Stephen Donnelly (Wicklow, Fianna Fail)
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The Programme for Government committed to the delivery of a second Cath Lab in University Hospital Waterford. The second Cath Lab opened in September 2023 and operates 5 days per week, Monday to Friday, 8am to 6pm. 24 WTEs were provided to open the second Cath Lab. The hospital uses a combination of day beds and recovery spaces for the operation of the second Cath Lab. The medium to long term options for recovery beds being discussed with HSE Estates involve the relocation of the on-call residence and refurbishment of this area. The opening hours for the first Cath Lab were extended to 8am – 8pm Monday to Friday (excluding bank holidays) in Sept 2022.

22 WTE have been approved for inclusion in the HSE’s Pay and Numbers Strategy as part of 1,850 New Development posts for 2024 agreed by the Minister with the HSE. Instructions to recruit the 1,850 new posts have issued to the HSE and the recruitment process is currently underway. This is now an administrative matter for the HSE. The HSE have advised that UHW is currently working through a previously submitted Business Case with Acute Operations with a view to progressing same to facilitate an expansion of cardiac services to a 7-day emergency service at UHW Cardiac Cath Lab.

In relation to Stroke Services at UHW which you raised with the Taoiseach during Questions for Promised Legislation in June this year, there have been significant improvements in stroke care since the establishment of the HSE National Clinical Programme (NCP) for Stroke in 2010, including:

• a reduction in annual number of strokes by about 25% from 10,000 to 7,500
• the number of acute stroke units increasing from 1 to 22 units
• thrombolysis therapy rates increasing from 1 to 11%
• thrombectomy rates increasing from 0 to 9% making Ireland one of the European leaders in that area.

The government is fully committed to supporting improvements and advances in stroke services and has allocated a total of €7.3m to fund the HSE National Stroke Strategy over the last two Budgets.

The HSE’s Stroke Strategy (2022-2027) was developed to build upon the significant achievements already made in stroke care and to address the burden of stroke at a patient, organisational and system level with a clear direction for stroke care in Ireland in line with international standards. The strategy will assist in addressing the challenges faced in Ireland and Europe including the predicted increase in the total number of strokes over the coming decade, an ageing demography, and the rapidly changing milieu of acute stroke treatment.

The overall aim of the Strategy is to modernise and reform stroke services in line with Sláintecare policy, to help sustain and improve upon the significant achievements already made to date. The Strategy provides a blueprint for the required investment over a 5-year timeline (2022-2027) to deliver on key priorities under the pillars of Stroke Prevention, Acute Care and Cure, Rehabilitation and Restoration to Life, and Education and Research.

The successful implementation of the strategy will lead to improved outcomes including reduced death and disability, reduced hospital length of stay, more patients living independently at home with better quality of life after stroke with reduced need for institutional care.

Acute Specialist Stroke Units (ASU), staffed with a stroke specialist multi-disciplinary team, are the single most effective intervention in delivering improved outcomes for patients presenting with a potential stroke.

All patients presenting with a potential stroke should be managed in an ASU in accordance with the National Stroke Strategy, International stroke guidance, and evidence-based practice.

Admission to an ASU result in the best outcomes for patients as well as value for money to institutions when implemented fully. Currently University Hospital Waterford has 5 dedicated ASU beds with 2 single side rooms.

In respect of UHW the following was data recorded in the reporting table of latest Irish National Audit of Stroke (INAS) Report 2022 . The report analysed 4,999 cases of Stroke in Ireland in 2022.

• 176 patients were admitted to UHW with a stroke representing 3.5% of the total cases analysed
• 60% of admissions were admitted to a stroke unit
• 66% of patient time was spent in a stroke unit compared with 68% nationally

It is important to note that the above metrics are National Key Performance Indicators (KPIs) which are used by the both the HSE and Department of Health to measure the performance of stroke services nationally.

A gap analysis of stroke unit beds has been undertaken and is reported within the HSE’s National Stroke Strategy 2022-2027. This gap analysis looked at the existing number of designated stroke unit beds (210 beds) and what would be needed over the next five years using a calculation based on the proportional growth in the over 65-year-old population.

Based on this calculation, a further 117 acute stroke unit bed designations were reported to be required to meet the KQIs of 90% of patients with a stroke admitted to a stroke unit and for those patients with a stroke who were admitted to a stroke unit that 90% of their total hospital stay is spent in a stroke unit.

The HSE will endeavour to bring all services up to recommended capacity over the lifetime of the strategy by a graduated incremental scale up process, as outlined in Appendix 3 of the strategy.