James Reilly (Dublin North, Fine Gael) | Oireachtas source

I apologise at the outset because I will have to leave for an important meeting at approximately 5.25 p.m. There is nothing at all contentious in the health sector, as Senators know. We welcome our friends from the Irish Heart Foundation in the Visitors' Gallery.

I am grateful to the Senator for providing me with the opportunity to speak on this matter in Seanad Éireann. It is estimated that approximately 5,000 people die every year as a result of sudden cardiac death. Most of these deaths occur from late middle age onwards as a result of coronary heart disease. It is important therefore to place the Public Health (Availability of Defibrillators) Bill 2013 in a broader context of prevention as well managing cardiovascular disease.

Let us start by acknowledging the improvements in cardiac care brought about through various means, including the national cardiovascular health policy. This policy, named Changing Cardiovascular Health, 2010-2019, provides an integrated and quality assured approach to the prevention, detection and treatment of cardiovascular disease, including stroke. Since 2010 significant improvements have been made with regard to access for acute treatments for coronary heart disease as well as the development of stroke units across the country. The policy report also included a section on sudden cardiac death, a key element of which involves first response survival from cardiac arrest through the development, co-ordination and integration of the emergency medical services with co-responder networks.

On publication of this policy the HSE published the sudden cardiac death steering group report later in 2010. A key element in this was improving first response for a cardiac event. This included guidelines for communities and groups wishing to set up a first responder group, and the integration of the HSE pre-hospital emergency care with community risk responder programmes. It also involved the development of standards for first responders, mainly for general practitioners and voluntary organisations. The HSE has established three programmes to implement the different elements of the cardiovascular policy covering acute coronary syndrome, heart failure and stroke. For the purposes of developing a range of initiatives to improve service delivery in these areas, the Department continues to liaise with the HSE on the implementation of the strategy. Key elements of stroke care include new and existing stroke units provided with additional therapy, nursing and consultant posts. The clinical programme for stroke continues to work to develop and disseminate care pathways and protocols for treatment, a national 24-7 access to safe stroke thrombolysis through service development, telemedicine and training is already available in many hospitals with access protocols agreed for others. Ambulance protocols are being developed for rapid access to hospitals.

Thrombolysis is now available in all acute hospitals admitting stroke patients and 9.5% of patients are being thrombolysed. This rate compares well the best European figures and exceeds our target of 7.5%. In 18 months we have gone from the bottom of the league in Europe to the top. We are now saving a life a day through the stroke programme.

Key elements of the acute coronary syndrome care include improving and standardising the care of acute coronary syndrome patients by having put in place an optimum reprofusion service for patients, otherwise known as stenting; having ambulances equipped and paramedics trained to recognise a major heart attack and transporting these patients to the best place, that is a primary PCI centre hospital for appropriate care; having designated primary PCI or percutaneous intervention centre hospitals based on having available cathether labs plus a requisite number of cardiologists who are trained in PCI; additional cardiologists experienced in PCI are being recruited during 2013; and other non-PCI centre hospitals being clear on how best to treat all ACS patients and arranging their timely transfer.

Key elements of the heart failure care include structured services for the management of advanced heart failure which have been established in 11 hospitals. The heart failure programme in conjunction with the diabetes clinical care programme has recently commenced a screening project for left ventricular dysfunction among diabetic patients in order to prevent further complications. A new diagnostic clinic in Gorey, Wexford, St. Vincent's University Hospital Group, provides direct access for general practitioners to echocardiography in the community with remote specialist advice on echocardiographic results and specialist review of patients in the community when required. This is very welcome as it underscores our principle of bringing the services to the patient rather than the patient to the service where we can. Another element is training for pharmacists to screen for cardiovascular disease and to link in with the heart failure programme.

In 2006, the then Minister for Health and Children launched Reducing the Risk: A Strategic Approach, The Report of the Task Force on Sudden Cardiac Death. The report made a range of recommendations covering four areas of change, including the detection and assessment of those at high risk of sudden cardiac death, systematic assessment of those engaged in sports and exercise, reducing response time, and surveillance and audit. The report made specific reference to automated external defibrillators or AEDs. It noted that the number of AEDs is increasing across the country and that there were no restrictions on who could purchase an AED or where they should be placed. There is evidence that some locations are more appropriate than others and the scientific literature has identified facility types at which the incidence of cardiac arrest is highest. These include health facilities, important transport hubs, universities and colleges and other venues for major public events. The report identified a number of issues in relation to storage and maintenance of AEDs, national signage for defibrillators, traceability of devices, adverse event reporting and that these responder programmes are compatible with the local ambulance service model.

