Jim Daly (Cork South West, Fine Gael) | Oireachtas source

I thank Deputies for their contributions to the debate on the very important matter of neurorehabilitation services which has been raised in the Private Members' motion today. It is clear from the contributions in the House that we are agreed that the work of progressing the implementation plan for neurorehabilitation services is critical if we are to achieve the best possible outcomes for people who require these services.

We are all acutely aware that neurological illness or injury has significant implications for the individual and his or her family, and impacts on their social, educational, vocational and recreational participation. I want to take this opportunity to re-emphasise the Government’s commitment to the area of neurorehabilitation. The commitment in A Programme for a Partnership Government, along with the priority actions in the area of neurorehabilitation identified by the Health Service Executive in its national service plan for 2017, will have a positive impact on the development and integration of these services and on the lives of those people with neurological illness or injury.

The HSE national steering group is tasked with developing a national implementation framework for the national policy and strategy for the provision of neurorehabilitation services in Ireland. The representation on the reconstituted steering group will ensure that the framework has a collaborative and holistic approach. It is of great benefit that representatives are now included on the group from across the whole health service, including the Neurological Alliance of Ireland.

The focus of the national steering group is to develop a framework which can be implemented across the country and the group has agreed an approach to the development of the framework. The proposed managed clinical rehabilitation network demonstration site will test the feasibility of this model to provide neurorehabilitation services nationally. Managed clinical rehabilitation networks ensure that only those patients with the highest levels of need are admitted to the specialised medical facilities at the National Rehabilitation Hospital. Appropriate care for all other neurorehabilitation needs would be met within the network through alternative inpatient facilities and enhanced community rehabilitation teams.

It is, of course, possible for the group to draft a theoretical implementation framework document within a much shorter timeframe. It is very important to note, however, that this approach may not provide a feasible, fit-for-purpose framework which can be implemented nationally. It is for this reason that the HSE has adopted the approach of developing and testing a demonstration model and this work is progressing. In addition, the mapping exercise undertaken by the HSE to identify the levels and gaps of existing neurorehabilitation services is important in order to establish a clear picture of where specialist rehabilitation services are currently being delivered and where the demands are for these services. This will also ensure that the best possible use is made of available resources.

The National Rehabilitation Hospital plays a central role in the provision of neurorehabilitation services to adults and children who, as a result of an accident, illness or injury, have acquired a physical or cognitive disability and require specialist medical rehabilitation. The hospital has a reputation for excellence and provides patients with every opportunity to meet their rehabilitation goals through personalised treatment plans which are delivered by consultant-led interdisciplinary teams which are expert in their fields. Rehabilitation programmes at the National Rehabilitation Hospital are tailored to meet the individual needs of adult and paediatric patients. Existing bed capacity at the hospital was reduced last year by hospital management to enable it to provide a safe and appropriate level of care to patients from within its existing resources.

Following engagement between the hospital and the HSE, funding has been provided by the HSE and a total of four beds have been reopened in the brain injury and spinal cord system of care programmes at the hospital. It is also important to note that additional funding of €0.65 million has been made available towards the cost of opening a further four beds at the hospital as part of the Government’s 2017 winter measures and measures to improve access to hospital care in 2018. It is planned that two of these beds will reopen next week in the hospital’s brain injury programme.

It is also significant that the contracts for new development works at the hospital have been signed and that construction works are now well under way. These new facilities will provide a major enhancement to rehabilitation services in the country. They will have a direct and significant impact on patient recovery by providing an optimal ward and therapeutic environment for patient treatment at the hospital. The design is patient-centred and based on the principles of empowerment, dignity, privacy, confidentiality and choice.

The HSE has a priority action to establish an innovative pilot day service aimed at supporting people with severe acquired brain injuries. This day service is at a very advanced stage of implementation and will provide core specialised services for a particular group of patients. 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. The HSE is committed to protecting the level of personal assistant and home support hours for people with disabilities, including neurological conditions. Nursing home support can also he an appropriate care option in cases where persons concerned have clinically assessed complex medical and social care needs requiring this form of support.

Stroke represents one of the greatest areas of needs for neurorehabilitation care in the Irish health services and the national clinical programme for stroke has been in place since early 2010 and aims to improve the quality, access and cost effectiveness of stroke services in Ireland. More recently, in 2015, the Minister for Health established a trauma policy for Ireland steering group, chaired by Professor Eilis McGovern, to make recommendations in regard to the development of a trauma system for Ireland. The group completed its final report in July 2017.

It is important to acknowledge the range of excellent neurorehabilitation services which are already provided. It is also important to acknowledge the work that is under way by the HSE national steering group to develop an implementation plan for national neurorehabilitation services. Neurorehabilitation is an area of our health service that requires a collaborative and strategic approach from all of the service providers. Again, I thank the House for the opportunity to address these issues and Deputies for their valuable contributions to this very important debate.

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