Matt Shanahan Demands 24-7 Cardiac Care at Waterford Hospital
Matt Shanahan pressed the Taoiseach over cardiac services at University Hospital Waterford, saying South East heart attack patients are suffering delays and the government has not delivered on promised 24-7 emergency cardiac care. He cited a National Office of Clinical Audit and lengthy blue-light transfer times and demanded a yes-or-no commitment that 24-7 emergency cardiac care will be in place by December.
Audit findings
Matt Shanahan referenced a NOCA, National Office of Clinical Audit, into heart attack care using data from 2017 to 2020, arguing that no patient from the South East region reaches alternative cardiac care when the CAT lab at University Hospital Waterford is closed.
Transfer delays and clinical standard
He told the Taoiseach that between 2019 and 2022 there were 134 blue-light emergency transfers from Waterford to Cork with an average elapsed time of 3 hours and 15 minutes, while the National Clinical Protocol for Heart Attack requires CAT lab access within 90 minutes from first responder.
Demand for a clear commitment
Shanahan demanded a straight yes-or-no answer on whether a 24-7 emergency cardiac care service would be in place when the Taoiseach leaves office in December, saying patients in the South East are exposed to additional heart damage and increased morbidity.
Government response and planned investments
The Taoiseach replied that construction of a second CAT lab commenced in March 2021, would be completed by the end of August and available for operational use from the end of October. The second CAT lab will mirror the existing unit, provide the full range of diagnostic, interventional and non-interventional cardiac procedures, and staffing moves include filled consulting cardiology posts, recruitment of an additional registrar to support an 8am-8pm Monday-to-Friday service, and approval of 24 whole-time equivalents by the South-Southwest Hospital Group in November 2021.
Capacity planning and funding
The Taoiseach said the National Review of Specialist Cardiac Services is awaited, the ARCOS report is expected in the coming weeks, and HSE estates will make capital submissions including a Capital Steering Committee submission for additional bed capacity. He stated the hospital's overall budget has increased by £60 million since January 2020 - an increase of about 20%.
Local concerns remain
Shanahan responded that despite the additional money, University Hospital Waterford "still remains the most underfunded model four of nine in the country," reiterating his call for urgent, guaranteed 24-7 emergency cardiac provision.
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Taoiseach, I gave a commitment to the people of Walford City and County and indeed to the people of the South East when standing for election that I would do my utmost for our regional hospital, University Hospital Walford and the patients it serves. Yet again I have to bring the issue of this hospital's under-resourcing onto the Dáil floor. A recent NOCA, National Office of Clinical Audit into heart attack using data from 2017 to 2020, demonstrates that no patient from the South East region is getting to alternative cardiac care when the CAT lab at University Hospital Walford is closed. In addition, in the years 2019 up to 2022, of 134 blue light emergency transfers from Walford to Cork, the average time elapsed was 3 hours and 15 minutes. The National Clinical Protocol for Heart Attack requires CAT lab access within 90 minutes from first responder. Every heart attack patient from the South East region, Taoiseach, is being exposed to additional heart damage, exposed to additional medical trauma, exposed to additional and increased morbidity because of the lack of treatment being available in the location where it is required, one that you Taoiseach promised you would provide. Taoiseach, I have watched your government walk through walls to build a hospital that is largely for the people of South Dublin. I have watched the government parties whip their deputies furiously to get them to support the National Maternity Hospital project, despite misgivings as to the ultimate ownership. I heard the rationale offered by the Taoiseach to our next Taoiseach in this House in the debate, where he said that the maternity hospital needs to be in Dublin because if a woman has a cardiac arrest, she can be in ICU within 20 minutes. The Hippocratic Oath, Taoiseach extends to the people of Watford and the South East also. Over the past two years Taoiseach, I have seen you in action and I would say you are a formidable operator. You get your way, you can build a new runway in Cork in less than six months from a standing start. You can green light the Dun Kettle interchange. You are certainly a man of your word to your electorate, to the people of Cork. So on behalf of my electorate Taoiseach and the people I represent, I need a simple yes, no answer from you today. Will you keep your promise to the people of Waterford and the South East? Will there be a 24-7 emergency cardiac care service in place when you leave the Taoiseach's office in December? Yes or no please, Taoiseach. Taoiseach. Taoiseach. First of all, I thank you Deputy for raising this very important issue and generally for your consistency in raising these issues in respect of Waterford Hospital and indeed the broader constituency. The budget, could I just first of all say to you that, you know, you referenced the Maternity Hospital, National Maternity Hospital. That was first announced in 2013 and it's now 2022. So we have, you know, it's questionable whether there were too many walls gone through in the seven years now. It took seven years to get to a decision where a decision