Rose Conway Walsh (Sinn Fein)
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The Chairman does not want to demote the Deputy.

I thank the delegates for their presentations. I disagree with nothing they have said. The models proposed are fantastic and should have been put in place many years ago. They are the way forward. The language used by the delegates would lead people to believe everything will be patient-centred and so on.

On treating patients with heart failure, I very much like the idea of having 12 hospital-based acute units. What is being done in that regard to fill geographical gaps, particularly in counties Cork and Kerry? Is there an estimate of the funding required to make the service available throughout the country?

How many stroke patients have access to a stroke unit? The Irish Hospice Fund and Health Service Executive national stroke audit shows that only 29% of such patients are directly admitted to a stroke unit. The FAST campaign was of great benefit. Have the delegates sought funding for a new campaign of the same ilk?

In my experience, one of the main problems people encounter after a stroke is the lack of availability of physiotherapy in many areas. I am aware of people's experiences in that regard in Mayo, the county from which I come. Patients are discharged from hospital, but thereafter are not provided with physiotherapy and their health deteriorates as a consequence. Is that a big concern for the delegates?

Another issue relates to timing and the centralisation of services. As services become more centralised, it will take longer for some people to get to the units or care services they need. This also applies to patients suffering from heart failure. Problems are being caused in patients being over an hour away from a hospital and by the relevant infrastructure not being in place. It is wonderful to have the models referred to by the delegates, but it will be a huge problem if people cannot get to them or do not have access to them. It could lead to apartheid in access to health services. Have the models been rural-proofed in their development and the decision-making process?

I must ask about the withdrawal of Versatis because chronic disease is directly linked with chronic pain management. Approximately 25,000 patients rely on Versatis to control their pain. Were the delegates consulted about its withdrawal and can they comment on the decision? Are they concerned about the fact that so many people with chronic disease are trying to manage pain without Versatis? Are they concerned that patients' relationships with their GPs and consultants were undermined by the decision? Is it a good use of public money for such senior personnel to review the reviews?

I am very interested in virtual consultations and how they will be rolled out. When the pilot projects under the primary care programme were set up in ten areas across the country in 2000 or 2001, information technology was to play a huge part in providing access and having a better alignment between hospitals and primary care settings, but that never happened. I am concerned that although virtual consultation is a wonderful idea and absolutely the way forward, it will not be delivered, similar to how it was dropped from the development of primary care services almost 20 years ago. I am concerned about the potential impact of the lack of broadband on its delivery, particularly in areas of the west. Will the roll-out of virtual consultation services be population-led?

I have many concerns about post-stroke patients trying to access rehabilitation units. A fantastic job is done in the National Rehabilitation Hospital, Dún Laoghaire, once patients are admitted. However, patients are begging for beds in order to access timely post-stroke rehabilitation services, which are of great importance.

I acknowledge that I have asked the delegates to address many points. I thank them for their attendance as it gives members an opportunity to raise these issues which are of importance in our communities.