Kathleen Lynch (Cork North Central, Labour)
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I move:

That Dáil Éireann,

concerned at the impact on patients and those dependent on the health service of continuing cutbacks, staff shortages and under-resourcing; and noting in particular:

that there are an estimated 10,000 people who acquire a brain injury in Ireland every year;

that up to 2% of all people have disabling problems following an acquired brain injury, whether from traumatic brain injury, stroke or other causes;

that there is only one rehabilitation hospital in the country, with just 110 beds, for those who suffer from acquired brain injury;

that the number of neurologists, neurosurgeons and rehabilitation consultants available to treat these patients are well below the levels available in other countries; and

deplores the long waiting times that can see patients waiting up to two years for rehabilitative care;

calls for:

the establishment of a regional network of rehabilitation facilities and services to be established in the context of a national rehabilitation strategy;

the immediate publication of the national review of neurology and clinical neurophysiology services;

an increase in the number of approved posts for consultant neurologists from 24 to 42 and neurosurgeons from nine to 16;

a significant increase in the number of rehabilitation consultants to reflect demand for these services; and

the provision of effective community rehabilitative and support services for post-medical ABI patients.

In putting down this motion, the Labour Party hopes this debate will have some impact on a much neglected area. It is estimated that approximately 30 people a day suffer some kind of brain injury and a further 30 people suffer a stroke, which can also lead to brain injury. It is also estimated that approximately 30,000 people have an ongoing disability due to brain injury. Services are woefully inadequate to cope with these kinds of numbers; they are also inconsistent across the country. The majority of services are provided by voluntary organisations, but all of them have waiting lists and they know they are only scratching the surface.

Acquired brain injury, ABI, can happen at any time to anyone. It can happen after a road accident, assault or other blow to the head, as well as after a stroke, infection, haemorrhage or cancer. It means someone's life can change overnight, as well as that of their family and friends. The impact can be lifelong. It is not always obvious that someone has been affected, as the effects are not always physical, but can lead to memory, planning, emotional and behavioural problems.

Many organisations are to the forefront of highlighting this situation such as Headway Ireland, Brí — the advocacy group for people with acquired brain injuries — Brainwave, the Irish Epilepsy Association and the Peter Bradley Foundation. All claim there is a chronic shortage of beds for patients with acquired brain injuries and a complete lack of such beds in some regions. With a serious head injury, immediate intervention is essential to ensure the person returns to normality, if normality can be achieved.

It is conservatively estimated that there are 10,000 new brain injuries every year but there are just 110 beds to deal with these people. This does not make sense at any level. A recent report stated there are 20 neurologists when, given our population base, there should be 42. We have nine neurosurgeons when we should have 16. The Netherlands has 12 times the number of rehabilitation consultants per head of population than Ireland. Approximately 700,000 people have a neurological condition and, because of the process of ageing and with people living longer, it is estimated there will be 800,000 in ten years' time.

People with a brain injury may spend three years in a long-stay care bed. However, if they were to receive the proper treatment and rehabilitation process, they could be up and about, returning to normality and looking after themselves. This is where our resources should be invested because the impact a brain injury has on the individual and his or her family is immeasurable. The cost of keeping someone in long-term care is equally immeasurable when that person could return to a productive life.

Cork University Hospital has estimated an average 3,825 acute bed days are lost annually due to inadequate access to rehabilitation beds. The recent Health Service Executive, HSE, document, Acute Hospital Bed Capacity Review: A Preferred Health System in Ireland to 2020, estimated the daily cost of an inpatient bed in a major teaching hospital as €1,917, which implies the waste of €7.7 million annually in that hospital alone due to inadequate access to rehabilitation beds.

The annual cost of just two beds in Cork University Hospital, put beyond use due to cumulative discharge delays, is more expensive than a team consisting of one consultant, two occupational therapists, two physiotherapists, one speech and language therapist, one psychologist, one secretary and an equipped office.

Rehabilitation has the potential to reduce long-term care costs and enhance prospects of return to work for affected patients. Previous studies in other countries have demonstrated that rehabilitation services are cost effective and result in savings for the national economy in the long run.

While optimally people who suffer brain injuries through trauma, illness or stroke should be treated in an hour, or at worst 24 hours, it is seldom the case. Rather than waiting 24 hours, people wait 24 months or two years for treatment. If that is not remarkable enough, some doctors are not referring patients who need rehabilitation services to a consultant because it is seen as a pointless exercise as waiting lists are endless.

Anything beyond a two-week delay is unacceptable. The tragic certainty that a sick person has to wait two years for an initial assessment is nothing short of abandonment of its obligation to the public by the HSE. This is a sad commentary on our times. The HSE has a national annual budget in excess of €14 billion, a sum that would float some of the newer economies in the EU. It should be giving us a much better service.

This cannot be ignored and must be tackled. Proposals have been made to deal with this problem but all have been ignored. The stated intention to await the development of an overall strategy and action plan for the development of rehabilitation services is regularly given by HSE and the Department of Health and Children as the reason for not developing services at present.

The action plan creates a false impression of ongoing progress in the development of services. It was first proposed in 1997 in response to the report of the national advisory committee on medical rehabilitation. Its alleged imminent arrival has been quoted in a multitude of reports since then, including health strategies, national partnership agreements and national development plans.

This prolonged period of anticipation has had only one effect, that of preventing any development. The stated need for a strategy as a prerequisite to any service development has resulted in the rejection of various proposals by health services and voluntary sector bodies. It has delayed approval of capital funding for the redevelopment of the National Rehabilitation Hospital. This approach based on figures from health services documents results in an estimated 1,600 new patients with neuro-disability being denied accessible rehabilitation services each year. The plan is now mythical in status, frequently referred to in national partnership agreements and health service strategy documents.

The development of a service that is fit for purpose requires the involvement of appropriately trained clinicians who are intimately aware of the extent of the problems and resources to implement any proposals. Locally based expertise is necessary to identify local needs and propose realistic solutions. More importantly, only locally based professionals can take ownership of the recommendations and commit to implementing them.

In the absence of locally employed trained professionals, one has to rely on expert committees, the majority of whose members probably have no rehabilitation expertise. Those who do could be based outside the region. Many will be based in clinical areas, the needs of which will compete with rehabilitation services for scarce resources and funding.

Even narrowly focused reviews take a long time to produce. A current example is the recently published report of the committee to review neurosurgical services. Neurosurgery is provided on two sites and has relatively few links to other specialties or disciplines. Despite this narrow focus, it took five years to produce the report, having been commissioned in March 2002. Given that rehabilitation services have a much more diverse role across all sectors of the health service, how long would it take to produce a comprehensive report on it?

To manage this diversity, a review of rehabilitation services would be much more manageable if compartmentalised into priority areas. Thus, individual focus groups with relevant expertise could deal with those aspects with which they are most involved. For example, individual groups might focus on areas such as power wheelchair provision, amputee-limb deficiency rehabilitation, transition for disabled school leavers or services for multiple sclerosis patients, the experts recruited in each of these areas having different backgrounds depending on the focused topic. The recently produced stroke review is an example of this type of focused approach, an example that should be used in respect of the sector under discussion.

Our experience is probably the greatest argument against the action plan approach. Previous action plans, such as those developed by the former health boards, have been ignored. The report of the national advisory committee on medical rehabilitation has been largely ignored, the national action plan being one of the few recommendations that attracted the Department's attention. Those recommendations that required action were set aside. The appointment of regional teams with specialist expertise and the development of regional planning were core recommendations, but they were dropped. The national action plan has failed to materialise after ten years of planning stagnation. The HSE has been in existence for three years and has not managed to progress the plan. This lack of progress is not due to neglect on anyone's part, but it is an inevitable consequence of an unrealistic approach. However, to persist further with a failed strategy would be difficult to justify.

