In terms of looking after patients, both general medical and Covid-related, we need to look at the best configurations for their care. I would like to speak briefly about University Hospital Waterford, which is a model 4 hospital in the south east. It provides medical services and acute care services to a population of 520,000 to 615,000, depending on which report one reads. It certainly is in excess of 500,000. The hospital is the regional cardiac care centre and the regional cancer centre for the south east. It provides all general surgical specialties. It is the regional orthopaedic centre and, in fact, the busiest trauma centre in the country. It provides cancer surgeries and breast, colorectal, head and neck, urology and dermatology services. It also supports the south-east palliative care service.

University Hospital Waterford's critical care bed number is totally inadequate to the needs of the region. There are only six ICU beds in the hospital and between three and four high-dependency beds at any one time for the entire population of the south east. The hospital needs investment in critical care beds, at least 12 ICU beds and 12 high-dependency beds that can be stepped up or down. The Dunmore wing was a great addition to the hospital and we were very lucky it was there to provide additional isolation rooms. However, those rooms are nearly all currently in use.

University Hospital Waterford is the most underfunded of the eight model 4 hospitals in the country, yet it is one of the busiest in output terms. For instance, University Hospital Limerick has a smaller patient catchment than University Hospital Waterford but has 700 more care staff. The latter has the lowest staff to bed ratio of all the model 4 hospitals. When will the Government recognise the budget deficits at the hospital and when will it receive a funding allocation on par with the other model 4 hospitals? When will the Government recognise the obstruction to enhancing services at the hospital which has been going on for years, exemplified by the delay in building the new mortuary that was approved in 2014? The remodelling of the CAT laboratory, which was supposed to take 12 weeks this year, took almost seven months to complete. A new CAT laboratory development was announced in September 2018 but has not yet advanced to the awarding of a tender, which will supposedly happen in December this year.

There has been a failure to implement a 24-7 cardiac care pathway for the south-east region, with University Hospital Waterford as one of five regional cardiac care centres. On the past two weekends, patients have been transferred by road ambulance, risking the nurses and doctors who may have to travel, the patients themselves and paramedic staff. That is unacceptable. We have to see about restoring the modular diagnostic laboratory activity that was taking place in the hospital, providing 30 patient angiograms a week. That service was suspended in February this year and has not been reinstated. It could possibly be done through a service level agreement with the local private hospital. Otherwise, the laboratory that was taken off site should be brought back.

The current Covid pathway for cardiac care means University Hospital Waterford cannot give a service to the other south-east hospitals. There is only one isolation bed available to the cardiac service, which means only one patient from an outlying hospital can be accommodated in the morning and one in the afternoon. The Minister, Deputy Michael McGrath, may be aware that there were seven patients awaiting transfer to the CAT laboratory in University Hospital Waterford this morning. Those patients are stuck in hospital beds in the meantime. The hospital has only one seat on the South/South West Hospital Group advisory board, even though it was promised three at the outset of this agreement. I have raised this a number of times but it has not yet been dealt with. When will University Hospital Waterford have funding on par with the other seven model 4 hospitals in the country and when will the Government approve funding to implement a 24-7 cardiac care service there?

I thank the Deputy for his questions. I know his commitment to this issue, about which we have had a number of discussions. In terms of the broader issue of model 4 hospital funding, an ongoing assessment will be undertaken that will include the question of funding for Waterford and its needs and demands. I will revert to the Deputy in that regard.

As the Deputy is aware, the programme for Government commits to the delivery of a second cath lab at University Hospital Waterford. The preferred option is a second cath lab and associated 12-bed day ward, which would deliver six additional beds on the roof of the existing cardiology department. Covid-19 did delay the work on that but it is now intended that it will go to tender at the end of this month. I have been assured of that not just by the Minister for Health but by the HSE as well. Prior to that, a lot of progress had been made. The HSE had been advised that funding was allocated in the 2019 capital plan for the provision of the second cath lab. Planning permission was received from Waterford City and County Council in January of this year. The disability access certificate was granted in April, the fire certificate in June and, as I said, it will go to tender now at the end of the month. It is a two-stage process as there are main and specialist contractors. The whole process, which is necessary because of procurement, will take about four months. Thus the works on the new cath lab are due to commence in quarter 1 of 2021. In the interests of being fully transparent, the build will take 12 months so the new lab should be ready by early 2022. This will transform cardiac services in County Waterford. The national review is still under way. As the Deputy noted, the upgrade works to the existing cath lab were also delayed when the contractors had to close the site due to the Covid-19 pandemic. They returned to the site in early August and the lab has been, I understand, fully operational since 14 September. I understand that the arrangement between UPMC Whitfield Hospital and the HSE is ongoing and that the recruitment of an interventional cardiologist has been successful, which will significantly help throughput in the cardiac department as well.

On ICU beds, we will assess that but broadly speaking, additional capacity was developed across the country. In addition to that, there is the issue of potential capacity for use in the event of a surge as a result of Covid-19, for example. It is interesting that up to 1,500 staff were trained up to work in ICUs. ICU beds are very labour-intensive and it is not just about the bed. It is about a 1:1 nurse to patient ratio so there are very substantial human resources behind every ICU bed that is provided. I have heard the Deputy's comments on the ICU issue in County Waterford and I will pursue it further.

I thank the Taoiseach. I ask that the Government and the Taoiseach's own office move the Office of Government Procurement review. We have had a specification and a build tender capable on this project since January of this year and we are now expected to wait another four months while we approve an approval for a total spend of €6 million, while every week we are deferring diagnostic angiograms and risking patients up and down the roads. It is unacceptable and I ask the Taoiseach to look at it. Will the Taoiseach also see about the restoration of the diagnostic service? Although the Taoiseach did say that there are ongoing arrangements with Whitfield Hospital, there is no service level agreement, SLA, in place at this time as far as I am aware. Something needs to be done about the cardiac care isolation rooms in Waterford hospital because the service cannot be provided. There are even constraints on providing it between the hours of 9 a.m. and 5 p.m. and something must be done about that.

I ask the Taoiseach to consider a further matter. I have asked the Oireachtas Library and Research Service to do an independent review of costings and support budgets across the model 4 hospitals. I would like the Government to conduct a full independent review of the funding of the model 4 hospitals, looking at University Hospital Waterford's primacy in the region, as well as its funding relative to that of other model 4 hospitals. When the Taoiseach sees that he will understand that something serious and fast needs to be done about that hospital.

I spoke to the HSE earlier and my understanding is that the UPMC Whitfield facility is being used by the hospital. I got that assurance an hour before I came into the Chamber. I will double-check on that, to make sure that facility is being used.

The Deputy and I both know one has to be careful of full independent reviews in terms of their analysis and what they might bring to bear. In health people have their ways of looking at issues. We saw this in terms of cardiac services. I do not mean that in any facetious way. When the reconfiguration was originally announced by Professor John Higgins and his team a full 24-7 cardiac service was provided for. That was overturned by a second independent review commissioned by the then Minister. I had discussions with Professor Higgins after that. I hope I do not misinterpret him but he was somewhat put out that the commitments he had made as part of the review were not fulfilled by a subsequent review. I take the overall point. I would much prefer to see what the immediate demands and objectives of the hospital are and make sure we meet them in terms of funding. I have no objection to an independent funding review of model 4 hospitals.

The point I was making was purely on a review of the funding for the service and the activity. It was nothing more than that.