Catherine Murphy (Kildare North, Independent)

While this motion considers the health care issues associated with stroke, there are of course wider issues, some of which have been addressed during the debate. Some of these relate to lifestyle choices which generally lead to better health outcomes. Many of these need to be considered in the context of health promotion initiatives. More exercise, a better diet and reduced alcohol consumption will play a part, but the really big change would be a reduction in the number of people who smoke.

In their joint pre-budget submission in 2010, the Irish Cancer Society and the Irish Heart Foundation stated that there are 1 million smokers in Ireland and half of all smokers will die prematurely, which is shocking. In addition to cancer, people who smoke have a threefold risk of heart attack compared to non-smokers and smokers are twice as likely as non-smokers to have a stroke. Tobacco kills more people in Ireland than road accidents, suicides, drugs, farm accidents and AIDS put together.

We have seen the results from the investment in the Road Safety Authority. We need an ongoing and consistent approach to assist smokers to give up. It is in their and all our interests. We cannot wait for better times. That health promotional message needs to go out all the time. My father died of lung cancer. It is a horrible death where patients can be left gasping for even a tiny breath for months on end. It is distressing and one would be convinced never to take up smoking if one saw one person die like that.

In its stroke manifesto the Irish Heart Foundation found up to 50% of strokes are preventable. That means 5,000 strokes and 1,000 deaths could be avoided if people took simple steps to cut down the risk. If we are to get more from less in our health service, the focus on prevention is essential when funds are so limited. Strategic investment in dedicated services such as stroke units makes good medical, economic and social sense.

Limiting the number of deaths and reducing long-term dependence makes sense for more than economic reasons. According to the Irish Heart Foundation, fewer than 3% of stroke patients received the life-saving clot buster treatment, thrombolysis, in the 12 months to April 2010. There has been an improvement since then. In its 2010 document the foundation told us almost half of our acute hospitals cannot provide the treatment and many that do can only provide the drug during office hours or on an intermittent basis. Unfortunately strokes do not confine themselves to office hours. We need to have a comprehensive response.

Is it any wonder that we spend €441 million of the total €557 million spent on nursing home care dealing with strokes? The full cost is much higher, including the loss of independence for so many and a lowering of the quality of life. Changes in family and personal economic circumstances are all components of the true cost. It is scary to read in the stroke manifesto that most people do not know immediate medical treatment after a stroke can make a difference in terms of recovery, death or permanent dependency. It is clear this serious information deficit is dangerous and expensive. We cannot wait for the good times to come back to deal with it. Investment in health promotion has to happen.

One point which jumped out at me was the lopsided and patchy nature of our acute rehabilitation service. It does not surprise me and it is not exclusive to rehabilitation. A good outcome cannot depend on one's address. For many the sense of loss that follows a stroke leads not only to a loss of independence but also spells of depression. That is very understandable.

The Irish Heart Foundation said the average stroke destroys 2 million brain cells every minute. Trained ambulance staff, telemedicine support and properly equipped ambulances and emergency departments are crucial for the prompt treatment of stroke patients. The term "plan" has been absent from how we do things in this country and that needs to change.

We also need to better understand the process of how people become disabled. One of the many excellent reports that have been compiled on behalf of the Joseph Rowntree Foundation deals with this. It is based in the UK but it does some work in Ireland. It found the majority of disabled people who experience the onset of health problems or impairment do so during adulthood.

It should come as no real surprise that income inequality also contributes towards the level of ill health, including stroke. People in the poorest fifth of the income distribution are 2.5 times more likely to become disabled than those in the top fifth. We have to examine the issue not just from a medical point of view but in terms of the totality of policy responses and initiatives taken.

A person becoming disabled also affects other members of the household. In single earner couples, even when the earner does not become disabled one in five leaves employment, in some cases to take up new caring responsibilities. While the focus of this motion is on the health aspects of stroke and the kind of rehabilitation services that should be available we need to think beyond that.

The effect on employment, particularly those of working age, is an issue.

Employment status varies widely depending on the severity of the impairment, according to studies by the Joseph Rowntree Foundation. Of those with the least complex impairments, 84% retained their employment. I do not know how that compares to this country; I feel they may be doing better than us because of better distribution.

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