Peadar Tóibín (Meath West, Sinn Fein)
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I understand that the Minister for Health is very busy. There is no doubt about that in light of the current crisis. When we raise Topical Issue matters, however, it is important that we hear from someone of whom we can ask questions and who can provide answers. I mean no criticism of the Minister of State - she is fulfilling her role and I understand that.

Navan hospital is a great facility. It provides top-quality healthcare to thousands of patients in County Meath every year. It is a vital part of the health service in the county. The population of Meath is increasing rapidly, with a little under 250,000 people living there at the moment. The staff at the hospital do a tremendous job caring for patients and their work is of the highest standard. It has not been easy for them because they have had to operate in the shadow of significant cuts in recent years, including cuts to staffing numbers as well as in respect of the machines and technology with which they work.

In recent weeks, a problem has come to my attention. A general practitioner called me and said that he had received an echocardiogram report from the hospital that included a disclaimer. The disclaimer indicated that the health professional could neither stand over the quality of the machine nor the quality of the report. I investigated the source of this. I found out that the machine was outdated. Navan hospital had put in an application for the machine to be replaced in early 2016 but it was not replaced until late 2017. During that period, a total of 2,500 echocardiograms were carried out. Many, if not all, of the reports had a disclaimer from a senior medical professional stating that the quality of the echocardiogram could not be stood over. I approached the HSE on the issue. Let us bear in mind that an echocardiogram machine is important equipment. It allows doctors to understand the way the heart of a patient moves and the strength of the pumping. It also allows them to ensure that the valves in the heart are working correctly and works out whether blood is leaking backwards through those valves. It works out whether the valves are too narrow. It can actually work out whether there are tumours or infections growing around the heart valves.

This is critical technology. It is a critical diagnostic tool in an area of medicine that is critical for the survival of the individual in future. We know that a request was made to replace this out-of-date machine over a long period but it was not replaced. We know that health professionals in Navan hospital were forced to keep using the machine. However, the medical professionals put in a disclaimer stating that they could not stand over the quality of the machine or the reports. As a result, up to 2,500 patients have been given an echocardiogram report with a disclaimer.

I was cautious at the start of this because I did not want the message to go out to people who had gone through this process that in some way their diagnoses were sub par. I did not want them to get fearful. That is why I brought it to the HSE and sought for the HSE to retest these individuals in order to ensure that the original diagnoses were correct. In recent days, I have been told that the HSE has refused to retest these patients.

Let us suppose the Minister of State received a diagnosis on the basis of a diagnostic tool in respect of which a medical professional wrote a disclaimer stating that he could not stand over the quality of it. The Minister of State would want a retest. Why are other patients not granted the same?

Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister, I thank Deputy Tóibín for raising this matter. I wish to reassure the Deputy that the most important issue in the consideration of services for the people of Meath is to ensure patient safety and outcomes come first. I understand that the Deputy is referring to echocardiograms carried out at Our Lady's Hospital, Navan. The HSE has informed the Department of Health that approval was received for capital funding for the replacement of an echocardiogram machine in Our Lady's Hospital, Navan as part of the capital equipment replacement programme 2017. Following the appropriate procurement process, the new machine was commissioned and came into use before the end of 2017. I understand from the HSE that the replaced echocardiogram machine was decommissioned in August 2017.

The HSE has confirmed that service contracts on the old echocardiogram machine were still in place until the end of 2017 and these service contracts provide full traceability documentation which demonstrated that the machine was performing within acceptable parameters.

As the Deputy may be aware, an echocardiogram machine is a very subjective diagnostic tool and can vary for several reasons depending on the patient being reviewed. The HSE has confirmed that all echocardiograms conducted in Our Lady’s Hospital, Navan, where anomalies or visual complexities were identified were escalated for enhanced imaging and the referring consultant was informed.

Management at the hospital is satisfied that there is no requirement to recall patients who had an echocardiogram.

