Catherine Murphy (Kildare North, Independent)
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I am very pleased this subject has been selected. I doubt the Minister for Health or any other Minister can be satisfied with the situation that pertains in regard to neurological services. We have just seven rehabilitation consultants in the country and we are ranked second worst in Europe. If we increased this figure to 50, we would still be ranked second worst in Europe, and if we increased it to 150, we would still have fewer consultants per capita than Serbia, Croatia or Latvia, all of which have overcome very serious economic and governance issues in recent years.

This is having a very direct impact on people who urgently need care. It is inhibiting and making people dependent rather than independent, and that itself has costs. The Neurological Alliance of Ireland, which is an excellent organisation that works tirelessly on this issue, has produced statistics recently that show 40% of those affected could not access neuro-psychological services, 25% could not access physiotherapy or occupational therapy, 57% were badly impacted by the rising cost of medication, 25% were forced to use private physiotherapy services, which is a very big expense for them, 17% were refused a medical card, 10% had their medical card withdrawn and 84% had serious concerns into the future about the cost of health care and cutbacks.

The alliance has identified a number of areas where it believes changes need to happen urgently. The question of waiting lists and the recruitment of specialists is critical. Multidisciplinary care is hampered by an over-stretched level of staffing and the embargo. The aftercare at community level is practically non-existent in some areas. This is an area where we are not working very smartly in that it will cost us to keep people dependent. Urgent investment is required in this area.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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I welcome the opportunity to raise this very important issue. There are some very startling figures in regard to the number of people who are suffering with neurological problems. More than 700,000 people in Ireland have some neurological condition and in ten years time there will be 860,000 such people. That is a staggering number of people who will be impacted and it points to the urgency of the issue. Some 44,000 individuals are newly diagnosed each year and 89,000 individuals are disabled by their neurological condition. In excess of 66,000 people care for someone with a neurological condition. I know people's eyes sometimes glaze over when one starts quoting numbers, but these are very stark and startling figures.

I will not repeat the points made so ably by Deputy Murphy in regard to the low number of neurologists in the country. I take a moment to reflect on our colleague, Deputy Nicky McFadden, who is suffering from motor neurone disease. What we need is not just adequate but proper neuro-rehabilitation. If the people who are suffering from any of the many known diseases which are neurologically based, such as multiple sclerosis, Parkinson's disease and motor neurone disease, do not have proper access, they are less likely to return to work, which may be possible depending on their condition. They are also more likely to need expensive nursing home care and their stays in hospital will be for longer or they will be more frequently readmitted. We need to look at implementing the neuro-rehabilitation strategy which was planned in 2011 by this Government. That is something we need to prioritise and I call on the Minister for Health and the Government to do so.

Brian Hayes (Dublin South West, Fine Gael)
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I thank both Deputies for raising this very important issue on health care provision and service. As both Deputies will know, in 2011 a national policy and strategy for the provision of neuro-rehabilitation services in Ireland was set out for a four year period from 2011 to 2015, and the Health Service Executive established the clinical rehabilitation medicine programme by way of a number of initiatives in that area. Many people believe the key to success of these developments is the approval and assignment of regional rehabilitation medicine consultants, which was the point raised by Deputy Murphy. I want to put on record, because it is important to do so, that the number of rehabilitation medicine consultants nationally increased from seven to 12 in 2013 with the appointment of five new national and regional specialists currently taking up posts, a point I will return to later. Specialist inpatient and outpatient units have been identified to operate in each of the four current Health Service Executive regions, with clinical governance and expertise provided by the National Rehabilitation Hospital.

I understand the National Rehabilitation Hospital has put in place a number of new initiatives to address the issues raised by the Deputies. The first is a pooled shared waiting list so that, whereas previously the patient waited for the consultant he or she was under, the patient now waits with everyone else and, as availability arises, he or she is dealt with. Second, the early access rehabilitation unit caters for patients whose treatment programme can typically be completed in a shorter period, which enables increased throughput of patients with less complex needs. Third, the National Rehabilitation Hospital actively manages the waiting time for admission to the high intensity rehabilitation beds, and the current average waiting time for admission is down from 273 days to 148 days, so obviously some progress has been made under the National Rehabilitation Hospital.

The Government has committed to part-funding a 120 bed rehabilitation unit with integrated therapy spaces to replace the existing National Rehabilitation Hospital at an estimated total cost of €54 million. The national clinical programme for neurology has reviewed the demand and capacity for access to neurology consultants for adult services. Consultants have been appointed to seven of the proposed ten additional posts over the past 18 months. The remaining three consultant posts are in various stages of the national recruitment process. One consultant neurologist has commenced in paediatric services, along with two additional consultant paediatric neuro-physiologists.

The HSE has made commitments in the 2014 operational plan on the implementation of the neuro-rehabilitation strategy. A steering group has been established to guide its implementation and ensure adequate links with the clinical rehabilitation medicine programme.

Catherine Murphy (Kildare North, Independent)
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The improvements are tiny in comparison with the need identified. It is shameful. When one looks at the return from being smart and helping people to rehabilitate in order that they can play a more active and, possibly, complete role in society, it is mind-blowing that our ambition is so limited. It is not just about counting the cost of appointing specialists; it is also about outcomes and the roles people can play. We talk about the provision of high dependency beds in the National Rehabilitation Hospital; there are only three such beds. We are keeping people in acute hospitals when they could move to rehabilitation centres. It is so short-sighted. Money is also being cut in the not-for-profit sector in which there is voluntary support. Therefore, people are being hit on the double. There is a need to revisit this issue. It is about working in a smarter way and taking a longer view. Too little has been done.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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I very much welcome the news that additional consultant neurologists have been appointed this year, but that is only part of the picture. There are many other parts of the strategy on which we need to focus. Only a very small proportion of people can access the National Rehabilitation Hospital. I think the figure is about one half because of where they are located. Those living in regional areas need to be able to access specialist rehabilitation services in regional hospitals. There is also a need for community-based teams to provide rehabilitation services for people close to their own homes. Aids and appliances will be needed to enable response times to be much quicker. People with a neurological condition require counselling, support and information. This is part of the bigger picture for those who urgently need a response from us to resolve the difficulties they are experiencing.

Brian Hayes (Dublin South West, Fine Gael)
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I share the frustration of colleagues about the roll-out of a programme that dates back to 2011 and a strategy which at the time was to be achieved within a four year timeline and their desire to achieve much more for people who find themselves in this position. As Deputies Marcella Corcoran Kennedy and Catherine Murphy said, this is about more than just acute hospital services. It is also about the supports we need to provide for communities to help people on their journey of rehabilitation.

On behalf of the Minister for Health, I wish to state the Government is committed to the strategy and believes it is the best way to achieve the improvements in services for people who find themselves in this position. Obviously, the commitment to part fund to the tune of €54 million a new rehabilitation centre with over 120 beds and which will provide multidisciplinary therapy support is welcome, but we must get on with the task of fully funding the service because that is the only way we will be able to make a difference. I note that the steering group has been established. I am not aware whether both Deputies are members of the Joint Committee on Health and Children, but it might be offer a useful opportunity to call in the steering group at the earliest opportunity to see what progress we can make, particularly in making sure the three additional postholders are in place this year. Providing for such oversight of the work of the steering group would be very useful and is something the Minister would support. We need to keep up the pressure to make sure we deliver on the strategy.