Maureen O'Sullivan (Dublin Central, Independent) | Oireachtas source

I welcome the opportunity to discuss this matter. The Minister for Health, Deputy Harris, explained that he had to leave, but I know he will hear about it. This issue is particularly alarming because I was in the audio-visual, AV, room last week and heard from the Irish Heart Foundation and doctors who are involved in the treatment of strokes that there has been a regression from the positives of some years ago. The advances in acute stroke care, which saved more than 200 lives a year and reduced the rate of severe disability by more than a quarter, are being undermined. They are the facts as presented by Professor Joe Harbison, who was the head of the HSE national stroke programme. For me, right across the board on health matters, whether it is to do with heart, cancer, addiction, strokes or whatever, prevention and immediate intervention are paramount. If we get those right, it is infinitely better for the person involved, his or her family and our health services. In the main, prevention and immediate intervention do not cost as much as long-term care.

The facts are that stroke is Ireland's third-leading cause of death. It is the biggest cause of adult physical disability. Some 20% to 25% of residents in nursing homes are there due to strokes. It is estimated that the rate of stroke will increase by a further 50% in the next five to eight years. There is a crisis and it has been described as an avalanche. Very sadly, this comes after a number of years of improvement. We knew, and the recent census figures have confirmed it, that we have an increasingly ageing population with people living longer. An important indicator of the worsening outcome is the increase in the length of hospital stay and the increase in direct discharges to nursing homes. That is the case for the first time since the national stroke programme was established and it means that the costs are increasing. We know that nursing home care is expensive. There was a figure from 2015 on nursing home care which showed a 2.3% increase, which amounts to €17.3 million. That would pay for 1.6 million hours of home care at current rates. I want to stress very forcibly the fact that death and severe disability from stroke were being dramatically reduced in recent years.

There was a stroke survivor in the AV room who was visible proof of how those procedures were working. He had a stroke a number of years ago and was totally paralysed on one side, unable to speak and unable to move. He got to Beaumont in a reasonably timely way, was subjected to the necessary procedures and normal life resumed. He spoke very graphically of what that has meant to him. If it had not happened, the process would have meant that he would be in a nursing home long term.

In the four years from 2010 on, the national stroke programme was responsible for reducing nursing home costs by €30 million a year. If the HSE had spent €15 million a year on providing the 200 extra therapists required in stroke units, the cost reductions would be restored and the service would be able to deal with the increase in strokes that the hospitals are seeing. It was horrifying to hear that there are more people being employed in a coffee shop in one hospital than there are in the stroke programme in that hospital.

We know what works. Initially, prevention is needed beforehand, as well as awareness and screening programmes for those with high blood pressure and atrial fibrillation. Also required are immediate investigations and assessments of mini-strokes and access to the clot treatment thrombectomy for all stroke patients regardless of location. Timely access is needed to appropriate levels of in-hospital rehabilitation as well as a national roll-out of an early supported discharge programme. That is what works. It is what saves money and lives. I ask the Minister to look at the 2017 manifesto of the Irish Heart Foundation because the measures suggested there are largely deliverable within the funding, with perhaps only a small increase necessary. Many consider as basic the standards of care in other countries that are not available here. This is about preventing death and disability.

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