Thursday, 20th September 2018
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The following article is penned In light of recent events most notably the failure of 19 South East Oireachtas members to win any concessions from Minister for Health Simon Harris on the issue of South East cardiac care – this despite some telling political and clinical developments on the issue including expansion of Dublin Catheterisation capacity in the interim and the continuing enforcement of emergency cardiac care outside the standards of the national clinical care programme. There is also significant politicking and jockeying going on behind the scenes with some of our regional representatives - the headline grabs with a full synopsis below -

1. Despite the Minister receiving a report of the availability to UHW of a full service Modular Interventional Cath Lab in December 2017 he said he had ‘no knowledge of the subject’ when meeting the South Regional TDs on February 14th 2018

2. The ongoing refusal of the Dept of Health to provide even the Modular lab as an interim solution to UHW cardiac care deficiency clearly demonstrates the Government is both willing and is mandating that the south east service continues to operate a suboptimal standard of cardiac care to emergency patients! This clearly demonstrates that expansion of the South east service is a political issue and not an issue of patient welfare as expressed by Dept of Health and the line Minister!

3. ACS (Acute Coronary Syndrome Programme) clinical leads conducted a review of the South East cardiac service in November 2017 and identified a patient load at over 30% above the required national threshold to justify a 24/7 cardiac care service in the south east – (203 expected stemi patients in 2017). Despite knowledge of the numbers, nobody challenged the Minister or his aides at their Oireachtas meeting on these numbers where again the Minister expressed no knowledge or sight of the report to date.

4. Despite the Ministers guarantee reiterated over past weeks that no cardiac service expansion would be approved anywhere in the country in advance of the national review completion, HEFSE now understands that ongoing work in St Vincent’s Hospital due to complete August 2018 will deliver two new full service PUBLIC Cardiac Catheterisation laboratories at the Dublin Campus. This brings the Dublin complement to 13 from the previous 12 full service interventional labs available in the city and directly contradicts statements made recently by Deputy David Cullinane (SF) on the issue!

5. The issue of a national review being promoted above a regional review by Deputies Cullinane (SF) and Deputy Butler (FF) is also somewhat intriguing? We offer some possible insight to the political backdrop to their sea change?

6. Re the south east cardiac issue the present Minority Government is now more stable than ever as opposition parties prove they are unable to mount a clear challenge or have meaningful policy change implemented despite a clear weight of evidence to support it

Full information below:

Health Equality For the South East ( offers the following on Governments desire to require a national review of cardiac activity to decide the south east cardiac service question. We also outline our opinion on the motivations and ability of our South East elected representatives to come together and organise a meaningful political response on behalf of constituents. This following points form a basis for where we believe we are now at on the issue!

1. Taoiseach Varadkar has recognised the need for a 2nd Cath lab at UHW while the announced national review takes place. The health minister was made aware in December 2017 of the availability of a full service modular Cath lab that could immediately treat patients on the emergency waiting list at UHW - now again the largest in the country! Despite the Ministers office receiving a report of this modular lab in December 2017 he said he had ‘no knowledge of the subject’ when meeting the South East Regional TDs on February 14th 2018! When pressed he promised to ‘look into it’!

2. In November 2016 the exact same scenario was unfolding regarding the provision of a mobile cardiac diagnostic lab to be placed at UHW to deal with the largets cardiac waiting list nationally. Again, the Minister declared himself unaware of this labs availability despite a report going to the Dept of Health 3 months previously! Are the Dept of Health confined to using ‘Morse Code’ in communication exchange or what could explain the delay in informing the Minister? This mobile lab was subsequently delivered to UHW in Sept 2017, albeit 7 months after a ministerial deployment order had been given to immediately release it!

