Commencement Matters

House Purchase Schemes

Cuirim fáilte roimh an Aire Stáit. This issue relates to the home choice loan scheme which was established in late 2008 or 2009 and funded by the Exchequer to the tune of €500 million initially. However, less than €4 million worth of loans have been approved by the home choice loan programme since its inception. As I understand it, only 21 loan approvals have been granted.

There has been much commentary in recent times on the difficulties people are experiencing in obtaining loans to build or purchase homes. Obviously, the curtailment of the Central Bank mortgage lending rules has also had an impact. The home choice loan scheme is administered through the local authority system, however, and not subject to the Central Bank lending rules. Under the scheme, the borrower is only required to have 8% in savings up to a maximum threshold of borrowing €285,000. The borrower must have 8% in savings for an application to be deemed eligible. There are other criteria, including having been refused by two other mortgage lending agencies prior to applying for the home choice loan scheme.

The scheme was set up to support people who wanted to purchase and live in their own homes. The State should do everything possible to afford people the opportunity to progress to a phase in their lives when they can actually do that. The scheme is essentially defunct - it is not working. A spokesman for Irish mortgage brokers, Mr. Karl Deeter, commented on the scheme at the end of August. He stated not only was the scheme defunct but also that mortgage brokers did not even know how to get in contact with the home choice loan provider. We need to put our hands up and say the scheme has been a complete and utter failure. However, that does not mean it should not be resurrected. It should be resurrected in the light of the need to provide housing and the demand among individuals, especially those in rural areas who may wish to build their own homes on their own land. They should be allowed to do so. Often, the only show in town for them is a mortgage through the lending agencies, but they are not available, despite what may be said to the contrary by those in the lending agencies.

The lending rate of 3.25% is competitive within the market, but why is no one applying? The reason is that the scheme is not being promoted, marketed or structured properly. I am keen to hear what the Minister of State has to say. If we are not going to revamp and revitalise the scheme and make it available to everyone, we would be as well to close the door and say we have failed. Where has the money initially allocated to the scheme gone?

It is good to be back in the Seanad again.

I thank the Senator for raising this issue. It is important to bring clarity. Like many schemes, people do not always know about them until they go looking for them. In our offices people have asked about them in the past and we pointed them in the right direction. Generally, if someone wants a loan through this mechanism, they will find out about it. However, I understand what the Senator is saying about promoting the scheme also.

The home choice loan is a Government-backed mortgage for first-time buyers introduced in 2009. It was introduced as a temporary loan offering from local authorities. It was designed to facilitate those in creditworthy households wishing to purchase or build new homes or purchase second-hand homes who had been affected by the credit conditions in the mortgage market. As the Senator said, it can also be used to build a home on land owned by individuals.

It is available nationwide through mortgage brokers who are included in a designated panel compiled by the Housing Agency. The loans are made available and administered by four lead local authorities on behalf of all local authorities - Dublin City Council, Cork City Council, Kilkenny County Council and Galway County Council. A dedicated website, www.homechoiceloan.ie, gives full details of the scheme.

To support local authorities in operating home choice loans in a consistent and efficient manner, the Housing Agency provides a central service for them. This shared central service processes loan applications, carries out credit checks and issues a recommendation to the local authority on each loan application in accordance with the credit policy. The final decision on loan approval is a matter for the relevant local authority and its credit committee on a case by case basis.

The loan is available to first-time buyers who can prove that they have been refused a loan by two financial institutions. It provides up to 92% of the market value of a property purchased to a maximum loan amount of €285,000. The loan is a normal capital and interest bearing mortgage. It is offered at a single, competitive variable interest rate, currently set at 3.25%. Since the home choice loan scheme commenced in 2009, 21 home choice loans have been issued with a total value of more than €3.9 million.

Local authorities can offer another type of product to first-time buyers. In accordance with the Housing (Local Authority Loans) Regulations 2012, local authorities can offer eligible first-time buyers a local authority standard variable rate annuity mortgage loan directly, which offers a rate of 2.55%. Like the home choice loan, this loan type is only available to individuals who have been refused a mortgage loan by two other lenders. The annuity mortgage scheme has a lower loan limit, lower income thresholds and lower interest rates but a higher loan-to-value, LTV, ratio of 97% compared with the home choice loan ratio of 92%. In addition, the standard annuity mortgage is available and administered directly by local authorities. Almost 1,100 of these loans have been provided by local authorities since 2009 when the current product was introduced, totalling €87 million.

