Minister of State John Halligan has told the author of the independent review of cardiac services in Waterford, which found that a second catheterisation lab in the hospital was unjustified, that elements of how he had gone about the review had been “outrageous”.
Mr Halligan was one of several parliamentarians who engaged in robust exchanges with consultant cardiologist Dr Niall Herity during Wednesday’s sometimes heated session of the Oireachtas joint committee on health.
A cath lab is where angiograms are performed, along with scheduled and emergency stenting. The absence of a night service in the southeast means emergency patients have to be rushed by ambulance, or helicopter when available, to Dublin or Cork.
Dr Herity said he stood over the contents of his report, which found that the unit in Waterford was not busy enough to meet international standards for best practice.
Cardiologists in Waterford have argued the terms of reference for the review were skewed, and that the methodology was flawed as it was based on the number using the unit during its 9am-5pm hours rather than how many might use it over 24 hours.
Responding to questions, Dr Herity said he had arrived at University Hospital Waterford at 10.30am for the review on a given day and had left in the afternoon. He added he “would have been happy” to remain at the hospital until 10pm.
Higgins report
Dr Herity said he had not met consultants in Cork or South Tipperary General Hospital and had not met Prof John Higgins, who carried out a report for government in 2012 on reform of hospital systems.
“I’m astounded that you didn’t meet with Prof Higgins,” said Mr Halligan. “I think that’s outrageous. Not doing that is quite appalling. For that – and because you didn’t meet with consultants in the southeast – to my mind your report is fundamentally flawed.”
Dr Herity replied that it “isn’t obvious to me” that Prof Higgins was someone he should have consulted. “I read the Higgins report and made my own decision on whether he was somebody I had to consult with specifically,” he said. “I decided he was not.
“I hear the reactions of elected representatives, particularly from Waterford. What we don’t hear is the reactions from other people around the country who have agreed with the conclusions of the report. The positive feedback has outweighed the negative.”
Dr John Harty, chairman of the committee, asked Dr Herity if he was in any doubt as to the methodology of his report and the catchment dealt with. “I don’t,” he replied. “The key word I would apply is effective catchment population. It means operational rather than aspirational.”
Dr Herity also asserted that a second cath lab would not necessarily result in greater numbers of patients attending the facility. “I would make no assumption that that’s the case,” he said. “The referral patterns to specialist centres focus on many different aspects.
“In terms of the relationship between volume and outcomes, it is especially clear in emergency procedures. Concentrated expertise and the performance of the entire team determines the outcome.”
