Brexit ‘must not scupper’ lifesaving cross-Border treatment

When Donie Cronin had a heart attack, cross-Border treatment saved his life.

A grandfather of seven from Newtowncunningham in Co Donegal, he was among the first patients from the county to receive a life-saving operation in Altnagelvin hospital in Derry under a new cross-Border initiative which began in 2016.

Initially Cronin thought he was suffering from indigestion, but drove to Letterkenny hospital when he realised something was wrong.

“I was going through a fairly massive heart attack,” he recalls. “I didn’t know this at the time, but they were monitoring and liaising with Altnagelvin, and they said whip him up, this is a guy for us.

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“In a very short time I was in an ambulance and I had the quickest run up to Derry I ever got.”

In half an hour, Cronin was having stents inserted in Derry.

"I was extremely lucky, because the doctor said at the time that in my situation Galway or Dublin was too far away.

“It was a life or death thing, and there’s no doubt in my mind they did save my life.”

Primary percutaneous coronary intervention (PCI) is internationally regarded as the best available treatment for a major heart attack and is proven to reduce mortality. When patients have a major heart attack – where an artery is completely blocked – the procedure reopens the artery by inserting stents.

Time is crucial. The procedure must be done as soon as possible, and in a maximum of two hours from the patient’s first medical contact.

This means hospitals must be near population centres – and there must be sufficient numbers of patients and staff to make it viable 24 hours a day, 365 days a year.

Primary PCI was introduced in Altnagelvin in 2014, and the hospital began treating cross-Border patients in May 2016 – a month before the Brexit referendum.

Consultant cardiologist in Altnagelvin and the clinical lead for cardiology in the Western Health and Social Care Trust – which covers much of counties Derry, Tyrone and Fermanagh – Dr Albert McNeill was one of many on both sides of the border who worked to make it possible.

"When centres were set up in the Republic they were in Dublin, Waterford, Cork, Limerick and Galway," says Dr McNeill. "The difficulty was Donegal, so we were approached by Saolta [hospital group covering the western seaboard] and asked if we could provide primary PCI for the Donegal population."

Co-ordinated effort

In two years, about 100 heart attack patients from Donegal have been treated in Derry, receiving immediate life-saving surgery they would otherwise be unable to access.

“Instead patients would have been given a clot-dissolving drug, that works on about 75 per cent of people and hopefully the patient would be in the good three quarters,” explained Dr McNeill.

“After a day or two the patient would have gone to Galway and you would have probably had the same procedure as you would have had in Derry, only two or three days later, the drug having bought them time.

"When primary PCI started in Europe maybe 20 years ago I used to say that would be fine if you happened to be walking past the hospital I used to work in in Rotterdam when you had your heart attack, or past Guy's in London, but it's not much use if you're in Limavady or Sion Mills or wherever.

“Now our patients are getting the same treatment as they would get anywhere else.

“It’s very fulfilling to know that patients from rural parts of Donegal or Fermanagh have access to the same management as if they had a heart attack in Belfast or London.”

Setting up the scheme required huge levels of co-ordination.

The ambulance services on both sides of the border now transmit ECG readings straight to the cardiology centre at Altnagelvin; patients arriving from the Donegal islands by helicopter have helipad and portering staff – and the NI Ambulance Service – ready and waiting for them as soon as they land.

Border

In a procedure where time is critical, any delays at the Border could mean the difference between life and death.

Dr McNeill cites the example of an ambulance encountering a queue of cars at the border and having to wait for customs checks.

“I don’t want to be melodramatic,” stresses Dr McNeill, “but it could be the difference between living and dying.

“Even without being that dramatic, if you’re delaying the patient their heart muscle function subsequent to their heart attack would be less good than if they’d had the procedure done earlier.”

In such circumstances, Dr McNeill is confident common sense will prevail, and a solution will be worked out.

“No matter what happens between London and Brussels and Dublin, there has to be some sort of fast track where people jump the queue and go through.

“There is such a body of clinical sense, but there’s also a body of public opinion, public opinion is really supportive of this and in fact many people want us to roll this out and do other heart treatments.

“There will have to be political wisdom to say no, we’re not going to have people coming from Buncrana or Ballybofey sitting in a queue waiting for half an hour even if there is a hard border.”

‘Inconceivable’

Dr McNeill is equally adamant that, whatever the eventual nature of the UK’s exit from the EU, cross-Border treatment will continue.

“It is inconceivable that the service would be discontinued,” he says.

“It would be a real clinical problem for the people of Donegal, and a real political problem for the Government in the Republic because they’d suddenly be in a situation where once again the Donegal population were disenfranchised.

“As clinicians, as health services on both sides of the Border, there’s no way we’re going to sit back and watch something which is a potentially life-saving service be allowed to fall apart.”

Eighteen months after his heart attack, Donie Cronin is fully recovered and enjoys spending his time looking after his grandchildren.

“It’s very important for people like us, family people, that the older ones get a chance to see the younger ones coming on and that we’re there for them and we can enjoy them in a decent, long-lived way,” he says.

“Derry is ours, Altnagelvin is ours, and the co-operation is brilliant and hopefully it will stay.

"It's crucial for Ulster, and I'm saying Ulster in the broader sense of the whole province. It's a geographical necessity and it's common sense.

“Brexit must not scupper what is a brilliant initiative.”