When the home choice loan and standard mortgage loans were introduced, careful attention was given to the terms and conditions that should be applied. It was set against the background of the experience of previous mortgage lending by local authorities, under which the current level of arrears is running at approximately three times that of the private mortgage sector, presenting challenges for the home owners and lending local authorities concerned, and liberal mortgage lending by the private banking sector in the years running up to the economic collapse in 2008. Therefore, the regulations underpinning the home choice loan and the standard annuity product provided for the first time for the development of a statutory credit policy that would govern any lending under the scheme. Decisions on all loan applications must be made in accordance with this statutory credit policy to ensure lending prudence and to assist authorities across the sector to engage consistently in responsible mortgage lending in the best interests of borrowers and local authorities as lenders.

My ministerial colleague, Deputy Simon Coveney, and I will continue to keep the home choice loan scheme under review and would welcome whatever suggestions Senators might have as to how the product might be better publicised. To some extent, however, what we are seeing in terms of the home choice loan is a mirror image of what is happening in the private housing market in which there is a misalignment between house prices and the capacity of first-time borrowers to raise sufficient cash deposits to meet prudent financial rules that are intended to safeguard the borrower into the future. In this context, the Senator will know that the Government has made its intentions clear in increasing the supply of affordable houses for first-time buyers into the market. The Minister and I are committed to ensuring the ambition of Rebuilding Ireland - an Action Plan for Housing and Homelessness is achieved. The full intention is to work with all stakeholders to make houses more affordable. Announcements in the budget in two weeks' time will help to address this issue. It is a question of supply and demand and having a product people can afford.

I do not have information on the number of applications, but it looks like people are, for whatever reason, not choosing this product. However, there have been more than 1,400 council loans. People are aware of the former, but they are choosing the latter route. It could have to do with the LTV ratio.

I thank the Minister of State. The figures which are shocking were given in a parliamentary reply. I agree with much of what the Minister of State said, but his reply obviously comes from the departmental officials and is not imaginative. The scheme is worth €500 million, but less than 0.8% of that money has been given out in mortgage loans at a time when people are looking for them. The reply referred to the limit, the misalignment and the fact that people must have savings before they could get a mortgage, but the Central Bank's rules have set a higher bar at 10% or 20% than the home choice rules at 8%. Therefore, one would imagine that if people had a difficulty in saving a deposit, their first port of call would be the home choice loan scheme.

The Minister of State put his finger on the issue when he suggested the scheme had not been advertised or promoted. I call on him to leave his footprint in the Department by revamping the scheme or getting rid of it altogether. There should not be a false impression that these loans are available. A radical revamp of the home choice loan structure and a marketing programme are required. In 12 months' time, I would like to see several hundred applications having been approved under the scheme.

To be clear, imagination works both ways. We will take on board any idea the Senator has, but I will not force anyone to take out a loan. The loan is available, but people are choosing not to avail of it. They are choosing local authority products instead. It is not that people do not know. The 1,100 people who chose the other mortgage would have been aware of both options. It is not our job to force them to choose this one. I agree that it is our job to advertise and promote the scheme but brokers also encourage people to take out what are the best products for them. Under the scheme, if one fails to get credit through the normal lending institutions, this is another option. People who look to borrow money are aware of all the options. I would have no problem with putting more effort into promoting the scheme but please do not tell me that it is our job to make them choose it. It is not.

I did not say that.

No, the Senator said-----

There is a large measure of agreement between the Senator and the Minister of State.

The money and the product are available for people who meet the criteria. I am open to ideas. As for imagination, the Senator should not blame the officials if he has no ideas either.

I will provide the Minister of State with plenty of ideas.

I did not hear them.

I offered a few today. One concerned the marketing of the product. That was No. 1.

I agree with that one.

The two Members can have a good chat afterwards. I thank both of them.

Community Services Programme

I welcome the Minister of State.

I thank the Minister of State for attending to address this issue. I also thank and acknowledge a couple of staff from St. Andrew's community centre in Rialto who are present for highlighting to me during the summer the problems facing the community service programme, CSP. The other staff are busy hosting a local economic event in the area today.

