Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I thank Deputy Dowds for providing me with the opportunity to speak on the subject of rehabilitation services for stroke survivors. The aims of the HSE's national clinical programme for stroke are to improve the quality, access and cost-effectiveness of stroke services in Ireland and I am pleased to report that significant improvements in stroke services have been made, as Deputy Dowds has acknowledged.

Emergency thrombolysis is provided now to patients in all regions of the country by improved hospital and ambulance protocols, health professional training and the appointment of new physicians. There is national 24/7 access to safe stroke thrombolysis, the rate of which has increased from 1% in 2006 to a current rate of 11.6%. This exceeds the national target of 9% and is among the best in national rates worldwide.

Access to stroke unit care has been shown to improve stroke patient outcomes through reduced rates of death, dependency and shorter lengths of stay. Since the commencement of the national clinical programme for stroke, nine new stroke units have been opened, bringing the total number of stroke units in acute hospitals to 22. New care pathways have also been developed to standardise stroke management. Early rehabilitation, including speech and language therapy, physiotherapy and occupational therapy are key parts of the care provided in these units. This is a major improvement from the first national stroke care audit report in 2006, which reported that there was only one stroke unit in the entire country.

As it stands, fewer stroke patients are dying in hospital, with the rate having dropped from 16.1% in 2009 to 15.1% in 2013. This represents an average of 36 fewer deaths a year. There are fewer stroke patients being discharged to nursing homes, which is an indication of reduced disability outcomes after a stroke and more stroke patients are being discharged home directly from acute hospitals. The average length of stay in hospital for stroke has fallen from ten days in 2009 to nine days in 2013. This is estimated to have saved 19,000 bed days in the 2011 to 2014 period.

The Deputy mentioned early supported discharge services for stroke patients which aim to accelerate discharge home from hospital and provide rehabilitation in the home setting. Three early supported discharge services for stroke patients have been established at the Mater Misericordiae University Hospital and HSE North Dublin, Galway University Hospital and Tallaght Hospital. Excellent clinical outcomes and very high patient and care satisfaction rates are reported across all three sites. The average bed days saved per patient range between 6 and 12.6 days across sites.

My Department is conscious of the business case for early supported discharge submitted to my Department by the HSE's national clinical care programme for stroke and the Irish Heart Foundation. This advocates a phased roll-out of early supported discharge services. It was considered as part of the development of the HSE's national service plan for 2016 but unfortunately, there was no scope to develop this initiative due to other funding demands. My Department will take account of the additional resources needed to expand this initiative gradually in the context of next year's Estimates process. These additional resources will then be considered as part of the HSE's service planning process next year. Funding for stroke rehabilitation is provided in the overall allocation to the HSE for acute hospitals and community services.

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