Evidence I have received in the past ten days shows the worsening clinical situation for heart attack transfers in the south east when the Waterford cath lab is closed. In the three years from 2019 to 2022, of 134 blue-light ambulance transfers from University Hospital Waterford to Cork University Hospital, not one arrived within the 90-minute treatment window. In fact, the time from call of ambulance to Cork University Hospital patient hand-over averaged three hours and 14 minutes. A three-year audit of heart attacks by the National Office of Clinical Audit, NOCA, has just been published and supports the evidence on transfer times.

As a doctor, the Tánaiste knows well the catastrophic damage resulting from this delay to emergency cardiac intervention. Will he, as a clinician and the leader of Fine Gael in government, immediately designate University Hospital Waterford a 24-7 cardiac centre and commit the requisite funding to fulfil a 24-7 service plan?

The pending Nolan report now has overwhelming evidence from the HSE and NOCA. In the opinion of clinicians, any counter conclusions to 24-7 service delivery at University Hospital Waterford would amount to snake oil. The evidence is clear. Will the Tánaiste designate University Hospital Waterford a 24-7 cardiac care centre?

I appreciate this is an important issue in Waterford and the south east. The Deputy will be aware of the work being done to construct and fit out the second cath lab in University Hospital Waterford. Obviously, when the laboratory is ready staffing it will be a challenge. Finding staff to staff two cath labs 24-7 will be a real difficulty. It is in large cities and it will certainly be a difficulty in Waterford too.

I cannot make any commitments of the nature the Deputy requested. I do not have the authority to do so. I will certainly let the Minister for Health, Deputy Stephen Donnelly, know that Deputy Shanahan raised the matter again and ask him to speak to the Deputy directly.

I support Deputy Shanahan. It is a scandal that people have to wait that length of time. It is a two-tiered system for the people of the south east, Tipperary included. There is a further problem, apart from the cath lab not being open. There is a huge problem with the National Ambulance Service and waiting times. People are dying on the roadside and in their homes while waiting for three, four, five and six hours. Ambulances are flying all over the country because boxes are being ticked regarding the time a 999 call is responded to. The ambulance service may have responded but it will not say the ambulance could be 120 miles away in Donegal. A farcical game is being played with people's lives. It is not good enough.

This issue has been raised countless times in this House. Ambulance staff and personnel are fatigued. Ambulances are becoming burned out with the distances they travel. They are doing nothing but meeting each other on the road and failing to collect sick patients. People have lost their lives. We are going to continue with this farce. It is disgraceful. The people of Ireland, rural and urban, are entitled to and deserve a better service. The two issues are linked. The Tánaiste knows that 90 minutes is a crucial time for heart attacks and any other service. People have to wait or go by car.

It is increasingly understood that with heart attacks, or myocardial infarctions, the time period that is most relevant is the point from which the person starts to experience symptoms, rather than the 90 minutes from the time the call is made. There is a better understanding of that in recent years. I appreciate the comments the Deputy made but perhaps the best place to raise this matter would be during health questions with the Minister, or perhaps as a Topical Issue matter.