Denis Naughten (Roscommon-South Leitrim, Independent)
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89. To ask the Minister for Health his plans for the roll-out of the national stroke programme; and if he will make a statement on the matter. [42744/14]

Denis Naughten (Roscommon-South Leitrim, Independent)
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Since the launch of the national stroke programme, the death rate from stroke has fallen by 13% and the rate of discharge from nursing homes is up 28%, with savings of at least €21 million per year being made in reduced nursing home costs alone. Those statistics could be doubled if the Minister could provide the required investment, into both hospitals and the committee, to deliver on the totality of the national stroke programme and to install in the acute hospitals the seven telemedicine stoke machines that are currently in a warehouse in Cork.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy for raising this question. Understandably, in health, we always talk about what is going wrong but the national clinical stroke programme is an example of something that has gone well and is now used as an example in other countries as to what can be done.

I am checking up on those seven pieces of equipment. I am not sure the Deputy's assertion is true. They could be spares, but I will check up on that because someone else has asked me about them.

The programme, as Deputy Naughten mentioned, started early in 2010. The mission of the programme is to deliver better care through better use of resources. The vision is to provide an integrated model of clinical care in acute and community services.

Since its implementation in 2011, the national stroke programme has resulted in improved services for stroke patients. The 24-7 access to safe stroke thrombolysis, that is, where one busts the clot that is causing the blockage of blood to the brain in a stroke, is progressing, with emergency thrombolysis provided now to patients in all regions of the country. This has involved improved hospital and ambulance protocols, health professional training and the appointment of new physicians. The national stroke thrombolysis rate has increased from 1% in 2006 to 11%, exceeding the national target of 9% and is comparable to the highest rates internationally.

Since the national clinical programme for stroke commenced, nine new stroke units have been opened, bringing the total number of stroke units in acute hospitals to 24. The programme has provided funding to support staff for the implementation of stroke unit care, with 54 new nursing and therapy posts being filled. There are 20 additional clinical nurse specialists in stroke working in acute hospital services. Good clinical outcomes are being provided through initiatives such as early supported discharge for stroke patients. Early supported discharge involves intensive specialised stroke rehabilitation provided in the patient's home for up to eight weeks. This reduces the length of hospital stay, reduces long-term dependency, reduces the risk of further disability after six months and reduces the number of patients requiring long-term care. Early supported discharge services are funded in a number of locations. The feasibility of implementing this model in geographically dispersed populations is limited but the national stroke programme continues to provide funding for these sites.

Denis Naughten (Roscommon-South Leitrim, Independent)
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Following up on the Minister's last comment, is it the case, based on a study by the Royal College of Surgeons in Ireland and the ESRI, that the early supported discharge programme, if completely rolled out, would save 3,000 patients spending too long in hospital, save 24,000 bed nights and result in a net saving to the health service of €7 million a year?

The HSE sets aside €2.4 million each year for the national stroke programme in the acute hospitals. Will the Minister assure the House that all of that money is being spent on supporting the acute stroke service in the emergency hospitals?

Leo Varadkar (Dublin West, Fine Gael)
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I assume it is. I will double-check that for the Deputy. I suspect probably a little more is being spent than that.

I am a big fan of early supported discharge. It makes a lot of sense to get patients home more quickly to do their rehabilitation at home and that produces better clinical outcomes. Unfortunately, like a lot of savings posited in health care, it is not quite that simple. I have studied the ESRI report in detail and so has the HSE. We intend to extend the early supported discharge programme, if we can. However, it is not as simple as merely stating it will save millions of euro. Commentators always put that across in health. It requires us setting up a community infrastructure first and there is an initial investment cost before one can make any savings, and the savings only arise if one then reduces capacity in the hospital because there is the cost of setting up the service in the community. The saving only arises if one starts taking staff and beds out of hospitals and I would not do that because we need those staff and beds. If I can free up staff and beds in hospitals, I want to get patients off the waiting lists and into those beds. Unfortunately, there is not a net saving. There is an efficiency, but not a saving.

Denis Naughten (Roscommon-South Leitrim, Independent)
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The Minister said in his initial contribution the emergency thrombolysis service is available in all regions.

As the Minister is aware, it is not available in all acute hospitals. Portiuncula Hospital in Ballinasloe does not have an emergency stroke or thrombolysis service at present. Will the Minister give a commitment to the House, first, that priority will be given to the appointment of a geriatrician physician to provide a thrombolysis service at one of the emergency hospitals in the country that does not have it currently and, second, that one of the seven telemedicine stroke machines that are gathering dust in a warehouse in Cork would be installed in Portinucula Hospital in Ballinasloe and linked to Galway University Hospital? We would then have a 24-7 emergency stroke service that is available in other parts of the country but is not available at present in my region, which is putting lives at risk.

Leo Varadkar (Dublin West, Fine Gael)
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I said it is available in every region, not in every hospital. There is a difference. Trying to do everything in all 47 hospitals around the country does not produce better clinical outcomes. In fact, it can produce inferior outcomes.

Denis Naughten (Roscommon-South Leitrim, Independent)
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As the Minister is aware, that is not the case with stroke.

Leo Varadkar (Dublin West, Fine Gael)
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The best thing we can do is think about the health service differently and make sure that patients are, first, treated from the moment they get into an ambulance, which is done a lot in other countries, and, second-----

Denis Naughten (Roscommon-South Leitrim, Independent)
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Not with stroke.

Leo Varadkar (Dublin West, Fine Gael)
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-----that they get to the most appropriate centre as quickly as possible, which might not necessarily always be the nearest centre. If someone has a major trauma, he or she needs to go to a trauma hospital that has a trauma orthopaedic surgeon. We must begin to think differently about where ambulances take people in order that they go to the right hospital, not necessarily the nearest one.

Deputy Naughten is aware there are currently 200 consultant vacancies. I believe the position of geriatrician in Portiuncula is one of the vacancies. If it is, we will certainly do our very best to fill the vacancies. Each and every vacancy is a priority. I will not say that a consultant in Deputy Naughten's local hospital should be prioritised over a consultant service in another local hospital as quite frankly that is a parish pump approach, but I will prioritise the filling of all those vacancies as much as possible.

Denis Naughten (Roscommon-South Leitrim, Independent)
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We are the only region in the country without a stroke service. Minutes are very important in the case of stroke.

Michael Kitt (Galway East, Fianna Fail)
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We must move on. I call Deputy Paul Murphy.

Leo Varadkar (Dublin West, Fine Gael)
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Absolutely not. That is not correct.