Declan Breathnach (Louth, Fianna Fail)
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6. To ask the Minister for Health his plans to reconfigure cardiovascular services in County Louth and the north-east region; and if he will make a statement on the matter. [17085/18]

Declan Breathnach (Louth, Fianna Fail)
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The question raises the proposed reconfiguration of cardiovascular services in County Louth and the north-east region but could equally be applied to the 33 units providing cardiovascular services across the country. It is my understanding the advisory group was convened to devise a new clinical model of care for the provision of cardiovascular rehabilitation settings in Ireland, and that its proposal is to introduce a community-based and single-outpatient programme which can be provided anywhere. Will the Minister reassure both patients and staff that there will be no reduction in the service received by high-risk and low-risk patients or in patient outcomes?

Simon Harris (Wicklow, Fine Gael)
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I thank the Deputy for the important question. I can assure him the HSE has advised there are no current plans to reconfigure the cardiology services in County Louth and the north-east region which are currently provided in Our Lady of Lourdes Hospital, Drogheda, with consultants with cross-site commitment in the Mater Hospital. In addition, vascular surgeons from Beaumont Hospital provide an outpatient and varicose vein surgery service in Louth County Hospital, which I have had the pleasure of visiting.

The national cardiovascular policy 2010-19 made recommendations across a range of areas, including prevention, primary care, acute services and rehabilitation. These continue to be implemented by the HSE and its clinical programmes on heart failure, acute coronary syndrome and stroke. Since the publication of the policy, there have been a number of service developments, including structured care for heart failure, the expansion of stroke services and the provision of thrombolysis. Given the ongoing implementation of the policy, there are no changes proposed beyond the scope of the policy at this time. It should be noted, however, that a national review of specialist cardiac services started work on 31 January 2018 and has been welcomed by Deputies on a cross-party basis. Given the breadth of the review, it is possible that some of its recommendations may have an impact on cardiovascular services. However, the review is still in its early stages and a final report is not expected until 2019. There will also be an opportunity through public consultation for all citizens and stakeholders to give their view in regard to how we can further improve cardiac services.

I reiterate to the Deputy, so I do not create any confusion or ambiguity, that the HSE has advised there are no current plans to reconfigure the services referred to in the Deputy's question. I will be happy to arrange a more comprehensive briefing for the Deputy with the HSE to provide him with assurances in that regard.

Declan Breathnach (Louth, Fianna Fail)
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It is almost 20 years since the Building Healthier Hearts cardiovascular strategy was adopted by the Department of Health to deliver a standard of care to patients of cardiovascular disease in terms of both prevention and treatment. The strategy clearly states that every hospital treating heart disease should provide cardiac rehabilitation, which was one of the six strands of care identified to manage the significant burden of heart disease in Ireland. It is vital that we follow evidence-based models of care and the standard of cardiac rehabilitation currently delivered is a gold standard. However, in light of the new model being considered by the advisory group, I suggest there is a real need for cardiovascular services to be delivered not just in a community setting but through people who have strong knowledge of the situation. Patient safety is always our top priority and cardiac patients who complete hospital-based cardiac rehabilitation after a cardiac event live longer, feel better and have greatly reduced need for acute care.

I will take the Minister at his word but I believe it is very important he meets the professionals who are delivering the service because they are not satisfied that moving into the community will not affect the outcomes.

Simon Harris (Wicklow, Fine Gael)
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I will be more than happy to take the Deputy up on his invitation to meet those professionals and I will be in touch with him to arrange that. I understand he has had a particular interest for a long number of years in cardiac rehabilitation services and concerns around the potential shift of after-care services from a hospital to a community setting, as he has outlined.

The policy context for the development in cardiac rehabilitation is the current cardiovascular strategy, Changing Cardiovascular Health: National Cardiovascular Health Policy 2010-2019. Most recently, the HIQA health technology assessment and the national self-management support framework identified cardiac rehabilitation as one of the most cost-effective methods of supporting patients to self-manage and, most importantly, to improve clinical and health service usage outcomes. The provision of cardiac rehabilitation capacity to meet the population needs is a top priority under the self-management support framework.

This framework is being prepared by the health and well-being division within the integrated care programme for chronic disease, and the actions concerning cardiac rehabilitation will be to combine the relevant recommendations of the 2010 to 2019 policy and include the recommendation for the development of a community model of cardiac rehabilitation to make services more accessible. I will be happy to meet the healthcare professionals.

Declan Breathnach (Louth, Fianna Fail)
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Will the Minister categorically state to the House that any proposed changes that may be in the pipeline will not impact on the stated outcomes of any previous strategy? We committed to a reduction in mortality of up to 30%, a reduction in cardiac events, to cut cardiac readmissions by almost one third and, of course, most importantly, to improve the health and quality of life of our citizens, and this has been cost-effective. There is a worry that carrying out an experimental model in the community may impact on and reduce the quality and safety of care for patients. I ask the Minister to ensure investment in our current system, with a full multidisciplinary team, continues and will be enhanced.

Simon Harris (Wicklow, Fine Gael)
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Of course I am delighted to give Deputy Breathnach that assurance. Everything all of us want to do in healthcare is to improve patient outcomes. That has to be at the absolute centre of what we do . As Deputy Breathnach knows very well, cardiovascular disease remains the commonest cause of death in Ireland. One of the ways we must address it is through prevention, with population-based approaches that target the entire population as well as those high-risk groups. We need to focus on issues such as obesity, particularly central waist obesity, and cardiovascular diseases such as heart failure, heart attack and angina. I fully agree everything has to be about improving patient outcomes.

I would point out to the Deputy who has a particular interest in this, to his constituents and to the healthcare professionals he referenced that the national review of specialist cardiac services, which I have asked Professor Philip Nolan, the President of NUI Maynooth, to chair and which includes two representatives of the Irish Heart Foundation, making sure the patient's voice is heard, and a number of other professionals, is an opportunity for us as a country, much like we have done in the area of cancer, to map out a roadmap of where we want to be to ensure the best possible outcomes for cardiac patients over a five and ten-year period, so we can make the same progress in cardiovascular disease that we have made, thankfully, in other areas including cancer. I will be delighted to work with the Deputy on it.