Gerald Nash (Louth, Labour)
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I doubt there is a family in Ireland that has not experienced the affliction of stroke. Strokes, as the Minister of State knows, can vary from relatively mild occurrences from which people can and do make full recoveries to devastating attacks which greatly impair the quality of life of patients and their carers. Once, we viewed strokes almost as an act of God. There was nothing we could do except sit and hope that a sufferer would regain some functionality. Thankfully, we have come a long way since then.

Last year, as the Minister will be aware, the Irish Heart Foundation published ESRI research showing that 750 extra people could be saved from death or lifelong dependency each year, with a cost saving to the taxpayer of €230 million over the next decade, if stroke unit care and clot-busting thrombolysis treatment was generally available. The HSE accepted this research and, in fact, allocated an extra €4.2 million to stroke services in the 2011 service plan to fund the appointment of 45 clinical nurse specialist and therapist posts countrywide. These were in addition to a number of new consultant neurologist and geriatrician appointments that are currently being made. Two of these posts were approved for Drogheda - a clinical nurse specialist and a therapist - with the full expectation that they would be filled early this year. We are almost at the year end and, apparently, these posts are no closer to being filled. It is essential to understand that an effective, functioning stroke unit is made up of people, not simply buildings and equipment. A stroke unit requires people with the necessary expertise who altogether offer a holistic approach to patient care. As the Minister of State is aware, when done properly the results are spectacular in terms of the recovery of patients and, crucially, in terms of reducing the likelihood of further attacks and incidence. Without the required expertise there may be a "Stroke Unit" sign on the corridor but it will not meet the guidelines of what constitutes a stroke unit as envisaged by the Irish Heart Foundation and the ESRI and, therefore, the benefits and the savings will be lost.

We are all aware of the difficult situation this country is in but this is not a case of seeking additional resources; the budget for these posts has already been approved. What is more, these appointments will greatly improve the effectiveness and efficiency of our stroke care system, saving money and freeing up resources to meet other demands in the health service. This is a win-win situation and it is deeply frustrating to see such a delay in implementing a measure that will greatly improve quality of life for patients and their carers. I appeal to the Minister of State to give this her full attention and to ensure these two essential appointments are made as quickly as practicable.

Kathleen Lynch (Cork North Central, Labour)
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I am grateful to Deputy Nash for raising this issue. The Deputy is aware that I have an interest in it through family circumstances. Following the transfer of acute services from Louth County Hospital to Our Lady of Lourdes Hospital, Drogheda, the Health Service Executive has worked to reorganise stroke services in the Louth-Meath hospital group. Stroke services in the group were prioritised by the HSE in the 2011 service plan. A dedicated consultant physician lead for stroke services is in place in the Louth-Meath hospital group. The consultant physician is progressing the planned development of the stroke service in line with the HSE's national clinical programme for stroke and is working with the programme's national clinical lead in this regard.

I am pleased to report that stroke services in the hospital group have been significantly improved this year with the designation since March of a seven-bed area for acute stroke patients in Our Lady of Lourdes Hospital, Drogheda and the introduction of thrombolysis for acute stroke patients last July. An eight-bed stroke rehabilitation unit has also been commissioned in Louth County Hospital for appropriate patients from Our Lady of Lourdes Hospital, Drogheda. Admissions to the areas are co-ordinated at weekly cross-site, multidisciplinary meetings. It is planned to increase the capacity of this unit to 11 beds once recently appointed speech and language therapists have completed a period of upskilling and induction.

A draft Louth-Meath implementation plan for the national clinical programme for stroke has been developed. Discussions are ongoing with the consultant physicians in this regard with a focus on agreeing a strategy to ensure that all stroke patients are admitted under the care of a stroke physician with a dedicated on-call rota for stroke thrombolysis. Recruitment to appoint physiotherapy and clinical nursing specialist staff to the service is being progressed by the HSE. Once this implementation plan has been agreed with the national clinical lead, the stroke service in the Louth Meath hospital group will be officially recognised by the national clinical programme. This is a welcome and important step in the development of services at Our Lady of Lourdes Hospital, Drogheda. I emphasise the importance being placed by the Department and the HSE on improving services for patients suffering strokes.

As Deputy Nash has pointed out, the Irish Heart Foundation has made some estimates of the economic burden of stroke and transient ischaemic attack, TIA, in Ireland. It has estimated the cost of stroke care at between €470 million and €1.008 billion and it has suggested that introducing changes to stroke service provision would have important implications for health outcomes and costs.

In June 2010 Changing Cardiovascular Health: National Cardiovascular Health Policy 2010 - 2019 was launched. This policy establishes a framework for the prevention, detection and treatment of cardiovascular disease, including stroke, and seeks to ensure an integrated and quality-assured approach in disease management to reduce the burden of these conditions. The policy proposes that cardiac and stroke services should be reconfigured on a network basis at hospital and emergency care level. It is planned that each network will provide specialist services by a blend of hospitals designated as local and general and regional and comprehensive centres. As part of these plans, an improved ambulance service will ensure that 80% of patients will be brought directly to the appropriate centre for initial treatment within the accepted criteria framework.

To help implement the report, specific teams have been established in the HSE. Four lead clinicians, two of whom have responsibility for stroke, have been appointed by the HSE to direct the implementation of the recommendations. The policy acknowledges the key role that primary care plays in raising awareness, in risk assessment and in the management of cardiovascular disease. A shift to community-based care is envisaged for such patients, with primary care teams providing structured, proactive care supported by specialist ambulance services. I welcome the important developments in stroke services in Ireland and especially the important role that Our Lady of Lourdes Hospital, Drogheda will play in the future.

I accept fully that the outcomes could be improved significantly if we had a proper service in place. It seems that with the programme envisaged of nine stroke units throughout the country and with the proper expertise and the thrombolysis treatment - although not everyone is necessarily an ideal candidate for this - the outcomes could be a great deal better and the burden stroke can place on communities, the individual and the State could be reduced greatly.

Gerald Nash (Louth, Labour)
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I thank the Minister of State for her comprehensive reply. She has acknowledged some of the developments that have taken place not only with regard to additional resources for stroke, but also the changes in attitude towards stroke and stroke prevention and other interventions. The fact remains that an extra €4.2 million was allocated to stroke services in 2011 service plan. There was an expectation that the two positions, the clinical nurse specialist and the therapist, would be allocated to Our Lady of Lourdes Hospital, Drogheda. As I stated earlier, a stroke unit is not simply about a building or equipment it is about interventions, the type of which can be provided by the clinical nurse specialist and the therapist. I believe that the Minister of State accepts the need for such interventions and staffing arrangements. I am unsure whether the question has been satisfactorily addressed but my concern is whether we can expect these positions to be filled by the end of the year as per the plan and the resources allocated. If this is not the case, will a commitment be made that these positions will be filled early next year to deal with the clear demand in the north east and in the Louth-Meath area for interventions for stroke?

Kathleen Lynch (Cork North Central, Labour)
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I cannot give the Deputy an answer to the specific question but I will relay his concerns. I will find out the answer and I will get back to the Deputy in terms of these specific areas. The Deputy is correct. If we intend to use multidisciplinary teams for other chronic diseases then we must introduce them in this case as well. The outcomes for stroke can be a great deal better if correct and speedy diagnosis and treatment is put in place and this is what the plan is about. The plan is good and the network we will put in place throughout the country will be good. It will serve the needs of those suspected of having had a stroke and those who have suffered a stroke. We must ensure the personnel required to deliver this plan are put in place. I will inquire for the Deputy about when these two appointments will be made.