Mick Wallace (Wexford, Independent)
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It is an issue that is a real worry for the people where I come from in the south of Wexford because we are in the absolute worst position of all when it comes to the problems around this issue. A few months ago, I submitted a number of questions to the Department of Health on ambulance response times between various hospitals in the south east and St. James's Hospital in Dublin and Cork University Hospital. The questions were devised by a 24-7 cardiac care campaigner, Matt Shanahan, who has done tremendous and intelligent work over the past number of years to highlight the madness of a lack of 24-7 emergency cardiac care in the south east. His aim was to try to establish how many patients in the south east are getting to a cath lab within the 90-minute window recommended in the Herity report. The 2016 Herity report states that the average blue light ambulance journey time between Waterford hospital and Cork is one hour and 20 minutes. The HSE's answers to my parliamentary questions have demolished this claim and made a nonsense of the report.

I appreciate the Department needs to make evidence-based decisions in the provision of health services but how can the Department continue to stand over the Herity report, especially considering its problems in terms of population calculations and the lack of consultation with consultant cardiologists at Wexford General Hospital? The data show that not one of the 37 emergency cardiac transfers from Wexford over the past three years was completed within 90 minutes. In the same three-year period, from the time the ambulance was called, just two patients made it from University Hospital Waterford to Cork in under 90 minutes. The dogs in the street in the south east know this. It is common sense. The Department, the HSE and Dr. Herity all have access to the national ambulance service response times. They must have been aware of the reality of these transfer times. Did the Department look at them and was it aware of the reality of the transfer times?

The Herity report estimates that approximately 175,000 people in the south east are outside the 90-minute window accessing Cork hospital and St. James's. In the real world, the data I received via my parliamentary questions suggest that the population outside the 90-minute window is closer to 0.5 million people, which is almost the whole south-east region. The Herity report uses a 90-minute journey time as its acute coronary syndrome, ACS, standard. This ACS standard does not exist anywhere else. The equivalent standard in the UK is based on 90 minutes from first responder time to balloon time, or when the patient is on the operating table. Elsewhere in the EU, they aspire to a 60-minute transfer time. Meanwhile for people in south Wexford and the south east, the data I received show transfers of closer to two hours. Consultant cardiologist at University Hospital Waterford, Dr. Patrick Owens, told "Prime Time" that people have without doubt died en routeto Dublin or Cork because they have been unable to access the service in a prompt and timely manner. Does the Minister of State accept that statement as true? Dr. Herity told the Oireachtas committee that 150 STEMI cases per year in the south east was needed to justify 24-7 cardiac care in the region. I have been told that approximately 200 STEMI cases were treated in Waterford hospital in 2017. Professor Daly, who did the 2018 ACS report, gave a figure of 203 STEMI cases to cardiologists at Waterford Hospital as a predicted outcome figure for 2017. The Herity report does not stack up. If one takes on board the extra time, Dr. Herity did not look at the time it takes to get to the patient. He was only counting from the time the ambulance picked the patient up to the minute the patient got on the operating table. We cannot ignore the fact that in Wexford on average it took an ambulance 53 minutes from request and departing Wexford hospital to St. James's or to Cork.

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputy for raising the important issue of 24-7 emergency PPI cardiac care at University Hospital Waterford. The Minister, Deputy Harris, met the Deputy and many other Oireachtas Members from the south east last week to discuss the issue. I am happy to provide an update to the House in this regard. I commend the Minister of State, Deputy John Halligan, for his determined efforts on behalf of the people of Waterford on this issue.

The Herity report of 2016 concluded that the needs of the Waterford catchment area could be met by a single cath lab but it recommended that the existing lab be staffed and funded to provide additional sessions. That funding has been provided and I am happy to report that recruitment, which is being progressed by local management and the HSE’s national recruitment service, is at an advanced stage.

On the issue of ambulance transfer times, the analysis of emergency patient transfer times between University Hospital Waterford and Cork University Hospital in the period October 2015 to June 2016, undertaken by Dr. Herity, was based on information from the national ambulance service, NAS, on the times of contemporary blue light journeys between the two hospitals.

