John Halligan (Waterford, Independent)

I do not need to remind the Minister of the potential role primary programmes for chronic diseases can play and I welcome this opportunity to highlight some of the significant gains and savings on expensive hospital treatments that have been made by addressing some of the deficiencies in stroke services. The inadequate acute services meant the time and place where a person had a stroke largely determined their chance of survival. The HSE and the Minister's Department are to be commended for delivering improvements in acute stroke services across the country.

I will focus on the quality of life of stroke patients once the hospital stay has come to an end. Research carried out for the Irish Heart Foundation by the ESRI shows that the direct costs of stroke in Ireland are up to €557 million per year, with as much as €414 million spent on institutional care and less than €7 million spent on community rehabilitation services that could, in the long term, keep a large number of people out of nursing homes. As has been noted by previous speakers, stroke is the single biggest cause of severe disability, and approximately 50,000 people in communities are now living with disabilities resulting from a stroke.

Gross deficiencies in community rehabilitation face stroke survivors after the completion of hospital treatment. Increased availability of services in the community, especially physiotherapy, speech and language therapy, occupational therapy, nutrition advice and emotional support and psychology, would go a long way in assisting the recovery of somebody who suffers a stroke. As it stands, an average of less than €140 is spent on the rehabilitation of a stroke survivor, which will not go far in assisting a person with a weakness down one side of their body, who is unable to walk, who suffers depression or who needs daily assistance with basic activities such as tying shoe laces. These people may have cognitive impairment and their quality of life could be severely eroded.

In effect, the system waits until after the time in which the stroke survivors can be helped most before any real money is spent. I urge the Minister to put in place supports to allow a more rounded and holistic approach to stroke patients in community settings. It has been proven in many countries around Europe that this increases the chances of people having a better quality of life. For example, patients affected by stroke should have straightforward and immediate access to information and help with entitlements and available services. This could happen immediately upon discharge from hospital.

The lack of follow-up when a stroke patient goes home is of serious concern to many of us. Ideally, patients and carers should have a central person in an area to contact. That is the process in France but in Ireland a person would contact the HSE, if possible. In various areas and cities central contact people could be used to increase the chances of people coming through a stroke without being too psychologically damaged. This would also help carers, who are invariably members of a family.

On a related note, more must be done to support carers for stroke patients. An estimated one in ten carers is at risk of health problems, and the majority of carers are women. My sister is one. The latest statistics show that many carers are over 65 and a failure to support them can often result in the persons being cared for needing long-term residential care, which is at odds with the stated Government policy of supporting elderly people to live independently in their homes. The Government has cut home support hours, which puts in place considerable difficulties for people trying to access carer's allowance, another significant issue.

In the 2012 service plan the HSE has missed an opportunity to put in place long-held plans for the management of such chronic diseases as stroke in primary care. Instead of an uncosted pledge - as it is in the plan - to develop an overall chronic disease watch model of care, with initial focus in 2012 on the diabetes programme, the HSE should move to a new model of primary care. In this respect I draw the attention of the House to the Heartwatch initiative, the first such programme in general practice, which saw 475 GPs involved and 11,000 patients treated. It is reckoned that approximately 81 deaths were prevented or postponed due to treatment in the first two years of the programme.

The Minister should consider the initiative as it was only ever brought to 20% of the population and was never rolled out nationally. It could be an approach that is GP-supervised but delivered by practice nurses, which would be highly effective. A more comprehensive chronic disease management system in primary care may not necessarily bring about decreased demand on hospital services in 2012 but it is important for the overall health of the population, and it could bring about long-term benefits. That has been proved in major cities in other countries around the world.

There is a clear, logical, cost-effective and, more importantly, a humane case for the provision of rehabilitation services for stroke survivors and others with neurological conditions. With the right care and support, thousands of people could be living independently instead of requiring long-term care. I urge the Minister to publish the neuro-rehabilitation policy and include in it clear details of the funding to be provided for its implementation. I ask the Minister to consider the Heartwatch initiative, which proved to be very successful. Many GPs have asked for the programme to be taken up again. It has a low cost and would save money within a year if it could be rolled out nationally.

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