Róisín Garvey (Green Party)
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I welcome the Minister of State.

Martin Conway (Fine Gael)
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The Minister of State, Deputy Butler, is very welcome to the House. I am delighted she is taking this Commencement matter because I know her commitment to health issues and the work she has done over recent years, particularly since becoming Minister of State with responsibility for mental health and older people. This is a very important issue. This month is cardiovascular month. It is a month when people are reminded to mind their cardiovascular health. Unfortunately, too many people in this country die and suffer serious illness as a result of issues to do with cardiovascular health. This month, therefore, is an opportune time for us, as a nation, to look at what we are doing in this area.

I have always believed that screening is very useful and very important and saves countless lives. However, one never really sees the headlines about the lives that are saved because people just get on with it. That means the programme is achieving what it is meant to achieve. Of course, we have had scandals as a result of screening not working, but they have been a minority of cases. Overall, screening works, and one would like to see a lot more screening, particularly when it comes to the early detection of cardiovascular health issues. It would be very useful if we had a national screening programme in this area. We need an overall national cardiovascular strategy anyway, not just from a screening point of view, even though screening is critical. From an educational perspective, a personal health perspective and a fitness perspective, there are a myriad of areas that would tie into a national strategy to reduce the number of people who suffer death, bereavement and long-term illness as a result of this issue.

The Minister of State will be aware that HIQA carried out a report into this area. It was asked by the Government to do so. It has recommended that TAVI, which is a medical intervention system, be used as an alternative to SAVR. It would reduce the number of bed nights people would require. While it is being used at the moment as an alternative in some cases to open-heart surgery, HIQA believes it should be rolled out in a much more focused way and to a much greater number of patients. That HIQA report is there and, like many reports, I do not want to see it just gaining dust on a shelf. HIQA did the report, it did good work on it and, as such, the report should be implemented. That would be another element and another cog to a national strategy. A national strategy on cardiovascular health should include education, awareness, health promotion and proper dietary awareness. It should also include the roll-out of a national screening programme to people a lot younger than those who may benefit from it at the moment. Such a strategy should look at full implementation of the HIQA report, which was carried out some time ago.

I know the Minister of State will join me in wishing the people who work in this area all the very best and thanking them for the work they do daily, particularly with September being the month when we acknowledge, appreciate and get a better understanding of our own cardiovascular health.

Mary Butler (Waterford, Fianna Fail)
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I thank the Senator and acknowledge his persistent advocacy in all health matters. I have come before him in this House many times. I join him in acknowledging and marking the fact that September is cardiovascular month. It is very important we continue to put a focus on that. I am taking this question on behalf of the Minister, Deputy Donnelly.

The national review of cardiac services was established to recommend the best service configuration, clinical governance and performance requirements for national cardiac services for the next ten to 15 years. The review is finalised and the Minister has reviewed it. He wants to secure funding for the strategy via the Estimates process and plans to bring the review to the Government for consideration. The former Chief Medical Officer advised that reform of cardiac services should extend beyond a hospital-based focus. Therefore, the next steps for implementing the review and developing a new cardiac strategy will be situated within a holistic context which reflects all aspects of cardiovascular disease, including prevention and rehabilitation. That is exactly what the Senator has spoken to as regards education, informing people about their cardiovascular health and a more holistic approach. We all know prevention is better than cure. The holistic reform approach includes integrating cardiac services to deliver a more comprehensive systems approach to cardiovascular health in meeting the needs of our population.

The review represents a significant and comprehensive piece of evidence-based work, resulting in a detailed report, and the recommendations of the review will inform the future provision of cardiac services nationally.It has taken some time for the review to reach this point however, considering the requirement for data and consultation to progress a major reform programme. This is understandable, and the results will be worth it.

In parallel, within a year, the HSE will be tasked with reform in several priority areas to address the immediate cardiac service needs of our population. These initial priorities will deliver results in the short term and will be developed in parallel with a longer-term implementation plan for the review’s recommendations when they are published. My understanding is that there are 23 recommendations.

Cardiovascular disease is multifaceted and incorporates a myriad of disease conditions which include, as the Senator has mentioned, transcatheter aortic valve implantation, TAVI, among other heart disease conditions and stroke. Plans to develop a new strategy will be informed by the review’s recommendations once published. This will include structural heart diseases. The implementation plan for the review’s recommendations will be the most appropriate way forward in progressing structural heart disease interventions such as TAVI. Operational leadership for Ireland’s complex cardiac services is provided by the HSE’s National Heart Programme. The National Heart Programme focuses on the design and delivery of the full spectrum of care for cardiovascular conditions. Underpinned by a whole-system approach, in line with Sláintecare, the National Heart Programme aims to improve population health, reduce health inequalities, improve patient outcomes and reduce the burden of cardiovascular disease in the population.

Beyond cardiac services, the Government is fully committed to supporting improvements and advances in other cardiovascular areas. The Minister has allocated a total of €7.3 million to fund the HSE National Stroke Strategy 2022-2027 over the last two budgets to support the development of stroke services. The overall aim of the strategy is to modernise and reform stroke services in line with Sláintecare policy and to help sustain and improve upon the significant achievements already made to date. I will come back to the Senator about screening in my closing comments.

Martin Conway (Fine Gael)
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Gabhaim buíochas leis an Aire Stáit. That is a comprehensive reply and I note the fact that work is being done. The Estimates process is coming to its conclusion now so, hopefully, we will see some resources identified for this. I would like to see the strategy launched, if possible, in the lifetime of this Government but certainly committed to by the various parties in their manifestos. Hopefully, it will be something committed to in the programme for Government with whoever makes up the combination that will run the country for the next number of years.

I believe strategies work. I have long been calling for a national strategy for the elimination of preventable blindness because four out of five people who suffer sight loss do so unnecessarily. There are unfortunately 20% who just go blind and nothing can be done about it. There is a great number of people who go blind and suffer severe sight loss and do not need to. If they just checked their eyes once every two years, that would be incredible. The number of people between 40 and 60 years of age who only check their eyes when they need to get a driving licence and then discover that they have a problem is phenomenal. The same is the case when it comes to this particular issue. If there was screening, we would see a dramatic reduction in the number of people who suffer from this condition.

Mary Butler (Waterford, Fianna Fail)
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I will agree with Senator Conway on screening, which is very important. This is an early detection and population-based screening programme for early detection of cardiovascular disease. The Minister for Health is fully committed to supporting our population screening programmes which are a valuable part of our health service. As the Senator may be aware, decisions on whether to introduce new screening programmes are made on the advice of the National Screening Advisory Committee. The committee is an independent, expert committee that makes recommendations to the Minister. I cannot reiterate how important screening is, whether one is called to BreastCheck or another screening service. It is very important that people attend because early intervention is key. As the Senator has said, many people - and we can all be guilty of this - put it on the long finger sometimes, as the Senator spoke there about blindness and sight loss, and wait until it is too late. I thank the Senator very much for his question.