Press Release

Minister for Health announces chair of National Review of Specialist Cardiac Services

The Minister for Health, Simon Harris TD, today (Thursday) announced that Professor Philip Nolan, NUI Maynooth, has agreed to chair the National Review of Specialist Cardiac Services.
Professor Nolan will lead the National Review Steering Committee consisting of patients, relevant health professionals, senior HSE management and senior departmental officials. The work of the group will be based very clearly on evidence, data from existing service provision and appropriate consultation.

Minister Harris said “I am committed to ensuring that all Irish citizens have access to safe, high quality and evidence based care, which is in line with international norms. That is why this National Review of Specialist Cardiac Services is being undertaken. It will incorporate rigorous reviews of evidence and data, international peer review and stakeholder consultation. Professor Nolan is eminently suitable to Chair this important review. He brings the necessary leadership, clinical understanding and commitment to a scientific approach for service planning.  I am confident that Professor Nolan has the standing and credibility to gain support and buy in right across our health services, the professions involved and our public representatives.”

Speaking on this announcement Professor Nolan stated “I am delighted to accept the Minister’s invitation.  I am looking forward to making a sound contribution to national health service planning that will not only advance a modern, safe cardiac service for the Irish adult citizen but will show the benefit of an independent and expert model of service review that can be pursued in the future.”

It is expected that the review will commence in the coming weeks.


Notes to the Editor

Biography – Professor Philip Nolan
Professor Philip Nolan has been President of Maynooth University for the past 6 years where he has led strategic development that has advanced research capacity and transformed undergraduate curricula. He is currently President of the Irish Universities Association (IUA) and Chair of the IUA’s Task Group on Reform of University Selection and Entry.

Professor Philip Nolan’s academic career, which includes a PhD and various scientific research accolades, point to a strong commitment to methodological rigour in generating evidence. This followed a primary degree in Physiology in 1988 and the medical degrees of MB BCh BAO in 1991 from University College Dublin (UCD).  Professor Nolan then spent a short time in medical practice so understands the health service and the need to use and apply data and evidence to optimise patient outcomes.

In 1996 Professor Nolan joined the staff of University College Dublin, where he received both the UCD President’s Research and Teaching Awards.  He led the development of UCD’s Health Sciences Centre, which opened in 2005, and was Director of the UCD Conway Institute from 2003-2004. Professor Nolan was appointed Registrar and Deputy President of UCD in 2004, where he continued to lead developments until his appointment to Maynooth.

Why do we need a National Review of Specialist Cardiac Services?
The Programme for a Partnership Government committed to an independent clinical review of the need for a second cardiac catheterisation laboratory in University Hospital Waterford (UHW). This was completed by Dr Niall Herity in July 2016.  One of the recommendations in his report was that the UHW cardiac catheterisation laboratory (“cath lab”) should operate as an elective catheterisation laboratory, providing all specialised cardiac services except emergency interventional treatment for patients who are having heart attacks (STEMI).

The Minister requested his Department to address the implications of this recommendation by undertaking a national review of all primary percutaneous coronary intervention (PPCI) services, with the aim of ensuring that as many patients as possible have access on a 24/7 basis to safe and sustainable emergency interventions following a heart attack.  This was in the context of ensuring that any change to how a service is delivered results in improved services for patients.

In July 2017, the Minister agreed to expedite the commencement of the national review of all PPCI services, encompassing the South East region, and to commence the preparatory work, including examining the scope of the review. He stated that the guiding principles for this review would be to strive to provide a PPCI service that can deliver clinical outcomes on a par with international standards.

In examining the scope of this review, it has been determined that the most appropriate and effective approach, in order to ensure the best possible clinical outcomes, is to consider all adult cardiac service needs and their optimal service configuration as a whole.

What are specialist cardiac services?
Specialist cardiac services cover scheduled and unscheduled hospital-based services for the diagnosis and treatment of cardiac disease. For the purposes of this National Review, services will include diagnostic (invasive and non-invasive) services, interventional services (to manage coronary artery disease, rhythm disturbances, structural abnormalities and adult congenital heart disease with such interventions usually being performed in cardiac catheterisation laboratories), intensive cardiac care unit, heart failure service, arrhythmia management service, in-patient care for chronic cardiovascular disorders, out-patient services, rehabilitation, teaching, management functions, and sub-specialist clinics and electrophysiological services where appropriate.

What will the National Review consist of?
The terms of reference for the National Review are as follows:

1.        To recommend the best service configuration for a national adult cardiac service with population-based regional cardiac networks and network hospitals by:
a.        establishing population-based need at national, hospital group and county level for adult cardiac services, as set out in 4.2 above
b.        setting out minimum service requirements (including for relevant sub-speciality services) relating to staffing, activity, performance, and any measure deemed relevant to the scope and these terms of reference
c.        setting out how service configuration and minimum operational requirements are supported by evidence, where available, and/or conform to international best practice and standards
d.        examining and validating activity and related operational information from existing services within the scope to determine their ability to meet the minimum requirements set out.

2.        To explicitly consider the sustainability of the service for the following 10-15 years, with specific regard to manpower requirements, capital requirements and clinical/technological advances

3.        To set out appropriate clinical governance and performance information requirements for all components of the service to ensure that:
a.        patients have access to service based on clinical need rather than geographic location
b.        the safety and quality at each level of service including national level can be audited against evidence based safety and quality standards and reported in public
c.        resources are utilised in the most clinically effective and efficient manner possible to meet service needs.

The National Review will conduct its business by firstly generating key questions on which rigorous systematic reviews of the evidence will be undertaken using internationally recognised methodology. Secondly, stakeholder consultation will occur including a call for submissions. Finally, a peer review panel of 3 international experts will be formed that will provide independent, robust and transparent criteria-based peer review from the outset. These measures taken with the relevant professional and patient input will make sure the National Review is comprehensive and of the highest quality standard.

Who is involved in the National Review?
Whilst the National Review Steering Committee is being chaired by Professor Nolan, it will have 15 other members.  These include 2 patients, 7 health professionals nominated by relevant professional organisations, 3 senior HSE representatives, and 3 senior department officials.  Collectively, the team will have expertise in clinical provision, service management, service policy, clinical effectiveness and patient safety, public health and patient experience.

When can we expect to hear from the National Review Steering Committee?
This National Review is significant as it will provide a blue-print for the future of adult cardiac services.  It is imperative therefore that the necessary time is given to ensure a robust, comprehensive review conducted to a high standard. The Minister has requested that the National Review Steering Committee supplies him with its report within 12-18 months of establishment but at the outset the National Review Steering Committee will prepare and follow a communication plan with regard to its ongoing work.