Derek Keating (Dublin Mid West, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to speak on the issue of rehabilitative care for persons with an acquired brain injury in Ireland, and I thank the Minister of State for being present. Due to the advances in medicine and technology, brain injury survival rates in this country have improved. Advanced imaging and surgical techniques mean that early intervention can lead to long-term survival for persons with acquired brain injury. However, they are often saved and then left, because access to, availability, and funding of rehabilitation services have not matched medical and technological advances.

Persons who acquire a brain injury frequently occupy a bed in an acute hospital for a protracted period of time and might move from there to a nursing home setting, or home, if they are lucky enough to have support in the family. Persons with an acquired brain injury in many cases cannot access services and rehabilitation on their own behalf. As a result, they often are left with a lack of rehabilitation opportunities and remain in inappropriate settings.

At this point, I will discuss the case of Sara Walsh Delaney, who entered hospital for a biopsy for a benign brain tumour in October 2011, three months after her marriage at the age of 28. She suffered a massive brain haemorrhage, could not be roused from a coma and ended up bed-bound in Beaumont Hospital for two years and three months. Her mother, Mary, her father, Martin, and her sister, Niamh, fought for her to have access to treatment when the powers that be saw her as a problem and wanted her to be moved to a nursing home to free up a bed. Sean O'Rourke of RTE championed her cause, and my colleague Deputy Finian McGrath asked questions in this House on Sara's behalf.

Sara was taken to the National Rehabilitation Hospital, NRH, in August 2014, was treated there for a period and then returned to Beaumont Hospital. Later, in December 2014, Sara, then 31, went to the Royal Hospital Donnybrook, in the ward for young patients under 65, under the Fair Deal scheme. Sara's family and friends engaged in extensive fundraising that meant she could travel to Germany for six weeks of intensive rehabilitation. Once there, she made great progress. After her return in April to the Royal Hospital Donnybrook, however, Sara regressed because she was entitled to only two hours of therapy per week.

A further scan a number of weeks ago showed the benign tumour to be growing, and Sara was transferred to St. Francis Hospice in Blanchardstown, where, sadly, she died on 17 June, a few short months after her 32nd birthday.

I mention Sara's case because it highlights the lacuna in the health services in Ireland. There is no golden ticket that fast-tracks treatment, as long-term care and rehabilitation is specifically excluded from health insurance policies by all providers. For persons with disorders of consciousness for which 24-hour care is needed, there are three beds in the country. Rehabilitation cannot be accessed or paid for in Ireland except through the HSE, and a person with an acquired brain injury cannot bring his or her own physiotherapist into a long-stay hospital in Ireland.

This evening I make the case that we need to urgently review the position with regard to the National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland 2011-2015.

Kathleen Lynch (Cork North Central, Labour)
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I thank Deputy Keating for raising the issue. I assume he understands that I will not be referring to any individual case other than to express our sympathy to the family of the person he mentioned. It was quite a tragic case. I hope that is accepted.

I am pleased to take this opportunity to outline the current position in relation to the provision of rehabilitative services to persons with acquired brain injury in Ireland. Brain injury health services are provided across a range of settings, by different organisations and by many health professionals and carers. The HSE clinical strategy and programmes directorate has a number of clinical programmes that are working in the area of the brain, including neurology, epilepsy, stroke and rehabilitation medicine. These programmes are focused on reducing waiting times and addressing specific disease pathways and models of care with a view to developing a national framework for the management of long-term neurological conditions. The HSE also provides services through primary care teams with community-based therapy services and personal social services, often funded through partner agencies in the non-statutory sector. The Government's national policy and strategy for the provision of neuro-rehabilitation services in Ireland provides the overarching framework for the development and provision of such services. The strategy made a number of recommendations for services for persons with neuro-rehabilitation needs that covered different types of provision, including clinical, therapeutic, social, vocational and community supports. The HSE has established a steering group which will guide the implementation of the strategy with the development of a framework for implementation and ensure adequate links with the national clinical programme for rehabilitation medicine.

