Ms Esther O'Shea:

There are no such supports. Once a person gets home, he or she depends on his or her family and the support of the community.

When I talk about community I am talking about neighbours and friends. It is a huge burden. They are already trying to manage a very sick person in their house and trying to adapt to a new way of living because of that person's illness, yet the burden on them is significant; it is insurmountable really. It is too much. If a person got a discharge plans saying next week you are going to meet a counsellor, the week after there is going to be a nutrition programme and then someone who will talk to you, then a follow up in six weeks with your counsellor and then we will bring you in for a group session. That is part of cardiac rehabilitation, but cardiac rehabilitation is tied to hospitals. It was great to hear the Deputy mention the ExWell programme. Excellent, that is fantastic, I would love if that was rolled out all over Ireland. However, cardiac rehabilitation is linked to the hospitals. Some hospitals do it better than others and there is definitely scope for improvement. Again, not every condition fits the standardised cardiac rehabilitation model. Some hospitals are better at adapting that model to suit to that cohort of patients.

Cardiac rehabilitation can expand into the community. There are different levels of cardiac rehab to encourage movement, to encourage weight watching and there is a social element. There is something to be said for being with other patients who are reminded every day of their illness and of what they cannot do as opposed to what they can do. They might not be able to do it like they used to do it; it is a new normal but they will have a go of it. When there are bad days, there is somewhere they can reach out to. We also cannot undermine the financial burden that is placed on people who are paying for medicines who do not have medical cards or GP visit cards. It is another stressor. It all adds up. We see in any chronic illness, as the Cathaoirleach rightly said, comes anxiety, stress and worry. That disables people's coping skills and coping mechanisms and it also affects their health. They could be taking the medication and the tablets to help them but if their emotional and mental well-being is suffering because of this illness, the two do not work well together. It is about the next step of the journey. Recently I was with a heart failure group and we all had different heart diseases, cardiopathy and congenital heart defects. I said we are all on the same train journey we are just in different carriages. We all have the same struggles financially, psychologically, lack of support in the community and struggling to get into the hospitals. We are all on the same journey, different characters because of our condition but we are all in the same class. I will not say what class we are in. We are getting momentum here today and a great opportunity, we just need to get traction now.