Margaret Murphy O'Mahony (Cork South West, Fianna Fail) | Oireachtas source

I move:

“That Dáil Éireann:

notes that:— the World Health Organisation in a 2004 report on neurological conditions described these conditions as the greatest public health challenge facing public health systems in developed countries worldwide;

— the United Nations Convention on the Rights of People with Disabilities calls on countries to ‘strengthen, organise and extend rehabilitation services’ for people with disabilities;

— over 25,000 Irish people each year struggle to get the neurorehabilitation services they need to prevent disability and support recovery from conditions including stroke, acquired brain injury, multiple sclerosis and Parkinson’s disease;

— the National Policy and Strategy for Neurorehabilitation Services (neurorehabilitation strategy) was published by the Department of Health and the Health Service Executive (HSE) in 2011, with an implementation plan promised within six months but still unpublished six years later;

— the Minister for Health in February 2017, requested an implementation plan to be published by the end of June 2017, but a working group to develop the plan has not yet been put together and this is the second deadline announced and missed in 2017 as the HSE will not deliver the plan by December 2017;

— it is estimated that only one in six people who need specialist rehabilitation services in Ireland can access them;

— as a country, we lag far behind the rest of the developed world when it comes to neurorehabilitation services;

— Ireland has less than half the number of specialist rehabilitation beds recommended for its population;

— Ireland has the lowest number of consultants in rehabilitation medicine in Europe;

— despite the recommendations of numerous reports and decades on from when the issue was first highlighted, there is still no dedicated specialist medical rehabilitation unit for people with a neurological disability in the south of Ireland; and

— in June 2016 the Neurological Alliance of Ireland and sixteen member organisations launched a campaign ‘We Need Our Heads Examined’ to increase political awareness and call for investment in neurorehabilitation services;agrees that:— there is an overwhelming lack of neurorehabilitation services at all stages of the pathway for a person with a neurological condition;

— at the bare minimum, there should be one dedicated specialist neurorehabilitation team per Community Health Organisation (CHO), yet only three such teams are in place and are not even fully staffed, and not one new team has been put in place since the Neurorehabilitation Strategy was published in 2011;

— where services do exist, they are underdeveloped, under-resourced and patchy;

— there are long waiting lists and access to services is largely based on a geographical lottery; and

— people with neurological conditions:

— spend significantly more time in hospital than is necessary;

— live in inappropriate settings such as nursing homes for older people or psychiatric facilities or at home with families who cannot cope;

— largely lead lives of exclusion and isolation, distanced from social, community and economic life;

— have families who equally experience significant burden and isolation; and

— are forced to travel abroad to get the services they need;

accepts that:— the demand for neurorehabilitation services is growing, with our ageing population and with increased survival rates of people with a neurological disability, but services are completely insufficient to meet current needs;

— the lack of neurorehabilitation services is having a devastating impact on people with neurological conditions and their families, resulting in unnecessary disability and inability to live to their full potential in their community;

— to optimise the gains for individuals, neurorehabilitation services must be provided on a timely basis and in a seamless fashion by a range of providers using a multidisciplinary approach;

— the piecemeal and patchy nature of the current services mean that people lose gains they make at another stage of the pathway if they cannot move seamlessly from one service to the next;

— many people with a neurological disability end up in nursing homes but residents in nursing homes cannot access community neurorehabilitation services and this is despite evidence that provision of neurorehabilitation in nursing homes can improve outcomes including discharge home; and

— the lack of neurorehabilitation services is a major factor in our Emergency Department crisis and delayed discharges with the National Clinical Programme for Rehabilitation Medicine noting that the lack of neurorehabilitation services may be responsible for up to forty per cent of delayed discharges; andcalls for:— dedicated, multi annual investment in forthcoming budgets in order to develop neurorehabilitation services, particularly in the community, in response to significant unmet needs and decades of neglect and underinvestment;

— the publication of an implementation plan for the neurorehabilitation strategy by the end of March 2018, with a clear timeframe for implementation, mechanisms to ensure governance and accountability at the highest levels of the HSE and by the Minister for Health and the Department of Health and a scope of service that provides a holistic response to all neurorehabilitation needs, in line with the recommendations of the neurorehabilitation strategy;

— the establishment of dedicated community neurorehabilitation teams in each of the nine CHOs; and

— investment in 2018, to target current waiting lists in the community following the outcome of a HSE mapping exercise earlier this year.”

I am pleased to move the motion and in doing so I thank my party colleagues for supporting me in putting it forward. I understand the Government is supporting the motion, which is very welcome, but we need to see the motion supported not just in words in this Chamber, as often happens, but in action in 2018. I also acknowledge and pay tribute to the Neurological Alliance of Ireland which has campaigned so tirelessly for investment in neurorehabilitation services. Some of those involved in the alliance are in the Gallery today. In particular, I want to highlight the contribution of the alliance's executive director, Mags Rogers. Well done to her. It is a good name. Many Members of this House have met those involved in the Neurological Alliance of Ireland and will agree that they make a very strong and compelling case. I am happy to have the opportunity to bring that case to Dáil Éireann.

The World Health Organization in a 2004 report on neurological conditions described them as the greatest public health challenge facing public health systems in developed countries worldwide. The WHO has also stated that an estimated 6.8 million people die every year as a result of neurological disorders. In Europe, the economic cost of neurological diseases was estimated at approximately €139 billion in 2004. According to the WHO:

Because most of the neurological disorders result in long-term disability and many have an early age of onset, measures of prevalence and mortality vastly understate the disability they cause. Pain is a significant symptom in several neurological disorders and adds significantly to emotional suffering and disability. Even burden estimates combining mortality and disability do not take into account the suffering and social and economic losses affecting patients, their families and the community. The socioeconomic demands of care, treatment and rehabilitation put a strain on entire families, seriously diminishing their productivity and quality of life.