An implementation framework for the strategy is being developed by both the HSE disability services division and the HSE clinical programme for rehabilitation medicine. It will be circulated to a wider group of stakeholders for consultation. The development of this framework is the first phase of the implementation planning process. It will establish implementation structures, develop a model of services and supports, map existing resources and review and reconfigure existing services. In addition, the framework will identify requirements to support service delivery, such as information systems, staffing competencies and quality improvement. Communication with stakeholders will take place during the implementation process. A priority will be to establish an implementation structure in order to guide the development of services. Services will need to be determined and informed by clear referral and service protocols which are developed nationally and implemented consistently throughout the health care system.

The strategy proposes a hub-and-spoke arrangement between the National Rehabilitation Hospital in Dún Laoghaire and a network of regional rehabilitation units. Plans to invest in and redevelop the National Rehabilitation Hospital are well under way, and I hope that this will give us greater scope and greater availability of beds. I also understand that a number of proposed developments at regional level are at early design stage. The HSE also provides substantial funding to a number of organisations, such as Acquired Brain Injury Ireland, Headway Ireland, Enable Ireland and Spina Bifida Hydrocephalus Ireland, to provide supports and services to persons with neurological conditions. It is important that the continuum of services and supports required are made available by the health system and by those other State agencies to provide specific services consistent with their statutory remit. Waiting times, access, treatment and quality of care continue to be priorities for reform for this Government, despite budgetary constraints. The Government recognises that neurological illness or injury has significant implications for the individual and his or her family and impacts on the individual's health and social, educational, vocational and recreational participation.

I hope this is of some benefit to the Deputy. The further development of the National Rehabilitation Hospital in Dún Laoghaire will give us greater scope for delivery of these services.

Derek Keating (Dublin Mid West, Fine Gael)
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I thank the Minister of State. I fully appreciate that she is not in a position to comment in any way on a specific case, but I am sure she understands that bringing such an example to the Dáil today helps to emphasise the need for progress on an issue such as this. I appreciate the Minister of State's statement on behalf of the Minister for Health.

I recognise that the Government's national policy and strategy for the provision of neuro-rehabilitation services in Ireland provides that overarching framework for the development and provision of these services. I referred to the 2011-2015 strategy report, and I recognise the importance of this. The strategy sets out a national model for service delivery and a framework for the future based on a continuum of individualised supports and services that are accessed at different stages in the rehabilitation journey, but what concerns me is that this report is still awaiting the development of an implementation plan by the Department of Health and the HSE. There is a large and growing unmet need since the report was introduced in 2011. What I really want is to see that strategy implemented and progress made on it after the number of years that have passed since its introduction. I thank the Minister of State.

Kathleen Lynch (Cork North Central, Labour)
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As I stated, the priority will be to establish an implementation structure in order to guide the development of services. Services will need to be determined and informed by clear referral and service protocols which are developed nationally and implemented consistently throughout the health care system. I reiterate that on the basis that we know how to implement it. The difficulty is pulling together all of the services that already exist, not only within the Dublin region but throughout the country. Those services were fragmented to a significant degree, but they were there. With the hub-and-spoke approach, which is, I believe, the one that we should follow, one would have the hub, which is centralised within the National Rehabilitation Hospital in Dún Laoghaire, and the other areas would develop on a consultation basis, with rehabilitation consultants in different areas delivering services.

The most important issue - which, as an elected representative, I am aware that others hear about as well - is the constant cry to get people into an appropriate bed in that rehabilitation hospital. Even when this country was awash with money, that need was there, but it was not given any great freedom to develop. We have decided to allow that development to go ahead and we will be providing whatever resources are necessary to ensure that the hospital is redeveloped, because we need additional capacity and it has the expertise. As I stated, I do not want to refer to individual cases, but in the event that someone in a crisis situation had easier access to a bed within that type of specialist centre, I am not saying the outcome would have been different, but I believe that the security within the family would probably have been different.