Thursday, 31 March 2022
Saincheisteanna Tráthúla - Topical Issue Debate
I thank the Ceann Comhairle for the opportunity to raise this important issue.
Where is the neurorehabilitation strategy at within Government? In 2021, the World Health Organization identified neurological disorders as the most significant cause of acquired disability worldwide. The UN Convention on the Rights of Persons with Disabilities calls on countries to strengthen, organise and extend rehabilitation services for people with disabilities. More than 25,000 Irish people each year struggle to get the neurorehabilitation services they need to prevent disability and support recovery from conditions, including strokes, acquired brain injury, multiple sclerosis and Parkinson's disease.
It cannot be overstated how important it is to have early and timely access to rehabilitation services to reduce secondary complications, improve health outcomes, improve function, reduce the length of time in acute hospital settings, and facilitate a return to home and community living. Ireland has less than half the number of specialised rehabilitation beds recommended for its population. Some 240 are needed in total and Ireland has just 120 and, at fewer than 12, the lowest number of consultants in rehabilitation medicine in Europe. Despite the recommendations of numerous reports, and decades on from when the issue was first highlighted, there is still no dedicated specialist medical rehabilitation unit in the south of Ireland.
There continues to be an overwhelming lack of neurorehabilitation services at all stages of the pathway for persons with neurological conditions. At a bare minimum, there should be one dedicated specialist neurological team per community healthcare organisation yet only three such teams are in place nationwide. The additional teams in CHO 6 and CHO 7 funded in 2019 have not yet been established. People who look at this are very concerned about it. One of the clear recommendations arising from a presentation to the Joint Committee on Disability Matters in November from those appearing before it related to when the neurorehabilitation strategy would be published. Where is it at? We got signals from the Government and Departments that it was being looked at and was going to be published but we need to see when that will happen. Unless we see it will be published, we do not believe there is a seriousness at Department and Government level to tackle the neurorehabilitation services that are so vital.
There is a long waiting list for access to services, which is largely based on a geographic lottery. People with neurological conditions spend significantly more time in hospital than is necessary and live in inappropriate settings, such as nursing homes for older people, psychiatric facilities or at home with families who simply cannot cope. They largely lead lives of exclusion and isolation distanced from social, community and economic life. Equally, their families experience a significant burden of isolation. These are the challenges. If we are serious about it, we need this strategy in place. From the experience of teams that were set up in 2019 in different CHOs, they are still not in operation or in place. They need to get staffing.
I hope the Minister of State has some good news for us. I would appreciate it if he takes seriously the concerns I have raised.
I thank the Deputy for raising this issue. I am responding on behalf of my colleague, the Minister of State at the Department of Health with responsibility for disability, Deputy Rabbitte. I know that, as part of Deputy Moynihan's work on the disability committee, he has been very active in promoting this and other related areas. It is very important the committee continues to highlight his work.
I am glad to take this opportunity to set out the position regarding the status of the national policy and strategy for the provision of neurorehabilitation services in Ireland. Such services play a critical role in supporting recovery and in maximising the ability of those with neurological conditions at inpatient and community level. Programme for Government: Our Shared Future includes a commitment to advance neurorehabilitation services in the community. The HSE is leading the implementation of the recommendations of the national policy and strategy. The HSE neurorehabilitation implementation framework, From Theory to Action, was launched in February 2019. The framework outlines a ten-step approach that will see each HSE CHO introducing local implementation teams to oversee and guide the implementation process.
The overarching aim of the strategy is to develop neurorehabilitation services to improve patient outcomes by providing safe, high-quality, person-centred neurorehabilitation at the lowest appropriate level of complexity. This must be integrated across the care pathway and provided as close to home as possible or in specialist centres where necessary. This objective represents a significant change in practice from the current model that sees specialist rehabilitation services centralised in one location, namely, the National Rehabilitation Hospital. The new model will see the introduction of a multi-tiered system, with access to services based on clinically assessed need. Services would work together across organisational boundaries, with patients seamlessly moving across the continuum of care based on their needs. These services should be configured into population-based managed clinical rehabilitation networks. The rehabilitation network, while an effective model in several European countries, is a new concept in Ireland. Managed clinical rehabilitation networks are recognised as having the potential to bring together an appropriate range of primary, secondary and tertiary services to ensure equitable provision of high-quality and clinically effective services.
