Paudie Coffey (Fine Gael)
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I welcome the Minister of State, Deputy Marcella Corcoran Kennedy. The Minister for Health, Deputy Simon Harris, is only too well aware of the significant issue I wish to raise.

Access to cardiac intervention is a critical need where a citizen has a heart attack. Unfortunately, in the Ireland of 2016, we do not have equality of access to health care in the event of an emergency. That is particularly the case in the south east. The essential target response time to achieve the best cardiac intervention outcomes in the event of a heart attack is 60 to 90 minutes. The south-east region, however, has only one catheter lab which operates at University Hospital Waterford between the hours of 9 a.m. and 5 p.m. five days per week. The south east is , therefore, the only region in the country which does not have access to 24/7 interventional cardiac care within the critical period to which I referred. No intervention is available after hours, which means lives are being put at risk. This issue has been highlighted consistently by myself and others in recent years.It is important that we examine the context and background to this issue. In 2012, Professor John Higgins was appointed by the Government to take an objective, independent view and to make recommendations to Government on the reform of the hospital systems in the South and in the country. His findings are otherwise known as the Higgins report.

In 2013, there was reform of the acute hospital network and the establishment of hospital groups. It resulted in the break up of the old South Eastern Hospital Group that transformed what was then the Waterford Regional Hospital into the University Hospital Waterford. At that time, clear commitments were given to the public, politicians and clinicians by the former Minister for Health, Senator Reilly, and the former Secretary General for the Department of Health, Dr. Ambrose McLoughlin. The commitments included an enhancement of interventional cardiology at University Hospital Waterford. The records are available for anybody to see in the Department of Health and I urge the Minister of State to make herself aware of them. Three years later, the hospital boards have still not been appointed and commitments have not been met. This is a serious breach of trust in the reform programme in terms of the public, politicians and health professionals.

In terms of the recent Herity report, three areas require specific focus and attention. First, the base population and throughput data that was used in the report is fundamentally flawed because it took into account the current patient throughput of a part-time service. It also did not take into account the potential patient referrals in a region of 500,000 people if a 24 hours, seven days a week service was available.

Second, Dr. Herity has stated that it is possible to travel from Waterford to the University Hospital Cork within a 90 minutes' timeframe. That is incorrect in terms of many of the outlying areas of Waterford, including south Wexford, south Tipperary, east Waterford and south Kilkenny. His timeframe does not take into account the transfer times for patients from outlying areas, who are in urgent need of intervention, going to Waterford in the first instance. Dr. Herity acknowledged in his report that there is no stated alternative to get patients outside the 90 minute zone to cardiac care. The only way to do so, and logical people would agree with me, is through the provision of an air ambulance, a measure that is not possible in the current climate. Therefore, lives in the south east are at risk in the event of an emergency.

Third, I am seriously concerned about the fact that the Department of Health gave a note to Dr. Herity prior to him compiling his report. That gives the impression, whether it is right or wrong, that Dr. Herity was guided by the Department officials and, thus, his report was pre-determined. The situation raises questions about the independence of his report and is a matter that needs further analysis and examination. In my opinion, the basic flaws in his report undermines its findings and recommendations. Alternative findings have been proposed to the Minister and we ask him to consider them. It is essential that the three aspects of the report that I have identified be reviewed before decisions are made about the future of the cardiology services in the south-east region.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank the Senator for raising this important matter that I know has been close to his heart for a long time. I am taking this matter on behalf of my colleague, the Minister for Health, who is unable to be here this morning due to a pre-arranged meeting with the Oireachtas Joint Committee on Health. He has asked me to convey his sincere apologies.

As the Senator will know, the Minister received the report on the independent clinical review of the need for provision of a second cath lab at University Hospital Waterford, on foot of the programme for Government commitment. The report was completed by Dr. Niall Herity, a consultant cardiologist and clinical director of cardiology at Belfast Health and Social Care Trust. He is a well known and highly respected cardiologist in Belfast. It is a comprehensive report that reflects the fact that Dr. Herity consulted widely and met all of the key stakeholders, including the management and staff of both University Hospital Waterford and Cork University Hospital.

Dr. Herity's calculation of the catchment population for the University Hospital Waterford's cath lab has been challenged since publication of the review. In his report, Dr. Herity quite rightly points out that it would be a mistake to assume that the catchment area of University Hospital Waterford is represented by every resident in Waterford and its surrounding counties. Dr. Herity therefore determined the effective catchment population by looking at regional patient flow data and combining this with 2016 census data in terms of the population of Waterford and surrounding counties.

