Tuesday, 19 July 2016
Topical Issue Debate
Is the Minister of State aware there are over 25,000 people who need rehabilitation each year? Most of these people struggle even to get the most basic level of service, according to the Neurological Alliance of Ireland. One of them is a lady named Vera Ronan. She was a happy energetic woman, active in her community and fond of the game of darts. She was close to her family and a very vibrant individual. She suffered a fall on 2 July 2015 and following some very good care in Beaumont Hospital, she was transferred on 18 July 2015 to Connolly Hospital, receiving care there for approximately six weeks. Following that, she waited in the hospital bed for a transfer to the National Rehabilitation Hospital or for any form of rehabilitation services. Her family assisted the nurses and carers and sat by her bedside, minding her as anybody would mind their mother. They watched her deteriorate and wait every single day. While she was in the bed, there were people downstairs on trolleys in the accident and emergency department. She should not have been in that bed; she should have been getting neuro-rehabilitation but she could not get it.
According to the Neurological Alliance of Ireland, the problem is at crisis level. We should have 270 inpatient beds for our population but we have fewer than half that number, with none outside Dublin. We should have four regional inpatient specialist rehabilitation services nationwide but we have none. There should be a minimum of nine community neuro-rehabilitation teams nationwide, with one in each community health organisation as a starting point, but there are only three, with none adequately staffed. I know Vera Ronan's family and their hearts break over the eight months lost, when their mother could have made serious progress. Every day that is lost, it takes two or more days to get the day back. It was heartbreaking for her family to have to see her in a hospital bed when she did not need to be there, effectively getting very expensive bed and breakfast. She needed neuro-rehabilitation.
Will the Minister of State commit to publishing a meaningful plan by the end of 2016 for the implementation of the national neuro-rehabilitation strategy that covers key actions, timeframes and a deadline to implement it? We have the report and know what needs to be done. We need a timeline, actions and identifiable targets. Will the Minister of State commit to appointing a senior manager in the HSE in 2016 to complete the plan and lead on the development of rehabilitation services nationally? We are failing people who need these services so badly because they have a chance of recovery; every day they spend without the neuro-rehabilitation services, they are being pushed back even further. There are 25,000 people per year who require this level of intervention. We have a plan so we do not need another report, as the Minister of State knows as well as I do. We need timeframes and a commitment to implement the plan.
I am pleased to take this opportunity to update the Deputy on the implementation of the National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland, which made a number of recommendations for services for people with neuro-rehabilitation needs. The programme for a partnership Government places a particular focus on a number of key programmes and strategies, including publishing a plan for advancing neuro-rehabilitation services in the community. Currently, a steering group led by the Health Service Executive social care division, with representation from the national clinical programmes for rehabilitation medicine and neurology and the Neurological Alliance of Ireland, has drafted an implementation framework for the national policy and strategy for neuro-rehabilitation services. The draft framework is the subject of consultation at present.
Following on from the development of the neuro-rehabilitation policy and strategy, the HSE established the clinical programme on rehabilitation medicine. The scope of the clinical programme on rehabilitation medicine covers the whole of the patient journey from self-management and prevention through primary, secondary and tertiary care. It provides a national, strategic and co-ordinated approach to a wide range of rehabilitation services. The implementation framework will guide and oversee the reconfiguration and development of neuro-rehabilitation structures and services at national and local level.
The framework outlines the key issues, themes and considerations, particularly with reference to the necessary reconfiguration and development of community services within the HSE's community health care organisations and inpatient specialist rehabilitation services.
It is envisaged that implementation will involve reconfiguration and development of resources with the community health care organisations to establish specialist neuro-rehabilitation teams within each area as well as reconfiguration and development of specialist inpatient rehabilitation services. This is in line with the rehabilitation medicine programme model of care and national trauma policy and integration of all specialist rehabilitation services within what is envisaged as being managed clinical networks where each of the nine community health care organisations will establish local implementation teams. A neuro-rehabilitation network, based on a hub and spoke model, will serve population based areas of the country. Managed networks will link closely with the National Rehabilitation Hospital, community rehabilitation teams, primary care centres and acute hospitals in their areas.
Alongside these developments, the Government announced a major capital development of the National Rehabilitation Hospital. This will deliver a modern, purpose built hospital on the current site. It will have 120 inpatient beds and will include support therapies, paediatric and acquired brain injury wards, a hydrotherapy unit and a sports hall. A priority for the implementation of the recommendations of the national policy on neuro-rehabilitation services in Ireland will be to establish a structure and methodology to provide the development of neuro-rehabilitation services. This will include the reconfiguration of current service provision. Services will be developed by the HSE social care division and other relevant HSE divisions in collaboration with the national clinical programme for rehabilitation medicine. This will ensure appropriate planning, service delivery and governance for neuro-rehabilitation services.
I agree with Deputy Louise O'Reilly that it is not acceptable that 25,000 people are waiting for rehabilitation services. I listened carefully to what she said about Vera, the woman she mentioned.
With the greatest of respect, what the Minister of State has just read out is word for word a copy of a letter I received. I did not even have to look at the copy of the reply I was handed because I had it already. I received it on 15 July from the HSE. I asked the Minister of State for a date and a meaningful plan by the end of this year, with dates and achievable timeframes. The report was first published in 2011 and these people have already been let down enough.
The Neurological Alliance of Ireland currently has a campaign called "We Need Our Heads Examined". Sometimes I say that to myself when getting out of the car in the morning on coming into work. The campaign outlines the litany of broken promises and missed deadlines. We do not have a deadline today. What we have is a plan but we had a plan before we came into the House. What we need are deadlines and timeframes and a commitment to appoint a person from the HSE who will drive this forward.
There are many benefits to the strategy. The HSE itself is clear that its implementation will result in reduced length of stay in acute hospitals, a 10% reduction in readmission rates, a 5% reduction in care requirements and a reduction in discharge to nursing homes. There is a saving to be made. However, we still do not have a date.
The Minister of State agrees that it is not acceptable. If that is agreed, will he agree that we need to put a plan in place? We do not need more statements such as "we will have a group" or "this might happen and, at a later date, something else might happen". Vera Ronan has lost vital time. She has also taken up a bed in a hospital that could have been used by someone who needed it. We have people on trolleys in the accident and emergency department and Vera in the hospital bed but she does not need to be there. It really is not acceptable. If the Minister of State agrees that it is not acceptable, will he agree that we need a plan with a timeframe and identifiable and achievable goals as well as a person to head this up and drive it forward? These people have been let down far too many times.
This is exactly what will happen. In the programme for Government, the 2016 national service plan includes the rehabilitation strategy and integrated care programme. On particular plans over the coming months, the 2016 capital plan includes the progressing of this National Rehabilitation Hospital. There are also actions to implement the rehabilitation strategy and the integrated care programme. For example, each community health care organisation is to review the draft implementation plan. Second, they will amend implementation plans following feedback as appropriate. Third, each community health care organisation is to map existing services and identify deficits. Finally, each community health care organisation will identify reconfiguration of staff to prepare a plan for implementation of the strategy.
I will go back to the Minister on this matter. There are no particular dates but there is a plan for 2016 to get on and build the hospital. As stated, I find it unacceptable that people in this particular situation are in hospitals. Deputy O'Reilly makes the valid point that their occupying of a bed takes it from someone else who needs it. I will go back to the senior Minister, Deputy Harris, and put on the record my concerns about implementing the actions that are committed to in the programme for Government. We need to do our best to support these people. There are 25,000 of them out there. We have a direct plan to put in a 120 bed unit as a start and we have to roll out other services as well to assist these people. We need action and I will demand it from the Minister.