Most new services arise when a clinician or manager in an existing service identifies a local need. Following a period of advocacy and negotiation, the need is usually addressed through a service that starts out as a subdivision of the parent organisation. Several specialties and therapy disciplines in the HSE south region have identified this need in respect of rehabilitation, but none has the capacity to provide it from existing resources. The only comparable Irish model for this dilemma is that of palliative care, which started with an approach of developing specialist teams in each region and evolved into an inpatient service, at which stage the 2001 strategy document Design Guidelines for Specialist Palliative Care Settings was produced. This action plan was able to be produced having the twin benefits of relevant input and a limited focus based on identified needs.

In all other developed countries, rehabilitation services have evolved from within other services through one of a number of routes, those being progression of the role of community-based rehabilitation teams and extension of services from within other specialties, such as rheumatology, geriatric medicine and neurology. We should remember that there is no model whereby an entire regional service has been developed in a single operation. For example, it is universally acknowledged that there is an overwhelming need for a regional rehabilitation service based in Cork, nor is there any doubt that initial emphasis for this service would be to provide neurorehabilitation for patients of working age with brain injury, stroke and progressive neurological disorders.

It is equally uncontroversial to state that any rehabilitation team appointed would need to include relevant expertise drawn from rehabilitation medicine, rehabilitation nursing, physiotherapy, occupational therapy, speech and language therapy and psychology. Based on experience elsewhere, there is no option but to consider that this team will need to be outpatient-based initially as the design of any inpatient unit should be strongly influenced by the team that will want to make the most efficient use of it. I am conscious of the time.

Brendan Howlin (Wexford, Labour)
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The Deputy has five minutes remaining.

Kathleen Lynch (Cork North Central, Labour)
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There is no need for an action plan to come up with these self-evident conclusions. To persist in an elusive quest for an all-embracing strategy rather than taking pragmatic steps to address current unmet needs is a compassionless bureaucratic approach that values process over outcome. Often, neurorehabilitation requires prolonged hospital admissions and-or repeated outpatient management. Reintegration into one's own environment and community is integral to the role of rehabilitation medicine and requires close links between the discharging hospital and the primary care team.

It defies logic to suggest that removing patients who have a combination of cognitive, emotional, behavioural and physical impairments to a location that is at least two hours from their homes, families and communities is in their interest.

Emmet Stagg (Kildare North, Labour)
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Hear, hear.

Kathleen Lynch (Cork North Central, Labour)
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Given that health service estimates suggest a prevalence of almost 20,000 patients aged 16 to 65 years with a disability secondary to brain injury, stroke or progressive neurological disease in the HSE south and west areas and an annual incidence of new cases of 3,000, this is not or should not be seen as a niche specialty.

Not only is there a need for services in Cork, but also in Galway, Limerick, Waterford, Kilkenny and the north west as well as probable satellite services in Kerry and Mayo. A start in Cork would address the greatest need for those beyond the Pale and would provide a pilot for further development.

The population of Massachusetts is 6.3 million and it has 14 rehabilitation units and 19 specialists per million of population. Germany, with a population of 82 million, has 120 rehabilitation units and 30 specialists per million of population. Romania, one of our poorer neighbours, with a population of 22 million, has 32 specialists per million of population. The Republic of Ireland, with a population of 4.2 million, has one rehabilitation unit and 1.4 specialists per million of population. Ours is the only western European state larger than Luxembourg in which rehabilitation services are centralised in one city.

The British Society of Rehabilitation Medicine estimates that approximately 60 beds per million of population are required for the rehabilitation of under 65 year olds with acquired brain injury and that units should ideally be based on populations of 1 million to 3 million. This would mean 240 beds in Ireland. As a minimum and allowing for population dispersal, there should be units in Cork and Galway with links to less specialised slower stream rehabilitation units in other population centres.

The social and personal effects of acquired brain injury are a loss of income, which is self-evident, a loss of relationships with loved ones due to personality changes, which we do not always consider, and a high incidence of marital breakdown, of which we do not hear much. When we consider why acquired brain injury has not been part and parcel of our major concerns through the years, we must think about certain issues, namely, those that affect the people in question. Our caring community is stressed and does not have the energy to make its case. In addition to this, people are desperately worried that their concerns might be seen as a criticism of their service provider, the only one they have, and that should not be the case.

We must take into consideration that delays cause distress and a loss of dignity, not just for the affected patients and their carers but also for those who are unable to gain admission to the hospital beds they occupy. A hospital bed in Cork University Hospital costs €1,919 per night or approximately €700,000 per annum. In February 2007 in the neurosurgical ward alone, six beds were occupied by patients awaiting transfer to the National Rehabilitation Hospital in Dún Laoghaire. This number is not atypical. The same circumstances prevailed across all the other acute wards in all the hospitals in HSE south.

While I am anxious to allow my colleagues to contribute, I will ask one question of the Minister before concluding. Which would cost the HSE more — the annual cost of two beds in Cork University Hospital that are put beyond use due to cumulative discharge delays or a team consisting of one consultant, two occupational therapists, two physiotherapists, one speech and language therapist, one psychologist, one secretary and a fully equipped office? Which would have a more direct benefit?

Jan O'Sullivan (Limerick East, Labour)
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I thank my colleague, Deputy Kathleen Lynch, for tabling a motion that sets out a highly comprehensive case on behalf of the Labour Party and for giving me some of her allocated time. I also welcome the many people present in the Gallery this evening, many of whom have direct experience of the issues under discussion. Representatives are present from such organisations as Headway Ireland, Brí, Brainwave, the Peter Bradley Foundation and the Neurological Alliance of Ireland, as well as ordinary families who have been hurt by acquired brain injury in a variety of ways. I refer to those who have directly experienced such a brain injury, as well as their nearest and dearest. The Labour Party Members hope that by proposing this motion tonight, they will be able to make a difference with regard to their experience and lives.

I am concerned that this debate is taking place at a time when one hears of cutbacks throughout the services provided by the HSE. One reason the Labour Members have used their scarce Private Members' time on this issue is that sometimes, in a time of cutbacks, such groups are left aside and their voices are not always heard in the clamour for resources. The Labour Party Members wish to ensure that those who have acquired brain injuries and their families are not left behind at a time when one hears of cutbacks throughout the service.

I am concerned that one hears of the long-needed development of service being abandoned, simply to keep the service going without any changes in the manner in which it is run. Unfortunately, this is a real concern. Deputy Kathleen Lynch is correct that we know what must be done and where are the gaps in service and waiting lists. Waiting lists exist throughout the services for people with acquired brain injuries. For example, a two-year waiting list is in place for neurology services, which is appalling. I understand that although a neurology report has been available since December 2007, it still has not been published. Tonight I call for the report's publication and implementation because a two-year waiting list for neurology services is completely unacceptable.

Waiting lists obtain throughout the service in Ireland, which lacks the kind of linkages and automatic progression that should be present. Those who have worked in such services in other countries can give examples of what happens when someone is admitted to an accident and emergency unit with a brain injury after a serious traffic accident. Such people are dealt with in the accident and emergency unit and thereafter, if necessary, are dealt with by a neurosurgeon. Subsequently they move onto rehabilitation, which is followed by a move to community services. There is linkage of, and a seamless flow to, the services and there is no delay. In respect of acquired brain injuries, Members know how important it is to provide the service as quickly as possible to the person concerned. A couple of hours can make an enormous difference in respect of a traumatically acquired brain injury, perhaps through a road accident, to someone who suffers a stroke or to someone who acquires an brain injury in another fashion. Such an immediate reaction can make life-transforming differences for the people affected. However, this does not happen because we lack the services that people need.