Considering the scale of the fundamental change proposed, the HSE is advancing a demonstrator project across CHO 6 and CHO 7. The focus of this project is to develop post-acute and community neurorehabilitation services in both these areas. Funding for the demonstrator pilot scheme became available from the Sláintecare redesign fund for quarter 4 of 2020, with full-year funding of €2.29 million available for 2021. This funding is available on an ongoing basis and includes provision for the establishment of ten additional inpatient beds in Peamount Healthcare. The implementation of the ten-bed neurorehabilitation unit in Peamount has improved timely and early access to post-acute specialist rehabilitation services for patients with complex disability.
This development is part of the overall HSE implementation plan for neurorehabilitation and the new beds introduce in the order of 3,500 additional specialist rehabilitation bed days per annum into the system. With average length of stay of approximately 90 days, this means that about 40 patients per annum will have their rehabilitation needs met in an appropriate setting outside of acute hospitals. The HSE has confirmed that work is under way to establish community neurorehabilitation teams in the demonstrator project areas. Once these community teams are in place, the HSE will have all the elements of the basic construct of a full managed clinical rehabilitation network across the demonstrator project.
Where are we with this? This has been talked about for some time. The biggest challenge is the additional teams in CHO 6 and CHO 7, funded in 2019, which is three years ago, that have not yet been established. That is an indictment of the system and a major challenge in respect of funding. The Minister of State mentioned a figure of €2.29 million available for 2021 on an ongoing basis. Has the funding allocated to neurorehabilitation over recent years been spent? This is the envelope of funding put into it at the very start of the years 2019, 2020 and 2021. The Minister of State may not have an answer to that but I would appreciate it if he could get departmental officials to come back to me.
When we consider neurorehabilitation in the context of prevention or assisting better outcomes for people, the State, the HSE and the Department must look at the places that are falling down in a major way. There needs to be a co-ordinated strategy. By any standards, we are a small nation and to have a different set of circumstances or different outcomes because of geographic location is simply not acceptable.
How much of the funding made available in CHOs 6 and 7 over the past three years has been spent? Is it likely that the €2.29 million allocated for neurorehabilitation, which is peanuts, will be spent this year? When will the national strategy be launched?
I will ask the office of the Minister of State, Deputy Rabbitte, to make direct contact with the Deputy on the funding provided versus what was spent, the areas to which it was allocated and the funding that continues to be available, as I do not have that information to hand.
Neurorehabilitation services play a critical role in supporting recovery and maximising the ability of those with neurological conditions who will benefit from rehabilitation services in the community. The HSE is leading the implementation of the recommendations of the national policy and strategy and learning from the HSE demonstrator project in CHO areas 6 and 7. This will inform the implementation of the neurorehabilitation strategy across the community healthcare organisations. There has been tangible progress in the development of post-acute and community neurological teams and services. The implementation of the ten-bed neurorehabilitation unit in Peamount Healthcare has improved timely and early access to post-acute specialist rehabilitation services for patients with complex disability.
On a personal note, I visited the new neurological rehabilitation unit in Peamount, Newcastle, County Dublin, privately, not in connection with my official duties but in relation to people I know. The quality of the buildings and facilities provided on the campus by the HSE through Government funding in recent years is outstanding. The service is not just the best in Ireland but has some of the best facilities in the world. I hope people will see the benefit of that.
The HSE has also confirmed that the managed clinical rehabilitation network co-ordinator is in place supporting the triage of patients across the acute, post-acute and community continuum. The learning from the demonstrator project will inform the HSE executive implementation of the neurorehabilitation strategy across each of the community healthcare organisations.