Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I am grateful to get the opportunity to update the Seanad on cardiology services at University Hospital Waterford, UHW. First, I again extend my condolences to the family of the late Thomas Power on their extraordinarily sad loss. While I cannot comment on the detail of individual cases, I expect that all the proper procedures will take place with regard to the examination of the circumstances of Mr. Power's death.

Last year, in line with a commitment in A Programme for a Partnership Government, an independent review of the need for a second catheterisation laboratory, cath lab, at UHW was undertaken by Dr. Niall Herity, a world renowned cardiology expert. The review concluded that the needs of the effective catchment population of UHW could be accommodated by a single cath lab. However, investment was recommended to enhance cardiology services at the hospital and to provide an additional eight hours cath lab activity per week to address waiting times and to provide improved access for patients.

At the time of the publication of the report, I committed to providing additional resources to the hospital. I am happy to confirm to the House that the HSE National Service Plan 2017 identified the implementation of the recommendations of the report as a priority and, in that context, additional funding of €0.5 million was provided for the hospital.

I should also mention that the HSE issued a tender last week for a temporary mobile cath lab at UHW. No doubt this will contribute, on an interim basis, to the further reduction in elective cardiology waiting lists at UHW. I expect that the mobile cath lab will build on the significant progress which has been made following a targeted initiative by the South/South West Hospital Group to address cardiology waiting times at the hospital.

I also committed to a further review to assess the impact these improvements have had on the volume of patients attending the cath lab and this review will take place at the end of the deployment of the mobile lab. I am happy to keep Oireachtas colleagues briefed on this. Last week I offered in the Dáil to keep Deputies from the south east informed on this review and I offer in the Seanad today to keep Waterford and south-east Senators briefed. It affects, in particular, Senators Coffey, Senator Grace O'Sullivan and Murnane O'Connor. I would be more than happy to keep them briefed, along with their Dáil colleagues, on that review as it progresses at the end of the deployment of the mobile cath lab.

In regard to emergency care, Dr. Herity recommended that such work should cease in order to allow the hospital to focus on a much larger volume of planned work. I should explain that primary percutaneous coronary intervention, PCI, is used as an emergency treatment for patients having a heart attack. It is distinct from PCI work where scheduled procedures are provided on a planned or elective basis.

Planned work represents 96% of the overall caseload in the cardiac cath lab in Waterford and, as I mentioned earlier, this service will be enhanced this year. Funding has been provided for an additional eight hours activity per week - in other words, a 20% expansion in operating hours. The cath lab will now be funded to provide 12 sessions - in other words, 48 hours activity per week. It is expected that this additional capacity will facilitate the provision of an increased volume of scheduled cardiology care at the hospital.

However, the organisation of primary PCI services is an issue for the whole country, and this is an important point. It relates to how we provide services to our whole population taking account of the best evidence available.

Based on this country's population we can only operate a limited number of primary PCI centres in order to ensure that the services we provide achieve the required standards. We also need to ensure that we provide sustainable services.

I would point out that throughout the country patients are transferred to cardiac centres for primary PCI. Patients in Monaghan or Louth are transferred to Dublin, patients in Sligo go to Galway and patients in Kerry go to CUH or Limerick.

Highly specialised services, such as primary PCI, need to be carried out in a small number of hospitals where the volume of patients supports the provision of a safe service. Low volume services do not facilitate the ongoing and sustainable achievement of the patient outcomes required. That is obviously not my view but a clinical one. Clinical staff cannot maintain their skills where patient volumes are insufficient and there are recruitment or retention issues with staff in low volume units. On foot of Dr. Herity's recommendation with regard to primary PCI at University Hospital Waterford, I indicated that I had asked my Department to address the implications of this recommendation by undertaking a national review of all primary PCI services with the aim of ensuring that as many patients as possible have access on a 24-7 basis to safe and sustainable emergency interventions following a heart attack. I did so as I wanted to be certain that any changes to how a service is delivered will result in improved services for the patients using that service and the maximum number of people possible in this country living within a close and appropriate time range to a primary PCI service. I can confirm to the Seanad, as I did to the Dáil last week, that the national review will proceed. I have asked my Department to make arrangements for this review which will address the wider implications, for all parts of the country, of Dr. Herity’s recommendation regarding primary PCI services.

I want to repeat that extra investment is being provided to allow additional activity at the existing lab. Second, the mobile cath lab for Waterford is confirmed and on the way. Third, there will be a further review of the Waterford situation following the deployment of this mobile lab. Fourth, there will be a national review recognising the importance of access to primary PCI services for all citizens. I look forward, in due course, to the finalisation of both of these reviews and I will continue to liaise with all Members of the Oireachtas, especially those from the south east, on what I understand is a very important and sensitive issue. I will always be guided by clinical advice on this issue and should the clinical advice change, then I will change my position. We have two significant developments in the additional resources, the mobile cath lab, we have a review of the situation in Waterford and an ongoing national review. We need to continue to develop health services based on a medical evidence approach and one which is objective and independent, and that is what I intend to do.