Dáil debates

Wednesday, 27 November 2013

Topical Issue Debate

Hospital Stroke Facilities

12:30 pm

Photo of David StantonDavid Stanton (Cork East, Fine Gael)
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I thank the Ceann Comhairle for allowing me to raise this extremely important issue which is the need to open the stroke unit in Cork University Hospital. I have been following up progress on the CUH stroke unit for more than two years, since November 2011. During this time I have been in contact with Chris Macey of the Irish Heart Foundation. I am pleased that one of its representatives, Emma Jane Morrissey, is in the Public Gallery.

The HSE's 2012 national stroke programme provided for the opening of 28 dedicated stroke units in acute hospitals throughout the country to care for patients admitted through accident and emergency departments The aim is to have 90% of acute hospitals operating a stroke unit to cover 90% of all stroke admissions. I acknowledge the Minister is very dedicated to this project. A total of 27 of the 28 units have been open and operational for the past 12 to 18 months. The only unit not yet open is the unit in Cork University Hospital. It is only one of two locations in the country that has the potential to operate as a centre of excellence in stroke care. I understand that to date, a considerable amount of funding has been allocated approximately for the recruitment of additional staff for the stroke unit but it is still not in operation. Why is it not open and when will it be opened? I understand that the Mercy University Hospital was not allocated additional resources but despite this, its stroke unit has been open for two years. The Bantry hospital stroke unit was opened in 2009.

It is widely accepted that general access to properly staffed stroke units will not only greatly improve stroke outcomes but could cut by 20% to 25% the annual death toll in Ireland of more than 2,000 people. This is a life and death issue. Stroke units save money as well as lives. The development of stroke units will reduce the number of stroke survivors requiring nursing home care. Figures from the Irish Hear Foundation indicate that as much as €414 million out of an annual cost of stroke of €557 million is spent on nursing home care for stroke survivors. An ESRI report for the Irish Heart Foundation, The Cost of Stroke in Ireland, states that the wider availability of stroke units and thrombolysis can save at least an extra 750 people each year from death and lifelong dependency and disability, while also saving the health service an estimated €230 million over the next ten years.

Funding was allocated to the HSE for the CUH stroke unit under the 2012 national stroke programme. A stroke unit is essentially made up of people rather than equipment. It is a concentration of expertise that has a dramatic added impact on patient outcomes. Essential personnel include stroke consultants, specialist nurses, occupational therapists, physiotherapists, speech and language therapists, dietitians, social workers, and psychologists.

In 2011, the chief executive officer of the HSE spoke at the joint committee on health about the development of stroke units at Cork University Hospital, Mercy University Hospital Cork, St Vincent's University Hospital Dublin, Limerick Regional Hospital and Our Lady of Lourdes Hospital, Drogheda. He said they would be completed by the first six months of 2012. We are still waiting for the CUH unit. When I raised the issue by way of parliamentary question in June 2013. I was advised by the HSE that upgrading work has been completed on ward 3A for some time. This ward will contain 11 beds for the stroke service, 13 neurology beds and a four bed epilepsy monitoring unit and video telemetry. The HSE has also advised in June, August and September this year that recruitment is under way for the necessary posts to staff the unit, and it was envisaged that the CUH stroke unit will be fully operational in the third quarter of 2013. It is still unopened.

I have continued to follow up the matter with the HSE since the summer and I understand that delays in opening the unit have been due to difficulties in the recruitment of staff, specifically additional nursing staff, despite an extensive recruitment campaign. I received a further communication from the HSE today advising me that a further series of interviews for nursing posts commenced yesterday and it is hoped that these will yield sufficient nurses to allow the unit to open in January or February 2014.

12:40 pm

Photo of James ReillyJames Reilly (Minister, Department of Health; Dublin North, Fine Gael)
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I am very grateful to the Deputy for providing me with the opportunity to speak on this matter.

Improvements in stroke services were envisioned in the Changing Cardiovascular Health: Cardiovascular Health Policy 2010-2019, which was launched in 2010. The policy establishes a framework for the prevention, detection and treatment of cardiovascular diseases, including stroke, which seeks to ensure an integrated and quality assured approach in their management to reduce the burden of these conditions.

The Health Service Executive has advised my Department that the situation with Cork University Hospital, CUH, is that it provides a full and comprehensive range of services for the victims of stroke. These services include neuro-radiology, including intra-arterial thrombolysis, acute neurology and elderly care medicine, which, when taken together, designate CUH as providing a comprehensive range of stroke related services.

To enhance this service delivery further and to provide a dedicated facility for stroke services, the executive management board at CUH allocated ward 3A as a suitable location for a stroke unit to be shared with the epilepsy and neurology services. When fully operational, ward 3A will comprise 11 stroke beds, 13 neurology beds and a four-bed epilepsy monitoring unit with video telemetry.