This would be money extremely well-spent. Those who can benefit from the required interventions at an early stage, such as those who, for example, can get a bed in the National Rehabilitation Hospital in Dún Laoghaire when they need it, enjoy a better quality of life and much greater opportunities to participate fully in their community, return to work or to avoid needing long-term services. Regardless of whether one balances this issue in respect of quality of life, which is much more important, or discusses the cost of the services, the provision of such services when they are needed for the people who need them constitutes a win-win outcome either way.

Deputy Kathleen Lynch has outlined the Irish statistics whereby approximately 10,000 people per year suffer an acquired brain injury, as well as the absolute inadequacy of having only 110 beds for those people. Quite detailed studies have been carried out in this regard. For example, a study was carried out in the Glasgow area on behalf of the British Medical Journal that indicated the potential throughput and results that can be and were achieved when a proper service is provided. A Royal College of Surgeons of England working party produced a report in 1999 that outlined the processes that were needed. This is the kind of strategy to which Deputy Lynch has referred. However, they put it in place in 1999 and are implementing it and providing such a service at present. The Labour Party Members call for the service to be provided without being obliged to wait. While they certainly would welcome a national strategy, provision of a service should not be obliged to wait for the development of a national strategy that may take place well into the future.

In particular, I wish to discuss the services that are required in the community and the motion calls for a series of regionally-based services. Practically every family in Ireland has experience of what it is like when a family member acquires a brain injury. It affects the whole family. Courses are held in the National Rehabilitation Hospital in Dún Laoghaire for family members who are dealing with a loved one's acquired brain injury. However, as the courses are held in Dún Laoghaire, the affected families are obliged to travel there to attend them.

I spoke to someone today who has a family member who recently acquired a brain injury. Such people talk about the various important services and of the cost to families at times of being obliged to travel to such services, or of being obliged to access them in the private sector when such services are unavailable in the public sector. In the brief time available to me, I wish to quote from a document that outlines one particular experience. The person concerned is a young man who was injured in a road traffic accident:

[He] was without physiotherapy for 9 months in 2006-7 and the physiotherapist has over 200 clients — now how could she deliver any service to each person on her case load. The same with the occupational therapist. He is unable to deliver the type of service that would be appropriate for a person with [acquired brain injury] and he has over 200 clients also. If a clinician is on leave or leaves the service, there is no plan for backup and there is no one to fill in so the clients are just abandoned.

There is no psychologist in the service and even if there was it would be the same thing — over 200 clients in the service waiting for services. They have not had a psychologist for over 3 years and the psychologist assigned to work sessionally with him had no idea how to work with a person with ABI and has now left due to illness. He has had an hour a week of psychology (privately provided by the HSE) by a psychologist who works part time for the HSE and part time privately providing services (to the HSE). He is not part of the multi disciplinary team and is not engaged with programme planning, staff training, etc. etc. as recommended. The HSE does not have medical expertise available to this service nor does it have brain injury expertise as recommended. There is no vocational or day service in the area specifically for people with brain injury and no support or outreach service and no emergency services.

All Members are familiar with the enormous obstacles that those who have an acquired brain injury must overcome. Lately, I have been involved with a pilot programme for Headway in my native city on a group that oversees the programme, together with representatives of FÁS, the VEC, the HSE, etc. I have been enormously impressed by the work done by organisations such as Headway and the others. A great deal of voluntary effort takes place, as do enormous efforts by those who possess acquired brain injuries. They must put a great deal of work into their own recovery. The State must respond to their needs and one cannot simply allow the service be as minuscule as is the case at present. Although Deputy Lynch referred to the amount of money that has been invested in the health services, other countries appear to be able to implement such services and to be able to respond to the needs that exist. We also must do so.

I also wish to refer to one or two matters because I tried to consult with and talk to as many people as possible. Some of the specific issues that people raised include memory assisting technology, which costs €2,000 per person, card recognition, which allows someone to present a card that outlines his or her brain injury, and the failure of disabled driver VRT to cater for the needs of people with acquired brain injuries. Compulsory motorbike helmets were also recommended. I have a list of issues, the most important of which is the need for a full service that can support people with acquired brain injuries.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I fully support this motion and welcome its identification of the devastating effects of current HSE cutbacks and, in particular, its focus on the massive gaps in the provision of neurology services in this State. The motion speaks at the outset of the impact of cuts and staff shortages on patients in general. Given that the Minister for Health and Children is here, I have to note the outrage that is growing daily throughout the country at the cutbacks being imposed by the HSE and its policy of destroying the services provided in local hospitals.

Yesterday I revealed the internal HSE plan to impose a sentence of death on Monaghan General Hospital and a sentence of hard labour on Cavan General Hospital. Under this Taoiseach and the Minister, the HSE plans to close 50 acute inpatient beds and six critical care beds in Monaghan by the end of November. In one fell stroke Monaghan will be denied the ability to care for 3,000 acute inpatient admissions per annum. Those admissions will have to be dealt with by Cavan, which already has 5,000 inpatient admissions per annum and 160% bed occupancy.

I hope the Minister and the Minister of State at the Department of Health and Children, Deputy Devins, are discussing the issues I am addressing.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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Absolutely.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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This is to be done without a single additional bed being provided in Cavan. The HSE's plan is fraudulent in the extreme. It claims that the net loss of 56 hospital beds in Cavan and Monaghan and the north-east region will be compensated for by greater provision of non-acute care, rehabilitation, step-down beds and respite care, but these are the services that are being slashed by the HSE in its current wave of cutbacks. It is closing a 12-bed respite unit in St. Oliver Plunkett Hospital in Dundalk. That is being replicated across the country, notably in respect of the 12 respite beds being cut in Cherry Orchard Hospital in Dublin.

I warn the Minister and her colleagues that the death threat to Monaghan General Hospital will be resisted. We will not allow a hospital that has served our community for generations to be destroyed by this Government. She can be sure this is not the last she will hear of this. People throughout the country should take note of the template she intends visiting on other local hospitals. Shame on the Minister and the Minister of State.

Turning to the main substance of the motion, I commend the Labour Deputies on highlighting neurological needs. The huge gaps in the provision of neurological services in Ireland were identified by an expert panel, together with the Neurological Association of Ireland, in three standards of care documents published between 1999 and 2002 and a series of far-reaching recommendations were generated. These identified a number of problems regarding neurological services, including: long waiting times for initial diagnosis and follow up due to a chronic shortage of neurologists; lack of resources for provision of multidisciplinary care needed by those with neurological conditions, palliative and respite care and co-ordinated follow up in the community; and problems in accessing transport, health care, employment and information about their condition for those with neurological conditions. The documents make a series of recommendations which focus on changes in the health sector to meet the needs of those with neurological conditions, as well as the wider issues of access to information, support, employment and transport. As the motion makes clear, however, progress on these vital recommendations has been minimal.

In January 2006, after an inquest on a woman who died during an operation in Beaumont Hospital's neurosurgery centre, Professor Ciarán Bolger, head of research and development in neurosurgery at Beaumont and head of clinical neurosurgery at the Royal College of Surgeons in Dublin, spoke out. He stated that approximately 200 patients throughout the country were on an urgent waiting list for a bed at the national neurosurgery centre in Beaumont. The condition of ten of those patients was life-threatening. He also stated that the computer guide system in the operating theatre had broken down during five of the last six neurosurgery procedures which he had carried out in Beaumont. While this made the operations more difficult, the procedures had to continue. According to the professor, various other machines used in the clinic also regularly break down. That happened under the Minister's watch. The buck stops with her for health care and no amount of buck passing to the HSE will exonerate her from responsibility for these matters.

