Alan Shatter (Dublin South, Fine Gael)

At the outset, I congratulate the Labour Party on the motion before the House this evening. I fully support it, as does the Fine Gael Party, although it is regrettable at this stage in the life of a Government in which some Ministers have been in office for 11 years. The Minister, Deputy Harney, who has served as Tánaiste and now is simply Minister for Health and Children, has been a member of a Government for 11 years that has utterly and completely failed to provide the type of neurological services to which people are entitled. A myriad of reports have described the inadequacies of the services and have prescribed what is required. In the health strategy of 2001, the Government promised to prepare an action plan for rehabilitation services for people with brain injuries and recognised the shortage of inpatient and community-based services. The action plan was supposed to set out a programme to meet existing shortfalls in speech and language services, occupational therapy and physiotherapists.

Today, the usual nauseating and self-congratulatory amendment tabled by the Government in response to the motion provides an insight into the negligent manner in which the health service has been treated. One line of the Government's amendment notes that the Department of Health and Children together with the HSE is committed to developing a strategy for the future of rehabilitation services and both parties have agreed to jointly address this area as soon as possible. In 2008, the HSE and the Government now promise to do what was originally promised in the health strategy of 2001. In seven years, the world in that sector has not moved forward.

Experts recommend that patients with a brain injury must be seen within two weeks to maximise recovery. However, Irish patients must wait up to two years for an initial assessment because our sole rehabilitative hospital, which has 110 beds, only has the capacity to treat approximately one quarter of the 10,000 people who suffer from brain injury each year. The Disability Act 2005 promised an independent assessment of needs for all those with a neurological condition. At present, that is being rolled out to all children under the age of five. However, anyone over that age is not being assessed.

The HSE strategic review of neurology and clinical neurophysiology services was due to be published in February 2007. I understand the review was given to the HSE in December last but it still has not been published. It is not merely unacceptable, it is scandalous that those who suffer from brain injuries as a result of a car crash, stroke or other accidents and illnesses must wait for as long as two years for rehabilitation services.

Access to early rehabilitative treatment is critical to helping people to talk or walk again and to normalise their lives. Although the health budget has never been larger, accessing services such as speech and language therapy, occupational therapy and physiotherapy has not improved. Long waiting lists have resulted in patients being left in debilitating conditions, dependent on others at home or in nursing homes, for the rest of their lives. Many patients are being cared for at home by relations or spouses, who are available 24-7 to take care of them. However, the State is utterly failing in its duty, not only to those who are stroke victims but to the carers who are undertaking duties that otherwise would fall on the hospital and nursing home services, by failing to ensure they have the relief and services they require to maintain their own physical and mental well-being.

I refer in particular to the problems now developing in the respite sector. I will read out a letter that I received a few days ago which states:

I am writing to you with some disturbing news, that my mother received this morning.

Firstly let me tell you quickly what her story is:

Both my parents are in their late 70's and my father is suffering from Parkinson's and also due to an operation he had a stroke, so he needs care, my mother provides this with the help of carers — so far so good, but my mother is suffering from blood pressure and on the advice of her GP and the district nurse has been told to take a break otherwise she will end up in hospital and will be of no use to either herself or my dad.

So after getting the forms from the district nurse and getting them signed, getting the GP to sign them and booking him into the respite care ... in Leopardstown [Park Hospital], where I might add he attends the day centre every Thursday and then booking a holiday for 7 days with JWT, she has now found out some really disturbing news and that is — the respite care in Leopardstown hospital is being closed, so they have cancelled the respite, surely they could see their way clear in letting the people who have booked a break, have a break.

How can the HSE live with itself with the deplorable way it is dealing with the sick, disabled and old of this country. Mary Harney wants you to keep "them" at home, but she does not have to look after them 24-7 — we do. ... I cannot look after [my father], I work and have 3 children of my own to look after. . . . My father over the years paid taxes and never, never could he claim anything back, but he was able to get respite care — but now that has been snatched away from them, private care is not ... an option, due to the fact of a severe lack of "carers" they do not have the back up if a carer is not available to attend — and where does that leave the "client" as they like to call them!!

Leopardstown Park Hospital withdrew respite care for all those booked in for the months of May, June and July as a consequence of not having the requisite funding available from the HSE to maintain such care. This is a cutback that affects the most vulnerable people within our community. I understand that Baggot Street and Cherry Orchard hospitals also will terminate respite care.

I understand, to use a good old Yiddish and American phrase, there is a schmozzle going on in the background whereby the HSE is disputing that it was necessary for Leopardstown Park Hospital to take such action. However, the hospital is asserting that in March, the HSE knew of the position in which it found itself. This constitutes a classic example of the deplorable state of the health service. I ask the Minister to take action this week to ensure the respite care service provided by Leopardstown Park Hospital is restored and to ensure that respite care is not withdrawn in other hospitals for those caring for stroke and other victims.

The HSE has commissioned three reports on neurology services, first in 2003, then three years later and finally the aforementioned report that was presented in December 2007 but which has not yet been published. Like its predecessors, the third report criticises the fact that there are only 20 neurologists, nine neurosurgeons, six rehabilitation specialists and 110 rehabilitation beds in Ireland. Services are seriously under-resourced and this is having a devastating effect on patients. Ireland, with only 20 consultant neurologists, proportionally has the lowest number in Europe. Although the 2003 report found that 42 consultants were required, after three reports within five years there still are fewer consultants than the recommended number.

The HSE and the Department are failing brain injury and stroke victims. Their function should pertain to the provision of medical care and not to the drawing up of reports that are ignored and the maintenance of a costly, bulging unacceptable and ever-growing bureaucracy that is denying resources to frontline services. In recent days, Members have learned of a variety of cutbacks being introduced by the HSE, all of which are in respect of frontline services. The Government has presided over the creation of a bureaucratic and administrative monster, in circumstances in which it should have streamlined the available administration to provide the health service that is needed and should have ensured that scarce resources went into the frontline essential patient care services that are required so badly.

The Neurological Alliance of Ireland has a number of specific aims, which include increasing the number of neurologists in Ireland to 42 from the present total of 17. It also seeks to have neurologists in those parts of the country in which none is in place at present, as well as an overall increase in the number of consultant neurologists to cut down the unacceptable waiting lists. Doctors and neurosurgeons in Beaumont have pleaded for additional consultant staff and, even though the need for those staff has been recognised, there has been extraordinary lethargy in recruiting them.

The Government's report on neurosurgery, which was published in 2006, needs to be implemented, as do the key recommendations of the Irish Heart Foundation. The latter's report highlighted the fact that only one Irish hospital has a fully resourced stroke unit, despite the myth spread by the Government that other hospitals have such units. One in 37 hospitals, or 3% of the total, compares with the 91% of similar UK hospitals which have stroke units. It is likely that between 350 and 500 deaths per year could be avoided if stroke unit care was properly introduced in the Republic. In this and in other areas of the health service the Government has totally failed in its public duty to provide the patient care, hospital services and back-up respite care to which the people of this country are entitled.

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