Pat Gallagher (Donegal, Fianna Fail)
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Tá áthas orm deis a bheith agam labhairt ar an ceist tábhachtach seo in Ospidéal na hOllscoile Leitir Ceanainn. This is the fourth time I have had an opportunity to raise a Topical Issue on Letterkenny University Hospital but, with no disrespect to the Minister of State, Deputy Finian McGrath, the Minister has yet to present himself in the House to debate these matters. I will deal later with the political aspect of it, in which he is more interested. I am pleased to bring this issue before the Dáil today. I am convinced that by doing so, I have secured the necessary funding for the replacement of the telemetry monitoring unit at the hospital. I know the answer already. It is a sad indictment that it took a Deputy like me to drag the Minister to the House to deal with this.

For the last six weeks, no cardiology rehabilitation services have been provided in Letterkenny. They have not been available for outpatients who had heart attacks or who had undergone a cardiac procedure. As the Minister of State knows, this service should be available four weeks after a heart attack or stent procedure. It is a critical, essential treatment for cardiac patients. The service commenced in Donegal in 1999 and has been excellent. I pay tribute to all involved in it. In addition, it was available in the community in my own town of Dungloe, as well as in Ballyliffin on the Inishowen Peninsula. The approval of funding for the telemetry monitoring unit is only the first step, however. There is no point in having this unit if it is not fully staffed. There is only one nurse available while a second nursing position has remained vacant for six years with the result that the equipment in the unit cannot be used to its full potential.

For the last number of years, we have been failing to provide the minimum number of cardiac rehabilitation sessions. The Irish Association of Cardiac Rehabilitation recommends a minimum of two sessions per patient. Due to staffing shortages, Letterkenny University Hospital is unable to provide that, which is not good enough.

I am here to represent the people of County Donegal and want to ensure that they will get the same services as those that are available throughout the country. Without the second nurse, this will not be fully utilised. The first step we need to take after the announcement I expect the Minister of State to make today is to ensure that the second nurse is made available and that the funding is provided for the employment of that nurse as quickly as possible. It is not acceptable to me that patients in County Donegal are treated in this manner. The second nurse is absolutely essential.

This was decided today by the Minister for Health, Deputy Harris, but the Minister of State, Deputy McGrath, may not be aware that the Minister is more interested in the PR surrounding the statement which the Minister of State will make this evening than the patients in County Donegal. Although not in the same wing, the Minister of State is in government, and that Government spent some time this afternoon, after I had raised the issue, deciding how it could get out a statement before I raised it in the Dáil and secured a favourable response. I am not interested in the politics of this. I put the people of County Donegal and their health ahead of any politics. I await what the Minister of State has to say.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Pat The Cope Gallagher for his passionate representations on behalf of the people of County Donegal. I know from my visit there a few months ago that he is also very much involved in disability services issues. I thank him for his kindness and for being an excellent host.

I offer the House the Minister's apologies. The Minister for Health would like to thank the Deputy for raising this important issue and wishes to acknowledge the inconvenience and upset that the suspension of the cardiac rehabilitation programme, as part of the overall cardiology rehabilitation services at Letterkenny University Hospital, is causing to patients who are eager to continue on their path to recovery.

Cardiology rehabilitation services are aimed at optimising physical function in patients with cardiac disease or who have had recent cardiac surgeries. As part of the programme, patients attend rehabilitation sessions under the direct care of nursing staff and the supervision of a consultant cardiologist. A critical element of this type of rehabilitative care is the gathering of telemetry data on patients undergoing these sessions. These data are gathered using monitors worn by the patients while undertaking physical activity during their rehabilitation sessions.

Evidence based research shows that cardiac rehabilitation can reduce hospitalisation by 30% in the following year. A recent health technology assessment by the Health Information and Quality Authority rated cardiac rehabilitation as one of the most effective self-management support services and the importance of the continued provision of these services is recognised by the Department of Health and the HSE. However, the HSE advises that there is currently an unmet need for these types of cardiac rehabilitation sessions. The HSE is currently preparing a self-management support framework which will specifically target this issue at a national level.