Funding of €25,000 was provided by the national stroke programme to enable some infrastructural upgrading of the ward. This work has been completed for some time, and Cork University Hospital has been working on progressing the staffing of the unit. The stroke unit will be staffed by relocating some existing staff from within the hospital and the recruitment of additional staff. The stroke unit includes a four-bed high dependency unit, HDU, which requires higher staffing levels. The HDU is where stroke patients who meet clear clinical criteria will receive thrombolysis. Currently, in many cases, this is provided in the emergency department. The new stroke unit will lead to this treatment being provided in a safer, more appropriate environment.

The delay in opening the unit is primarily attributed to difficulties in the recruitment of the additional staff required for the unit. Cork University Hospital has put in place a staffing plan based on training up a number of more experienced nurses who work in the hospital to allow them to work in the high dependency unit, but their current positions must be backfilled before they can be released.

Over recent months Cork University Hospital has engaged in a number of extensive recruitment campaigns with a view to recruiting additional nurses for the hospital. These nurses are required to replace those nurses who have left the hospital through resignation or retirement, and to staff new developments such as the stroke unit. While these recruitment campaigns have made progress in the recruitment of nurses for Cork University Hospital, the hospital has not yet reached the level of staffing required to allow the stroke unit to open.

A further series of interviews for nursing posts in Cork University Hospital commenced this week on 26 November. It is anticipated that these interviews will yield a sufficient number of nurses to allow the unit to open. The opening date for the unit will depend on how soon the new nurses can commence, but management in Cork University Hospital are confident they will have adequate nurse staffing levels to open the unit in late January or early February of next year.

Cork University Hospital provides an excellent service to stroke patients and the opening of the stroke unit later this year will further enhance the service available.

Photo of David StantonDavid Stanton (Cork East, Fine Gael)
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I thank the Minister for his response and I am hopeful this unit will open soon. There is new information in the Minister's response, namely, that experienced nurses working in the hospital will be transferred to the high dependency unit and that other nurses will then be recruited to fill their positions. I take it from that information that the hospital will be recruiting nurses who may not be as experienced or who are general registered nurses. The country is full of nurses who are unemployed so why is that process taking so long? We are talking about late January or early February before these positions are filled. As this is November, we are talking about another three months.

I do not know what is going on but we have had this false start on more than one occasion. I agree with the Minister that the hospital provides an excellent service and that this additional service will enhance what is in place. It is a shame the ward is available but is not being used. The Minister might find out, if not now then later, the reason it is taking so long to recruit ordinary nurses, and I use the word "ordinary" in a careful way, who are not as experienced, according to what the Minister has just said, to backfill the positions that will allow people move from their current posts to the high dependency unit. What is going on? I may be missing something but I cannot understand why nurses cannot be recruited when there are so many nurses looking for work. A series of interviews started only yesterday. I was led to believe that process was ongoing for months. Somebody must answer questions in that regard because, as I said at the outset, this is a matter of life and death for people, and these units make a huge difference. Something is wrong and it is not good enough that it has reached this stage. I know the Minister is committed to this issue. He works very hard on the anti-smoking campaign, which is related to stroke in that we know smoking causes stroke. It is important, therefore, that we get this done as quickly as possible, preferably before Christmas.

Photo of James ReillyJames Reilly (Minister, Department of Health; Dublin North, Fine Gael)
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I thank the Deputy again for raising this issue because it is unacceptable that it has taken two years to open this unit. Every other unit in the country has opened. The consequence of that is that we have gone from the bottom of the league in Europe to the top regarding the administration of thrombolysis, the blood clot busting drug that has saved so many lives. Moreover, the current statistics show we are saving virtually a life a day and saving three people from going into long-term care.

There has been an extraordinary improvement in outcomes for people with stroke as a consequence of these stroke units, and the Deputy is correct that it is not just about the presence of a CT scan or of thrombolysis. Having a dedicated unit with dedicated staff who become very experienced in the various nuances of dealing with people with stroke improves the outcomes also. I am aware that President Obama's health spokesman mentioned this, at an international conference in Oregon last year, as one of the areas where significant improvement has been achieved despite that country being in the face of a serious economic recession.

The people who work in our stroke units have done a phenomenal job in an extraordinarily short period, improving outcomes for people, and the people of Cork are entitled to the same service. As the Deputy rightly pointed out, I fail to understand why it is that the Mercy University Hospital has its unit in place and Cork University Hospital still does not. I will be meeting Mr. Ian Carter, the new director of hospital services, today and I will raise this subject with him. It is unacceptable it could take this length of time, when we know a large number of nurses have said they are leaving this country because they cannot get work, to recruit nurses for Cork University Hospital. It will be dealt with.