HEALTH Minister Simon Harris gave the green light to a controversial cardiac lab despite strong recommendations against it from senior departmental officials.
The second cath lab at Waterford University Hospital had been a key priority for Independent Alliance junior minister John Halligan and was given approval by Minister Harris in early July.
However, internal Department emails reveal that senior officials did not believe the lab – which is to be built in a prefab – was justified or fit in with national plans.
In addition, they said a business case put forward by the HSE was out of date, contained factual inaccuracies, multiple miscalculations, and could not be used as the basis for any decision.
On March 29, Minister Harris was given a preliminary briefing on the proposal, which advised against the plan on three separate grounds.
Despite that, Minister Harris asked for the idea to be investigated further in an email sent by one of his special advisers.
An internal email from the adviser said: “I understand that on a recent visit to Waterford this issue was raised with the Taoiseach who said he would ask Minister Harris to examine the issue further.”
The Department of Health subsequently looked for a business case from the HSE on the proposal and prepared a second briefing for Minister Harris.
Pressure for a decision on the cath lab intensified in June when the Taoiseach’s department also sought updates on the proposal, records reveal.
An internal email from Secretary General Jim Breslin on June 13 said: “Following the meeting with Minister and advisors (here and in D/Taoiseach) we have been asked to press the HSE to submit the business case.
“The submission should include the key steps necessary to commission such a lab, the associated timelines and costs.”
On June 21, an internal email from Minister Simon Harris’ special adviser said Mr Harris now wished to “proceed with the provision” of the second lab and wanted to update TDs in the South East on the news the following day.
A half an hour later, a health official urged caution: “We strongly advise against providing an update to the South East Oireachtas members confirming intention to proceed with provision of a modular cath lab in advance of receipt of the Department’s analysis.”
The following day, senior officials provided a second lengthy briefing on the proposal saying there were “factual inaccuracies” in it and that some of the information in it was out of date.
They also said there appeared to be “numerous miscalculations” in tables of costs that were provided.
“Given the miscalculations referred to above, it is also not possible to make a definitive determination on the value for money of the preferred option outlined in the business case,” it said.
The briefing then listed eight recommendations about why the plan should not proceed as outlined, the first two because of the mistakes in the business plan.
It also said the development – which could cost between €1.85 and €3.4 million a year – was not consistent with the “Herity Plan”, an independent clinical review that said a second cath lab in Waterford was not justified.
It said the South East catchment area could be served by extending opening hours of the existing lab and that staffing challenges would be a problem if it was developed.
It concluded by saying: “Acute Hospitals Policy Unit 4 strongly recommends that the project not proceed at this time, in advance of more detailed information on costs and timelines.”
In a handwritten note, Department Secretary General Jim Breslin also raised the issue of how the development would fit in with funding plans.
“Minister,” he wrote, “you will also be aware of the significant gap between available capital funding in 2018 and 2019 and the cost of existing commitments.”
The previous briefing from March of this year had also strongly recommended against proceeding with the unit.
It explained that waiting lists in Waterford were “demonstrating good performance” with the vast majority of patients waiting less than six months for procedures.
It said providing a prefab lab would take anything between twelve and sixteen months and was not a viable interim solution while a national review of cardiac services took place.
It also warned of possible staffing issues where industrial relations risks had arisen in the past when people were asked to work in “modular builds”, i.e. prefabs.
In a statement, the Department of Health said: “Given University Hospital Waterford’s status as a primary [cardiac] centre, the Minister believes there is merit in the proposal for a modular cardio-catheterisation laboratory [there].
“The HSE has submitted details of the costs and timescales for options for the provision of a modular cath lab to the Department for review and further details on costs are awaited.”
Campaigners in the South East strongly dispute the points of view expressed by Department officials.
For more information on their work for enhanced cardiac services in the region, you can visit: http://www.hefse.com/