With regard to Letterkenny University Hospital, the Saolta University Health Care Group has advised that the cardiac rehabilitation programme has been suspended for the past few weeks on the advice of the consultant cardiologist for reasons of patient safety. This is due to the technical malfunction of some of the telemetry monitors required to monitor patients during their rehabilitation sessions. Saolta advises that these malfunctions are due to expected wear and tear on the units. It is important to note Saolta has confirmed that these issues are not affecting the monitoring of telemetry for cardiac patients in need of acute care. Telemetry services are in place in Letterkenny University Hospital for these critical patients.

Since 2012 the HSE capital plan has included a separate allocation for the equipment replacement programme. In 2017 this allocation was increased to €35 million. Saolta has advised the Department of Health that it has applied to the HSE for suitable replacement units through this scheme. In light of the critical need for the cardiology rehabilitation service in County Donegal, Saolta has advised the Department of Health that it has recently given Letterkenny University Hospital authorisation to order suitable replacement telemetry devices. This process is currently ongoing.

Pat Gallagher (Donegal, Fianna Fail)
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I thank the Minister of State for, in particular, the last paragraph in his statement, which was that the funding will now be made available. After six weeks, I have no doubt in my mind, and I am not trying to promote myself in any way, that it would not have happened if not for the raising of this Topical Issue in the House. People were scurrying in various offices, wondering how they could get this statement out before the issue was raised in the Dáil. Had I not had the opportunity to raise it today, I am convinced that there would be procrastination until September. Between now and September, I will be calling on the Minister to return to the House to confirm what he will have done with regard to the second nurse.

I know the Minister of State cares. When he was in County Donegal, he met many people, took a particular interest and followed through. I am now asking the Minister of State to bring to the attention of the Minister for Health and the HSE the importance of providing the necessary funds for a second nurse. Why would the HSE expend between €40,000 and €50,000 on this piece of equipment, which is so important to those who require these services four weeks after a heart attack or stent procedure and two to three months after surgery, and not use it to the full? We need the second nurse. From a health and safety perspective even, a second nurse is absolutely essential. I know the HSE is trying to say that this is not affecting the monitoring of telemetry for cardiac patients in need of acute care. We know that. However, these are for patients who have had their surgery carried out in other parts that are not in the hospital. That is absolutely essential.

Good Government PR seems to be more important than the substantive issue of health care. We must ensure, and I will ensure, that the patients in County Donegal receive the treatment that is available in all other parts of the country. I thank the Minister of State and ask him to pursue this because I will be pursuing it vigorously over the next number of weeks.

Finian McGrath (Dublin Bay North, Independent)
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I will bring all the suggestions that the Deputy raised back to the Minister for Health, particularly the second nurse issue and his major point that the people of County Donegal should be treated equally to those in the rest of the country. I know the Deputy is a supporter of cross-Border services. This is particularly relevant to County Donegal. The primary percutaneous coronary intervention, pPCI, service provided through Altnagelvin Hospital in Derry - a cross-Border cardiology project - became operational on 4 May 2016. This service provides pPCI services at the area hospital in Derry for patients with a diagnosed heart attack in County Donegal. Patients are also referred to a state-of-the-art new cardiac laboratory at the same hospital. These things are happening in terms of the delivery of health services.

It is also important to remember that, in terms of budget allocations, model 3 hospitals, of which Letterkenny University Hospital is one, were allocated amounts ranging from €57 million to €141 million in 2016 and that Letterkenny University Hospital was resourced towards the top of that range at approximately €120 million. We will invest in services. We need to develop them. I will bring the Deputy's message about the second nurse being made available and the development of services for the people of County Donegal back to the Minister.

Pat Gallagher (Donegal, Fianna Fail)
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If I may, I wish to acknowledge the excellent coronary care unit that was opened in Letterkenny last week.