3. Professor Niall Herity the author of the infamous and now defunct Herity report has stated that the National Clinical Care Protocol (NCCP) for treatment of both emergency and elective cardiac cases can only be carried out in a centre with two full service Interventional Cath Labs. The ongoing refusal of the Dept of Health to provide even the Modular Interventional Lab as an interim solution to UHW cardiac care clearly demonstrates the Government is both willing and mandating that the south east service continues to operate a suboptimal standard of cardiac care to patients accessing it! The South East is still the only emergency cardiac care centre in the country confined to a 39 hours operating week!

4. The ACS (Acute Coronary Syndrome Programme – national cardiac clinical leadership) conducted a review of the South East cardiac service in November 2017 and identified a patient load at over 30% above the required threshold to justify a 24/7 cardiac care service – (203 expected stemi patients in 2017). South East Oireachtas members had stated in advance of their meeting with the Minister Feb 14th that they would demand sight of these figures at this meeting. The Minister said he has still not received the report or the figures as yet and so could not inform the regional deputies further - despite knowledge of the numbers, nobody challenged the Minister or his aides at the meeting on these numbers which were given to UHW clinical leads by the ACS when visiting the centre!

5. Despite the Ministers guarantee over past weeks that no cardiac service would be augmented in advance of the national review completion, HEFSE can now report that the ongoing work in St Vincent’s Hospital will deliver two new full service PUBLIC Cardiac Catheterisation laboratories to sit alongside the private Cath lab at the Campus where previously there has only ever been one public interventional Cath Lab! Completion date is August 2018. There was previously a cardiac implantation suite on site to augment the single full service cath lab – this suite was not capable of offering intervention or stenting procedures. The tender concerning this cath lab service expansion was published and closed within a 2 week period in July 2017 - this while the Minister was announcing a national review of cardiac activity was needed to decide any expansion of the South East service!

6. Considering that south east deputies Mary Butler (FF) and David Cullinane (SF) have been such stalwarts in supporting a national cardiac review they might provide answers as to how the Dublin public Catheterisation Lab number complement will rise from 12 units to 13 units in 2018? This is even more suspect when one considers the cardiac procedures output each year from the existing Cath Lab at St. Vincents has been significantly less than activity per annum at UHW for the past 5 years? Perhaps the Minister was again ‘unaware’ of this cardiac capacity expansion when he informed Deputy Cullinane of his directive. Deputy Cullinane, was most likely therefore unaware when he went on local radio in the South East denouncing those who had provided information on such expansion and while copper-fastening his support and approval for an ‘unbiased’ national review of cardiac activity in favour of the promised regional review of emergency access guaranteed by Minister Harris and Taoiseach Varadkar in the Dail in 2017!

7. Not to be outdone Deputy Bobby Aylward (FF) Kilkenny post the meeting with the Minister announced that the health minister had confided in him that the south east cardiac issue was purely down to an issue of staff recruitment! The Deputy may be unaware, but clinical specialists do not move job location until there is a ‘cast iron guarantee’ of resourcing to a new clinical service - as this does not exist at UHW yet there is no one foolish enough to leave their present employ for the promise of same! Until service provision is mandated and published in future budgetry planning this situation will not change - Deputy Aylward might also be interested to know there are a number of consultant positions open and unfilled in St. James hospital for over two years for exactly the same reason. We confess we have not heard of any plans to reduce clinical activity at St. James - quite the reverse in fact especially in light of it being green lighted to accommodate the proposed new National Childrens Hospital! Despite ESRI reports pointing to a 37% increase in Dublin based construction costs no one has yet explained how this Billion euro project can now be delivered on tender? Well perhaps it can if people are willing to accept additional spend of 370 million and rising on the project or else reduce the bed count and service provision by 37%!

