David Cullinane, T.D., Sinn Féin spokesperson on Public Expenditure and Reform launched a major submission to the National Review of Primary PCI on Friday last in the Tower Hotel. Deputy Cullinane said that there was a fairly good level of co-operation between politicians, local and regional, to work together on the issue. “We are all putting on the South East jersey and working together on this issue.”
He refused to be drawn into a controversy about public promises and statements made by other politicians and said he hoped political considerations would be left aside to concentrate on sound clinical need and said it was a clear injustice that patients had to travel outside of the region for treatment.
The document points out that in May 2016 the Programme for Partnership Government was agreed between Fine Gael, Independent T.D.’s and the Independent Alliance. The Programme for Government stated: “We are committed to the development of a second Cath Lab in University Hospital Waterford subject to a favourable recommendation from an Independent clinical review of the needs of the region to be carried out within 6 weeks.”
In July 2016 a report entitled an ‘Independent Clinical Review of Provision of a Second Catherisation Laboratory at University Hospital Waterford’ otherwise known as The Herity Report was published. This Report was accepted by the Minister for Health but greeted with dismay across the South East region. The Sinn Fein submission challenges Herity’s Report findings on a variety of grounds including patient safety, risk analysis, the role of UHW as a Regional Level 4 Hospital and distance patients travel for emergency PPCI. It also states that it is contrary to existing Government and HSE Policy.
The Sinn Féin document proposes that a National Review is framed in the context of existing national and regional policy (the ACS programme and the Higgin’s Report); Is independent and based on clincial and medical need and is underpinned by the National Clinical Programme (NCP).
The Sinn Fein document recommends that the National Review consults widely with local clinicians and medical experts, and is based on the actual population of the South East and not an arbitrary effective catchment population. It further states that the National Review is cognisant of the range of travel time to hospitals outside the region and not the average time.
It asks that the National Review clarifies the status of University Hospital Waterford as a Regional Hospital and identifies need and capacity based on the geographical area the hospital serves, namely the South East.
Deputy Cullinane states that the South East deserves the same level of services as all other regions. Patients in the South East want safe and accessible cardiac services. This must involve provision of a second Cath Lab and provision of 24/7 PPCI at University Hospital Waterford for all patients in the region.
Since the publication of the Herity Report an additional €500,000 has been allocated to UHW for 2017.
It is also the case that patients in the South East have been outsourced to hospitals in Cork for planned work.
In November 2016 there were 596 patients listed on the Univeristy Hospital Waterford Cardiac Catherisation Laboratory Waiting List and 130 of these patients were waiting longer than 12 months.
A service level agreement has been agreed between UHW and Cork University Hospital for the referral of 337 patients. The terms of this agreement requires that diagnostic cardiac angiography procedures will be provided for 337 UHW patients in Cork University Hospital who will be referred back to UHW and remain under the clinical care of the UHW Consultant Cardiologists.
Discussions between the HSE, University Hospital Waterford and South/South West Hospital Waterford are almost finalised and it is planned that a mobile solution will be in place early June.
In setting out a business case for a mobile lab, UHW management outline the clinical risks of prolonged or static cardiology waiting lists including:
- inadequate capacity impacting on patient flow
- Delayed diagnosis and treatment
- Potential harm or death
- Unsatisfactory service user outcome
- Prolonged hospital stay as a result of delayed access
- Inability to meet standards (SBHC and HIQA)
- Legal action
- Risk to Reputation and public confidence.
It is obvious from this business case that the current single lab service is not fit for purpose. The single cath lab facility at UHW is incapable of meeting the clinical demands of the South East catchment area.
However, a Mobile Cath Lab and an outsourcing of planned work is not the solution and nor is it intended as such.