There has been no increase in the number of neurosurgeons working in the health service in 25 years, despite a dramatic increase in the population.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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That is not true.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Before the Minister, Deputy Devins, repeats his claim, I remind him that fewer neurosurgery operating slots are available now than 25 years ago. He should chew on that for a minute. In 2006, 1,000 non-urgent patients were on a waiting list for a bed at the neurosurgery centre. Cork University Hospital is the only other hospital in the State with a neurosurgery department but it is limited by staffing and medical equipment in what it can do. Professor Bolger has described the national neurosurgery service as a mess. He stated that we have nine neurosurgeon consultants in Ireland, six in Beaumont and three in Cork, but if we were in line with the UK, which has the lowest in Europe, we would have 16 based on our population and by US and continental Europe standards we should have 20 to 30.

Promises to improve neurosurgery services have repeatedly been broken. At Beaumont, priority is given to making space for one of the Government's precious private-for-profit hospitals on a co-located site. The long promised psychiatric unit at Beaumont is again to be deferred because the private hospital that the Minister cherishes is to be located on the site earmarked for this vital facility.

Many issues have arisen in respect of this State's health delivery systems. They are complex and a mighty effort will be required to correct them, yet there is no intent on the part of the Minister and her colleagues to address them in the interests of ordinary people who depend on our public health system. This motion identifies one area of pressing need in health care. There are many others and we are all equally affected. At any given time, the needs of neurosurgeons and all of the other related support staff could be our need also. Let no one in the Chamber forget this. The real pain and hardship caused by the Government's failure in its health delivery responsibilities are again exposed here today.

In conclusion, it is a shame on the Minister and her colleagues. I join in the demand for justice for patients requiring neurological services in this State. As a first reaction, the Minister might consider wrapping up her position as Minister and joining the outgoing Taoiseach as he makes his way out of that role and responsibility in the coming days. It is time to say adieu.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I wish to share time with the Minister of State at the Department of Health and Children, Deputy Jimmy Devins.

Brendan Howlin (Wexford, Labour)
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Is that agreed? Agreed.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I move amendment No. 1:

To delete all the words after "Dáil Éireann"and substitute the following:

acknowledges the substantial resources, €14.931 billion, provided by the Exchequer for the HSE to provide health and personal social services;

recognises that this is an increase of over €1.1 billion over the funding provided in 2007;

supports the Government's position in prioritising and providing additional funding of €344 million in the 2008 budget for additional services for older people, people with disabilities and cancer control;

recognises that the number of people employed in the public health service since 1997 has increased by over 64%, from just under 68,000 to 111,505 whole-time equivalent staff in December 2007; and

in particular, by the end of 2007, there were:

3,029 more medical and dental staff, a 61% increase;

9,767 more health and social care professionals, a 164% increase; and

11,660 additional nurses, a 43% increase;

notes that the HSE has been given approval for an additional 1,050 new posts arising from development funding provided by the Government in the budget day package for 2008;

notes that the temporary recruitment pause put in place by the HSE towards the end of 2007 ended on 31 December 2007;

reaffirms the statutory requirement that the Health Service Executive should manage its budget within the Vote approved by Dáil Éireann;

supports the Government's National Disability Strategy;

recognises the substantial additional funding provided for new and enhanced disability services over the past number of years;

acknowledges the Government's multi-annual investment programme for services for people with a disability;

acknowledges the plans to develop the National Rehabilitation Hospital and increase its capacity to treat more patients;

notes that the Department of Health and Children together with the HSE is committed to developing a strategy for the future of rehabilitation services and both parties have agreed to jointly address this area as quickly as possible;

welcomes the additional revenue investment of €7 million since 2006 to support the development of neurosciences (including neurology, neurophysiology and neurosurgery services), acknowledges the increase in the level of consultant manpower on foot of this investment and notes the intention by the HSE in the national service plan to continue the development of these services in 2008;

welcomes the progress being made by the HSE in developing a framework for the future development of services in the neuroscience area;

welcomes the emphasis in the new consultant contract on providing for consultant delivered services through a significant expansion of consultant numbers across all specialties; and

welcomes the increase since 2003 of ten additional consultant neurologist posts and four additional consultant neurophysiologist posts, bringing the total approved complement of posts in these specialties to 24 and seven respectively; the increase since 2006 of two additional approved consultant neurosurgeon posts at Beaumont Hospital and the provision of the necessary funding by the HSE for the creation of a fourth post at Cork University Hospital; the recent advertisement by the HSE for two permanent consultant neurologists at Beaumont and Waterford and for a consultant neurophysiologist at St. James's-Beaumont Hospitals.

I say to Deputy Ó Caoláin, who talks constantly about the shambles in our public health care system, that life expectancy in Ireland between 1999 and 2003 increased by three years, one of the fastest improvements in the world. A child born in Ireland today will live longer than a child born in the Netherlands, Denmark, Germany, the United Kingdom or Belgium. That, by any standards, is a measure of the success and improvements that have taken place.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Is that a by-product of what the Minister is presiding over in terms of the provision of services at acute hospitals?

Brendan Howlin (Wexford, Labour)
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Allow the Minister to continue. The Deputy had ten minutes.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What of the baby, Bronagh Livingstone, who died in an ambulance on her way to Cavan General Hospital. Is she one of the Minister's statistics?

Brendan Howlin (Wexford, Labour)
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The Deputy should allow the Minister to respond. This is a place of debate. The Deputy had an uninterrupted contribution. He should allow the Minister to have hers.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I welcome the opportunity this debate provides to put on the record of the House the Government's commitment and plans for rehabilitation and other services. There will always be new health services we will want to provide faster, and in better facilities. Advances in medical science alone will ensure that. As a people, I have no doubt we will also strive for constant improvement in the services we can provide in our communities within what we can afford.

I believe that a reasonable foundation for a health policy debate will recognise three things: first, the work and effort put in by all staff — clinical, management and administration — to provide and build up existing services, and the resulting improvements in health status for the Irish people that are actually being achieved; second, the real and substantial funding increases that have been provided by taxpayers in recent years, to the level of €15 billion this year for the HSE, paying for 110,000 whole-time equivalent staff; and third, the need to ensure maximum efficiency in the use of resources so the highest level of services can be delivered for a given level of funding, so that good plans are developed and implemented and priorities within set budgets are achieved. These considerations are as relevant for the development of rehabilitation services as every other part of the health service.

The motion before us refers to the National Rehabilitation Hospital. The hospital is currently a 120-bed hospital which provides treatment and rehabilitation for patients with spinal cord injuries, head injuries, amputation, traumatic and non-traumatic brain injury, strokes and neurological disorders. The allocation for the National Rehabilitation Hospital is nearly €30 million. It also provides assessments for wheelchair and mobility aids and vocational training programmes involving a wide range of social, personal and work related skills. The hospital also has a 12-bed hostel which enables patients from outside the Dublin area to access day services at the hospital and attend the vocational training unit.

A new rehabilitation hospital is part of the national development plan. When built, the new hospital will provide additional treatment and diagnostic capacity. A project team is now working with an appointed design team to develop the new hospital. The design will be submitted for planning later this year with a target completion date for the hospital of 2012.

The Health Service Executive has also informed me that plans have been prepared to develop a satellite unit of the National Rehabilitation Hospital attached to Beaumont Hospital, linking the rehabilitation expertise of the national hospital with the neurological services in Beaumont. This new proposed unit will provide acute medical rehabilitation services and early rehabilitation for those suffering from brain injury who access the national neurosciences unit at Beaumont Hospital and who currently have to access services at the National Rehabilitation Hospital. In addition, I understand that plans have been prepared in some regional areas for rehabilitation facilities.

Michael D Higgins (Galway West, Labour)
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It is very vague.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Rehabilitation is a core element of health services. It is fundamentally about enabling and supporting individuals to recover or adjust during this time, achieve their full potential and, where possible, to live full and active lives. Increased trauma survival, especially in the area of stroke, road traffic accidents and occupational accidents, has increased the need for rehabilitation. An increase in life expectancy has also affected the rehabilitative needs of the population. There is an increased awareness of the importance of rehabilitation especially in the areas of stroke and acquired brain injury.

