Maureen O'Sullivan (Dublin Central, Independent)
Link to this: Individually | In context | Oireachtas source

Ba mhaith liom buíochas a ghabháil leis an Cheann Comhairle as ucht an deis seo a thabhairt dom an cheist seo a ardú. I know this matter was selected before the recess but I waited so that the Minister could address it in the Chamber.

Like me, I am sure she has had family and friends who have suffered strokes. We know not just about the medical side of stroke, but the psychological and emotional effects it has on the victim and on those who love them. We know also that there are personal, emotional and psychological costs along with the physical ones. Stroke is a life-changing experience.

Every year, the financial cost of strokes comes to over €550 million with €400 million of that going on nursing home care. Up to 75% of stroke victims never go back to work and there are major difficulties for them and their families. When the HSE, Health Service Executive, launched the national stroke programme four years ago, the death rate from strokes fell by 13% while the rate of discharge of patients from hospitals to nursing home care was down 28%. The savings from the reduced requirement for nursing home care are conservatively estimated at €22 million. These are positive results which came about because the HSE invested in a stroke network and took account of reports that stated better acute stroke services would save lives and money on a significant scale.

Better community rehabilitation services can maximise recovery, however. I acknowledge the work of the Irish Heart Foundation and its research in this area. Up to 44% of all stroke sufferers, more than 3,000 people every year, are in the mild to moderate stroke category. They could benefit from early supported discharge programmes. The idea is to get them home earlier. The Government’s health policy in many areas is about getting people back to their families and communities. We are very much in favour of that with mental health issues. This would be particularly valuable also in the stroke rehabilitation area. It is estimated that €12 million could be saved by such a move and it would free up 24,000 hospital bed days which are in demand. It is expected that an initial outlay of between €5 million to €10 million would be the annual cost to resource community therapy and services to stroke victims. The cost to implement this would be considerably less than the cost of inpatient stay. With so much going into nursing home care, those in the mild to moderate range are losing out when they leave hospital because they need physiotherapy, occupational and speech and language therapy. It would be better for them to be at home where they would have services and a greater delivery of care in the community.

The 2014 Irish Heart Foundation, Economic and Research Institute of Ireland, ESRI, and the Royal College of Surgeons in Ireland, RCSI, report stated:

Clinicians engaged in stroke care in 24 out of 28 acute hospitals agree that inadequacies in community services lead to referrals of patients post-discharge for rehabilitation services in hospitals or other inpatient locations such as nursing homes, who could be treated at home by community services if these were more readily available.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for raising this issue. I am glad to be here as I have a particular interest in this area due to family circumstances. Since the introduction in 2010 of the national cardiovascular health policy, significant improvements have been made with regard to access to acute treatments for coronary heart disease, as well as the development of stroke units. Key elements of stroke care now available include new and existing stroke units provided with additional therapy, nursing and consultant posts. Thrombolysis is now available to acute hospitals admitting stroke patients, 9.5% of whom are being thrombolysed which compares well with the best European figures.

The aims of the national stroke programme are to provide national rapid access to best-quality stroke services including acute care and the implementation of early support discharge, ESD, services. The implementation of ESD services is within the context of the wider range of rehabilitation services required by stroke patients. The stroke programme estimates the number of people with enduring disabilities as a result of stroke has decreased as the percentage of patients with stroke discharged from acute hospitals to nursing homes dropped from 17.3% in 2009 to 14.5% in 2012. It has gone down again since then. The percentage of patients discharged directly home increased from 49.4% in 2009 to 51.1% in 2012. A certain percentage of stroke patients will be suitable for ESD which involves intensive specialised stroke rehabilitation provided in the patient's home for up to eight weeks. I agree with the Deputy that the notion of taking up a hospital bed when one can have treatment in the comfort of one’s home makes no sense. This reduces the length of hospital stay, long-term dependency and the risk of further disability after six months, as well as reducing the number of patients requiring long-term care.

ESD services are funded in several locations. The feasibility of implementing this model in geographically dispersed populations is limited. The national clinical programme for stroke, NCPS, continues to provide funding to these sites. During 2013, a total of 90 patients were discharged home via an ESD service across three ESD service sites - the Mater Misericordiae University Hospital, Galway university hospitals and Tallaght hospital. Patients requiring more intensive rehabilitation are referred to the nearest available rehabilitation service. The establishment of managed clinical rehabilitation networks for neurological and prosthetic rehabilitation services in each of the four HSE regions contributes to rehabilitation services. The National Rehabilitation Hospital provides specialist stroke rehabilitation as a national hub and links in with regional services.

The Department of Health's national policy and strategy for the provision of neuro-rehabilitation services in Ireland, in collaboration with the national clinical programme for rehabilitation medicine, provides for improved access to and quality of services for patients requiring rehabilitation. The rehabilitation medicine clinical programme and the HSE’s disability services division are developing an implementation plan for the neuro-rehabilitation strategy.

Primary care also plays an important role in stroke rehabilitation. As of 6 September 2014, some 229.5 of the 264.5 primary care team posts have been filled or start dates agreed. The HSE is striving to have the remainder of the posts filled as soon as possible in 2014.

Taken together, all these developments show we have made significant progress in preventing stroke and its complications. The issue of how best to further develop and support early stroke discharge is under consideration by the HSE stroke programme.

A friend of mine recently had a stroke. A lot depends on how quickly one gets to a unit that has the capacity to deliver the relevant treatment.

Maureen O'Sullivan (Dublin Central, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for that reply. We are saying the same. It is opportune because World Stroke Day was on 29 October. The reports, findings and the opinions of people who work with stroke victims all say the same thing: proper consultation, organisation and better community therapy services for stroke survivors will improve their quality of life on a major scale. We would see more cost savings than under the current system; therefore, there is an economic justification for the rapid development of community rehab and care services. We are also talking about international best practice. Above all, however, there is a greater justification on the personal side. It is about making a difference in the lives of those who suffer stroke and those who love them. My own recent experience involved someone who had a stroke. He was quickly admitted to hospital, where the care was excellent. He then went to a nursing home but spent far too long there. The care and therapy there was too intermittent and too short. If that person had been at home receiving community care with his family and friends around him, encouraging him, that informal therapy would have been much more valuable. If we are going to make a difference, we must deal with the matter urgently. The services are not seeking a blank cheque, and while it is not an astronomical amount of money, it can make a big difference.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

I could not agree more with the Deputy. The joining up of posts we are putting into the community provides that sort of interconnection between primary teams and community intervention teams. I have first-hand experience showing that when strokes are treated quickly and in the correct location, the outcome can be as though the stroke had never occurred. It is incredible. I credit the last Government and ourselves for identifying that system and making it work.

I was hugely impressed recently by a normal gym that had equipment everyone could use for balance and muscle capacity in terms of stroke. The general population also uses that gym. It was not a matter of having different equipment, but equipment that could be used by both able-bodied people and those who need additional help. We are on the right track but we need to do more.