Two weeks ago we briefly discussed the sad passing of Thomas Power who could not access emergency heart treatment in Waterford University Hospital. Today Deputies Mary Butler and David Cullinane hosted a meeting in the Leinster House audio-visual room for public representatives at which Thomas Power’s sister gave a heart-rending account of the devastation endured by her and her family as a result of her brother’s untimely death. She used simple words to encapsulate the entire event, namely, that the doors had been closed to him in seeking access to emergency heart treatment or intervention. Thousands more in the south east are beyond the 90-minute window that cardiologists say is the essential timeframe within which to be treated from first medical contact. Others argue that it is less than that, but every minute counts, as the Taoiseach knows.

In 2012 a national assessment was made and Waterford University Hospital featured as a designated PCI, percutaneous coronary intervention, centre.

In essence, it was to be a centre for emergency heart treatment. The third appendix to the report identified the issues that would have to be addressed. Essentially, it stated that Waterford has the potential and needed a second cath lab. A configuration report by Professor Higgins again calls for an extension of the facilities at Waterford hospital in terms of PCI and interventional cardiology facilities.

A business report was presented in 2014. It was accepted by the clinical review team in the south east at the time and it was sent to the HSE. It was accepted and those concerned were told the facility was queued for funding. I spoke to Dr. Owens about this some time back. He is a very reasonable man. He, along with Dr. Colwell from South Tipperary General Hospital, Dr. Mark Doyle, an emergency medicine consultant, and others have all identified the lack of a second cath lab as a major risk to safety.

What happened in 2014-2015? Why was the second cath lab not proceeded with? Why was the essence of the 2012 report and the configuration report not acted on before 2016? Why has so little happened even since last year, when the Minister made commitments in here to give eight hours extra? Nothing has happened. With regard to the provision of the mobile cath lab, nothing has happened in the past 12 months. The national review we were promised has not happened either. People in the south east, in particular in Waterford, are very angry and they feel marginalised and alienated. They feel there is a lack of any meaningful response from the Government on this issue.

Once again, on behalf of the Government, I convey my sincere condolences to the family of Thomas Power on their very sad loss. As the Deputy knows, I cannot comment on individual cases. However, I stress the importance of patient confidentiality and patient privacy. The Minister for Health expects, as I do, that all proper procedures will take place with regard to the examination of the circumstances of Mr. Power's death, be it through a case review or an inquest, to find out what happened and why.

Last year, in line with the commitment in the programme for Government, an independent review of the need for a second cath lab at University Hospital Waterford was undertaken by Dr. Niall Herity, a world-renowned cardiology expert. The review concluded that the needs of the effective catchment population of University Hospital Waterford could be accommodated from a single cath lab. However, investment was recommended to enhance cardiology services at the hospital and provide an additional eight hours of activity per week to reduce waiting times and provide increased access for patients. At the time of the publication, the Minister, Deputy Harris, committed to providing the additional resources to the hospital. The HSE's national service plan of 2017 subsequently identified the implementation of the recommendations of the Herity report as a priority, and additional funding of €0.5 million was provided. An additional €0.5 million in funding was provided in 2017 to enable the hospital to provide two additional cath lab sessions per week, as per Dr. Herity's recommendations. The cath lab is now funded to provide 12 sessions, that is, 48 hours of activity per week. The HSE issued a tender, last week, for a mobile cath lab, which will contribute on an interim basis to the further reduction in elective cardiology waiting lists at the hospital. The Minister is also committed to a further review to assess the impact that these improvements have had on the volume of patients attending. This review will take place at the end of the deployment of the mobile cath lab.

With regard to emergency work at hospital, all decisions on how we configure our health services must be evidence based. Dr. Herity recommended that emergency work cease in order to allow the hospital to focus on the much larger volume of planned work and contribute to improved patient outcomes.