Key aspects of rehabilitation services are meeting the needs of older people, those with an acquired brain injury and those with multiple long-term conditions who wish to live independently in their own homes. We need to improve interdisciplinary co-ordination of service delivery. In addition, we need to improve access and availability. The transition between services provided in hospital and the community requires to be considered also. These are all matters that will be enabled by our reform programme, particularly the new consultants' contract.

Over the past ten years a number of former health boards and, more recently, HSE regions have commissioned local reports and research in recognition of the complexity of needs presented by people with acquired brain injury and the challenge of meeting those needs. These reports indicate the need for a national strategic approach to planning and delivering rehabilitation services. This need has been recognised by Government and social partners in the partnership agreement, Towards 2016.

The Government is also committed in our programme to increasing rehabilitation bed capacity. My Department, together with the HSE, is committed to developing a strategy for the future of rehabilitation services, including a network of rehabilitation facilities. A working group is being established to define the scope of rehabilitation services, research best practice approaches to rehabilitation services, assess the needs of the population and outline a model of service delivery that will encompass all stages of service required to meet the needs.

The HSE has recently conducted a national review of neurology and clinical neurophysiology services. The review was undertaken in view of the increasing demand for services along with the rapid pace of technological advances. The review was overseen by a multidisciplinary steering group whose aim was to identify the current level of service provision and future requirements for neurology and neurophysiology services in Ireland. The objectives were to evaluate current neurology services, including paediatrics and neurophysiology; review the evidence in regard to models of service delivery; identify requirements for the development of neurology and neurophysiology services nationally and prioritise service requirements; and to report to the director of the National Hospitals Office. The HSE has advised my Department that work on the review has recently been completed and that the final draft report has been submitted to the director of the National Hospitals Office for consideration.

In recognition of the need to develop neurology and neurophysiology services, additional revenue funding of €3 million was allocated to the HSE in 2006. In 2007 further additional revenue of €4 million was allocated to support the continuing development of services in the area of neurosciences. The HSE has advised me that there has been an increase in the number of consultant neurology posts arising from this investment. In the area of neurology there are currently 24 approved posts of consultant neurologist in Ireland, of which 19 are filled. With the current recruitment, the remainder will be filled. This is an increase of ten approved posts since the Comhairle report in 2003. Three such posts were advertised last week. In addition, there are currently seven approved posts of consultant clinical neurophysiologist, of which four are filled. This is an increase of four since the Comhairle report.

The Comhairle na nOspidéal report on neurosurgery recommended that the future development of safe, high quality neurosurgical services in Ireland would be best served by increasing capacity in Dublin and Cork and by improving access to neurosurgical units, including improved transport and telemedicine facilities for referring hospitals.

Michael D Higgins (Galway West, Labour)
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It was a very disappointing report for the west.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have met the doctors in the west but we need to develop what we have first. The report identified a need for additional investment in neurosurgical services and the planning and commissioning of such services on a national basis. The Health Service Executive has invested in the expansion of the service at Beaumont Hospital in recent years. For example, in 2006 additional funding of €800,000 was allocated to the hospital to address identified service requirements. In 2007 additional revenue development funding of €4 million was allocated to the HSE to progress the further development of neuroscience services nationally. The executive allocated an additional €1 million in service development funding in 2007 to enable the hospital to make further improvements to its neurosurgical service. Deputy Ó Caoláin should be aware that currently there are 11 neurosurgeons in Ireland, not nine. This funding has allowed for additional staff to be put in place, including a temporary consultant neurosurgeon and a specialist registrar in neurosurgery.

This year Beaumont Hospital has been allocated a further €1 million within its overall allocation to support the continued development of neurosurgery. For example, in addition to the revenue investment, capital funding of nearly €5 million was allocated to the hospital in 2007 for replacement equipment for the neurosurgery theatres, refurbishment of interventional radiology rooms, investment in intra-operative monitoring equipment, investment in image linkages and a database to improve reporting arrangements. The 2007 capital allocation builds on the investment made in 2006. The commissioning of the 11th theatre is under way. This new theatre is capable of being commissioned on a 2.5 day basis in the near future, subject to recruiting an additional three staff, which was approved last year.

The Health Service Executive has advised that €900,000 in additional revenue funding was provided in 2007 to further develop neurosurgical services at Cork University Hospital, including the creation of a fourth neurosurgeon post. The progressing of this development was tied up with the finalisation of the new consultants' contract.

The Health Service Executive and statutory agencies such as Headway, the Peter Bradley Foundation, the Irish Wheelchair Association and BRI are involved in providing support by way of service provision, family support advocacy or peer support for people with acquired brain injury. The need is to support the person with acquired brain injury and his or her family. Families have shown extraordinary support for their loved ones with brain injuries and the health service has a challenge to respond to them in kind. On discharge from hospital, a range of services are provided for people with acquired brain injury and their families by both statutory and non-statutory agencies. Headway, for example, provides rehabilitative training and occupational day services at a number of locations. Support is also available for those seeking employment. It also provides family support, psychology and counselling services, as well as a community access programme in counties Cork and Kerry. Its information service provides a range of information leaflets on acquired brain injury related issues, books and a quarterly newsletter.

The Peter Bradley Foundation has developed a range of community based local services which include assisted living, outreach community rehabilitation services, clinical support teams and case management services. I acknowledge the need for acquired brain injury specific services due to the highly individualised nature of the disability being addressed. The Health Service Executive now has a greater awareness and is developing a more integrated multi-disciplinary approach to acquired brain injury involving acute hospital services and primary and community care. It acknowledges the need for facilities that are age appropriate and appropriate for people with acquired brain injury.

The national disability strategy supports the goal of every individual resuming independent living where possible through assisted living services and housing provision. The Health Service Executive and the Department of the Environment, Heritage and Local Government are acting with social housing agencies to address these needs.

This debate provides a useful opportunity to highlight the Government's commitments and plans regarding rehabilitation and other services. The Government will continue to invest and lead reform to ensure taxpayers' resources are directed most efficiently towards building the new services we all desire.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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I am happy to avail of the opportunity this debate provides to clearly outline the Government's commitment to providing a high quality rehabilitation service for all people with acquired brain injury, as well as disability services generally. As we are all aware, an acquired brain injury can occur at any time as a result of an accident, assault, fall, brain haemorrhage or viral infection. Each injury is unique and those more seriously affected may suffer from severe memory problems, personality changes and chronic fatigue which can be devastating for both the individual concerned and his or her family.

When appointed by the Taoiseach to the position of Minister of State with responsibility for disability and mental health services, I was given responsibility for the oversight of the Government's national disability strategy.

Dan Neville (Limerick West, Fine Gael)
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Oversight is right.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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That included six departmental sectoral plans and the co-ordination of the implementation of the Disability Act 2005 and the Education for Persons with Special Educational Needs Act 2004.

I recognise the importance of effective rehabilitation to those who have suffered a stroke or brain injury. I will outline the main steps taken to improve rehabilitation services but I first want to mention the recent establishment of the Office for Disability and Mental Health which will make a significant contribution to the improvement of rehabilitation services, as well as disability services generally. In January the Government announced the establishment of the office to support me as the Minister of State with responsibility for disability and mental health services in exercising my responsibilities across four Departments: Health and Children, Education and Science, Enterprise, Trade and Employment and Justice, Equality and Law Reform. The new office brings together responsibility for a range of policy areas and State services which directly impact on the lives of people with a disability and mental health issues. It aims to bring about improvements in the manner in which services respond to the needs of people with disabilities and mental health issues by working to develop person-centred services, focusing on the holistic needs of clients and service users and actively involving them in their own care.

