Kathleen Lynch (Cork North Central, Labour)

Given that health service estimates suggest a prevalence of almost 20,000 patients aged 16 to 65 years with a disability secondary to brain injury, stroke or progressive neurological disease in the HSE south and west areas and an annual incidence of new cases of 3,000, this is not or should not be seen as a niche specialty.

Not only is there a need for services in Cork, but also in Galway, Limerick, Waterford, Kilkenny and the north west as well as probable satellite services in Kerry and Mayo. A start in Cork would address the greatest need for those beyond the Pale and would provide a pilot for further development.

The population of Massachusetts is 6.3 million and it has 14 rehabilitation units and 19 specialists per million of population. Germany, with a population of 82 million, has 120 rehabilitation units and 30 specialists per million of population. Romania, one of our poorer neighbours, with a population of 22 million, has 32 specialists per million of population. The Republic of Ireland, with a population of 4.2 million, has one rehabilitation unit and 1.4 specialists per million of population. Ours is the only western European state larger than Luxembourg in which rehabilitation services are centralised in one city.

The British Society of Rehabilitation Medicine estimates that approximately 60 beds per million of population are required for the rehabilitation of under 65 year olds with acquired brain injury and that units should ideally be based on populations of 1 million to 3 million. This would mean 240 beds in Ireland. As a minimum and allowing for population dispersal, there should be units in Cork and Galway with links to less specialised slower stream rehabilitation units in other population centres.

The social and personal effects of acquired brain injury are a loss of income, which is self-evident, a loss of relationships with loved ones due to personality changes, which we do not always consider, and a high incidence of marital breakdown, of which we do not hear much. When we consider why acquired brain injury has not been part and parcel of our major concerns through the years, we must think about certain issues, namely, those that affect the people in question. Our caring community is stressed and does not have the energy to make its case. In addition to this, people are desperately worried that their concerns might be seen as a criticism of their service provider, the only one they have, and that should not be the case.

We must take into consideration that delays cause distress and a loss of dignity, not just for the affected patients and their carers but also for those who are unable to gain admission to the hospital beds they occupy. A hospital bed in Cork University Hospital costs €1,919 per night or approximately €700,000 per annum. In February 2007 in the neurosurgical ward alone, six beds were occupied by patients awaiting transfer to the National Rehabilitation Hospital in Dún Laoghaire. This number is not atypical. The same circumstances prevailed across all the other acute wards in all the hospitals in HSE south.

While I am anxious to allow my colleagues to contribute, I will ask one question of the Minister before concluding. Which would cost the HSE more — the annual cost of two beds in Cork University Hospital that are put beyond use due to cumulative discharge delays or a team consisting of one consultant, two occupational therapists, two physiotherapists, one speech and language therapist, one psychologist, one secretary and a fully equipped office? Which would have a more direct benefit?

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