Dáil Éireann díospóireacht -
Thursday, 22 Jun 2017

Vol. 955 No. 2

Leaders' Questions

Deputy Billy Kelleher

Yesterday a young man by the name of Thomas Power was buried in Ballygunner, County Waterford. He has left behind a grieving wife, Bernadette; a mother, a father and two sisters, as well as a broader community of family, friends and neighbours. The previous Sunday, not feeling well, he had driven to University Hospital Waterford. He was subsequently transferred by ambulance to Cork but died on the road near Dungarvan. The case raises many questions. I do not know the Power family and do not want to add to their grief by raising this issue, but I would absolutely be failing in my duty if I did not highlight the case because the broader issue of the provision of cardiac services in the south east, including Wexford, Kilkenny, south Tipperary and Waterford, needs to be addressed. There are many questions that need to be asked, both in the context of the individual case and the broader issue. Was Mr. Power seen by a consultant who had travelled in the ambulance when he was being dispatched to Cork and were all protocols followed in the normal procedure of transferring a patient? That is the issue that really needs to be addressed in the individual case, of which there has to be a full clinical review.

We need to get to the bottom of it. We have to learn from this tragedy. It must not have been in vain.

Of course, the broader issue is the provision of a 24-hour catheterisation laboratory, cath lab, service, as well as broader cardiac services, in Waterford. Last year there was a commitment given by the Minister to review percutaneous coronary intervention, PCI, and primary percutaneous coronary intervention, PPCI, services across the country. The Herity report assessed the need for cardiac services in Waterford and found that there was no need for 24/7 cardiac services, yet many clinicians on the front line there in providing life-saving care on a daily basis have stated publicly and to me privately that patients will die if cardiac services are not available 24/7 in Waterford. Tragically, we saw that unfold on Sunday evening outside Dungarvan.

I will ask the Tánaiste a number of questions. Will she ensure there will be a full clinical review of the tragic case of Mr. Power? Will she also accept that there is now a need to address the fact that there is a deficiency in the provision of cardiac services in Waterford that is costing lives? Does she accept that there is a need for a full review and the prioritisation of the delivery of 24/7 cardiac services in Waterford as soon as possible?

The Tánaiste

I join the Deputy in expressing sadness at the news of the tragic death of a young man at the weekend while being transferred between two hospitals. I offer my sincere condolences to the family. Like the Deputy, I do not want to say anything that would add to the distress his wife and family are feeling at this time. I have discussed the issue with the Minister for Health who took a Topical Issue in the House yesterday when he gave as much information as he could. Obviously, we never go into the details of individual cases in the Dáil, but let me address some of the issues raised by the Deputy.

Of course, we want to ensure proper procedures are followed. That includes what the Deputy is saying about the circumstances surrounding this tragic death. Undoubtedly, in the first instance, the hospital will undertake a clinical review and a decision will then be taken on whether further action is needed. That is the normal process and it would be the right thing to do in this instance. If there are lessons to be learned, they should inform ongoing decisions in the provision of labs such as that discussed by the Deputy.

To outline the approach the Government has taken, in the programme for Government we stated there would be a review of services in Waterford. That review was undertaken by Dr. Niall Herity, an independent international cardiology expert. It concluded that needs in the catchment area could be accommodated from a single cath lab. However, it recommended investment - the Deputy will be familiar with this - to improve services by providing for additional hours of cath lab activity each week to address the issue of waiting times and provide extra access for patients. The Minister is committed to providing the extra hours to ensure the mobile cath lab will be provided. The national service plan of the HSE contains a sum of €500,000 to ensure the improvements will be made. I should also mention that this week the HSE issued a tender for the provision of a mobile cath lab which will on an interim basis contribute to a further reduction in elective cardiology waiting lists.

Like everybody in the House, I recognise that we had a tragedy last weekend, but the broader point I want to make is about provision. As Health spokesperson, the Deputy will be familiar with it. We have had to deal with this issue in the context of cancer services generally, for example, breast cancer services. The precise location and the development of specialist services have to be based on best clinical advice. There has been a lot of debate in the House about specialist services. We know that we would be doing the very best for patients if we were to centralise services in so far as possible, while also ensuring good access for patients all around the country. However, we must ensure the location of PCI services is based on the very best clinical assessment.

An Leas-Cheann Comhairle

Go raibh maith agat. The Tánaiste will have another opportunity.

The Tánaiste

As I said, Dr. Herity undertook that review and the Minister is following his report.

Deputy Billy Kelleher

Of course the issue here is that there is a lot of clinical advice from Waterford suggesting that the Herity report, in essence, is flawed and does not take into account the broader geographical challenges of the south east. The fact of the matter is that, as we sit here, 170,000 people are more than 90 minutes from an acute cardiac service. This is because there is no 24-7 service in Waterford. There is considerable fear and anxiety in communities throughout the south east. This particular tragic case brings it to the fore and is very much in people's minds.

This issue cannot be let rest. The Herity report is flawed in many other ways and clear issues have been raised numerous times by the clinicians, including the cardiologists who are working in the south east. They have said consistently that they need a 24-7 service. The mobile laboratory will deal with waiting lists but it will not deal with emergencies, for example, the emergency that presented last Sunday evening in Waterford.

Last September, the Minister for Health, Deputy Harris, committed to a review with regard to primary percutaneous coronary intervention. Can we now accept that the Herity report should not form any basis for that review and that it should be a full clean sheet with regard to assessing services in the south east?

The Tánaiste

The organisation of primary PCI centres throughout the country is a national issue - there is no question of that. It relates to how we provide services for the entire population. We have had this debate in respect of other services. We absolutely have to take account of the best evidence available. The best evidence was got from Dr. Herity at the time.

There is a national review of the provision of PCI centres. It is important that we have this national review. I believe that the Herity report should be taken into account; of course it should, because it is an expert report that we already have. That does not rule out further developments in the Waterford area.

It is time for a full national review of primary PCI services and that is being done. Based on the population of the country we can only operate a limited number of PCI services. I put it to Deputy Kelleher, as the health spokesperson of his party, that I believe he recognises that the location of specialist services and access to those services is singularly important. However, it is not feasible, in terms of giving the best service to patients, to have a PCI centre in every county. Certainly, every region needs to have access.