The organisation of primary PCI services is an issue for the whole country and it relates to how we provide services for our whole population, taking into account the best evidence available. The Minister for Health is, therefore, committed to a full national review of primary PCI services and his Department will make the arrangements for this to be undertaken based on the independent clinical expertise. This national review will, of course, include the south east of the country. It will seek to ensure that as many patients as possible can have access on a 24/7 basis to a safe and sustainable emergency intervention service following the type of heart attack in question. The review will, therefore, deal with the wider implications for all services in all parts of the country of Dr. Herity's recommendations regarding primary PCI services and come up with a plan for the achievement of the best patient outcomes possible, with clinical safety being paramount.

A man died because he could not get access to emergency heart treatment within any reasonable timeframe. People feel the time for review is over. I asked the Taoiseach a very specific question. The clinical review team said to go ahead with the second cath lab. A business case was made in 2013 and 2014. Who stopped that? Can someone give me a transparent answer to that question? Why was there a need for the Herity report at all when, according to the 2012 assessment of 12 designated centres, Waterford was identified as having the potential to become a PCI centre with expansion? Who actually stopped that in 2014 and 2015? The Minister of State, Deputy Halligan, is blaming invisible civil servants for stopping the Minister from doing what he wants to do.

The Taoiseach read out a statement about the national review. He could have been reading what the Minister, Deputy Harris, wrote in response to a parliamentary question ten months ago on 28 September of last year. He stated, "A national review of PPCI and PCI services is to be undertaken and completed by July 2017; recommendations will be made regarding the future configuration of these services, including the number and location of centres required to serve the population needs". The only difference is that the Taoiseach has moved it 12 months forward or maybe beyond. People feel that the Taoiseach has no credibility in reiterating meaningless statements of that kind.

Can the Taoiseach give me an indication or a reason as to why someone stopped the implementation of the 2012 recommendations and the actioning of that in terms of the business case of 2013 and 2014? The consultants in Waterford were making this case very strongly to everybody who would listen. They were clinicians as well. For some reason someone said we were not having that and that a new review was needed to bury this thing once and for all. I put it to the Taoiseach that if he follows the Herity report to the letter, which he seems to want to do, the idea of ceasing emergency heart treatment makes absolutely no sense.

The Taoiseach to respond. The time has expired.

It makes no sense. It is not tenable or workable in terms of patients in Waterford and the south east.

That is two minutes. I cannot allow it. The Taoiseach to respond.

I cannot answer that question for the Deputy. I do not know who stopped it or if anyone stopped it at all.

The Taoiseach was the Minister at the time.

As the Deputy will understand from the legislation he brought in to establish the HSE, those final decisions that are made in terms of funding-----

The Taoiseach decided on the review.

The Taoiseach without interruption.

-----were previously made by the HSE board and would subsequently be made by the Director General of the health service, and not by the line Minister of the time. That is and has been the case for the last ten years. Indeed, the HSE, which was established by Deputy Martin-----

The Taoiseach said that he would get rid of the HSE.

A man has died, Taoiseach.

The Taoiseach without interruption.

-----was established in part for that purpose in order to take clinical decisions and decisions such as that away from the Minister for Health or other politicians.

We need a Minister for Health to talk to.

There are two other points that I believe are worth making. The Deputy seems to be conflating the issue of a second cath lab with 24-7 services. One can have two cath labs and not have a 24-7 service. As was-----

We have neither now.

-----the case in St. Vincent's University Hospital for quite some time, a single cath lab ran a 24-7 service. Therefore, I believe there is an error in understanding there. We could have a single cath lab running a 24-7 service-----

Sorry, no. The absence of a second lab is a risk to safety.

-----and one can have two cath labs not running a 24-7 service. I believe it is important not to conflate the two issues. The Deputy also knows from his own time as Minister for Health that if it were possible to provide 24-7 emergency services of all sorts, not just cardiology, in every county or town, we would of course do so.

It is a regional issue.

It is a big area of the country.

However, it is not possible to do so. The reasons for that are that in order to make it sustainable, one needs to be able to staff it adequately. One also needs to have an adequate number of patient throughput for staff to retain their skills. That is why there is only a small number of these centres in the country. In Scotland, for example, which is a similar size country, there are only two.

The Government's own 2012 report identified it.