest or other emergency cardiac illness is whether transport to a primary percutaneous coronary intervention, PCI, centre is available within the recommended 90 minutes. For patients in the north west, there is not a simple "Yes" or "No" answer to this question, as is often the case in our region. The answer, unfortunately, varies from day to day and on a case-by-case basis, depending on whether or not the emergency helicopter transport service is available from Sligo at the time. If it is not available or is out on a call, often the only option available is to give the cardia arrest patient thrombolytic treatment followed by an urgent ambulance transfer by road to either Galway or Dublin for emergency treatment.

Having spoken to the senior consultant cardiologist at Sligo University Hospital, Dr. Donal Murray, this is unquestionably having an effect on the levels of cardiac mortality in the region. This tragic reality of the situation must be addressed this year as a matter of urgency. It is estimated that more than 50 patients per year are presenting at Sligo University Hospital in need of urgent attention for an ST-segment elevation myocardial infarction, STEMI, which is the most dangerous type of cardiac arrest. At this time, 50 cardiac patients at Sligo face that uncertainty. A further 150 patients present at the hospital with non-urgent STEMI heart attacks which require treatment outside the region. More than 1,000 patients every year need angiography services which cannot be provided at the hospital.

One of the key challenges in accessing primary PCI care in the north-west region is that the road network is not of the same standard as it is on the east coast or in the south. For example, it takes a minimum of two hours to travel from Sligo University Hospital to Dublin by ambulance. It takes the same length of time to get to Galway by road, but the journey by helicopter is 80 minutes. Therefore, the only option for patients in the region is via air travel to Galway. On that basis, Sligo needs a fixed cardiac catheterisation laboratory with three consultant cardiologists. People living in Sligo, Leitrim, north Roscommon, south Donegal, north Mayo and west Cavan have as much right to access this service as do the people of Galway, Cork, Dublin and Waterford. We have a combined population of more than 240,000 people, who must, as it stands, leave the region for care. Sligo University Hospital is the perfect location for the service given its position between the other primary PCI centres in Galway and Derry. Sligo has a proven track record in innovation, staff recruitment and clinical governance in this field and was the first hospital in the country to establish a mobile catheterisation laboratory service. That is no longer adequate and it is time to upgrade to a fixed service, which will require a minimal capital investment. Doing so would mitigate the impact of the lack of primary PCI care in the region. If the service is not delivered this year, 2,000 patients will have to leave the region for cardiac procedures, which will undoubtedly lead to increased cardiac mortality.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank the Deputy for raising this matter, which has been of concern to him for a long time. He has been consistent in raising it with the Department and the HSE on behalf of his constituents.

Sligo University Hospital is currently served by a mobile cardiac catheterisation laboratory which provides services on one day per week for elective procedures. In terms of cardiac services in the north-west region, a cross-Border cardiology service was established in early May 2016, which provides emergency primary PCI services for the treatment of patients from County Donegal with a diagnosed heart attack. at Altnagelvin Area Hospital in Derry. From May through to 20 December 2016, 23 patients from County Donegal received treatment under the scheme. Following admission and emergency treatment in Altnagelvin Area Hospital, patients are repatriated to Letterkenny University Hospital or Sligo University Hospital, depending on which is closer to their homes. The new service runs very efficiently and is of major benefit to very sick patients living in the north-west region.

Any proposal for the further development of cardiac catheterisation laboratory services at Sligo University Hospital must first be considered from a hospital group perspective and in the context of planning for the cardiology needs of the population cared for by the Saolta University Healthcare Group. During 2017, each hospital group will he required to develop a strategic plan setting out how it proposes to organise services to provide optimal care to the population it serves and how it will achieve maximum integration and synergy across local health services, including primary and community care. The Department of Health has developed a draft document, Guidance on Developing Hospital Group Strategic Plans, which will he circulated to hospital groups in due course. In addition, any further development of cardiac catheterisation services at Sligo University Hospital must be considered in a national context and in the light of the competing demands for scarce resources.

The Government is committed to prioritising waiting lists in 2017. Acknowledging the challenges in scheduled care provision, budget 2017 makes specific provision for the treatment of longest-waiting patients. An allocation of €20 million is set aside for the National Treatment Purchase Fund, NTPF, in 2017, rising to €55 million in 2018. In December, my colleague, the Minister for Health, granted approval to the NTPF for the first tranche of funding, in the region of €5 million, for an initiative focusing on day case procedures. The Minister has asked the HSE to develop an inpatient and day case waiting list action plan in conjunction with, and supported by, the NTPF's proposal for utilisation of the remaining €10 million of 2017 funding for patient treatment. Further, the Minister wrote to the director general of the HSE earlier this week in regard to waiting lists, with a specific request that priority be given to the development of a cardiology waiting list initiative in 2017. In the coming weeks, the Minister expects to receive a waiting list action plan from the HSE, which will include a cardiology waiting list initiative. That initiative will address cardiology waiting lists in a number of hospitals, including Sligo University Hospital.

Tony McLoughlin (Sligo-Leitrim, Fine Gael)
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The Minister of State's response does not address my concerns. There is a clear case for Sligo University Hospital having the required population for the service to be viable, and it makes sense in terms of geography, medical need and finances. Over a ten-year period, there would be a net saving of €3.6 million if the service were introduced. I have the facts and statistics to back that up.

When one looks at the map of this country to see the areas that are covered - the Minister of State mentioned about Altnagelvin in Derry - some of the patients, certainly, in south Donegal, are coming to Sligo but north Donegal is covered by the Derry service. Then the service is in accordance with a line from Dublin to Galway, and from that down to Limerick, into Tralee, Cork and Waterford. These are the areas. This is the map that I am subjected to on a weekly basis. There is no service north of a line from Dublin to Galway where there is a population of 245,000. That is not acceptable in this day and age.

The last letter I received from Ms Ann Cosgrove on my correspondence on the cath lab in Sligo University Hospital states that she has recently become involved in this project and outlines that there is further work to be completed by HSE procurement in advance of going to tender for this project. Ms Cosgrove wrote that she could not give me an exact date as to when it will go to tender other than to say that it will be the last quarter of 2016 at the earliest. We are now into the first quarter of 2017 and this is the information that I am getting.

I am not happy and I am not accepting the information that I have got here. With all due respects to the Minister of State, when one looks at the facts and sees what I have in front of me and what I am being subjected to on a regular basis from constituents in my area who must travel on a daily basis to Galway not knowing whether or not they will make it in the back of an ambulance if they do not get the helicopter, it is high time. We have seen in other areas of the country where promises have been made in relation to cath labs, second cath labs and various other services in the past couple of weeks. It is not acceptable at this stage that we, in the north west, have had to be subjected to that.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank Deputy McLoughlin. I ask the Deputy to give me a copy of that letter. If there are commitments in it, I would certainly want to ensure that the relevant persons are aware of it.

It might be helpful to talk about what is being provided at Sligo University Hospital. Angiographies are performed there using the mobile cath lab one day per week and they can do ten angiography procedures per day. The average number performed in Sligo is 455 per annum, broken down by inpatient and day-case activity.

Saolta has advised that there are 75 patients on the cardiac catheterisation waiting list for angiographies and this waiting list is reflective of patients from the Sligo catchment area only. In addition to the numbers treated in Sligo, the hospital refers approximately 300 per annum to St. James's Hospital and to the Mater Private.

I will certainly convey the Deputy's concerns. I would appreciate if the Deputy would give me a copy of the letter that he has to hand.