We see that in Ireland, with some 25,000 people each year struggling to access neurorehabilitation services. It is estimated that only one in six people who need specialist rehabilitation services in Ireland can access them.

There has been a persistent lack of investment in neurorehabilitation services down through the years. As a country, we have fewer than half the number of specialist rehabilitation beds recommended for a population of our size. Furthermore, we have the lowest number of consultants in rehabilitation medicine in Europe. Where services do exist, they are undeveloped, under-resourced and sporadic across the country. This is preventing people from accessing the services they need to support their recovery. For example, there is still no dedicated specialist medical rehabilitation unit for people with neurological disabilities in the south of Ireland. Such a lack of neurorehabilitation services is having a debilitating impact on people’s lives. People with neurological conditions are spending significantly more time in hospital than is necessary. They often live in unsuitable settings and lead lives of exclusion and isolation. They are also often forced to travel abroad to get the services they need.

The motion we are putting forward is calling for the investment necessary to make our neurorehabilitation services fit for purpose. It calls for dedicated, multi-annual investment in forthcoming budgets and the publication of an implementation plan for the neurorehabilitation strategy. It also calls for the establishment of dedicated community neurorehabilitation teams across Ireland and investment to target a reduction in waiting lists for such services. The national policy and strategy for neurorehabilitation services 2011 to 2015 was published by the Department of Health and the Health Service Executive almost six years ago on 16 December 2011, with an implementation plan promised within six months. Six years on, this four-year plan still has no implementation strategy.

Last February, the Minister for Health requested an implementation plan to be published by the end of June 2017, yet a working group to develop the plan has not been put together. This is the second deadline announced and missed in 2017 as the HSE will not deliver the plan by the end of this year. There is great frustration about the situation, as can be imagined, and this frustration is compounded by the absence of any real progress in the provision of services.

In 2015, the Neurological Alliance of Ireland in collaboration with the national clinical programme for neurology carried out a survey of neurology services and over two years later the findings are still relevant. The survey found key deficits in staffing across all 11 neurology centres, with little or no access to multidisciplinary teams in Sligo, Limerick and Waterford.

There was a lack of dedicated beds, with only six of 11 centres having dedicated neurology beds. These beds were frequently required for other specialties within the hospital and not available for neurology. There were unacceptable waiting lists. Waiting lists for MRI scanning are a significant problem, with seven centres having waiting lists of a year or more. There was a critical lack of neurorehabilitation services. Eight of the centres reported limited or very limited access to hospital-based neurorehabilitation services, while ten of the 11 centres reported limited or very limited access to neurorehabilitation services in the community.

Four of the 11 hospitals reported no dedicated occupational therapy services for neurology patients. Five neurology centres reported no dedicated speech and language therapist for neurology patients. Five neurology centres reported no dedicated medical social worker for neurology patients, including Cork University Hospital, which is one of the two national centres in Ireland. Only Beaumont and Tallaght Hospitals had dedicated neuropsychology services available to patients. Within these centres, waiting lists can be up to one year. Sligo hospital reported no dedicated posts for any of the core supporting therapies of occupational therapy, speech and language therapy, physiotherapy and neuropsychology. The regional centres of Limerick and Waterford also reported very limited access to dedicated health professional staffing. Every hospital group exceeded the ratio for consultant neurologists for our population.

No centre has MRI access for routine referrals in under two months and seven of the 11 neurology centres cannot even gain access within one year of referral. These are serious deficits by any measurement. How do we address them? In 2011, when the National Policy and Strategy for Neuro-Rehabilitation Services in Ireland was being published, by coincidence the Association of British Neurologists detailed its recommended requirements for neurology services. The recommended ratio is for one consultant neurologist per 70,000 of population. This is exceeded within every hospital group. In one hospital group in the mid-west, the ratio is 1:200,000, which is almost three times what is recommended.

At the bare minimum, there should be one dedicated specialist neurorehabilitation team in each of the nine community health organisation areas. Only three such teams are in place, however, and they are not even fully staffed. Not one new team has been put in place since the neurorehabilitation strategy was published six year ago.

The demand for neurorehabilitation services is growing, with our ageing population and with increased survival rates of people with neurological disability, but services are completely insufficient to meet current needs. The lack of neurorehabilitation services is resulting in unnecessary disability and an inability to live life to the full in the community.

To optimise the gains for individuals, neurorehabilitation services must be provided on a timely basis and in a seamless fashion by a range of providers using a multidisciplinary approach. The uneven nature of the current service is such that people lose gains they make at another stage of the pathway if they cannot move seamlessly from one service to the next.

Many people with a neurological disability end up in nursing homes but residents in nursing homes cannot access community neurorehabilitation services. This is despite evidence that the provision of neurorehabilitation in nursing homes can improve outcomes, including the rate of discharge to home. The lack of neurorehabilitation services is a major factor in our emergency department crisis and delayed discharges, with the National Clinical Programme for Rehabilitation Medicine noting that the lack of neurorehabilitation services is responsible for more than one in ten delayed discharges. The National Clinical Programme for Rehabilitation Medicine has stated the following benefits could be delivered as a result of investment in specialist rehabilitation services in both the hospital and community for patients with neurorehabilitation needs: a reduced length of stay in acute hospitals by five days; a 10% reduction in readmission rates; a 5% reduction in care requirements; and a reduction in the discharge rate to nursing homes. I will conclude to allow my colleagues to contribute.

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