Eoin Ó Broin (Dublin Mid West, Sinn Fein)
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10. To ask the Minister for Health the estimated cost of rolling out early supported discharge programmes nationally for stroke patients in circumstances in which this would improve patient outcomes and free up acute hospital beds; if he will roll out early supported discharge programmes nationally for stroke patients in view of the fact that this would improve patient outcomes and free up acute hospital beds; and if he will make a statement on the matter. [20214/17]

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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When I was a union official we had a particularly difficult employer and we used to say that if something we suggested made sense he would not do it. My question, however, makes eminent sense. Supported discharge programmes have been proven to work so will they now be rolled out nationally? Will they be funded and prioritised?

Simon Harris (Wicklow, Fine Gael)
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I always listen to the Deputy's sensible suggestions. The national clinical programme for stroke has been in place since early 2010. The vision of the programme is to design standardised models of integrated care pathways for the delivery of clinical care. Early supported discharge is a rehabilitation programme that aims to accelerate discharge home from hospital and provide rehabilitation and support in the home setting in order to maximise independence as quickly as possible after stroke. Pilot early supported discharge programmes in three sites in Ireland have proved to be effective, with up to 35% of stroke patients being discharged successfully.

The HSE has advised my Department that its integrated care programme for patient flow has identified the need to strengthen the integrated patient-centred approach. Improving discharge processes is not only necessary to deliver safe and truly person-centred care but also to optimise bed utilisation.

Funding has been allocated by the clinical strategy and programmes division to the integrated care programme to support the national clinical programme for stroke to expand the early support discharge stroke programme in 2017. This involves increasing staffing in three existing early supported discharge stroke teams and developing two new teams at a full-year cost of €460,051.

Early supported discharge complements the range of measures to improve stroke care including 24-7 access to thrombolysis and increasing the number of stroke units to 22. These measures have reduced stroke mortality, reduced average length of stay in hospital and enabled more stroke patients to be discharged directly to home. This is in their rehabilitative interest as patients, as well as being in the interest of the health service by ensuring better bed utilisation. In advance of the Estimates for 2018, the HSE will prepare costings for the roll-out of this programme and the Department is currently engaged with the HSE on the business case, as part of the development of the HSE's national service plan in advance of budget 2018. I will share more information on this with the Deputy as it becomes available. It will be hard not to agree on something that is beneficial and we are expanding it this year with additional teams. There is scope to do more and I hope we will have a full business case in advance of the 2018 Estimates.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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The Minister says it will be 2018. If it makes sense now, would it not make sense to prioritise it?

Even though pilot ESD programmes have been proven to be effective, only three early supported discharge teams are in existence covering four acute hospitals. If we have all decided we agree on it, it is farcical not to act on it. International studies show that 25% to 40% of all stroke patients can benefit from early supported discharge programmes. The long-established cost effectiveness helps in the production of any business case. It is estimated that we could save between €2 million and €7 million a year. It is not just saving money; it is good for the patient to have early supported discharge. When will we see this in place? Since it has been proven to work, I do not know what the problem is leading to its delay.

Simon Harris (Wicklow, Fine Gael)
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There is certainly no problem. We are not just saying it works and is that not great; we are actually saying it works and let us do more in 2017. That is why we are providing additional funding this year to increase the staffing in the three existing early supported discharge stroke teams and to develop two new teams. As I have outlined to the Deputy, the cost of that is €460,051 in a full year. As is normal, in advance of the Estimates process the HSE is working with my Department to prepare costings if we were to roll out this programme nationally. In advance of the Estimates process formally beginning I would be very supportive of this because it makes sense from a bed utilisation point of view. We have had the benefit of the pilots. We are now putting the staff into those two additional teams. I expect to be able to share with the Deputy more concrete details on the costs of rolling it out nationally well in advance of the budget 2018 process. This is something my Department, the HSE and I all support. A body of work is being done to see how it can be rolled out nationally.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Let me clarify this. We are agreed that the pilots worked, that there are savings for the Exchequer and that there are benefits for the patients. We are ticking all those boxes. Is the plan for the Estimates that it would be a full roll-out next year and not another pilot or a partial roll-out? I am not trying to put words in the Minister's mouth; I am asking a genuine question. It will not be another pilot, but a full roll-out giving full availability to those who need it for next year.

Simon Harris (Wicklow, Fine Gael)
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I accept it is a very genuine issue. The Deputy will also accept that I cannot deliver the budget for 2018 now at the start of May. However, my Department is working with the HSE to prepare the business and health case for the roll-out of early supported discharge services throughout the country. That is the work the Department of Health is undertaking with the HSE. I would like to see this rolled out nationally and the vehicle for achieving that is the budgetary process. The Deputy is correct; I am not talking about another pilot, but a national roll-out.