8. The issue of a national review now being promoted by Waterford Deputies Cullinane (SF)and Deputy Butler (FF) is also somewhat intriguing? Deputy Cullinane has been more than diligent in uncovering dept steering of the Herity report through Freedom of Information requests. One would suppose that in light of such activity a recurrence in a further regional review would not be possible and therefore a satisfactory outcome could emanate on the question of expanding the South East service? Despite this, Deputy Cullinane has decided to opt for a review of all national cardiac activity which has little bearing on the present service issues in the south east. Could it be that the Sinn Fein deputy has now moved to support his party colleagues Pearse Doherty’s desire to see North Eastern cardiac services included as part of any review? It would appear so! Deputy Cullinane’s new ally, Deputy Mary Butler (FF) has similarly ditched the regional review idea in favour of a national review – this coming from a deputy who stood with her party leader on the grounds of University Hospital Waterford for a photo opportunity pre the last election announcing a Fianna Fail ‘guarantee’ to deliver 24/7 cardiac care to the south east. In her most recent interview on the subject deputy Butler announced ‘We are taking baby steps’ on the issue – perhaps Deputy Butler thinks a 6 year smouldering clinical/political issue is still in its infancy? Or perhaps could she be heeding calls from three of her Cork based front bench party seniors to ‘back up on the issue’ considering the future potential windfall for the Cork Cardiac Service if expansion is denied to the South East?

9. What cannot be in doubt anymore is the degree to which the political representatives of the South East have failed to deliver a telling blow to Health Department policy despite the compelling clinical and medical evidence supporting the case for South East expansion of cardiac services. This includes the present Minister of State John Halligan who was part of the brokering of a temporary mobile diagnostic lab on site at UHW. It also includes Wexford Deputy Howlin of Labour who is intent on addressing the slump in Labour party fortunes in the South East – if only he was so engaged when Minister for Public Expenditure when his remit could have delivered the service expansion overnight! Or indeed one could look at the combined activity of regional Fine Gael TDs on the issue. Deputy John Deasy has been politically absent without leave for the past 2 years, Deputy Deering along with junior Ministers Paul Keogh, John Paul Phelan and Michael Darcy all have significant constituent numbers affected by the lack of service in the South East and yet seem incapable of influencing either the situation or their party colleague Simon Harris on the issue!

10. An additional factor which cannot be overlooked or underestimated is the duplicity of seniors within the Dept of Health who continue to obfuscate and obstruct the South East case for expansion – this to favour their policy of centralisation which is already outdated, cost inefficient and very likely clinically injurious to some cardiac patients - a fact that HSE litigation into the future will no doubt underscore!

11. The recent agreement reached between South East Oireachtas members to politically demand ‘a health service on par’ standard with all other regions or let Government face a ‘motion being put to the house’ on the issue also looks to have been superseded in the minds of our representatives post meeting with Minister Harris. Obviously debating skills honed at DIT’s school of journalism appear far superior to those possessed by our regional representatives given the outcome of meetings to date! What remains a fact is that a regional review of South East Cardiac services was promised by this Fine Gael led Government in the Dail in 2017 based on 20 weeks of mobile diagnostic lab activity at UHW which has now passed. That time horizon is now complete and this review and political commitment to south east patients should be delivered upon immediately.

12. If these political commitments are not delivered by Government then what is the point of our regional representatives agreeing to new commitments on this or any other issue? A commitment undelivered is just a wish, and ‘wishing pools’ should remain the preserve of visiting tourists and ‘Oirish’ tour guides. They have no place in politics beyond the proverbial kicking of the can down the dusty road which it would appear is starting to suit some of our regional representatives!

For those decrying minority Government as a means of delivering meaningful change what has been allowed to happen in the South East would now appear to make their case and make it very well! It certainly looks like there is little to fear in minority numbers in Government as long as your opposition cannot organise - Alas for us in the region it also appears that such minority numbers have no appetite to take on the civil service leadership and have no desire to politically reach or achieve beyond securing their seats in a future election! If any meaningful change is to occur in the future perhaps it will come from those on the receiving end of these political doldrums who may themselves become a catalyst for change demanding equity in resource allocation – if not, political forecasts in coming years are likely to be composed of long bouts of strong wind and hot air coupled with little movement and zero change!


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