Substantial progress has been made in recent years in the areas of disability and mental health but much remains to be done. In particular, there is a need to improve co-ordination and communication across Departments and agencies in their delivery of services to this client group. That will be the main focus for the new office. In addition, the development of a national rehabilitation strategy, which I will outline, will be among the key priorities for the office in the months to come. The director of the office is a member of the senior officials group on social inclusion which monitors progress on the Government's commitments regarding social policy, including commitments made in the national disability strategy. The Government has agreed that meetings will be held on a quarterly basis between the four Secretaries General of the relevant Departments, the director of the new office and me to review progress in the priority areas.

The Government's decision to establish the Office for Disability and Mental Health reflects our commitment to developing a more coherent and integrated response to the needs of people with disabilities and mental health issues. It recognises that clients and service users must be at the centre of service delivery and that we may need to examine the way services are delivered to ensure that is and will remain the case. To effectively achieve this requires a cross-departmental, cross-agency response. I was happy to be informed that representatives from some of the main voluntary organisations working in this area were present this evening to listen to the debate and was delighted to meet with most of them in the past few months.

With the establishment of the Office for Disability and Mental Health and the associated attempts by the Government to get the relevant Departments and agencies to work together in a way that will ensure better results for services users, I consider this to be an excellent opportunity to raise the issue of the way voluntary bodies work together. There are a number of excellent organisations striving to achieve similar goals in the area of brain injury and there is significant scope for a merger or alliance between them. The key benefits would be an improved and more integrated service delivery to clients, a stronger, more united voice for service users and last, but not least, a significant reduction in the operating costs involved.

The Government's objective in the coming years is to move the disability agenda to a level which matches that in any other country. We aim to achieve this objective in partnership with all stakeholders, thereby maximising the use of all our resources to promote the full involvement of people with disabilities in the social, economic, political and cultural life of Ireland. The Disability Act is a central element in that process. The Act provides a comprehensive framework for delivering services to people with disabilities, places obligations on State organisations to make buildings and services accessible to people with disabilities, provides for sectoral plans in key service areas which requires public bodies to take positive actions to employ people with disabilities and provides for the establishment of a centre for excellence in universal design. The Act is underpinned by the multiannual investment programme which was announced as part of the 2005 budget. This programme will provide €900 million for services for people with a disability between the years 2006 and 2009. This funding will help to build the additional capacity required to put in place the framework set out in the Disability Act. As part of the multiannual investment programme under the disability strategy, the Government provided the Health Service Executive with an additional €75 million in both 2006 and 2007.

This funding included moneys to provide new and enhanced services for people with disabilities. The Government has also committed to a further €50 million investment in services for people with a disability, as was announced in the budget for 2008. Some examples of the huge investment in health and personal social services being provided under this programme include 8,800 people with a disability receiving care in residential places, with more people living in group homes within their communities than in residential centres. There are 7,200 residential places providing respite care for people with a disability. I was delighted last Friday to open a new respite care centre in Tullaghan in County Donegal for counties Donegal, Leitrim and Sligo. Some 30,000 people with a disability are attending day services and there have been 3 million hours of personal assistance and home supports for people with a physical or sensory disability.

Of course these are more than just statistics. Each one of these hours, and every one of these residential and respite places, are making an important contribution to improving the lives of individuals with disabilities and their families. The national intellectual disability database annual report for 2007 states that 97% of the people registered with the database are in receipt of a service. The report goes on to state there has been significant growth in the level of provision of services to people with an intellectual disability, which reflects the success of the Government's investment programme.

A key initiative in the area of rehabilitation is the commitment by the Department of Health and Children and the HSE to the development of a national strategy for the provision of medical rehabilitation services. A number of issues will be considered as part of this, including an assessment of the need, the structure and location of facilities and services and the nature of the rehabilitation facilities, that is, whether they should be hospital type, step down or preparation for independent living.

Neurosurgery plays a key role in the rehabilitative process for many individuals with acquired brain injury. The Comhairle na nOspidéal report on neurosurgery from 2006 recommended the future development of safe, high quality neurosurgical services in Ireland would be best served by increasing capacity in Dublin and Cork and by improving access to neurosurgical units, including improved transport and telemedicine facilities for referring hospitals.

The report identified a need for additional investment in neurosurgical services and in the planning and commissioning of such services on a national basis. The Health Service Executive has invested in the expansion of the service at Beaumont Hospital over the past number of years, and the Minister has outlined this investment.

The Government has recognised the need for the development of improved services for those with acquired brain injury.

Brendan Howlin (Wexford, Labour)
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There are over seven minutes left in the Government slot.

Dan Neville (Limerick West, Fine Gael)
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The Deputy may conclude, we will use the time.

Paul Connaughton Snr (Galway East, Fine Gael)
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It is worth listening to.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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The initiatives outlined above, such as the commitment to the development of a national rehabilitation strategy, the investment in neurosurgery in Beaumont Hospital, as well as those outlined previously by the Minister, Deputy Harney, are examples of the steps this Government is taking to improving rehabilitative care.

With the establishment of the office for disability and mental health and my appointment as Minister of State with responsibility for disability and mental health, this Government has put in place the structures which will help to provide these much-needed services in the most efficient and effective way.

I take this opportunity to encourage the organisations that do so much good work in the area of brain injury to consider ways in which they can work together in order to provide an even better service for their clients.

Dan Neville (Limerick West, Fine Gael)
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I wish to share time with Deputies Stanton, Connaughton and Shatter. How much time do we have?

Brendan Howlin (Wexford, Labour)
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The Deputies have the benefit of an extra seven minutes, so there is a total of 27 minutes. The Deputies may split that as they wish.

Dan Neville (Limerick West, Fine Gael)
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Will the Leas-Cheann Comhairle alert me when I have used eight minutes?

Brendan Howlin (Wexford, Labour)
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I will.

Dan Neville (Limerick West, Fine Gael)
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I welcome the opportunity to speak in this debate and I welcome the initiative of the Labour Party to introduce it.

In the 2001 health strategy, the Government promised to prepare an action plan for rehabilitation services for people with brain injury, recognising the shortage of inpatient and community-based services. The action plan was supposed to set out a programme to meet existing shortfalls in speech and language services, occupational therapists and physiotherapists.

Experts recommend that patients with a brain injury must be seen within two weeks to maximise recovery but Irish patients must wait up to two years for an initial assessment because we only have one rehabilitative hospital with 110 beds. That has only the capacity to treat about a quarter of the 10,000 people who suffer a brain injury each year.

In 2005, the Disability Act was promoted strongly and debated by my colleague, Deputy Stanton. This Act promised an independent assessment of needs for all people with a neurological condition. At the moment this is being rolled out to all children under the age of five but anyone over that age is not being assessed.

The HSE strategic review of neurology and clinical neurophysiology services was due to be published in February 2007. That review was given to the HSE last December but has still not been published. Why is this so and why can it not be debated? It is unacceptable that people suffering from brain injuries as a result of a car crash, stroke or other accidents or illnesses must wait as long as two years for rehabilitation services.

Access to early rehabilitative treatment is critical for helping people to talk or walk again. Although the health budget has never been larger, accessing services such as speech and language therapy, occupational therapy and physiotherapy has not improved. As a result of long waiting lists, patients are left in debilitating conditions, dependent on others at home or in nursing homes for the rest of their lives.

The Health Service Executive has commissioned three reports on neurology services, one in 2003, another three years later, and the last one was presented to the HSE in December 2007 but it has not been published. I wonder why it has not been published. Like the reports before it, the third report criticises the fact there are just 20 neurologists, nine neurosurgeons, six rehabilitation specialists and only 110 rehabilitation beds in the country. Services are seriously underresourced and it is having a devastating effect on patients.

