John Brassil (Kerry, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I wish the Minister of State, Deputy Catherine Byrne, success in her new role. I look forward to working with her over the coming years in what is a very difficult area and a challenge for all of us. Today, I wish to specifically mention a very serious situation we have in University Hospital Kerry whereby we do not have an acute stroke unit. There have been great strides and progress made in many hospitals around the country. At present, 29 hospitals are serving stroke patients and 21 of those have an acute stroke unit. Unfortunately, University Hospital Kerry does not have one.

I wish to bring the Minister of State's attention to a report produced by the national stroke programme on the stroke services in University Hospital Kerry. The critical findings show that University Hospital Kerry does not provide an organised service for stroke or minimum mini-stroke patients. It does not have a dedicated stroke unit and it does not have a clinical lead for stroke treatment. It does not have a clinical nurse specialist in stroke treatment. It does not add to the national stroke register and it does not have access to early support discharge. Those findings are startling. It also states that these deficits would not only impact on death and disability, but would also impact on stroke standards, for example, early swallow screening, ongoing staff training, and patient and family education and support. The report adds that mortality for ischemic strokes - those essentially involved in the blockage of arteries supplying blood to the brain - are the cause of the majority of strokes and are 40% higher than that of the national average. It concludes that University Hospital Kerry is not providing an organised stroke service for its population. While national stroke services have improved significantly since the stroke audit in 2008, this is not reflected in University Hospital Kerry.

I have spoken to the doctors in Kerry hospital. Since the departure of a dedicated stroke specialist three years ago, that position has not been filled. There is still no filling of the clinical nurse specialist position. There was a post which was transferred to rheumatology due to financial constraint. That needs to be brought back. There is a lot of work that needs to be done immediately. There is a system failure here. The Irish Heart Foundation, which does fantastic work in this area, has flagged Kerry hospital as being one that it is extremely concerned about. My concern is greater than the lack of the acute stroke unit alone. Kerry hospital is supposed to provide this and if it does not, patients will start going to Limerick and Cork and there is the threat that the status of Kerry hospital will be challenged. There are wide-ranging implications around this issue and there needs to be immediate action. People's lives are at stake.

Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for providing me with the opportunity to speak on the subject of strokes. I am replying to this debate on behalf of my colleague, the Minister for Health, Deputy Simon Harris, and I am sorry that he cannot be here.

The aim of the HSE national clinical programme for stroke is to improve the quality, access and cost-effectiveness of stroke services in Ireland. Since the commencement of this programme, nine new stroke units have opened, bringing the total number of stroke units to 21. This represents good progress from the single unit that was available in 2008. I would like to draw the attention of the House to the national stroke audit which was published last year and pointed to encouraging improvement in many areas of stroke care. Specifically, the audit identified that inpatient mortality has reduced and discharges directed to nursing homes have reduced, and this has been matched with an increase in patients who are discharged directly home after a stroke.

The second national stroke audit emphasises the role of a stroke unit in a hospital. It reported that the provision of care in a stroke unit is supported by the evidence, reducing morbidity and mortality. Therefore, it is suggested that all sites managing acute patients should provide stroke unit care and all sites should develop their stroke units to provide the highest possible quality of care, including ensuring units are appropriately staffed, equipped and provide ongoing education and training for staff, patients and carers alike.

I am advised by the HSE that 24-7 access to safe stroke thrombolysis is available nationally. It is also worth noting that our current thrombolysis rate of 11.6% exceeds the national target of 9% and is among the best in national rates worldwide. I appreciate the Deputy's particular interest in University Hospital Kerry and the absence of a dedicated stroke unit at that hospital. I am advised by the hospital that recruitment and retention of the required staff is proving to be challenging. However, I understand that the business cases have been prepared for additional support staff, such that a stroke unit may be established.

These business cases will be considered by the South/South West Hospitals Group in the first instance and then by the HSE acute hospital division.

I am also advised that the case for a further geriatrician for the hospital has been referred to the consultant applications advisory committee for consideration. While there is no dedicated stroke unit at the hospital, I have been assured procedures are in place such that stroke patients can continue to receive treatment within hospital. Solutions are being sought across the hospital group to address the current situation. In that regard, the clinical needs of a patient will always be the determining factor, so patients will be transferred to tertiary hospitals if the need arises.

I accept that the Deputy will be disappointed that I cannot be more definite about the timescale for the establishment of a stroke unit at the hospital. However, the roll-out of stroke units is a work in progress and I thank him for drawing the particular need in Kerry to my attention.

John Brassil (Kerry, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

To say I am disappointed is an understatement. I am aware of the difficulties; we all are. The problem is that the situation is ongoing for three years. Somebody must take responsibility to get this unit established. The Minister said that thrombolysis is available nationally at a rate of 11.6% and exceeds the national target. In Kerry it is at 4%, as opposed to the national average of 11.6%. These figures are frightening. What is required is the establishment of the unit and the recruitment of the staff. There should be active participation by the Department and the HSE to recruit the necessary staff.

The last acute stroke clinical lead, Dr. McManus, resigned a number of years ago. Since then, in anticipation of the appointment of a replacement, the development of the acute unit has basically been in abeyance. That is no longer acceptable. Kerry General Hospital provides this service but does not have the facilities or staff to do it properly, so people are in danger. It is endangering their lives. It is a statistical fact that when proper stroke treatment is provided, the incidence of death and disability is reduced by 7%. That is a real figure and people are suffering due to the lack of a service that is provided in a majority of hospitals but not in one as significant as Kerry General Hospital.

I ask the Minister of State to convey to the Minister, Deputy Harris, the serious nature of this problem. We need action, not words. The unit must be set up and the staff and consultants must be put in place.

Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I certainly will convey the Deputy's concerns. The figure of 4% for strokes in Kerry General Hospital is a huge concern. I emphasise again that the Minister has made it clear that the HSE is trying its best to recruit staff but it has been challenging. It is in the process of ensuring there will be a unit in place as soon as possible. I will convey the Deputy's comments to the Minister. I will also mention the report he referred to, although I did not catch its name. Perhaps he would give me the name of it.

John Brassil (Kerry, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The national stroke programme.

Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy. I understand the Deputy's concerns and I will convey them to the Minister to the best of my ability when I meet him later.