Cardiovascular disease is the leading cause of death in Ireland.
The state of the art in cardiac care is therapies such as stents and pacemakers. These are delivered in a unit called a cath lab. Acute life-threatening heart attacks must be treated with emergency care delivered rapidly, in a matter of minutes, in such a lab.
To deliver this level of care, the unit needs to have staff and equipment commensurate with the needs of the population. Otherwise, we get waiting lists for outpatient care, and in-patients with life-threatening illness waiting longer than is safe or acceptable for treatment.
It is against this backdrop that the cardiologists in the south-east, covering Wexford, Waterford, south Tipperary, south Kilkenny, and Carlow, recognised major shortfalls in the level of resource for our cath lab at Waterford, and this was flagged up to HSE management in 2013, and identified as a critical clinical risk since then.
We sought the additional funding for a second cath lab at that time, recognising this infrastructural development was key to adequate provision of service for our population.
Subsequently, the Department of Health initiated a clinical review of service, tasked to look at the catchment population for the south-east cath lab. We had no part in the drafting of the terms of reference of the review, although we had stressed the critical issue to be addressed was one of patient safety, in this hugely oversubscribed service.
The review in the SE consisted of a single visit to the unit at UHW, and did not seek opinions from the consultant cardiologists in Wexford General and south Tipperary who, as advocates for their patients, were clearly key stakeholders in the service. The review was finalised and submitted to the Department of Health without discussion of its findings with the consultants regionally. This was the Herity report.
In our view, this is a flawed report. It contains a fundamental logical error in its methodology. It calculates the demand for the service by determining the number of service users. This methodology cannot be used in a system running beyond its capacity.
It underestimates the catchment of our lab as a result of the same fallacy. It mistakes constrained resource for low activity. And since all the recommendations ultimately derive from this catchment figure, the report recommendations are invalid.
The minister has accepted the review, without question, and he has undertaken to put in place its recommendations. This includes withdrawal of the existing 9-5 acute heart attack service, and a derisory increase of eight hours per week in operational capacity. This will have no measurable effect on the capacity of the service. The lists at UHW for the SE will lengthen, and inpatients will have to wait longer in valuable beds for their procedures. All of this means the service will continue to expose patients to avoidable clinical risk.
We have written to the minister to ask for a meeting, to discuss our concerns, and try to find a way forward. He has refused. We hope he finds the courage and statesmanship to reconsider this, for the sake of the health of patients in the South-East.
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