The handling of cardiology service provision in the South East is sadly degenerating into ‘clinical and political farce’ according to a prominent campaigner.
According to Matt Shanahan of the Health Equality for the South East (HEFSE) campaign, the recently leaked Acute Coronary Service (ACS) report suggests that “spinning
has become the order of the day” among those responsible for strategising the State’s health service. The detail of the ACS report, in Mr Shanahan’s view, “has further damaged remaining faith the South East public, healthcare workers and patients have in those supposedly charged with ensuring the best care is made accessible” on a regional basis.
Matt Shanahan went further, declaring that “it now appears obvious that Minister Simon Harris cannot control those charged within and subordinate to his Department to oversee equitable healthcare delivery with respect to South East cardiac care”.
Referencing the National Review of Cardiac Services sanctioned by Health Minister Simon Harris, which is not due to be completed until June of next year, Mr Shanahan offered a reminder of a commitment offered by the Minister when announcing the review. “He gave an undertaking that no cardiac centre in the country would be allowed to expand (during the review period). At the same time, the Department of Health has accepted a business case to provide two new interventional Cath Labs to St Vincent’s Hospital (in Dublin). This appears contrary to normal health planning given that this service is not a national designated PPCI centre and was only carrying out a four-day elective list.”
When the St Vincent’s issue was raised with Minister Harris by TD David Cullinane (SF), “backed up by the Head of Ireland East Hospital Group”, the Deputy was told “that the proposed installation was replacement of two previous Cath Labs on site,” as Mr Shanahan put it. He added: “The latest ACS report appears to give clear indication that this is patently untrue. The report cites there being only one Cath Lab at St Vincent’s up to 2016 and the report goes on to recommend delivering a second Cath Lab to that centre in 2019. This situation can also be backed up by the centres annual procedures activity which is one half (50 per cent) the number done by the single lab at UHW. How could a non PPCI designated centre doing half the procedures of UHW be upgraded and fast tracked by the Department in 2017?”
Matt Shanahan expanded: “This in turn raises another significant matter – either the Minister deliberately lied to Deputy Cullinane or else the Minister was misled by the Ireland East Statement confirming two labs. One supposes that given each Cath Lab has a value of €4 million to €6 million (in) annual asset audits would inform the head of a hospital group before making such a declaration to his line Minister? Either way someone is not telling the truth.” In the ACS report prepared by Professor Kieran Daly he states that “those who go directly to a PPCI centre, whether by ambulance or through their own resources, had double the likelihood of getting timely treatment with PPCI compared with patients who arrived following inter-hospital transfer (41%)”.
Said Matt Shanahan: “Considering that UHW is the only designated PPCI centre that refers emergency patients to other centres 121 hours each week, Professor Daly is acknowledging that these patients are being compromised through failure to receive treatment within the clinical standard time. Professor Daly may be referencing the idea of using a Helicopter Rescue service but given costs and flying restrictions expanding the UHW Cath Lab centre activity would be far less expensive and have a far greater impact to a wider group of patients. Given the status quo is a Department of Health enforced service criterion affecting patients attending UHW which is a designated PPCI centre, it would appear a legal basis may exist for ‘injury claims’ given the Clinical Service Standard is knowingly and regularly breached as evidenced by the report.”
Mr Shanahan also noted that no HSE-approved reviews had yet to reference the “new €250 million Kilkenny/Wexford River crossing delivering patients to UHW from Wexford to Waterford in 25 minutes”. He states: “If a part-time service in the South East can deliver more output per annum than a doubly scaled 24 hour service centre with double staff rota, then why not invest more in the efficient centre? The recommendation in the (ACS) report to provide only additional diagnostic capability at UHW while investing in an already over resourced service configuration in the Capital is testament to a deliberate downgrading of one of the most efficient service units in the State.”