has been taken to build it. Now in the case of Waterford, the issue for the last number of years has been the CAT lab. Work on the construction of the second CAT lab commenced in March 2021. It will be completed by the end of August. The second CAT lab will be available for operational use from the end of October of this year. And that's the context of COVID-19 as well with shutdown and construction. The second CAT lab will mirror the existing CAT lab. We'll be able to undertake the full range of diagnostic interventional and non-interventional cardiac procedures that are available in the existing upgraded CAT lab. And all consulting cardiology posts are currently filled within the hospital. There was an issue in terms of the recruitment of an additional registrar to support the 8am to 8pm Monday to Friday service. And that's been recruited as a matter of urgency. A total of 24 hotelium equivalents were approved by the South-Southwest Hospital Group in November 2021 for the staffing of the second CAT lab, which is a significant commitment to the undertakings that we gave to all of the deputies and all of the representatives in the South-East in relation to that work. The National Review of Specialist Cardiac Services, we're awaiting the presentation of that and the publication of that. And the overall budget of the hospital has increased by about £60 million since January of 2020. And that's an increase of 20% deputy, which is a very significant commitment to Waterford Hospital. I accept your point about timely care and the right care at the right time in the right place. That's critical. And more generally, we want to develop further services at Waterford University Hospital as well, in addition to the second CAT lab, in terms of the capital programmes in particular. As you know, the ARCOS report is expected to be finalised in the coming weeks. That strategically has been examining the current and future capacity requirements at University Hospital Waterford to make sure that we have proper planning for the next 15 years to invest in the hospital. And the South-West Group will work with HSE estates to make the relevant capital submissions for new developments and new developments that are required at the hospital. The HSE estates have confirmed that a submission will be made at the Capital Steering Committee for development of additional bed capacity for the hospital. And there has been significant investment across Waterford, but I don't have time to go into that here. Maybe it's a supplementary. Thank you, Taoiseach. I was hoping for a yes or no answer, but I understand that you just feel you cannot give it. Can I say to you one thing? With the additional money that you put into University Hospital Waterford, it still remains the most underfunded model four of nine in the country. That's the first thing. Secondly, you're talking about the provision of additional services to the cardiac care suite. What you're offering us now is an airplane with no pilots and no baggage people and no transportation on the ground to operate it. Without the people, we cannot operate it. We need a 24-7 service, Taoiseach, something that you and your party gave a commitment to in 2016. And I have to say to you that the lack of care and attention and the interest in following up on this promise over the years is quite evident now. So the people of the South-East, Taoiseach, I'd say to you they will have their say. Either the service will be in place in December and your word will have demonstrated its worth or not. And I apologise for saying that to you, but I have to keep the promises I made to fight on this vital service. And Taoiseach, what I'd say to you now about reviews is we're past reviews. We have 134 blue light transfers over three years. Not one of them could get out of Waterford Cork another three and a quarter hours. It's no longer a clinical case. It's a political decision. And it's up to you and your government to either follow through on what you promise to do or do not, and leave it to the electorate to decide how they appreciate that and take that. 250 new staff have been appointed since January 2020 to the hospital. 250, 25 of which are consultants. All consultant cardiology posts are currently filled. I don't know whether you're equating the consultants to the pilots. Consultants might have an issue. But in any event, there's a fair few pilots there in terms of the hospital. And we want to do more. We want to do more for the hospital. And I've been discussing this with you now since January 2020. And your issue with me was to get the second CAT lab up and running, along with the other deputies from the South East and from Waterford. And that is happening. I mean, I was saying to you, we've got to get this done step by step. The second CAT lab is there. 24 whole-time equivalent posts. Just hold on, please now, let me finish. 24 whole-time equivalent posts, through the Chair, have been approved by the South South West Hospital Group. And they were approved in November of 2021 for the staffing of the second CAT lab. So it's not without pilots. You know, it's not. It's ridiculous to say that without pilots. The staff, I mean, start dates have been agreed. Please, Deputy. Start dates have been agreed for two senior radiographers. Start dates are awaited for three cardiac physiologists. Recruitment campaigns for 10 staff nurse posts. Two healthcare assistants are ongoing. Recruitment campaigns for position of CNM1, CNM2 are ongoing. Recruitment of four administrative posts and two porters is on the way through the national recruitment process for this second CAT lab. Thank you, Taoiseach. The time is up. Thank you very much.
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