Community service projects are the bedrock of communities throughout Ireland. They are the link in the chain that serves to empower individuals to create a better society. They fill gaps in the provision of services that the Government does not provide. They educate, advocate, listen, guide and enable people to become leaders in their communities. As public representatives, we are merely the voice given to us by those who undertake these projects daily, weekly and monthly. There are more than 400 community service projects throughout the country providing child care, drug rehabilitation, youth projects, community development, training, education, etc. Without them, society would have been broken even further during the most recent recession.

Since January the minimum wage increased from €8.65 to €9.15. Sinn Féin welcomed this but is committed to providing for a living wage. Community service projects also welcomed the increase in the minimum wage and view it as a means to allow their staff to live, not just to survive. The problem arises from the fact that Pobal's annual contribution towards employing a full-time staff member remained at €19,033, inclusive of employer's PRSI. This served to pay the employee the minimum wage of €8.65, with the balance covering the PRSI contribution exactly. It was communicated to projects through Pobal that its annual contribution would not increase to provide the extra money required for them to pay the increased minimum wage lawfully.

Community service projects are nothing without their employees. The employees are the recognisable, hard-working faces that ensure communities advance. Therefore, projects want to be able to pay them a fair wage and fulfil their responsibilities as good employers.

That is easily solved. Whether there was an anomaly, oversight or distinct decision made at the time not to increase the contribution, it now needs to be rectified. The upcoming budget provides a space to do this and increase the annual contribution to community service projects in order that they can pay their staff adequately.

I thank the staff and volunteers in St. Andrew's community centre, Rialto and the hundreds of other community service projects throughout the country that do amazing work for society day in, day out. I hope for a positive response.

I thank the Senator for raising the issue of the community services programme, CSP. I welcome her friends and neighbours from St. Andrew's community centre. I acknowledge the massive contribution made by many such organisations in their communities, of which I know from first-hand experience.

On the broader issue, the provision of local, social, economic and environmental services is the core aim of the CSP, under which a total of 404 service providers are supported to provide such services through the application of a social enterprise model of delivery. For the purposes of the CSP, a social enterprise has been defined as "an enterprise that trades for a social/societal purpose, where at least part of its income is earned from its trading activity, is separate from government, and where the surplus is primarily reinvested in the social objective". The funding provided for the service providers under the CSP is expressed as a fixed annual co-funding contribution towards the cost of employing a manager or specified number of full-time equivalent staff. The CSP service providers are required to generate traded income from a variety of sources. To assist with sustainability, all CSP service providers should strive to be in circumstances in which at least 30% of annual turnover is from traded income and in which the CSP grant is not more than 50% of annual turnover.

The CSP grant contribution is provided on a co-funding basis and employers are expected to provide additional funds from their own resources to meet the full costs of employment. Support for an eligible person with a 39-hour working week is €19,033 per annum. The employer is expected to pay the local labour market rate for the position and to finance this from non-public grant revenue generated. An additional contribution of €32,000 per annum can also be made towards the engagement of a manager. We should focus on that figure also. The setting of wage rates is entirely a matter for the employer organisation in contract under the CSP.

Owing to the changes to the national minimum wage from January 2016, the issue of sustainability of some CSP service providers has come into focus. I accept that is the reason for this debate. In response, the Department has established - this is important also - a CSP support fund for a fixed period, between 2016 and 2018, to assist service providers in enhancing their sustainability as social enterprises. Therefore, a CSP support fund has been established for the next two years. The support fund is allocating additional financial supports to existing providers under the CSP to enhance their sustainability as social enterprises. Allocations under the support fund are supplementary to the CSP contribution that service providers currently receive. Appraisals of CSP service providers are ongoing to establish the extra funding required and it is expected to be finalised in conjunction with the current 2016 recontracting process.

The response is positive, but I would obviously need to take it in more. "Appraisal" can be a scary word when one is considering services, including community services. I hope it is not an appraisal to cut further or make the community service projects unsustainable. The Minister of State referred to an appraisal and report at the end of this quarter. Does he know exactly when the decision will be issued prior to Christmas? Will the arrangement apply retrospectively from January 2016 to provide specifically that employers can give the minimum wage to their employees?

I share the Senator's concerns when I see some of the phrases used, but the bottom line is that I personally will be supporting what she is saying. I will go back to the senior Minister about the issue. I am filling in this morning for the senior Minister because I feel very strongly that many of the organisations do a fantastic job. I believe the decision will be issued before Christmas 2016, but I will have to confirm this for the Senator.

