Jillian van Turnhout (Independent) | Oireachtas source

I second the motion. I thank my colleague, Senator Marie-Louise O'Donnell, for tabling this motion and helping us understand the rationale behind it. We all know it instinctively but she has hit it home for us all. I have long been a believer in balancing our supports and the need to invest more in community services. We tend to put an overemphasis on the medicalisation of too many issues, when we actually need to look at the humanisation of those issues to ensure people can get the help where they need it.

I am delighted to second this motion. My own father is in a nursing home. I have nothing against nursing homes. He had a severe stroke and is high dependency but getting high-quality care. However, there was a period when he should have been getting care in the community but it was not there. That is why tonight I have chosen to drill down in one area to illustrate why I am so honoured to second the motion.

Four years ago the Government launched its strategy, National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland 2011-2015. As the title suggests, the intended lifetime of this policy ends in two months’ time. Now is a good time to see what has been achieved. It will not take me long because there has been nothing, not even an implementation plan. As Senator Marie-Louise O’Donnell said, the difficulty has been with cutbacks, which have affected all services but particularly neuro-rehabilitation and older people services. In general, total community support hours have fallen, according to Age Action’s figures, from €11.97 million in 2009 to €10.29 million last year, despite an increase in the number of people who wish to access the services.

The Government rightly lauds the success of the Health Service Executive’s national stroke programme in transforming acute stroke services across the country. We have seen the death rate from the disease cut by 13%, against both demographic and international trends. This means that more people than ever are returning home after a stroke but the community rehabilitation services that enable survivors to maximise their recovery and their quality of life are as bad as ever, however. At the most vulnerable time of their lives, in the wake of a major brain injury, survivors are effectively abandoned at the hospital gates and left to face the future with no support or services. The Irish Heart Foundation "Cost of Stroke in Ireland" research illustrates just how badly stroke survivors are being failed. It should be underlined that the problem is not about how much money is being spent but where that money is being spent. The study estimates that the direct cost of stroke to the State is up to €557 million a year. Of that €557 million a year, €414 million goes towards nursing home care and less than €7 million goes on community rehabilitation. How does this fit into Government policy to keep people at home? We are saving more lives than ever from stroke due to improvements in hospital services and amazing staff. The system then waits until after it can help maximise the recovery and after it can help people return to and remain in their homes before it spends any money on them, instead of switching the focus to rehabilitation. We know that saves lives in instances of stroke, and saves the quality of life, which is core to the motion being put forward by Senator O'Donnell this evening.

I would like the Government to look at the issue of early-supported discharge programmes, which Senator O'Donnell called a fair deal for home. We need a way to ensure that we can care for people and that they can get the resources they need in their own homes. The ESRI and the Royal College of Surgeons in Ireland report last year concluded that over 3,000 stroke survivors could benefit from early-supported discharge. That would reduce hospital beds by 24,000 annually, freeing up vital space to ease the crisis. The data from the three early-supported discharge pilot programmes in the Mater, Tallaght and Galway University hospitals indicate bed savings of between eight and 14 days per patient, along with improvements in self-reported quality of life, which is absolutely core to what we are talking about here from 9.5% to 19.4%. Some people will say this is evidence from urban areas but, for example, Galway recorded the biggest bed day savings, even though the current programme only serves rural dwellers who make up to one third of its patient numbers.

I support this motion because it is about the quality of all our lives. If one looks at the UN principles for older people, one will see that they are about ensuring that people have the choices, that the services are there and that we do not needlessly put people into hospitals. We have to ask what the roles of the hospital and the community services are. I have experienced it with doctors on night call - all too often the easy option is to send a person to an accident and emergency department because the doctor is covered. We need to drill down and have supports at home.

My in-laws are Dutch and I see the amount of community support and the way the system is tailored around the home in the Netherlands. If people need those supports in their home they will be there - people ask for them when they want them. My father-in-law is quite ill and is able to ring and have a doctor within 20 minutes on every occasion. We should be striving to have support in the home when it is needed and as it is needed. We need to ensure that older people have access and the optimum level of physical, mental and emotional well-being. We also need to look at the other services. I have been discussing the medical services here this evening but there should also be educational, cultural, spiritual and recreational services. I am sure we can debate this further.

I second this motion wholeheartedly. This debate is part of a journey. Senator O'Donnell has done considerable work on this area. I hope this contributes to that debate but I really hope that it adds to action and a change in policy rather than platitudes.