Maureen O'Sullivan (Dublin Central, Independent)

I move:

That Dáil Éireann, in recognising the findings of the Irish Heart Foundation's report entitled 'Cost of Stroke in Ireland: Estimating the annual economic cost of stroke and transient ischaemic attack (TIA) in Ireland':

— acknowledges that in Ireland approximately 10,000 people per year will suffer a stroke which, at a cost of over 2,000 lives annually, makes stroke Ireland's third largest killer;

— accepts that in the region of 50,000 people throughout Ireland are living with a disability attained through stroke and that stroke is the biggest cause of acquired disability in Ireland;

— finds it to be of grave concern that the lack of prioritisation of rehabilitation services for stroke survivors to date has created, and continues to create, an unnecessary barrier to the achievement of better outcomes for as many of those affected by stroke as possible, thereby limiting the life opportunities of many of those affected; and

— is strongly committed to front-loading investment in stroke prevention and rehabilitation services to improve the quality of life of those affected by stroke and, as a significant by-product, address a situation whereby €414 million of the total €557 million in annual Exchequer spending on stroke goes towards nursing home care for the 1 in 6 nursing home patients who are survivors of stroke; and

calls on the Government to:

— develop forthwith an implementation plan based on the recommendations of the National Policy and Strategy for the Provision of Neuro-Rehabilitation Services;

— actively develop a multidisciplinary rehabilitation network to include teams throughout the country who would provide specialist supports to stroke survivors and persons with neurological conditions;

— place community rehabilitation and an aspiration towards independent living at the very heart of its stroke-related policies to ensure connectedness and quality of life for stroke survivors and their families; and

— proactively, creatively and realistically address the causes and implications of this silent killer.

I am sharing time.

I acknowledge the work of the Irish Heart Foundation on prevention, public awareness and input into the way forward. The way forward is being covered in this motion, which has been tabled by the members of the Technical Group.

From having listened to various experts, including medical experts, and those who have had strokes, I note it is vital that there be immediate intervention. Those who have strokes and their carers must be able to gain access to a range of services in and after they leave hospital, including services such as physiotherapy, speech and language therapy, occupational therapy and nutritional services. The key, apart from speedy availability of services, is for the services to be community-based.

I am told there are stroke survivors who do not have access to the rehabilitation services they need. This is not to take from the great work and services offered by various professionals, including medical, nursing and therapeutical professionals, to stroke survivors. They have allowed the victims to recover and resume their lives. In many cases, they live full lives after having a stroke.

There is sadness among those who would not be so incapacitated had more services been available and had more been done. The frustration among those needlessly disabled by stroke over not being able to communicate, move freely or attend to their hygiene needs and the feeling of being a burden on their loved ones are compounded by the realisation that they would not be in such circumstances had they received a certain drug, physiotherapy, occupational therapy or speech therapy more quickly.

The ESRI tells us the direct annual cost of stroke is up to €557 million, of which as much as €414 million is spent on nursing home care. Just €7 million is spent on community rehabilitation services that would keep Ireland's stroke survivors, numbering approximately 50,000, largely at home. I acknowledge the plans to do this but it is a question of direct action.

With regard to immediate intervention when someone suffers a stroke, stroke units and the thrombolytic clot-busting drug ought to be more widely available. This would reduce the number of deaths and the number who suffer from permanent severe disability by at least 750 per year. Economically, the saving through the reduced need for nursing home places would amount to some €230 million. We could imagine an injection of funding for the stroke units and the wider availability of the drug, and the effect on the number with permanent severe disability. It must be heartbreaking for those who were not able to avail of the drug, for whatever reason.

It requires saying "stop" and not investing vast amounts in the one area. Instead, we must invest money where it can do the most to prevent the worsening of circumstances for stroke victims.

We are told stroke is the biggest single cause of severe disability. Multiple sclerosis and motor neurone disease, which do so much damage in impairing one's ability to function, have in common with stroke the fact that they rob the person of his or her dignity and make him or her dependent on others for practically everything. They erode one's quality of life.

Some 10,000 people will suffer from stroke in Ireland this year. It is Ireland's third biggest killer, with some 2,000 lives lost every year.

It is also the biggest case of acquired disability and there are horrific numbers of people living with disability as a result of stroke.

In 2008, the Irish Heart Foundation undertook an audit which showed what people experienced after a stroke. Almost half had a weakness on one side of the body, 22% were unable to walk and one third had a cognitive impairment. More than half needed assistance with activities associated with normal daily life. Those are frightening statistics, particularly as some of that number need not be as disabled as they are had the necessary services been in place. Many people who suffer stroke also suffer from depression because of the frustration that stroke brings and the way in which people can be isolated because of suffering stroke.

There is a need to prioritise what needs to be done, as well as creating a proper rehabilitation network with the necessary multidisciplinary supports in place. I support the Irish Heart Foundation's call for stroke rehabilitation research to be conducted more regularly in order that health gains and economic savings can be made. Rehabilitation services, like services for those with mental health issues, need to be community based. Everyone who suffers stroke should have access as soon as possible to the appropriate service and the necessary specialised short-term and longer-term rehabilitation in hospital or in the community.