Dr. Herity has provided robust evidence that a second cardiac cath lab at University Hospital Waterford is not justified. However, he recommends increasing the number of weekly sessions currently provided, along with the requisite additional staffing for the increase in sessions, in order to address waiting times and to provide improved access. He also recommends that new specialist equipment be provided to improve contingency for radiological equipment failure during a procedure. The Minister is happy to provide the additional resources necessary to implement these recommendations and, as such, significantly improve services for patients at University Hospital Waterford. This investment will be reflected in the HSE's national service plan for 2017. During this period of investment and enhancement of services, the situation will be closely monitored. A further independent clinical review will be carried out in early 2017 to assess the impact that these improvements have had on the volume of patients attending the cath lab in University Hospital Waterford.

Dr. Herity has recommended that University Hospital Waterford's cath lab should operate as an elective lab that provides all specialised cardiac services except interventional treatment for patients who are having heart attacks. Dr. Herity has also recommended that the current nine to five provision of these services should cease to allow the hospital to focus on the much larger volume of planned cath lab work.

Senators will understand that the Minister must be certain that any change to how a service is delivered will result in improved services for the patients using the service. Therefore, he has asked the Department to address the implications of this recommendation by undertaking a national review of all primary percutaneous coronary intervention, 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. It is expected that this review will be completed by the end of July 2017.

The Minister intends to visit University Hospital Waterford in the coming weeks. He will take the opportunity to speak with staff and management on a broad range of issues.

Paudie Coffey (Fine Gael)
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I acknowledge the recommendation to enhance services at the existing cath lab. The recommendation should be implemented without delay.

I take issue with the fact that Dr. Herity has claimed he engaged with important stakeholders in the south east. He did not visit Wexford General Hospital, St. Luke's General Hospital in Kilkenny or South Tipperary General Hospital even though they are all hospitals in the region and catchment area of University Hospital Waterford. If he had done so, he would have heard the views of the consulted cardiologists in all of those hospitals and the GPs in the region who are critical stakeholders.

I repeat my three issues of concern. First, the base population and throughput data that Dr. Herity used in his report is fundamentally flawed. Second, he stated that it is possible to travel from Waterford to Cork in 90 minutes. That is the best estimate but it does not allow for outlying areas that is critical in terms of a heart attack and accessing interventional care. Third, I am deeply disturbed and suspicious about the fact that Department of Health officials gave a note to Dr. Herity prior to him completing his report. That scenario raises questions about the independence of his report.

I mean no disrespect to the Minister of State present or to the Minister for Health, but I am concerned given the context and history of this issue, the recommendations of Professor John Higgins who was appointed by the Government in 2012, and the commitments that were entered into at the highest levels in Government and also at the highest levels in the Department of Health. The 2013 commitments are on the record in the Department of Health and state:

The establishment of Hospital Groups will enhance cardiology cover in WRH. At present this is provided from 9 a.m. to 5 p.m. The increased flexibility of staff across the group will help enable us achieve our goal of providing cardiology cover at Waterford Regional Hospital 24 hours a day, 7 days a week.

What has changed since then? I deeply suspect that it is not the Minister for Health that is at issue here. I believe the Department of Health officials have an agenda. They are against the people who live in the south-east region and University Hospital Waterford due to being interested in providing efficiency in terms of health services. That efficiency excludes people who have an equal right to access care when they have a heart attack in the region. People are being deprived of that right. As a Government Senator, and as a former Minister of State, I am deeply disturbed by what has happened with the hospital groups, the non-committal of the commitments that were given, and also the non-establishment of hospital boards in three years.

The Dublin press and media have painted this matter as a local parish pump issue but that is not the case.This is a regional issue that potentially affects approximately 500,000 people and many of those have families who cannot access the service in an appropriate timescale. This is a matter of life and death and I do not say that lightly. I appeal to the Minister of State to take an alternative view and listen to the consultants who have made the alternative case. We often hear that doctors differ. This is one doctor who has given an opinion, there are many others giving a different opinion. If the Minister does not believe the people of Waterford he should go to Cork and listen to Professor John Higgins whom the Government appointed in 2013 and he will state the case.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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The Senator can rest assured that I will bring his points to the Minister and raise the question of the hospital board appointments too, which many of us are anxious to see established. The Senator asked questions that I cannot answer. I will certainly ensure that a response is issued directly to the Senator after I leave the Seanad this morning. He raises some very valid points which require elaboration and I aim to get them for him.