Paddy Burke (Fine Gael)
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I welcome the Minister, Deputy Varadkar, to the House.

David Cullinane (Sinn Fein)
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I welcome the Minister to the House. I am pleased he is taking this Commencement motion.

I have raised this at least seven times as a Commencement motion in the Seanad over recent years. When the new hospital groups were being established - it was not under Deputy Varadkar's leadership but under the leadership of a previous Minister for Health - Waterford was grouped with Cork in a new hospital grouping and we were promised 24-7 cardiology care for the south east to be provided in University Hospital Waterford as part of that new hospital grouping.

We have one catheterisation laboratory, cath lab, which is open five days a week from 8.30 a.m. to 5.30 p.m. and three interventional cardiologists. Patients may be treated in emergency circumstances from 8.30 a.m. to 5.30 p.m., but outside of these hours, if somebody presents as an emergency, although we have 24-7 consultant cover, we do not have the primary percutaneous coronary intervention, PPCI, cover and patients are transferred to hospitals in the south and south west for emergency treatment outside of those hours. On the previous occasion I raised this as a motion in the Seanad, I was told that an extension to the service would require three additional interventional cardiologists or consultant cardiologists, extra support staff and a second cath lab, involving a capital cost of €1.9 million and a revenue cost of approximately €2.7 million. The Government tells us constantly that the economy is recovering, there is more money and the Exchequer figures are up. If that is to mean anything to citizens, these are the types of services which should be provided.

Figures reported in the Waterford News and Starlast week show that Waterford was the sixth busiest cardiology service in the State. St. James's Hospital in Dublin was the busiest, followed by Cork, the Mater in Dublin, Galway, Limerick and Waterford. A number of hospitals see fewer patients but yet have 24-7 emergency cardiology cover and two cath labs. It is the same old story for Waterford and the south east. While we have the population of 500,000 and there is clear demand given that it is the sixth busiest cardiology service, we do not have the 24-7 cardiology cover that people feel they deserve and need and which was promised by the previous Minister for Health.

In light of the response I received in August which referred to the cost and the resources that needed to be put in place to have 24-7 cardiology, what is Government policy? Is there a commitment to 24-7 cardiology, are we working towards it, are there any plans for additional services in this area for University Hospital Waterford and will the Minister update the House on that?

Leo Varadkar (Dublin West, Fine Gael)
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I thank Senator Cullinane for raising this matter today.

Services at the regional cardiac catheterisation laboratory, cath lab, at University Hospital Waterford are led by three consultant interventional cardiologists and their teams.The service is developing in line with best practice and the national clinical programme for acute coronary care. The cath lab at University Hospital Waterford, UHW, performs approximately 40 invasive cardiovascular procedures each week and offers a comprehensive range of invasive and non-invasive diagnostic services. This includes the insertion of stents, pacemakers and implantable defibrillators. PPCI is undertaken on patients with ST elevation myocardial infarction, STEMI, heart attacks, which account for approximately 20% of all heart attacks. It is done in a cath lab by an experienced cardiologist. The cath lab at UHW is open five days per week from 8.30 a.m. to 5.30 p.m. Patients who require PPCI outside these hours are transferred to Cork University Hospital or to a Dublin hospital. However, 24-hour, seven-days-a-week consultant medical cover for cardiac patients, and all medical patients, is provided at UHW.

The acute coronary syndrome programme was established in order to standardise the treatment of patients. The model of care produced by the programme was informed by advice from the principals involved in centres in the UK and other European countries. 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. UHW is committed to the progressive extension of the current PPCI service. Any extension to the service will require significant investment, both capital and revenue.

To provide 24-hour emergency PPCI cover requires, at a minimum, two cath labs on site and a minimum of six interventional cardiologists. As for any complex acute hospital service, a key criterion for deciding if 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 or caseload, 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 with good patient outcomes. Given that funding for new developments is very limited, it is critically important that the available funds be targeted appropriately. UHW is a constituent hospital of the south-south west hospital group. The priority to be afforded to the expansion of the PPCI service in Waterford must first be considered from a hospital group perspective and in respect of the planning for the cardiology needs of the group population. The development must then be considered in a national context and in light of competing demands for scarce resources. The issue remains to be considered and prioritised by the HSE, in the development of the strategic plan for the south-south west hospital group. It is expected that the groups will develop and complete their strategic plans in 2016.

David Cullinane (Sinn Fein)
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The Minister's answer seems to be different from the one I received in May, which seemed to be an outright "No". The Minister's answer may be somewhat positive in that the issue remains to be considered and prioritised by the HSE. The Minister said one of the key criteria is that there be sufficient patient volume, which is the case. I gave the Minister the figures earlier and we have the population. It is concerning that the Minister said the priority to be afforded must be in the context of the needs and population of the group of which the hospital is a member. This will worry many people. One of the concerns the people of Waterford had when we joined the south-south west hospital group with Cork was that what is now UHW was a regional hospital servicing the population of the south east. If we are now ignoring this population base, we are ignoring the fact that Waterford is the capital, if you like, of the south east, and facility services patients in Wexford, Tipperary, Carlow and Kilkenny, but is seen solely in the context of the population of the hospital group. It is a clear departure from how services were provided in Waterford in the past, and I am slightly concerned about it. It remains to be seen what will be in the new plan for 2016. I appeal to the Minister to examine the facts and figures, the population and the patient throughput in the hospital. He will see that there is justification for full, 24-7 cardiology cover in UHW.

Leo Varadkar (Dublin West, Fine Gael)
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When we discuss patient numbers and caseload on the particular issue the Senator is raising, we are referring only to patients who could benefit from a PPCI, not patients or cardiology patients in general. General cardiology is already provided on call, 24-7 in Waterford. Only a few months ago - this year or last - there were three 24-7 PPCI hospitals in Dublin serving the greater Dublin area.That was reduced from three to two because the patient load was not sufficient to sustain three services in the greater Dublin area. That decision was made by the national programme. That is how these decisions should be made. It is a long time since Ministers or politicians decided where special centres or cancer centres should be. We are not going back to that. We are certainly not going back to it while I am Minister. Decisions will be made based on what is best in terms of patient safety and clinical outcomes. Consideration is being given to extending the existing service in Waterford to 8 p.m. Such a decision will have to be made in the context of the group's strategic plan. We will have to be sure it is safe, sustainable and staffable. Obviously, that is much more important than any financial issue. We need to know the caseload is sufficient to ensure any new service or extension of the service is sustainable and staffable.