People need to know - the Senator probably knows this - that in the region of 3,000 people are in supported employment under the programme in approximately 400 not-for-profit companies and co-operatives. Funding of €45 million has been provided for the programme in 2016. This will maintain the current level of activity. It is important to know that Pobal is contracted by the Department to take financial and contract management from the CSP.

On the minimum wage, employees should be paid a fair day's pay for a fair day's work. I strongly support that principle. In the long term we need to move towards a living wage. Within organisations and companies, this needs to be addressed and a balance needs to be struck.

I will raise with the senior Minister the issues raised by the Senator. I will then revert to her with a more detailed response, particularly on dates and timelines.

That would be great.

Motorised Transport Grant

I thank the Cathaoirleach for choosing this matter and the Minister of State, Deputy Finian McGrath, for being present to hear it. Since I entered politics in the other House, the Minister of State has been a strong advocate for the disability sector. Therefore, I know I will get a good hearing. I appreciate that very much. I congratulate the Minister of State on his advocacy for the disabled for many years.

Let me outline the background to the motorised transport grant for those who might not understand. The payment was suspended in 2013. It was for people with disabilities who needed to buy a car to retain employment or, in exceptional circumstances, people over 17 years with severe disabilities who lived in isolated locations and could not use public transport. I wish to concentrate on the latter.

I can best illustrate the point I wish to make by referring to extracts from a letter I received from one of my constituents, a woman who cares for her husband. I will refer to the important points and leave out names; therefore, no one will be identified. The woman states her husband contracted viral inflammation of the brain in 1995 and has considerable brain damage, epileptic and non-epileptic seizures, depression, word-finding problems and problems with comprehension and memory. She states he had a heart attack in 1999 and has had 16 stents put in his heart. She has been caring for him 24/7 and he has many seizures during the night. I am very much aware of the circumstances. The woman states her husband must be driven to attend appointments in Galway and Dublin. She has to get him out of the house every day for tea and take him to Sunday lunch as part of his therapy, as ordered by his consultants. She contends that she desperately needs to have a sturdy car because her husband is 19 stone, over six feet in height and has had seizures in the car requiring him to be stretchered out on numerous occasions. She has a 2009 car that really needs to be updated to a 2012 car. The Disabled Drivers Association of Ireland advised her she should change car every two years, but it is four years since she has changed hers. She called to the Castlebar clinic 18 months ago to ask for forms to apply for the motorised transport grant and was told it had been stopped and was to be replaced.

She says she has been telephoning every few months but still there is no replacement scheme. The car is now beginning to give trouble and she is extremely worried that it is going to break down when she is out with her husband and that this could trigger a seizure. His seizures are caused by stress, worry and anxiety. She says she gets the VRT and VAT back on the car but even with the motorised transport grant, she still has to go to the credit union for a loan to pay for the shortfall on the car. The older her current car gets, the more it depreciates. This means that she will have to get a bigger loan from the credit union. She desperately needs the motorised transport grant to be reinstated because if it is not, she does not know how she will manage. I know this case on which I have been working with the family for a number of years. It really is a lifeline and I would like to get a response from the Minister of State.

I thank the Senator for his contribution, as well as for his earlier congratulations on my new portfolio. I give a commitment to push strongly on many of the issues on which I have been advocating. The letter the Senator read from the carer is emotional and heartbreaking. I hope that in some of the responses this morning, we can progress the issue.

I thank the Senator for raising this matter and welcome the opportunity to outline the current position. As he will already be aware, conscious of the reports of the Ombudsman on the legal status of both the mobility allowance and the motorised transport grant in the context of the Equal Status Acts, the Government decided to close both schemes. As a result, the motorised transport grant referred to by the Senator has not been in place for over three years. There are no plans for its restoration on the basis on which it was previously operated. That is the first important part. The next part is, however, more important. The Government is aware of the continuing needs of people with a disability who rely on individual payments that support choice and independence. In that regard, monthly payments of up to €208.50 have continued to be made by the Health Service Executive to 4,700 people who were in receipt of the mobility allowance. The Government has decided that the detailed preparatory work required for a new transport support scheme and associated statutory provisions should be progressed by the Department of Health. I confirm that work is at an advanced stage on policy proposals for the drafting of primary legislation for the new scheme and anticipate that it will be brought to Government shortly. In that regard, a health (transport support) Bill is included in the Government's legislative programme.