Stroke survivors require different levels of therapy and support at various stages of their journey. In the immediate aftermath of the stroke, they need acute rehab in hospital and appropriate rehab in the community later. It is horrifying to learn that some stroke survivors in nursing homes often have no access to therapists. After 11 months in office, the new coalition Government is saying that great strides are being made and that care is being provided for stroke sufferers, but I can guarantee that right now, somewhere there are stroke victims who are not in receipt of those services or did not get the services they needed at the initial stages.

When I spoke on the disability issue last week, I referred to the matter of access. I wanted to acknowledge the progress that has been made in providing better access to those with a disability, including stroke survivors. We know there have been improvements in venues such as cinemas and theatres. Local authorities have been proactive on this matter but there is a need for a speedier resolution when someone suffers a stroke and their mobility is severely impaired, particularly if they live in local authority houses of flats without proper access.

The 2008 national audit makes for grim reading in stating that acute rehab was only available for one in four patients or was delayed to a point at which it was not as effective as it could have been if it had been made available sooner. Continuing care and long-term recovery programmes were haphazardly organised. In addition, so much in terms of care and delivery depended on location, chance and circumstances which meant avoidable and unduly prolonged disability. That was in 2008, but a new audit is needed now because ongoing auditing could identify the scale of the deficit, identify the gaps and set about narrowing them.

Everyone agrees that community rehabilitation would improve the outcomes for survivors and, in purely economic terms, would reduce the financial implications for the State. We know what is needed: supported discharge, community rehab and home care supports, as well as access to required services, including occupational therapy, physio, speech and language. Those elements would increase the survivors' ability to live independently. They would also reduce the number of stroke patients in nursing homes, which can only have a positive effect on their quality of life.

I have examined what is happening in Britain where, up to three years ago, there was a lot of anger at the poor level of services there. Up to then, stroke survivors described it as falling into a black hole between hospital discharge and community-based care. In Britain now, stroke has a higher priority in the health service than ever before. One stroke prevention and action project in Hull provided intensive support to assist people in making the lifestyle changes necessary to reduce the risk of further stroke. That involved one-to-one sessions in people's homes, including looking at risk factors, going into the necessary lifestyle changes such as giving up smoking, and eating more healthily. That personal focus on people's individual lives had a very beneficial effect.

The Hull project also featured a weekly healthy lifestyle course which examined how even small changes can make a difference. Another aspect was prompt treatment for people with minor stroke or TIA, which reduced the risk of a major stroke. Various studies in Britain and elsewhere abroad have recommended specialist assessment within 24 hours for TIA patients at high risk of a major stroke. All such studies say that being seen promptly means patients are more motivated to make the lifestyle changes that could cut the risk of a further stroke.

Another study in Britain completely reorganised stroke services at one London hospital, which saved lives. It improved outcomes within that hospital where strong links were developed between clinical staff and the stroke research team. It showed that when research is undertaken, the units carrying it out have better patient outcomes.

A hospital in Wales created a stroke unit from scratch and the only extra funding required was to create the post of a specialist stroke nurse. Everything else came from reorganising the existing services. There was better teamwork between accident and emergency, hospital management, consultant physicians and the ambulance crew. The unit also included a fast-tracking system within the hospital.

Another hospital developed an information strategy to ensure people with stroke, and their carers, got the information they needed. They produced a handbook entitled Living With Stroke. Communications support groups were set up, particularly for young people. The public perception is that stroke only afflicts older people, while one quarter of all strokes in Britain, for example, happen to younger people.

In Britain, there is a dedicated helpline for those who suspect they are having a stroke or someone they know is having a stroke. The helpline helps them to identify factors such as facial weakness, arm weakness and speech problems.

We should try to imagine an ambulance being called for someone who has collapsed. The ideal scenario is to go straight to a hospital where there is acute care for people with stroke. Within an hour they should have received clot-busting treatment and will go on to make a full recovery with additional services. However, such a person could sit in accident and emergency for hours until it is too late and so they are left with complex disabilities. The moral of the story is to go straight to the treatment that is most appropriate to ensure a speedy recovery.

One cannot discuss stroke without examining smoking and the role tobacco plays in the ill health of the nation. As the Irish Cancer Society tells us, tobacco is the single largest cause of preventable death and disease in Ireland today. It kills one half of all lifetime users, causes one in three cancers and contributes to stroke. In addition, it costs the State €2 billion a year to provide services for smokers.

We have a new experience this evening of debating an agreed motion. I hope it will be a positive step because I do not see why Private Members' business should have to be a them-or-us situation. Real reform should bring about an honest and frank debate whenever Private Members' business arises. I would also like to see such debates being accompanied by a free vote. I do not want to appear cynical but we do wonder what the level of interest in the debate will be tomorrow night when there is the prospect that there might not be a vote at 9 p.m. It is to be hoped this topic, which touches so many people, will generate a high level of interest.

It is important to work on a collaborative basis. Just because one moves to the other side of the House does not mean that all knowledge and expertise is on the Government benches. There is still some expertise on the Opposition benches, as the Minister for Health would have discovered when he was an Opposition Deputy in the previous Dáil.

See this speech in context