The three reports indicate we have less than half the consultant neurologists required. With only 20 consultant neurologists, Ireland has proportionately the lowest number in Europe. The 2003 report found we needed 42 consultant neurologists, but after three reports within five years, we still have less than half the recommended requirement.

The HSE and the Department of Health and Children are fond of commissioning report after report, gathering information to establish and re-establish what we already know, but they are not so good at implementing the recommendations of their reports. They seem to consistently ignore them.

Since the IHF audit was published we have seen stroke units being named which will not be staffed or have enough beds to cater for the full throughput of patients. Arising from a presentation at the IHF stroke conference, the HSE announced that stroke units are in place in the Mater, St James', Clonmel, Navan, Sligo, Portiuncula, with Connolly and Kilkenny opening in the summer. Will the Minister and Minister of State confirm these units are staffed and bedded to cater for the likely throughput? The HSE and the Department of Health and Children are failing brain injury and stroke victims. Their function should be about providing medical care, not about drawing up reports that are ignored and maintaining a costly bulging bureaucratic behemoth that is denying resources to frontline services.

Stroke is the third largest cause of death and disability worldwide and constitutes a formidable burden of disability for patients, their carers and the wider community. Each year, approximately 10,000 people are admitted to hospital in the Republic of Ireland with stroke disease as a primary diagnosis. It is estimated that more than 30,000 people in Ireland are survivors of stroke and many of them have significant residual disabilities.

Neurological conditions affect approximately 700,000 people in Ireland. Such conditions are those which affect the brain and spinal cord. Many of them are common and treatable but early intervention is the key. As stated, there is only one hospital, with just 110 beds, in the country for those who suffer an acquired brain injury.

A report by Comhairle na nOspidéal, commissioned by the Government in 2003, recommended that 42 neurologists were needed to serve the Irish population. People are currently obliged to wait up to two years to see a neurologist for diagnosis and commencement of treatment. Neurological conditions need to be identified and treated as soon as possible. The delay to which I refer is completely unacceptable. The projected increase in the number of people with neurological conditions will place considerable strain on services already under pressure as a result of long waiting lists, lack of rehabilitation facilities and personnel shortages at all levels.

David Stanton (Cork East, Fine Gael)
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I congratulate the Labour Party on tabling this important and timely motion. I was disappointed by the somewhat disinterested, hands-off response of the Minister and the Minister of State in respect of this issue.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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That is not a correct assessment.

David Stanton (Cork East, Fine Gael)
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There is either an issue at stake or there is not. The Minister and the Minister of State failed to acknowledge or speak to the motion. They also failed to indicate whether a problem exists and, if it does, the scale thereof. These are serious issues that affect people and their families. The latter are suffering. Neither the Minister nor the Minister of State acknowledged that fact. Both contributions were back-slapping, self-congratulatory, amateurish and insulting in nature. I do not like to say that but I am extremely angry about this matter. In addition, I am extremely concerned. I am of the impression that neither the Minister nor the Minister of State saw their speeches before they entered the House. They merely took possession of them and read them into the record. It seems there is an attitude to the effect that "We will go home and all will be grand". However, people are suffering and the Minister and Minister of State do not even seem to care.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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That is not true.

David Stanton (Cork East, Fine Gael)
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It is extremely worrying when Ministers do not care and when they merely come before the House, go through the motions and refer to the millions spent here and the millions spent there. They never state that there is a problem, that they need to do better and that Ireland is not as good as other countries in certain respects.

Ireland lags far behind international best practice and standards in the area of stroke rehabilitation. I travelled to Germany last autumn, at my own expense, to view rehabilitation centres in that jurisdiction. I was absolutely blown away by the scale of those centres, the service provided and the level of treatment of which people could, almost instantaneously, avail. I was informed that a huge percentage of the people treated at the centres, stroke and acquired brain injury victims, would be able to return home and lead almost normal lives. The commitment people in Germany display in respect of this matter is staggering. The Minister and the Minister of State should travel there to see what is on offer. On the next occasion on which they come before the House, they should write their own speeches and not rely on others to do it for them. They should focus on the people who are suffering on a daily basis. They repeated the litany regarding the hundreds of millions and billions that is trotted out by Ministers at every opportunity. If so much money has been invested, why is the service so appalling? Why are older people who suffered strokes lying in hospital and nursing home beds this evening, staring up at the ceiling and praying to die? Why are young people obliged to wait months or, in some cases, years for rehabilitation, particularly when it is provided within hours or days in other European countries?

The Minister has been in power for ten years and has had unprecedented wealth at her disposal and she now has the audacity to insult the House and the nation by delivering an amateurish, back-slapping, disinterested contribution. It makes my blood boil.

The Minister did not refer to the Irish Heart Foundation report. Does she agree with the assertion in the report to the effect that stroke units are virtually non-existent? The Minister should have addressed matters of this nature in her contribution and should not have stated that hundreds of millions of taxpayers' money was spent on this and that. The Irish Heart Foundation report also states that only a tiny fraction of patients who might benefit from acute interventions such as thrombolosis are correctly assessed. It further states that acute rehabilitation is only available to one in four patients or is delayed beyond the point at which it is most effective. Is that true?

The report of the Irish Heart Foundation also states that the results are predictable and that too many people die from stroke because they cannot access optimal treatment sufficiently rapidly. People are dying. Does the Minister care? Is she aware of what is happening or is she insulated from what is happening in the real world?

The report further states that too many survivors are left with avoidable and unduly prolonged disability. The Minister referred to establishing review groups. Such a group was established in 2003 and a second one has now been set up to review its findings. What the hell is the Minister playing at? Ten or 12 years ago, the former Minister for Health and Children, Deputy Martin, visited Cork and informed us that a rehabilitation centre was to be established there. However, this did not happen. Why was that the case? The Minister, Deputy Harney, did not provide information in that regard. We have asked this question time and again but we have not received an answer because Ministers do not care. The Government has been in power too long and its members are out of touch.

The Minister of State, Deputy Devins, failed to provide a timescale or targets in respect of the national strategy for the provision of rehabilitation services. All he provided were words and these mean nothing to people. That is absolutely not good enough.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Minister of State provided——

David Stanton (Cork East, Fine Gael)
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Only 5% of patients are admitted to hospital within two hours of stroke onset. Why is that the case? The Irish Heart Foundation report states there were only 12 stroke unit beds nationally and that 30% of hospitals do not have routine access to CT scanning within 48 hours of someone having a stroke. Why is that the case? Following ten years in power and with huge amounts of money available, this is the state in which we find ourselves.

I recently met a girl who was informed by the HSE that she would never walk again. She travelled to a clinic in Germany for treatment and she is now walking. What is happening in this country is beyond belief. Ireland has the worst record in Europe in respect of this matter. When I made my trip to Germany, I discovered that the various services required are offered at stationary centres. There are 15 such centres in southern Germany alone. Around these are located ambulant or day-care centres into which people can walk. The rehabilitation centres in Germany are funded by insurance payments and from contributions by the state.

Why can the Government here not get its act together and do something? Will timescales or deadlines be provided? When will a proper service be available? The Minister is in charge — she is responsible and accountable. If she cannot do what is required, she should resign and her job should be given to someone who can. It is as simple as that. This matter has been dragging on for too long and it is far too serious for that.

I apologise for becoming emotional about this matter. However, I am familiar with people and their families who are suffering a great deal. There was no feeling or emotion from the Minister or the Minister of State. They rattled off statistics and referred to the spending of millions and billions. However, this does not mean anything to anyone. The Government needs to start thinking about people and providing services for them. Those of us on this side of the House are not in a position to do this but the Minister is and she has a responsibility in that regard.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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We are providing the service.

