Kathleen Lynch (Cork North Central, Labour)

I am grateful to Deputy Nash for raising this issue. The Deputy is aware that I have an interest in it through family circumstances. Following the transfer of acute services from Louth County Hospital to Our Lady of Lourdes Hospital, Drogheda, the Health Service Executive has worked to reorganise stroke services in the Louth-Meath hospital group. Stroke services in the group were prioritised by the HSE in the 2011 service plan. A dedicated consultant physician lead for stroke services is in place in the Louth-Meath hospital group. The consultant physician is progressing the planned development of the stroke service in line with the HSE's national clinical programme for stroke and is working with the programme's national clinical lead in this regard.

I am pleased to report that stroke services in the hospital group have been significantly improved this year with the designation since March of a seven-bed area for acute stroke patients in Our Lady of Lourdes Hospital, Drogheda and the introduction of thrombolysis for acute stroke patients last July. An eight-bed stroke rehabilitation unit has also been commissioned in Louth County Hospital for appropriate patients from Our Lady of Lourdes Hospital, Drogheda. Admissions to the areas are co-ordinated at weekly cross-site, multidisciplinary meetings. It is planned to increase the capacity of this unit to 11 beds once recently appointed speech and language therapists have completed a period of upskilling and induction.

A draft Louth-Meath implementation plan for the national clinical programme for stroke has been developed. Discussions are ongoing with the consultant physicians in this regard with a focus on agreeing a strategy to ensure that all stroke patients are admitted under the care of a stroke physician with a dedicated on-call rota for stroke thrombolysis. Recruitment to appoint physiotherapy and clinical nursing specialist staff to the service is being progressed by the HSE. Once this implementation plan has been agreed with the national clinical lead, the stroke service in the Louth Meath hospital group will be officially recognised by the national clinical programme. This is a welcome and important step in the development of services at Our Lady of Lourdes Hospital, Drogheda. I emphasise the importance being placed by the Department and the HSE on improving services for patients suffering strokes.

As Deputy Nash has pointed out, the Irish Heart Foundation has made some estimates of the economic burden of stroke and transient ischaemic attack, TIA, in Ireland. It has estimated the cost of stroke care at between €470 million and €1.008 billion and it has suggested that introducing changes to stroke service provision would have important implications for health outcomes and costs.

In June 2010 Changing Cardiovascular Health: National Cardiovascular Health Policy 2010 - 2019 was launched. This policy establishes a framework for the prevention, detection and treatment of cardiovascular disease, including stroke, and seeks to ensure an integrated and quality-assured approach in disease management to reduce the burden of these conditions. The policy proposes that cardiac and stroke services should be reconfigured on a network basis at hospital and emergency care level. It is planned that each network will provide specialist services by a blend of hospitals designated as local and general and regional and comprehensive centres. As part of these plans, an improved ambulance service will ensure that 80% of patients will be brought directly to the appropriate centre for initial treatment within the accepted criteria framework.

To help implement the report, specific teams have been established in the HSE. Four lead clinicians, two of whom have responsibility for stroke, have been appointed by the HSE to direct the implementation of the recommendations. The policy acknowledges the key role that primary care plays in raising awareness, in risk assessment and in the management of cardiovascular disease. A shift to community-based care is envisaged for such patients, with primary care teams providing structured, proactive care supported by specialist ambulance services. I welcome the important developments in stroke services in Ireland and especially the important role that Our Lady of Lourdes Hospital, Drogheda will play in the future.

I accept fully that the outcomes could be improved significantly if we had a proper service in place. It seems that with the programme envisaged of nine stroke units throughout the country and with the proper expertise and the thrombolysis treatment - although not everyone is necessarily an ideal candidate for this - the outcomes could be a great deal better and the burden stroke can place on communities, the individual and the State could be reduced greatly.

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