Michael Harty (Clare, Independent) | Oireachtas source

This motion illustrates a deficiency in our health service which is replicated right across our specialties. It boils down to two basic facts, namely a lack of capacity in our structures and hospitals and a lack of staff to supply a service, which leads to long waiting lists. That is a simple analysis of the deficiencies in our health service. Critically, in neurological services in particular we have under-staffing in all of our level four hospitals. There are 11 such hospitals which are promoted as our centres of excellence but only four have dedicated occupational therapy services for neurological conditions. Five level four hospitals have no speech and language therapists and nine have no neuropsychological services which are vitally important for people with neurorehabilitation needs. Ten of the 11 reported limited, very limited or no access to community neurological rehabilitation services. Such services are extremely important because people will eventually go home. They will come out of hospital, return to their communities and will need community rehabilitation services.

There is a lack of dedicated inpatient beds in our hospitals as well as in the National Rehabilitation Hospital. There is a lack of community supports when people come home and a lack of diagnostic services. Patients have great difficulty accessing MRI and CT scanning. Most important, however, is the lack of staff, particularly in community care. That is what is holding up peoples' recovery and limiting their potential to make the best recovery possible. I welcome the fact that the Minister of State has said that the National Rehabilitation Hospital will provide 120 beds by 2020. That will make a huge difference to our services.

On the issue of manpower, we need one neurologist for every 70,000 patients but in many areas of the country the ratio is one to every 200,000 patients. The situation is particularly acute in the mid west. If we were to have a ratio of 1:70,000, we would need 66 neurologists. Currently we have fewer than 30 and some of those posts are not filled. We are very poor in comparison to our European counterparts in this regard. In fact, we are probably at the lower end of the scale in Europe in the provision of neurological services. Every hospital group has an excess of patients per neurologist which is quite unbelievable in 2017. This problem is only going to get worse because of our changing demographics. Our population is aging and we are developing more degenerative and traumatic brain injuries. Brain injury can be devastating. Strokes and traumatic brain injuries can have devastating consequences for patients and their families. The incidence of degenerative neurological diseases like Parkinson's disease, multiple sclerosis, motor neurone disease and dementia also increases as the population ages. All of these place a huge burden on families and patients. In that context, early intervention is critical but this is problematic when there is a lack of capacity and a lack of staff. Patients do not get the early intervention they need and consequently do not have the best outcomes. We need speech and language therapists, occupational therapists, physiotherapists, neuropsychologists and social workers to deal with the devastating effects of acquired brain injury. These need to be supplied within the hospital setting and also in the community.

This issue crosses all Departments and is not just confined to the Department of Health. The social determinants of neurorehabilitation will involve education, including retraining, to restore independence to patients. Patients will need housing, housing adaptation and extensions as well as access to transport and mobility allowances. Additional public transport will also have to be provided to allow people who have an acquired brain injury or who need neurorehabilitation to mix and have a social outlet. Social protection is so important in the context of neurorehabilitation. People will lose their employment and will need State support. As I said, this cuts across every Department and is not simply confined to the Department of Health.

Multi-annual budgets are buzz words in health planning now. The recently launched Sláintecare report has a huge section on integration and another on implementation. Recommendations for neurological services were made in 2011 but a plan to implement those recommendations has not yet been devised, six years later. If the same happens to the Sláintecare report, the development of our health services will be set back enormously. Changing demographics are a huge problem in the context of planning our health services. We need to publish that implementation plan. We need to have dedicated neurorehabilitation teams in every community health area. We also need to target our resources at staff in the community and in hospitals.

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