Marc MacSharry (Fianna Fail)
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I thank the Minister for taking the time to come to the House to discuss this issue. Among the successes in the health service are the national cancer control programme and the new approach to cardiac care where outcomes are improving. The Minister is very familiar with the fact that the north-west region, north of the Dublin-Galway line and south of Mullingar, is not adequately catered for. We will leave the cancer debate for another day. However, I have probably clocked up a good few hours during the years talking about the issue here. I understand a group is being put in place and that there has been an acknowledgement by the Minister and his officials that, from a cardiac care perspective, there should be an opportunity to insert a stent within 90 minutes of an episode occurring. A total of 80% of the population enjoy proximity to a cardiac centre where that should be possible. However, the north-west region is not adequately catered for in that respect. While there are cardiologists available there, there are no cardio-catheterisation laboratory facilities.

I understand a group has been put together and is chaired by the geriatrician Dr. Colm Henry. I think he is senior in the representative body of clinical directors in the various hospitals. With other cardiologists, he is looking at how best to deal with the anomaly in the north west where, frankly, people who have a heart attack do not have the same potential for survival as those within the catchment area of one of the specialist cardiac centres. I have seen this happen before when the centres of excellence were being chosen. From a clinical perspective, a particular clinic in Sligo was at an advanced stage. However, the Government of the day wound it down and revved up one in Letterkenny in terms of the provision of breast cancer care services.

I gather two cardiologists from Galway will be or are in this group with Dr. Henry. It would suit them to have a cardio-catheterisation laboratory as far away as possible because they do not want to have anything eating into their catchment area, which I know sounds laughable when we are talking about saving people's lives, but there are medical politics. I want to ensure that, if money is made available for the construction and staffing of a cardio-catheterisation to be run at least on a 9 to 5 basis, like the one in Waterford, it will be appropriately located within the region. The appropriate location, notwithstanding the fact that I am from Sligo, is Sligo Regional Hospital which is equidistant from Galway and Altnagelvin in Derry where there is a cardio-catheterisation laboratory and eight cardiologists. The logical location for the laboratory is Sligo.

I hope the Minister will confirm that the group is in existence and chaired by Dr. Henry and outline what it is considering. I want to use this opportunity to impress on the Minister the need to ensure Sligo will be the location of the facility where it would be best placed to serve the entire region. The northern end of the catchment area can be served by Altnagelvin hospital, with the hospital in Galway serving the southern end. I am interested in hearing the Minister's views and hope he will be able to give me some good news.

James Reilly (Dublin North, Fine Gael)
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I thank the Senator for raising this issue which I know is of some interest to Senator Michael Comiskey and Deputy John Perry, the Minister of State with responsibility for small business, as well as Deputy Tony McLoughlin. I was in Sligo a couple of weeks ago and was sorry to have missed the Senator.

The acute coronary syndrome, ACS, clinical care programme was initiated to standardise treatment nationally for patients suffering from a heart attack. It is one of a range of national clinical care programmes established by the HSE with the aim of improving quality access and cost effectiveness. Primary precutaneous coronary intervention, PPCI, is the preferred treatment for ST elevated myocardial infarction, STEMI, in terms of morbidity and mortality outcomes. Where PPCI cannot be delivered within an acceptable timeframe - the Senator mentioned a figure of 90 minutes - administering a clot-dissolving or thrombolysis drug is recommended, with early transfer to a PPCI centre for angiography.

International best practice indicates that Ireland should have four to eight PPCI centres to accommodate the demands of the population.

Based on the European Society of Cardiology guidelines, patients should be transferred directly to a PPCI centre if this can be achieved within 90 minutes of the first medical contact. No PPCI centre exists in the north west and a report for the regional director of operations of HSE west in 2012 highlighted that 91.4% of the population lived at a distance greater than 90 minutes road time from the nearest PPCI centre in Dublin or Galway. This situation is not unique to the north west, however, because other areas of the country are also outside the 90-minute range. The report presented a series of options that would lead to the provision of PPCI to a greater proportion of the population. These options include cross-Border collaborative initiatives that could deliver a sustainable model for a greater proportion of the population of the north west. The solution would also probably involve air ambulance services in order to meet the 90-minute target.

Data from the heartbeat system shows an increase in STEMI patients receiving PPCI from 45% in the period from October 2010 to September 2011 to 67% in the period from October 2011 to September 2012. We have made great progress, although I recognise that is scant consolation to the people of the north west who want to have the same access as everybody else to this service. It is our intention to ensure that happens. We will have to think outside the box to achieve our targets but the group is working to that end and will make recommendations shortly.

Galway and Limerick are currently operating well as PPCI centres. A project is under way to enhance the provision of cardiac services to the population of the north west in view of the considerable distance factors involved. A project team comprising senior clinicians from the west and north-west area, chaired by Dr. Colm Henry, programme lead for the HSE clinical director programme, was established in March 2013. This team is to provide a report making specific recommendations on the following issues: delivery of cardiology services in the north west, noting findings of the situation report on services for acute coronary syndrome in the north west produced by Dr. Peter Wright in 2012; delivery of PPCI in the north west in line with the ACS programme, to include consideration of cross-Border provision; identification of a fixed elective cardiac catheterisation laboratory for the region to replace the current arrangement whereby services are delivered from a mobile laboratory on both acute hospital sites; and configuration and integration of cardiac services in the north west in anticipation of hospital groupings. Dr. Henry has convened a group including cardiologists from Galway, Sligo and Letterkenny hospitals, the national lead for the ACS programme and representative of the ambulance service. The group has sought and will consider detailed information from both hospitals and will be visiting both hospitals as well as Altnagelvin Hospital in Derry to meet hospital personnel. The group is scheduled to deliver its final report to the regional director of operations by June 2013.

Marc MacSharry (Fianna Fail)
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I thank the Minister for his reply and for confirming that the group exists. Although I am sure that he intends to take heed of the advice of the clinicians involved, I caution him that heavy pressure will be brought to locate the cardiology laboratory in the northern end of the catchment at Letterkenny General Hospital. While I do not wish to disenfranchise the people of County Donegal, the reality is that it is 20 miles from Derry. I would hate to see us making the same mistake that we made on cancer care. I ask the Minister to use his good offices to impress that on the group.