Oireachtas Joint and Select Committees

Wednesday, 7 March 2018

Joint Oireachtas Committee on Health

Chronic Disease Management: Discussion

9:00 am

Dr. Rónán Collins:

It is interesting that she mentioned that area. When it came to accessing care, for example, that area was in our first tele medicine network, which greatly improved the provision of the clot-busting treatment.

Going back to thrombectomy, it is very specific and a lot of interventionist skill is required. There is a significant risk of bleeding and that can lead to fatal situations. That part of it needs to be done in supra-specialised centres. We are modelling the pathways around that to determine whether patients should stop off in the nearest hospital first to get the clot-busting drug before moving on. We have actually just produced a paper on that for the European Stroke Journaland I would be happy to send that on to the Deputy. That paper illustrates some of the mathematical modelling we have just done in the greater Leinster area.

In terms of the door-to-needle time, things are improving although more work needs to be done. We have started a quality improvement initiative with the Royal College of Physicians for all of our stroke teams and we hope that every hospital stroke team will have completed a quality improvement programme on door-to-needle time by the end of next year.

Going back to Deputy O'Reilly's comments about the neurorehabilitation strategy, that strategy started life as far back as 2010, became more focused in 2012, with the development of the model of care finalised in 2015. It is now at the level of implementation and this is the point where we actually engage. The model of care is generic - it is for everybody with neurological disabilities. Obviously, we need to explore the Venn diagram in terms of where strokes, as well as other neurological disabilities, will fit into the commonality of that. I would reiterate that the national stroke programme wants to ensure - as per the second pillar of our strategy on restoration to living - that everybody, irrespective of age gets the necessary rehabilitation that they require and not just to go home but also to get back to living.

In terms of the figures for discharge to nursing homes-----