David Stanton (Cork East, Fine Gael)
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The Minister has a short number of years to do something. Let us see action and let her provide timescales and deadlines. If people do not do their jobs or cannot do them, they should be moved aside and someone else should be appointed. The Minister needs to start kicking ass big time.

Brendan Howlin (Wexford, Labour)
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I remind those in the Gallery that applause is not allowed in the national Parliament.

David Stanton (Cork East, Fine Gael)
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Lots of things should happen in the national Parliament and proper debate is one of them.

Brendan Howlin (Wexford, Labour)
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The Standing Orders of the House——

David Stanton (Cork East, Fine Gael)
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I am not talking about them.

Brendan Howlin (Wexford, Labour)
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I will maintain order, if the Deputy does not mind.

David Stanton (Cork East, Fine Gael)
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Am I out of order?

Brendan Howlin (Wexford, Labour)
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The Deputy is not but I would rather that he did not refer——

David Stanton (Cork East, Fine Gael)
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I am suggesting that we should have proper debate here about serious issues like this. That is all I am saying, but we are not having a proper debate. That is the point I am making.

Too many people are dying and suffering needlessly. This national crisis is a scandal. The people in charge should wake up and provide proper rehabilitation services across the board because currently they are non-existent. I have met people who have come here from other countries and they are appalled at the situation. They cannot understand why it is so bad. Perhaps the Minister can send someone in here tomorrow to explain why it is so bad and at least acknowledge that there is a problem. Alternatively, they can tell us that there is no problem and everything is grand so we can all go home because we are wasting our time. The impression I got from listening to the Minister's speech was that there is no issue, but I disagree. There is a major issue.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Why does the Deputy think we are appointing so many consultants?

Paul Connaughton Snr (Galway East, Fine Gael)
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That should have happened years ago.

David Stanton (Cork East, Fine Gael)
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We hear that is happening now but we still have no timescale for proper rehabilitation services. Why, for instance, is there not a proper rehabilitation service in the south? It was promised almost ten years ago but it is not there. Why not? Can the Minister answer that question? What happened? The promise was made and the money was there, as was the commitment, but it did not happen. Why not?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The health board was in charge.

David Stanton (Cork East, Fine Gael)
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The health board was in charge so it must be blamed.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy should tell me why not.

David Stanton (Cork East, Fine Gael)
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We have heard it all now. The Minister blames someone else and passes the buck.

Paul Connaughton Snr (Galway East, Fine Gael)
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Everyone but herself.

David Stanton (Cork East, Fine Gael)
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She blames everyone except herself. I rest my case.

Jan O'Sullivan (Limerick East, Labour)
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The Minister is blaming everybody else.

Paul Connaughton Snr (Galway East, Fine Gael)
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We have heard it all again tonight. I am not surprised by the things that have emerged from this debate. The Minister told us that we are living three years longer.

Kathleen Lynch (Cork North Central, Labour)
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It just seems that way.

Paul Connaughton Snr (Galway East, Fine Gael)
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The people I wish to talk about, and who I represent, will be living a lot less than three, ten or 20 years longer. That sort of statement ill behoves a Minister for Health and Children.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Life expectancy is not within the power of the Minister.

Paul Connaughton Snr (Galway East, Fine Gael)
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The Minister was talking about an average life expectancy but, as she knows, averaging can be a dangerous science. It is like the woman who found her head in the fridge and her legs in the fire, but on average she was supposed to be all right. We are talking about a cohort of Irish people who could not have a more difficult situation. I am one of the many TDs who had the good fortune to be briefed a couple of weeks ago by BRÍ and the Irish Heart Foundation. I am ashamed that there are many aspects of the matter about which I was not fully aware. In the coming years, I will do everything I can to ensure that the route of those who suffer an acquired brain injury — as a result of an accident at work, on the road or a stroke — will not be like this. People with such injuries are brought to Beaumont Hospital and get a very good service but it is limited. Invariably the ambulance is soon on its way back to the local hospital. Unfortunately, that is only a limbo because local hospitals do not have the expertise to deal with brain injury. They do the best they can with a view to gaining admission for such patients to the National Rehabilitation Hospital in Dún Laoghaire.

Over the past five years, I have spent endless hours talking to consultants, bed managers, HSE managers and others but to no avail. I can think of two or three people in County Galway who are lying in a vegetative state in a hospital bed that was never intended for them. It is an awful tragedy.

The one thing we have learned from the debate is that, as the Minister said in her speech, there will not be a single additional bed in Dún Laoghaire until 2012 at the earliest. They are seeking planning permission in mid-2008. Unless I have misunderstood, that sort of timetable will go back by three or four years. We can take it therefore that the immense pressure on the National Rehabilitation Hospital from all over the country will continue for the next seven or eight years because there will not be one extra bed. Shame on the Minister and on the Government.

Mary Harney (Dublin Mid West, Progressive Democrats)
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What about the Beaumont beds?

Paul Connaughton Snr (Galway East, Fine Gael)
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Hold on a second. Do not mind Beaumont at all. The only reason——

Mary Harney (Dublin Mid West, Progressive Democrats)
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What about the beds in Beaumont?

Brendan Howlin (Wexford, Labour)
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The Minister should allow the Deputy to continue.

Paul Connaughton Snr (Galway East, Fine Gael)
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The Minister has had her say and a poor say it was. In fairness to Deputy Devins, of whom I would expect more, he did not even have enough to say. He ran out of script seven minutes too soon.

Dan Neville (Limerick West, Fine Gael)
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They do not care.

Paul Connaughton Snr (Galway East, Fine Gael)
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I have not seen that happening to a Minister for a long time.

Dan Neville (Limerick West, Fine Gael)
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They do not care.

Paul Connaughton Snr (Galway East, Fine Gael)
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The problem is that he had nothing to talk about.

Dan Neville (Limerick West, Fine Gael)
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They do not care.

Paul Connaughton Snr (Galway East, Fine Gael)
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I compliment the Labour Party Members on introducing this important motion. They are to be congratulated on bringing it to the floor of the Dáil.

People with brain injury are being forced to go through drudgery, but there is no case to be made against investing in the necessary beds. A delay of even two weeks in treating acquired brain injury cases is too long because it is remarkable what medical science can do under the right circumstances. Can one imagine the trauma for the families concerned who are told that nothing can be done for their son, daughter, father or mother? All they will get is a monthly assessment for a year or two. I was informed by representatives of BRÍ that for every one person admitted, at least three other urgent cases cannot find the required beds. One must imagine the personal problems involved for such families, including financial hardship and acute pain. They visit a hospital every day but nothing can be done for their loved ones. As they did not make the financial arrangements in time over the years, they know it is unlikely their loved one will ever get into the National Rehabilitation Hospital in Dún Laoghaire. Even if they do, it will be delayed by six months or a year and great damage will be done as a result. How can one expect any politicians, whether on the Government or Opposition benches, or the public to say the Government has done well on this topic? If the Minister thinks she is doing well, she is even more foolish than she looks. It is an outrageous carry-on because we know this can be ameliorated from the medical point of view. In so far as medical science is concerned, we know this is a win-win situation.

If the families of young married men or women with acquired brain injury were listening to what the Minister and Minister of State had to say, they would be absolutely disgusted. We are having this debate on behalf of such people. I compliment organisations such as Headway, BRÍ and the Irish Heart Foundation which have done a wonderful job on behalf of those who are least able to help themselves. If we have any social conscience left we should do something about this matter. The next time the Minister for Health and Children speaks I hope it will be possible for her to announce arrangements for extra beds at the National Rehabilitation Hospital, which is one of the best in Europe, a long time before 2012 or 2015. I sincerely hope the Minister and Minister of State will take seriously what we have said tonight, otherwise it will come back to haunt them. I guarantee that.