A Programme for a Partnership Government acknowledges the ongoing drafting of primary legislation for a new transport support scheme and that both and the Minister for Health, Deputy Simon Harris, and I are committed to its progression as soon as possible. We are on the issue of a transport support scheme. The proposals will seek to ensure that there is a firm statutory basis to the scheme's operation, that there is transparency and equity in the eligibility criteria attaching to the scheme, that resources are targeted at those with the greatest needs and that the scheme is capable of being costed and is affordable when introduced and on an ongoing basis. The Department of Health is seeking a solution which will best meet the aim of supporting people with severe disabilities who require additional income to contribute towards the costs of their mobility needs while keeping within the available budget and satisfying all legal and equality concerns. The challenge is to develop a new scheme on a statutory basis within a limited budget, targeted towards those with the greatest need.

The matter will be brought to the Government for consideration and decision as soon as possible. I look forward to what I am sure will be a valuable and constructive debate when the Bill is brought before the House in due course.

I thank the Minister of State for the latter part of the reply in which he set out the position on the promised legislation. I know the history of this issue. I note the point the Minister of State made to the effect that the scheme will be targeted at those in greatest need. In reality, if it is not restored quickly, the costs to the State in respect of the person about whom I am talking - there are many others - will end up being a great deal more. The letter I read was from someone who has won a national award as carer of the year. The person is a saint on this earth. We can talk about equality all we like, but if the scheme that is implemented fails to meet her needs, it will cost the State multiples of what it would otherwise have to pay. Without divulging anything about the person, some people who were in similar circumstances sued in respect of similar hospital treatment, but the family to which I refer refused to do so on condition that they would be supported to care for their father and husband at home. It is vital that this case be pursued to a positive conclusion at the earliest opportunity.

I thank the Senator. Of course, I share his concerns about the particular individual. It is an emotional and heartbreaking letter and there are many in the same position. I can give a commitment on two things. The first is more support for carers in society because I acknowledge the fantastic unpaid work they do. The Senator mentioned that the particular woman could have taken a legal case but did not. There are a lot of good, civic-minded people in broader society who act like that and need our support. I accept the Senator's argument. Second, I will be saying to the Minister, Deputy Simon Harris, that the legislation to help the 4,700 individuals in question who make a massive contribution by looking after the disabled and sick people must address their needs. It will reduce the cost to the State in the long term, which is a reality I accept. I will bring these key messages back to the Minister.

It is important that carers in Irish society not only be acknowledged and commended for their work but also supported. The Senator has mentioned that the woman in question won a carer of the year award. There are many like her and there are times when society and the State do not provide them with enough support. My job in the next two or three years is to do my best to increase the support they get, increase investment in services, implement the carer's strategy as set out in the programme for Government and, in this particular case, do something about transport support schemes for people with disabilities.

Hospital Services

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 a 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 that lives are being put at risk. This issue has been highlighted consistently by me 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 make recommendations to it on the reform of the hospital systems in the south and the country as a whole. 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 the time clear commitments were given to the public, politicians and clinicians by the former Minister for Health, Senator James 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 used in the report are 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 it is possible to travel from Waterford to 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, travelling to Waterford in the first instance. Dr. Herity has 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 - logical people would agree with me - is through the provision of an air ambulance service, 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. The basic flaws in his report undermine its findings and recommendations. Alternative findings have been proposed to the Minister which we ask him to consider. 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.

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 it on behalf of my colleague, the Minister for Health, who is unable to be here owing 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 for 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, with the requisite additional staffing for the increase in sessions, in order to address waiting times and 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 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 cease to allow the hospital to focus on the much larger volume of planned cath lab work.

Senators will understand 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 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.

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 these 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 are fundamentally flawed. Second, he states 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 the event 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 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 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? I deeply suspect that it is not the Minister for Health who is at issue. 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 owing to being interested in providing efficiency in 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 a former Minister of State, I am deeply disturbed by what has happened with the hospital groups, the non-committal to the commitments given and also the non-establishment of hospital boards in three years.

The Dublin press and media have painted this 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 travel to Cork and listen to Professor John Higgins whom the Government appointed in 2013 and who will state the case.

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

Sitting suspended at 11.20 a.m. and resumed at 11.30 a.m.