Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I commend Deputy Margaret Murphy O'Mahony and her colleagues in Fianna Fáil for bringing forward the motion. It is a timely debate for us to have. All of us who saw the shocking "Prime Time" programme last night will be only too conscious of the huge challenges that arise as a result of having family members with neurological difficulties and the problems caused for the patients themselves and also for their carers. It brought home to all of us the shocking lack of services for families facing these challenges. The motion provides us with an opportunity to shine a light on this aspect of the health service. It is yet another area in which there is huge under-investment and a huge level of unmet need and in which the services provided are wholly inadequate and being provided in the wrong place and probably at the most expensive level. This is instead of providing services at community level which obviously achieves greater health results and also much better value for money.

The motion references the 2016 report from the Neurological Alliance of Ireland which was appropriately entitled, We Need Our Heads Examined. There were three central demands in that campaign, the first of which was that we should develop inpatient neurorehabilitation services at both national and regional level and end the unacceptable delays in accessing rehabilitation services. The second was that we should set up community neurorehabilitation teams in every community health organisation. Again, this is about bringing services back into the community, close to where the patients and clients are, where they want to access services and the best results can be achieved. I understand local community services are provided within three of the nine community health care organisations, CHOs, which, again, is an indication of the inadequate provision made. The third demand was that we should invest in long-term, rehabilitation-specific services in the community in order to provide care and support in appropriate settings. This arises because of the fact that, when a younger person has an acquired brain injury or a degenerative brain condition, too often, the only service available for him or her is in a nursing home which was intended to cater for older clients. As we heard again on the programme last night and as we know from the many families who are campaigning on the issue, the nursing home setting which was intended for older people is entirely inadequate for younger people with neurological difficulties.

The motion calls for dedicated multiannual investment in coming budgets in order to develop neurorehabilitation services, particularly in the community, and, as I said, the publication of an implementation plan for the neurorehabilitation strategy by March next year, with a clear timeframe for implementation. Again, this is an example that is very common in respect of the implementation deficit disorder, one of the main conditions that dogs the health service. There is a strategy in place but no implementation. An implementation report was drawn up, but it was met with a scathing response from the Neurological Alliance of Ireland. What we need is a meaningful and real implementation strategy and for it to be delivered by the end of the first quarter next year. I support that proposal.

The motion also calls for the establishment of dedicated community rehabilitation teams in each community health area and investment in 2018 to target current waiting lists in the community, following the outcome of HSE mapping exercises earlier this year. We know that a lot of attention is focused on hospital waiting lists. However, when we consider other hidden waiting lists, for example, for community services such as psychological services, speech and language services, physiotherapy and occupational therapy, as well as all of the critical services which are essential for those who have been involved in an incident or developed a condition, we must ensure they are enabled to be the best they possibly can be, in other words, to develop all of the senses and capabilities that have been affected by their condition or the incident they experienced, to return them to full health as soon as possible. We are not very good at doing this. Generally, when people develop a condition, they are left waiting an interminable length of time. This raises huge questions about the human rights of the individuals affected. They should be supported by the Government and public services to make as full a recovery and to live as full a life as possible. We know that if they are given the right access to quality rehabilitation services at an early stage, many people with neurological conditions such as brain injuries will be enabled to return to a fair degree of normality in their lives.

6 o’clock

Currently, a number of people with neurological conditions are, for example, unable to speak. They need speech and language therapy. Several of them are unable to return to work because they have not been able to access rehab. Many of the disabilities in question develop later on for people with neurological conditions, yet they are preventable if there is early intervention and access to rehab. That many young people are forced to live in nursing homes is unacceptable.

It is important that we listen to what we are being told by the Neurological Alliance of Ireland, NAI, in that there are 800,000 people living with neurological conditions and that this figure increases by approximately 40,000 every year. The primary barrier to effective neurological care is the underinvestment and underdevelopment of community services in particular.

We must bear in mind what the Government's priority should be. These are people who have been struck down by conditions or accidents and acquired brain injuries and whose lives, although negatively impacted upon, could be so much better and fuller. In many cases, they could live independent lives if they were supported by the Government with decent public services. That is what we should be doing and that is what these people deserve. It is in the best interests of everyone as a society that people be as independent as possible and live their lives as free from disability as possible.

The plans are set out and it is clear what needs to be done. The strategy needs to be implemented and the Minister of State needs to get on with that as soon as possible.

See this speech in context