Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I thank the Deputy for raising this issue. I am glad to be here as I have a particular interest in this area due to family circumstances. Since the introduction in 2010 of the national cardiovascular health policy, significant improvements have been made with regard to access to acute treatments for coronary heart disease, as well as the development of stroke units. Key elements of stroke care now available include new and existing stroke units provided with additional therapy, nursing and consultant posts. Thrombolysis is now available to acute hospitals admitting stroke patients, 9.5% of whom are being thrombolysed which compares well with the best European figures.

The aims of the national stroke programme are to provide national rapid access to best-quality stroke services including acute care and the implementation of early support discharge, ESD, services. The implementation of ESD services is within the context of the wider range of rehabilitation services required by stroke patients. The stroke programme estimates the number of people with enduring disabilities as a result of stroke has decreased as the percentage of patients with stroke discharged from acute hospitals to nursing homes dropped from 17.3% in 2009 to 14.5% in 2012. It has gone down again since then. The percentage of patients discharged directly home increased from 49.4% in 2009 to 51.1% in 2012. A certain percentage of stroke patients will be suitable for ESD which involves intensive specialised stroke rehabilitation provided in the patient's home for up to eight weeks. I agree with the Deputy that the notion of taking up a hospital bed when one can have treatment in the comfort of one’s home makes no sense. This reduces the length of hospital stay, long-term dependency and the risk of further disability after six months, as well as reducing the number of patients requiring long-term care.

ESD services are funded in several locations. The feasibility of implementing this model in geographically dispersed populations is limited. The national clinical programme for stroke, NCPS, continues to provide funding to these sites. During 2013, a total of 90 patients were discharged home via an ESD service across three ESD service sites - the Mater Misericordiae University Hospital, Galway university hospitals and Tallaght hospital. Patients requiring more intensive rehabilitation are referred to the nearest available rehabilitation service. The establishment of managed clinical rehabilitation networks for neurological and prosthetic rehabilitation services in each of the four HSE regions contributes to rehabilitation services. The National Rehabilitation Hospital provides specialist stroke rehabilitation as a national hub and links in with regional services.

The Department of Health's national policy and strategy for the provision of neuro-rehabilitation services in Ireland, in collaboration with the national clinical programme for rehabilitation medicine, provides for improved access to and quality of services for patients requiring rehabilitation. The rehabilitation medicine clinical programme and the HSE’s disability services division are developing an implementation plan for the neuro-rehabilitation strategy.

Primary care also plays an important role in stroke rehabilitation. As of 6 September 2014, some 229.5 of the 264.5 primary care team posts have been filled or start dates agreed. The HSE is striving to have the remainder of the posts filled as soon as possible in 2014.

Taken together, all these developments show we have made significant progress in preventing stroke and its complications. The issue of how best to further develop and support early stroke discharge is under consideration by the HSE stroke programme.

A friend of mine recently had a stroke. A lot depends on how quickly one gets to a unit that has the capacity to deliver the relevant treatment.

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