The National Cadiovascular Health Policy 2010-2019 endorsed the recommendations of the Report of the Task Force on Sudden Cardiac Death. In this regard, the Pre-Hospital Emergency Care Council has developed educational standards. These include the cardiac first response standard, the first statutory standard for basic life support, and the standard for AED use in Ireland. In addition, clinical practice guidelines have been developed to support the delivery of interventions by emergency medical technicians, paramedics and advanced paramedics. On publication of the national cardiovascular policy, the HSE established a sudden cardiac death steering group which reported later in 2010. A key element of this report was improving the first response to a cardiac event. A number of actions have been implemented, including guidelines for communities and groups wishing to establish a first responder group and the integration of HSE pre-hospital emergency care with community risk responder programmes. It also involved training and development of standards for first responders, mainly for general practitioners and other voluntary organisations. Work on the AED register is ongoing and is an important feature in improving defibrillation and resuscitation in Ireland and, as a Senator pointed out, in improving survival rates.

The Bill proposed by Senator Quinn sets out the requirement to provide defibrillators in a range of settings and for events which have a regular attendance of in excess of 100 persons per day. Defibrillators would have to be registered and maintained and staff would have to be trained in their use. The Bill proposes that the Health and Safety Authority ensure compliance with the Act and that the relevant Safety, Health and Welfare At Work Act 2005 is amended accordingly. On this point, I wish to point out that the Health and Safety Authority is statutorily mandated to focus on workplace and chemical safety only. In addition, the list of designated places are public venues and not places that the Health and Safety Authority would identify for any level of inspection save in a workplace context.

I wish to clearly state that I endorse the general principle of making defibrillators available in public places, however, we must always be mindful of prevention as a first principle and, in turn, we must continue to progress the configuration and integration of the emergency medical services for co-responder networks, as I outlined earlier.

I want to speak about prevention. We all know that prevention is better than cure. Historically we have been quick to pay lip service to it and slow to pay for it. The actions that we take against the tobacco industry, making tobacco products less available and making children less vulnerable to the advertising of them are hugely important. I equally believe that the other areas we need to address are those of obesity and the abuse of alcohol and that addressing those will hugely reduce cardiovascular events. I accept that the principle of having more defibrillators available will also be valuable in fighting the loss of life resulting from cardiac events.

As most cardiac arrests take place outside the hospital, a public health programme based on trained lay first responders providing early cardiopulmonary resuscitation or CPR and defibrillation may save lives. However, the majority of cardiac arrests occur in the home and less than half of these have a heart rhythm abnormality that cannot be corrected by a defibrillator.

Evidence suggests that the clinical benefits and cost effectiveness of a public defibrillation programme are strongly related to the likelihood that a cardiac arrest will occur at a location where a defibrillator is sited. There are therefore a number of questions that need to be considered when designing such a programme for Ireland, including the quantification of clinical benefits, the identification of the appropriate sites for the defibrillators and to address other organisational issues, including costs.

I have sought and received Government approval that the Health Information and Quality Authority undertake a health technology assessment of a public access defibrillator programme in Ireland. The advice from the assessment will inform my subsequent decisions on the design and implementation of a national programme. I also have approval to draft a general scheme of a public health (availability of defibrillators) Bill, subject to the technology assessment which should also include a regulatory impact assessment, to which the Senator has alluded indirectly in terms of the cost of businesses and so on, and also subject to identifying where defibrillators are currently sited. There is no need to double up on their provision in that if they are already sited in the local Garda station and the GAA, would one be also needed in the post office as well in a small village? It would be hard to justify the cost of that. We need to get the best advice on where they should be sited and where they are currently sited to maximise the return in terms of lives saved.

There is therefore a considerable requirement in defining the range of settings and events as well as monitoring and evaluating the provisions of a community defibrillator programme. The health technology assessment will address key issues in determining how we advance this programme.

I thank Senator Quinn for introducing the Bill and request that the Seanad support my approach in conducting a health technology and risk assessment, HTA, and subject to that my Department will draft a general scheme of a public health (availability of defibrillators) Bill. I will not oppose the Bill. I hope that I will have the Senator's support to carry out the health technology assessment.