Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I thank the Senator for raising this matter. It strikes me that we learn very little from the appalling circumstances in which people find themselves as a result of failures in the health service. The lesson we must learn from recent revelations about maternity services is that services must have continuous throughput and significant volumes if they are to be safe and this is not always the case.

Services at the regional cardiac catheterisation laboratory, cath lab, at University Hospital Waterford are led by three consultant interventional cardiologists and their teams. This service is developing in line with best practice and the national clinical programme for acute coronary care.The cath lab at UHW performs approximately 40 invasive cardiovascular procedures each week and offers a comprehensive range of invasive and non-invasive diagnostic services. These include the insertion of stents, pacemakers and implantable defibrillators. Almost 3,000 procedures were carried out in 2014.

Primary percutaneous coronary intervention, PPCI, is done on patients with ST elevation myocardial infarction, STEMI, heart attacks, which account for some 20% of all heart attacks. It is done in a cath lab by an experienced cardiologist. The cath lab in UHW is open five days a week from 8.30 a.m. to 5.30 p.m. Patients who require PPCI outside these hours are transferred to another hospital in the south-south west hospitals group, namely, Cork University Hospital, or to a Dublin hospital. It is important to note, however, that 24-7 consultant medical cover for cardiac patients and all medical patients is provided at UHW. For 24-hour emergency PPCI cover, there is a requirement, as a minimum, for two cath labs on site. It also requires a minimum of six interventional cardiologists.

As for any complex acute hospital service, a key criterion for deciding whether a 24-hour PPCI service should be provided is whether there is a sufficient volume of appropriate patient activity to ensure the safe provision of the service. Without sufficient volume of patients, staff will not be in a position to maintain their skills and, in those circumstances, it will not be possible to ensure a safe service. That is the most important consideration in all of this. The acute coronary syndrome, ACS, programme was established in order to standardise the treatment of patients with all types of cardiac arrests. The model of care produced by the ACS programme was informed by advice from the principals involved in centres in the United Kingdom and other European countries. The programme was also informed by models of care from the United States and Australia. Experience at national and international level highlights the importance of having sustainable rotas of clinical staff to support the 24-7 requirements of the service.

The designation of PPCI centres outside Dublin is based on the recommendations of the ACS programme report of 2012. These were that Cork University Hospital and University Hospital Galway should provide a 24-7 service, with University Hospital Waterford providing a 9 a.m. to 5 p.m. service. UHW is committed to the progressive extension of the current PPCI service and will be pursuing this in the context of service planning for 2016. An extension to the service would require three additional consultant cardiologists, extra support staff and a second cath lab. This would have a significant capital cost of €1.9 million and an even greater revenue cost of €2.7 million. Another factor to consider is that international best practice indicates a requirement for one PPCI centre per 500,000 to 1 million population.

UHW is a constituent hospital of the south-south west hospitals group. It will, therefore, be necessary for the latter, in the first instance, to consider the issue from a group perspective and plan for the cardiology needs of its group population accordingly.