David Cullinane (Waterford, Sinn Fein)
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The need for expanded cardiac services in the south east has been a big issue for people who live in the region. On foot of a number of meetings with Members of the Oireachtas of all parties from across the south east, the Minister for Health agreed to carry out a national review that would look at the provision of primary percutaneous coronary intervention, PPCI, or emergency cardiac care not just in the south east but across the State.

The south east is the only PPCI centre that has a single catheterisation laboratory. The clinicians and consultants say that it is neither viable nor the best method because it is a single point of failure. When the laboratory runs into difficulty at any time or needs to be repaired, the service is shut down. In fact, the catheterisation laboratory has closed on three occasions in the past month because of maintenance problems. Funding has been made available to upgrade the catheterisation laboratory at University Hospital Waterford, but hospital management cannot do it until it has a contingency in place because it would meaning closing the laboratory for approximately three months. Having no emergency cases going to the hospital at any time of the day and especially during the busy weekdays for that length of time would be unacceptable.

I am anxious to know the current position regarding the national review. When it was established, the Minister stated that he hoped it would take 15 months but that it might take 18. It has certainly been in place for longer than that. I accept that it has a great deal of work to do. It involves public consultation and going to all the regions and meeting all the stakeholders, including consultants, in each of the PPCI centres. However, we must have an indication of when it will conclude its work, and some certainty must be given to patients across the region that there is a safe and accessible service. Clinicians must guide policy in this area.

To transition to a 24-7 PPCI service will require additional specialist staff and we all accept that. However, people in the south east deserve to have the same opportunities as anybody else and, from a logical perspective, it is not safe that patients who experience an emergency heart attack outside the hours of 9 a.m. to 5 p.m. from Monday to Friday have to travel to either Cork or Dublin for care because it is not provided 24-7 in the south east. A second catheterisation laboratory is being progressed and is at design stage. That it has taken so long even to get it to that stage is just adding to the frustration of people in Waterford and the south east. They were expecting far more progress on this and to see its delivery more quickly. The commitment has been given, the funding is available and it is at design 2 stage. A private hospital is constructing another catheterisation laboratory so, hopefully, we will end up with three such laboratories operating in Waterford in the next 12 months or so. With that in place it makes perfect sense to expand the service to a 24-7 one. That cannot happen overnight, however. It is important that the review group concludes its work and makes it recommendation, which hopefully will be a positive one that Waterford should become a 24-7 PPCI centre. For that to happen it must recruit the staff and have the interventional cardiologists, support staff, radiographers and so forth. That is why I am anxious that the report would be concluded and make its recommendation. If it is positive, the groundwork can be done and we can deliver this service for the people of the region.

Jim Daly (Cork South West, Fine Gael)
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I thank Deputy Cullinane for raising the important issue of the national review of specialist cardiac services and for giving me an opportunity to update the House on the latest position in this regard. The national review of specialist cardiac services commenced in January 2018 under the chairmanship of Professor Phillip Nolan and a steering group was formed from nominations from interested stakeholders representing medical, professional-technical staff and nursing and patient representatives. The aim of this review is to achieve optimal patient outcomes at population level with particular emphasis on the safety, quality and sustainability of the services that patients receive by establishing the need for an optimal configuration of a national adult cardiac service. As set out in the National Development Plan 2018-2027, investment in cardiac catheterisation laboratories and other cardiac services infrastructure nationally will be informed by the outcome of the national review.

Since the steering group first met at the end of January 2018, a large volume of its work has been completed. A total of 13 steering group meetings have taken place with a further two meetings scheduled to take place. To date the national review has completed a public consultation survey and collated and analysed information on activity levels in each of the hospital groups and all hospitals within the groups. A successful and well-attended stakeholder consultation was held in November 2018. The Health Research Board Collaboration in Ireland for Clinical Effectiveness Reviews, HRB-CICER, has completed an evidence review of specialist cardiac services looking at international standards for PCI centres, international models that might be applicable to the Irish healthcare system and the relationship between volume and patient outcomes for PCI. The evidence review has provided important guidance for the steering group thus far and arising from discussions at the steering group, the services have been asked to complete one additional evidence review question. Site visits to PCI centres around Ireland are under way and two international site visits are being planned. These site visits have included meetings with stakeholders in clinical, administrative, nursing and allied health professional roles. Further research is being undertaken by the health intelligence unit of the HSE with regards to geospatial analysis and mapping of networks of cardiac services from a national perspective.

David Cullinane (Waterford, Sinn Fein)
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The Minister's speech clearly sets out the work of the review group. The group has done a lot of research and has met with many stakeholders. Its members are visiting PCI centres in this State and internationally. I support the group's work because the decisions made will have to be underpinned by clinical evidence and good clinical governance. I asked for the Minister to give us an indication of when the group might conclude its work. There is urgency to this as it is a huge issue for people in the south east. There have been a large number of protests about the issue and, on the most recent occasion, 10,000 people took to the streets in the south east because they were fearful of not having the service.

I have never been alarmist about this issue and I am not going to raise people's fears. I did not promise to deliver it but to raise the issue as much as I can, in an honest and earnest way, to get the best outcome for the people who live in the south east. Those people will not, however, see anything in the Minister's reply on when the work will be complete. The work of the steering group is very extensive and welcome but it would be good if the Minister could follow up with a letter or some other indication as to when there might be an interim or, indeed, a final report. People are waiting for the recommendations and for a sense that this work will conclude. They are waiting to find out what services will be put in place in each region. I asked about a timeframe for delivery and it is no surprise to me that this was the one question that was not answered. That raises concerns for me so I respectfully ask the Minister of State to communicate some estimation of a timeframe for me.

Jim Daly (Cork South West, Fine Gael)
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I acknowledge the bona fides of the Deputy opposite and thank him for his constructive approach and assistance with this matter. I appreciate that he does not wish to be antagonistic or political about it but that he wants to get it sorted, as do all Oireachtas Members from the south east. The chair has indicated that he hopes to have the review completed by the end of this year. The Minister will be made aware of any changes to this timeline. I acknowledge the detailed work that has been undertaken by the review group and I thank its members and stakeholders.