Regarding services generally at Our Lady’s Hospital, Navan, since 2013 the hospital has been part of the Ireland East hospital group. Every hospital in that group, large or small, has a vital role to play within their group with smaller hospitals such as Our Lady’s Hospital, Navan, managing routine, urgent or planned care locally, more complex care managed in the larger hospitals and better linkages with primary, continuing and social care. As a smaller hospital, the challenge is to make sure that Our Lady’s Hospital, Navan, provides more of the right type of services for the people of County Meath, which can safely be delivered, so that we maximise the benefit to patients. In order to ensure that the hospital continues to play a significant role in the Ireland East hospital group, it is engaged in a programme of redesign work to further integrate and enhance the role of Navan hospital as a constituent hospital within the hospital group. The Ireland East hospital group is continuing to engage closely with all interested parties to ensure that the needs of patients, staff and the local and wider communities are addressed.

On the issue of the echocardiograms, I assure the Deputy that the HSE has confirmed that Ireland East hospital group and the management at Navan hospital are satisfied, following a full review of circumstances surrounding this issue, that there is no requirement to recall patients who have had an echocardiogram in the period referred to. I reiterate that Our Lady's Hospital, Navan, will continue to play a significant role in the Ireland East hospital group in providing sustainable, safe and effective care at all approximate levels and complexity.

Peadar Tóibín (Meath West, Sinn Fein)
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To be fair, it is important that I reaffirm the points the Minister of State has made in order that people are aware of the position. The hospital said that the technicians who calibrated the machine over that period of time were of the view that it was in the confidence levels that were required, but it has to be said that the request was made to replace the machine in early 2016, yet the machine was operating until August 2017. I was shocked about that but, on further investigation, I was told it is not unusual for machines to be out of date in hospitals and for the HSE not to provide the funding for those machines to be replaced in a timely fashion. The budgets are not with the hospitals. Therefore, the hospitals cannot purchase the necessary machines, rather they must apply for them. I am of the understanding that the instinct of the hospital initially when it became aware of this particular crisis was to re-echo 450 people who had negative outcomes in their diagnoses based on the echocardiograms.

What has happened is that there has been a flip in the decision of the HSE on whether to re-echo those people. What we have blatantly at the heart of this question are health professionals saying that they do not trust the quality of this diagnostic tool because this diagnostic tool is produced by a machine that is out of date. We have general practitioners, GPs, around the county who make diagnoses on the basis of a diagnostic tool with a disclaimer and then we have the HSE saying that everything is all right.

I ask the Minister to forgive me but when the HSE says that everything is all right in this environment it is not something that we as Deputies can take as read. We have a moral responsibility to push the HSE to make sure everything is all right. To make sure that everything is all right in this case, I believe, would be to make sure that anybody who is at home in County Meath who has had a heart issue diagnosed on the basis of an echocardiogram with a disclaimer has the opportunity to have another echocardiogram and another diagnosis as a result.

Catherine Byrne (Dublin South Central, Fine Gael)
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I understand the Deputy's frustration and annoyance about the Minister not being able to be here to take this matter. I can only respond to the Deputy on the basis of the reply to this Topical Issue matter that I have been given by the Department. I understand that when Topical Issue matters are selected by the Ceann Comhairle there is contact with the particular line Minister. Unfortunately, in the current circumstances, as acknowledged by the Deputy, the Minister, Deputy Harris, has been inundated with having to go from one place to another. Having heard the Deputy's concerns, from my reading of the statement provided by the Department, all I can do is assure him that it states an assessment has been done and that the hospital group has said that these machines are working. What the Deputy has said is very different from that.

I will, as one would say, echo the Deputy's concerns to the Minister about the 420 people, the issue about the disclaimer and the other references he made in his contribution. Unfortunately, I am not in a position to give a statement other than what is contained in the reply that I have been given by the Department because I cannot prejudge the issue of the machines that are in place and who gave permission for those machines to be used.

I have to be honest and say that I have been here on a number of occasions on a Thursday to answer Topical Issue matters raised and sometimes I have not been very clear because I do not have a clear answer myself. I want to assure the Deputies that I make it my business to contact each line Minister by email and personally to outline the concerns that have been raised. In doing that, I hope Deputy Tóibín and other Deputies would get some kind of response from the line Minister.

Declan Breathnach (Louth, Fianna Fail)
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If I am correct, I believe there is a facility that allows Members to postpone their Topical Issue matter until the Minister can take it.