Sandra McLellan (Cork East, Sinn Fein)

I welcome the opportunity to speak on this important motion and I commend Deputy O'Sullivan and her colleagues in the Technical Group for putting it before the House.

High levels of avoidable death and dependency from stroke in Ireland provide a compelling case for major improvements to acute rehabilitation and support services. The word "avoidable" is key to this discussion. It is generally accepted that the mortality rate from stroke would be cut by a massive 25% if stroke unit care was available to everyone struck by the disease here. Education and awareness raising are vital in stroke prevention and coping with strokes when they occur. Equally, services need to be in place for survivors of stroke and those who require rehabilitation.

The economic realities make it more important than ever that health policy makers are fully informed about the cost of existing services and the cost implications of service improvements when making decisions on resource allocation. Recent research has provided the most comprehensive data ever assembled on the baseline economic burden of stroke in Ireland, as well as assessing the potential costs and potential economic benefits of key interventions such as stroke unit care and the clot-busting treatment, thrombolysis. There is potential for improvements in acute stroke services that could save hundreds of people each year from death and institutionalisation at an actual cost saving to the State. The research illustrates the dire future consequences of failing to overhaul these services in terms of a significant increase in stroke incidence in the years ahead driven by factors such as our aging population. It is clear that by providing 95% access to stroke unit care, 650 stroke victims could be saved each year from death or dependency at a potential annual saving of up to €10 million. Achieving a 20% rate of thrombolysis could also save up to 100 people from death or dependency annually at a saving of up to €3 million per year. Better acute stroke services would lead to almost instant savings because increased access to stroke units and thrombolysis would result in immediate improvements in outcome. This would, for example, mean that fewer patients would require nursing home care, which is the single biggest factor in stroke service provision. The motion points out that €414 million out of a total of €557 million spent annually on stroke goes towards nursing home care for the one in six patients who are survivors of stroke.

However, the objective of improving Irish stroke services to acceptable international standards at the very least is not to save money for the Exchequer but to eliminate the catastrophic human cost of avoidable death and disability from stroke in Ireland. The vast majority of people who have a stroke today will face bleak prospects, including limited access to specialised stroke care, problems getting lifesaving thrombolysis at weekends and at night, a chronic shortage of therapists and long waiting lists for the rehabilitation which should be provided from the first day in hospital. Many people will face months, years or even the rest of their lives in a nursing home because their potential for independence diminished while waiting for proper care. These prospects would be transformed by the removal of the constraints on service improvements created by concerns over the cost implications.

This State has the lowest number of physical and rehabilitation specialists in Europe. While the European average is approximately 3.3 consultants per 100,000 of population, we have 0.17 consultants per 100,000 citizens. These serious shortfalls must be addressed.

The national cardiovascular health policy recommended that the Department of Health should prioritise actions to promote the behaviour and profiles underpinning cardiovascular health, with specific targets to pursue actively and achieve within ten years. It suggested that prioritised areas could include maintaining a healthy body weight, healthy eating and physical activity, reducing salt intake, refraining from or quitting smoking and consuming alcohol responsibly. Actions would include fostering intersectoral support for activities promoting health and prohibiting activities that maintain or foster unhealthy behaviours.

Details on how to achieve the targets are contained in a range of Government policies and reducing inequalities in cardiovascular health across society must be an underlying principle in achieving improvements in health behaviour. The lead organisation in developing this policy is the Department of Health. It is critical that the Department encourages other Departments in their efforts. Since the recommendations were made the then Department of Health and Children has been divided into two separate Departments with responsibility for health and for children and youth affairs, respectively. It is important that cross-departmental support and activity underpins awareness of the need to build a healthy nation by dealing with the underlying problems of obesity and the so-called metabolic syndrome. This issue is growing continuously and if we do not take it seriously there will be problems down the road.

When the Minister for Health, Deputy Reilly, was asked last year what action he proposed to take to improve the provision of neurological care he stated the office of clinical strategy and programmes in the Health Service Executive had established three key national programmes in neurological care. This, he added, showed the HSE's commitment to improving access to neurological services and gave these services a major focus in the HSE. He also noted that the third national programme deals with stroke services and aims to establish robust clinical governance systems for stroke care, including local stroke teams and regional stroke networks. This policy needs to be enhanced, improved and implemented.

I commend the Irish Heart Foundation on its efforts to inform the public on this subject. It reported last year that stroke-related hospital admissions had increased by 87% following the launch of its Act FAST, face, arms, speech, time, campaign. A considerable number of people have been educated by the foundation's effective television advertisements. According to research carried out by the college of surgeons, some 59% more stroke victims reached hospital in time to receive potentially life-saving thrombolysis treatment during the first phase of the advertising campaign in 2010. This increased level of awareness needs to be sustained and enhanced further because it is certainly saving lives.

It goes without saying that the role of emergency and pre-emergency care will be vital in the management and treatment of victims of stroke. Communities are rightly horrified when ambulance and emergency services are cut. I have ample experience of this issue in my constituency of Cork East and my hometown of Youghal. The reconfigurations proposed by the HSE will leave many isolated areas without ambulance services and even further away from the nearest emergency department. Where life saving alternatives exist we must do all we can to ensure they are delivered. Unfortunately, however, the HSE's regional service plans, which are currently being launched across the State, offer little ground for hope.

The Government needs to re-evaluate its priorities. Politics is about choices and this Fine Gael-Labour Party Government is favouring Europe and market confidence over the quality of life of its citizens. This policy approach must be reversed. I commend the motion and urge all Deputies to support it.

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