Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

I thank and commend Deputy Margaret Murphy O'Mahony for raising this very important topic and motion. I welcome the opportunity to state the Government's commitment to the publication of a plan for advancing neurorehabilitation services in the community, which is included in a Programme for a Partnership Government. Hence, the Government decided not to oppose the motion. I think we are all in agreement that neurological illness or injury has significant implications for the individual and his or her family. The care and support needs of patients are individualised and varied. The Health Service Executive, HSE, social care division and the HSE clinical programme and strategy division are working in tandem to progress the implementation of the national policy and strategy for the provision of neurorehabilitation services. The HSE has established a national steering group to develop an implementation framework for the strategy. Following a consultation process in 2016, the HSE has reconstituted the national steering group to ensure that the implementation framework takes a collaborative and holistic approach. The HSE national steering group is now comprises representatives across the whole health system, including heads of social care and the national clinical programme for rehabilitation medicine, acute hospital services, mental health, primary care, health and well-being, public health, health and social care professionals and the Neurological Alliance of Ireland. I welcome the involvement of the Neurological Alliance of Ireland in the national steering group. I welcome Mags Rogers and the team to the Dáil today. Their work and the work of their member organisations has been vital in raising awareness of the need for neurorehabilitation services.

It is important to note that the focus of the HSE national steering group is to develop a framework which is implementable across the entire country. The steering group considers that a managed clinical rehabilitation network model represents best practice as a means of providing neurorehabilitation services. To test the feasibility of this model, the steering group is developing a demonstration project pilot site to establish collaborative care pathways for people with complex neurorehabilitation care and support or accommodation needs. A working group has been established to support the demonstration project pilot site. The working group has drafted both terms of reference and an implementation framework.

The National Rehabilitation Hospital, NRH, provides complex specialist rehabilitation services on an inpatient, outpatient and day patient basis to adults and children who have acquired a physical or cognitive disability as a result of an accident, illness or injury and require specialist medical rehabilitation services. I am happy to say that the contracts for development works at the NRH were signed in August last and construction commenced on the site immediately. The construction work is due for completion by the end of 2019 and the new development is expected to be operational in 2020.

The development will see the existing ward accommodation at the NRH replaced by a new fit-for-purpose ward accommodation block of 120 single en suite rooms with integrated therapy services; a new sports hall; a hydrotherapy unit; a temporary concourse as well as clinical and ancillary spaces. In addition, links to the existing building will ensure full integration between the new development and the existing hospital on the site. The development will be a major enhancement to rehabilitation services in the country and will have a direct and significant impact on patient recovery, by providing an optimal ward and therapeutic environment for patient treatment in the NRH.

Good progress has also been made to reopen beds at the NRH, which were closed to enable the hospital to provide a safe and appropriate level of care to patients from within existing resources. Four beds have reopened since the end of October. The Department of Health has sanctioned €0.65 million towards the cost of reopening a further four beds.

The HSE's national service plan for 2017 contains a priority action to "establish an innovative pilot day service aimed at supporting people with severe acquired brain injuries". I am delighted to inform the House that work is well under way to complete the requirements of the service. Stroke represents one of the greatest areas of need for neurorehabilitation care in the Irish health services. The national clinical programme for stroke has been in place since early 2010. It aims to improve quality, access and cost effectiveness of stroke services. Early supported discharge services are recognised internationally as a basic, essential and cost-effective element of acute stroke care. Three pilot sites have demonstrated the effectiveness of early support discharge services in Ireland, including the reduction in delayed discharges, improvement in patient flow and the provision of greater access to stroke unit beds.

It is estimated that Ireland has approximately 1,600 major trauma patients each year. These patients have suffered injuries with the potential to cause prolonged disability or death. It is essential for these patients to get the right care in the right place first-time around. The trauma steering group, chaired by Professor Eilis McGovern, was established in 2015 to make recommendations on the development of a trauma system for Ireland. The group completed its final report in July 2017. The report sets out a series of significant and important recommendations, all of which are aimed at significantly reducing death and disability from major trauma. I understand the Minister for Health intends to bring a memorandum to Government on the matter shortly.

Although most families would prefer to be able to care for loved ones at home, hospital or nursing home care is at times necessary and form part of the continuum of care. The HSE is mindful of the fact that some people with a disability who are in nursing home care provision wish to, and should be supported to, move back to their home of choice. The HSE, through its network of community health care organisations, is working to facilitate this within available resources. However, nursing home support can also be an appropriate care option where persons concerned have clinically-assessed complex medical and social care needs that require this form of support. The HSE provides a range of assisted living services, including personal assistant and home support hours, to support individuals to live as independently as possible. While the resources available for the provision of assisted living services are substantial, they are finite. The HSE is committed to protecting the level of personal assistant and home support hours for people with disabilities, including neurological conditions. In the 2017 national service plan, the HSE expects to deliver 1.4 million personal assistant hours to 2,357 adults with a physical or sensory disability. This is an increase of 100,000 hours on the 2016 target, although I have heard the opposite said in recent comments. The relevant figure is 1.4 million personal assistant hours, an increase of 100,000 hours on the 2016 target.

The HSE service target is to provide 2.75 million home support hours to people with disabilities, which is an increase of 180,000 hours on the target for 2017. I am keen to ensure that the best possible services are available for all people with disabilities, including those with neurological illness or injuries. With budget 2018 we have been able to build upon significant existing resources and obtain additional funding for disability services. The allocation for disability services will rise to over €1.76 billion in 2018, which is an increase of €75 million. Of course, we could always do with more - many of my colleagues know that we always say as much.

It is intended that the 2018 HSE national service plan, once finalised and approved, will commit to progress the implementation of the national policy and strategy for the provision of neurorehabilitation services. Effective rehabilitation draws on a broad range of disciplines to meet the particular needs of individuals, with the object of assisting them to return to their life in the community. The Government, in speaking to the motion, clearly recognises the impact that rehabilitation can play in ensuring that people with neurological conditions can live a life of their choice to the greatest extent possible.

I welcome the opportunity to assure Deputies of the Government commitment to bring about real and substantial improvement in the provision of neurorehabilitation services.

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