As the Deputy is also aware, a national review of specialised cardiac services is taking place. This review is considering all adult cardiac service needs and their optimal service configuration as a whole. This will take on board not simply geographical location but also best international practice standards to provide a clinically effective safe service for all adults with cardiac disease. The national review will provide a sound scientific foundation for policy making in this area from 2019 onwards. As the Deputy will be aware from last week's meeting, the provision of 24-7 primary percutaneous coronary intervention, PPCI, services in University Hospital Waterford will be considered in the context of the National Review of Specialist Cardiac Services. The Deputy is also aware that the Minister is eager for a second cath lab to be operational in University Hospital Waterford to address waiting times at the hospital and provide a better service for the people of Waterford and the south east. As confirmed at the meeting with Oireachtas Members from the south east last week, plans for a second cath lab at University Hospital Waterford are now being progressed by the HSE and it will provide Members with updates throughout the process. In conclusion, and as set out in the National Development Plan 2018-2027, investment in cardiac cath labs and other cardiac services infrastructure nationally, and any decision with regard to the provision of 24-7 PPCI services in University Hospital Waterford will be informed by the outcome of the national review of specialist cardiac services, which is expected to be complete by June 2019.

Mick Wallace (Wexford, Independent)
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While the new cath lab that is to be built in Waterford is welcome, it will not make any difference in terms of helping emergency cardiac patients outside Monday to Friday from 9 a.m. to 5 p.m. The meeting with the Minister last week was a decent one. He explained to us that he has been trying to get extra hours from 8 a.m. to 8 p.m. or 9 a.m. to 8 p.m. That would help but it still leaves a huge window when people can need cardiac help and it is not available within 90 minutes. That is not good enough. He told us that the cardiac review would be finished by the end of June next year. Does the Minister of State think it is fair in particular for the people in Wexford? This is not parish pump politics, it just happens that they are furthest away from care. From the time Wexford General Hospital requests an ambulance to its arrival in St. James' Hospital is an average of two hours and 30 minutes. If someone goes to Wexford General Hospital they automatically go to St. James' Hospital. If they go to another hospital maybe in New Ross, I do not know if people are taken in there but they can end up going to Cork. International best practice is one hour. Ireland is working towards 90 minutes. It is completely unfair that a person in Wexford has to put up with two hours and 30 minutes. The Herity report was not fair from our point of view and it was a bit of a whitewash and now we are waiting for the results of another report. It is not fair that people have to wait for the report. Given what we got in the Herity report, people are a bit dubious about what the next one will say. The Government should be more proactive about anything less than 24-7 care within an hour and a half of the ambulance being first alerted, as that is only fair.

Finian McGrath (Dublin Bay North, Independent)
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I absolutely take the Deputy's point on Wexford and the south-east area, and his valid criticism. I will tell the Minister, Deputy Harris, about the time of two hours and 30 minutes. I live in Marino and Beaumont Hospital is only ten minutes up the road from my house. I met the consultants with the Minister of State, Deputy Halligan, and have heard their cases. I also will tell the Minister that there are 203 cases per year not 150 cases per year. We have to consider that. There is a determination to resolve this issue. It is recommended that the existing cath lab should be staffed and funded to provide for 12 sessions of four hours each every week. That is an extension of 20% in its hours. Certain posts have been appointed. The grade IV administrative campaign is under way and will be filled on a temporary basis by the end of this month via an agency. The porter position that it was not possible to fill as a temporary post on the HSE contract was converted from an agency on 30 July. The senior cardiac physiologist post was expressed to the panel, the senior radiographer has offered his post to the senior panel already in existence and the post has been accepted. The candidate, however, is on maternity leave but will return to take up the post on 6 November 2018. A staff nurse was appointed on 7 September 2018.

In respect of international best practice and University Hospital Waterford, I am well aware of the issue. It is very important. The people of Wexford and Waterford have the same rights as the rest of us in respect of cardiac services. I will bring all of the Deputy's reasonable and credible points back to the Minister.