Tom Fleming (Kerry South, Independent)

We need a fully equipped and staffed stroke unit in every county. There is a significant disparity, unfortunately, in the services and facilities between the west and east coast. I compliment the Minister as the new stroke unit for Tralee is imminent; it will be a valuable facility for the future health services in County Kerry. As we are a peripheral county at a significant disadvantage, with many remote communities and far distances to specialised services, many stroke victims are placed at high risk. There is a disadvantage in this respect in accessing appropriate, quick responses and treatment.

Prompt action and immediate intervention is of paramount importance. The "golden hour" factor is crucial in minimising health damage. There is a big variation in response and treatment due to geographical location. In the eastern half of the country the public has an enormous advantage with respect to survival and minimising the effects felt by stroke victims. People are entitled to the highest standards of quality and service, and they should be dealt with in a timely fashion, so we must strive to achieve that throughout this country.

In the remote area of the Ring of Kerry, at the western end of the Dingle Peninsula, the topography is mountainous and access is not easy to many of the valleys and districts. There is now an immediate need for a dedicated air ambulance service to meet demands of fast response not alone for stroke victims but for all types of emergencies, accidents and incidents where people are traumatised and in urgent need of quick transport for specialised service. I am glad the Minister is here and perhaps he might be able to address the following matter. A proposal that has been made by a charitable organisation, Air Ambulance Ireland, which is based in Kerry, is currently on the Minister's desk. The dedicated people who are involved in this worthy group have done a great deal of planning, thought, organisation and fund-raising. The facility they provide has never been more needed across the countryside and along the coastal terrain in Kerry and elsewhere in the south west. I ask the Minister to proceed with haste in approving the vital service that is provided by this charitable organisation, which has funding in place. We should not forget that as a tourism destination, Kerry receives a huge influx of visitors each year. That is all the more reason the proposed air ambulance service should be provided at an early date.

We need to give people an equal chance to access a quality health service. We have to correct the imbalance that exists in this country at the moment. There are statistics to prove that people on the east coast live longer, enjoy better and more immediate services and are closer to centres of specialisation. I ask the Minister, Deputy Reilly, to address this as a matter of urgency.

There is a need to develop proper post-stroke services and to provide for proper rehabilitation in the community. When patients recover, they want to live independent lives. The system makes many people depend on support services. We need to provide those services to people from the outset and thereby relieve the financial burden they often face. That would enable the victims of stroke to enjoy a good quality of life in their own homes.

Deputy Halligan mentioned that the direct annual cost of stroke in this country is €557 million. Of that figure, some €414 million is spent on nursing home care but just €7 million is spent on rehabilitation services in the community, including various essential therapies and the services provided by public health nurses. The €557 million fund should be loaded differently. We should not wait until people go to nursing homes before we spend this money. It should be used in a more meaningful and better fashion to keep the victims of stroke with their own families and communities, where they are happiest.

Reference has been made to clot-busting thrombolytic drugs, which are most effective when administered promptly. A significant statistic is that lives are 25% less likely to be lost, and patients are more likely to make more rapid recoveries, when that happens. Proper staffing levels are needed in the hospital units where this treatment is provided. There is a requirement for one-to-one nursing to be provided throughout the first 24 hours. This treatment should be rolled out in all our acute hospitals and available in strategic locations throughout the country. Now that these drugs are available, it is estimated that 750 patients' lives will be saved every year and €230 million will be saved over the next decade.

The Irish Heart Foundation, which is a small charity, has drawn my attention to the stroke awareness campaign it has been running in recent times. To date, it has spent €500,000 on the campaign, which has saved approximately 100 lives. Unfortunately, a VAT payment of €115,000 is included in the €500,000 figure. I believe that this money should be reimbursed to the charity in question, which is doing valuable work in the health sector. It should be waived as a VAT measure so that it can be reinvested in services that help these people.

I would like to inform the Minister and the Minister of State that, as I understand it, the same problem is being encountered by the cystic fibrosis unit in Cork University Hospital. VAT is being taken from an organisation that has collected a great deal of money through voluntary fund-raising. Perhaps the Minister and the Minister of State can address this matter in the context of the Finance Bill, with the co-operation of the Minister for Finance.

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