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A cath lab at every crossroads

By Dermot - 26th Sep 2016 | 9 views

The people of Waterford must feel safer now that politics has been taken out of healthcare. Politicians and local doctors should not play politics with people’s lives.

We can’t have a cath lab at every crossroads.

Well okay, there are only seven cardiac centres. And yes, University Hospital Waterford is not a crossroads. Sure, with almost 2,000 people working there, it’s nearly a town!  It’s kind of busy too: 50,000 emergency attendances and 20,000 admissions. Who’d have thought? That’s the same as a Dublin hospital, like St Vincent’s University Hospital.

But Dublin is different, of course.

Can you imagine telling Dubliners to travel 90 miles for emergency cardiac treatment? They’d have a heart attack on the spot! That’d mean travelling to Cavan or Kilkenny or Athlone.

But the expert report is out. Waterford does less than 100 primary percuaneous coronary interventions (PCIs) for heart attack cases annually, so it should stop and do none. The patients must travel to Cork or Dublin instead.

Of course I haven’t read the report. Who has? Like most people, I’m relying on radio and newspapers.

Apparently, some Dublin hospitals are also doing less than 100 primary PCIs, but it’s beyond the scope of the report to comment. Of course it is.

This is not like the small hospitals, where a report on one unit instantly applies to all the others.

It could be like cancer care. A unit must close, no matter how good the results are, if it is treating less than a special number of cases. And it is an absolute rule that there can only be eight cancer centres.

Unless it’s in a private hospital.

Hold on a minute – maybe that’s the answer! Maybe Waterford patients can be treated locally after all, if the private hospitals step in.

You’ve probably heard the radio ads offering emergency cardiac treatment in the private sector. I wonder if the 100  primary PCI number applies? Probably not.

It’s more like cancer care. There’s a report (in the business pages) of yet another cancer unit opening – in a private hospital.

We all know different rules apply in the private sector, whether it’s small hospitals or cancer care, so why not cardiac care too? What the consumer wants, the health insurers will pay for. And then the HSE and NTPF can pay for public patients too.

Just joking! But it would certainly be an Irish solution to an Irish problem.

There is other stuff that puzzles me about the expert report.

If it takes 90 minutes to get from Waterford to Cork, and a heart attack should be treated within 90 minutes, there is not much time for the hospital staff to recognise the emergency and organise the transfer. There is no time at all for the patient to get to hospital in the first place.

So there will be quite a few patients who can’t get to Cork in time. You would think the report would have some smart ideas for them, wouldn’t you? But they don’t.

It seems a teeny bit mean to leave that tricky bit to the local clinical stakeholders. They can choose anything for their patients as long as it is not primary PCI.

That’s a bit tough on them. They know it is the best and the most modern treatment. It also happens to be national policy for heart attack care.

And wouldn’t you wonder where the magic number 100 comes from? Has someone checked if it applies to Ireland? After all, because Waterford has so few cardiologists, they must be very experienced at primary PCI. They must have done a hell of a lot of cases each.

And maybe they are right – if the cath lab was open more hours, they would treat more cases and reach 100. After all, heart attacks don’t usually oblige during office hours only.

And when services move further from the patients, ambulances are expected to fill the gaps. But Ireland has a very rural population at 40 per cent, unlike 12 per cent across the water. The ambulance service has been told it is not possible to meet targets in such a rural country.

Maybe the experts know all this stuff. Or maybe it was outside the remit of the report.

But anyway, why should so much effort go into emergency cases? If Waterford gets rid of that service, there will be more time to spend on the cases that are not urgent and can wait for nine to five care. That makes sense doesn’t it?

Yes, it is very important to take the parish pump out of politics. The people of the south-east can rest easier.

Isn’t that right?

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