Ms Magdalen Rogers:

On behalf of the Neurological Alliance of Ireland, the national umbrella for more than 30 neurological charities, I thank the Chair and members of the committee for their invitation to discuss the issue of access to community neurorehabilitation teams. We welcome this opportunity to update the committee following on from the NAI presentation in March last year on growing waiting lists and pressure on neurological services, exacerbated by the Covid-19 pandemic. We requested the support of the committee in our call for investment to tackle the critical shortage of nurse specialists in neurology services. Thanks to its support and representations on this issue, funding for 23 specialist nurses was announced in budget 2023, which, together with the roll-out of the national headache pathway and other pathways, will see a total of more than 30 new specialist nursing posts created in neurology services this year.

We also highlighted to the committee last March our serious concern at the ongoing delays in implementing the 2019-2021 framework for the national neurorehabilitation strategy, a commitment in the current programme for Government. Our presentation focuses on a core recommendation of the neurorehabilitation strategy, namely, the establishment of a network of nine community neurorehabilitation teams, one in each community healthcare organisation, CHO, area in the country. This recommendation is echoed in the recently published national stroke strategy and the 2018 trauma strategy.

Community neurorehabilitation teams provide short-term intensive rehabilitation input of up to 12 weeks, with access to multidisciplinary services including physiotherapy, speech and language therapy, occupational therapy, social work and neuropsychology.

Delays in implementing the framework for the neurorehabilitation strategy have meant that no additional teams were established on the ground over the three-year implementation period 2019-2021. Seven of the nine CHOs nationwide have no community neurorehabilitation team up and running, as of May 2023. A postcode lottery now exists where 85% of neurological patients do not have access to a community neurorehabilitation team. The Neurological Alliance of Ireland is calling for funding to be allocated in this year's budget to enable the establishment of teams in CHOs 5, 8 and 9, where there has been no allocation to date, as well as priority action by the HSE to establish teams without delay in CHOs where funding has been made available.

Community neurorehabilitation teams are critical to tackling the lack of access to neurorehabilitation in the community. The consequences are a significant and preventable level of disability, resulting in higher healthcare use and increasing cost to the health service through earlier admission to nursing homes, the need for home care supports and an increased likelihood of falls and subsequent hospital readmissions. Demand for community neurorehabilitation services, already high pre-pandemic, is now critical due to the combined needs of those who needed to be discharged early and missed out on neurorehabilitation, those impacted by the curtailment and closure of services due to lockdown and those requiring rehabilitation after contracting the virus. The lack of neurorehabilitation teams in the community is exacerbating the problem of delayed discharges, further limiting access to inpatient rehabilitation in facilities such as the National Rehabilitation Hospital. The bed-day saving from having the national network of community neurorehabilitation teams in place is up to 42,000 bed days annually, based on an average saving of three bed days, if they can be discharged to a community neurorehabilitation team.

We thank the committee for the opportunity to highlight this issue and ask it for its support for our call for funding of teams in CHO areas where there has been no allocation to date, and priority action in areas where funding has been made available, in order to deliver on the commitment to having a team in each of the nine CHO areas.