David Cullinane (Waterford, Sinn Fein)
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1. To ask the Minister for Health the level of additional core expenditure for new developments, excluding funding for carry-over and otherwise maintaining existing levels of service, which has been allocated to specialist cardiovascular services and the new stroke strategy for 2024; and if he will make a statement on the matter. [48895/23]

David Cullinane (Waterford, Sinn Fein)
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Last year, the HSE published the national stroke strategy from 2022 to 2027, which I fully supported. It received €4.9 million in funding for 2023. I understand that approximately €1 million worth of posts are unfilled and there are concerns over their funding. For 2024, the national stroke programme requires millions of euro for 75 essential additional posts to safely staff our stroke units. In the budget just gone, how much additional core expenditure was provided to fund the national stroke strategy?

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy very much for his support for the stroke strategy. I think we can agree that our healthcare professionals are making important progress on behalf of patients and families. As a result of the work over the last ten years, deaths from the most common form of stroke have fallen by nearly 30%, which is very welcome. The average length of stay for patients has fallen a lot as well, from 11 days in hospital to eight. The proportion of patients being seen by a medical team within ten minutes of arriving at a hospital has more than doubled. I know the Deputy will join me in acknowledging the huge efforts of our healthcare professionals to put these responses in place.

The stroke strategy the Deputy referenced is from 2022 to 2027. It is a five-year strategy with aims around prevention, better outcomes and more after-stroke care. The predicted outcome of the new strategy is a reduction of about 1,000 strokes a year, so it is clearly very important. As the Deputy said, I approved the national stroke strategy last year and allocated in the budget for this year a significant amount of money, nearly €5 million, to support the implementation of the strategy. This included the recruitment of two consultant stroke physicians, a consultant neuroradiologist and senior speech and language therapists, with additional recruitment ongoing as well. Two new early supported discharge teams were established this year and six existing teams received increased staffing. A major FAST - face, arms, speech and time - awareness campaign has also been undertaken and I am sure we have all seen that.

Through next year, the amount of money being allocated will increase from €4.9 million to €7.3 million. To answer the Deputy's question directly, that is for the existing level of service. I expect the national stroke strategy will fully use up all that money. The next phase has a particular emphasis on the extension of the GP chronic disease management programme to include those with hypertension. There is funding in the budget for that as well.

David Cullinane (Waterford, Sinn Fein)
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This shows again that it was quite dangerous not to properly fund the health service for next year but also not provide any additional funding for new measures. As I suspected, any additional funding that will come to the national stroke strategy is simply to stand still and is funding for existing levels of service. Some 6,000 people have a stroke every year and 2,000 of them do not get to a stroke unit in the first instance. A further 2,000 are discharged early. We know we have lots of problems. The aim of the stroke strategy is to address the deficits we have. There are about 70 posts that need to be funded and put into the stroke units right across the State. There are posts that are still not funded even from last year. The concern I have is that we have again put a national strategy in place, which everybody welcomed. I welcomed it. Obviously we want the strategy to work and be properly invested in to support stroke patients and provide the funding for prevention but also for treatment. If it is the case that we have not provided enough funding or any new funding for next year, that will have consequences for patients.

Stephen Donnelly (Wicklow, Fianna Fail)
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I think we are going to be having different versions of this conversation throughout the next hour and a half, based on the questions the Deputy has tabled, which I fully appreciate. As to whether there is a level of funding for new development next year at the scale there is for this year, there is not. We will not be expanding these services next year at the pace we expanded them this year. However, is there funding to expand services, which can include stroke services? The answer is "Yes". The Deputy will be aware that there is additional funding in new developments through the Department of Children, Equality, Disability, Integration and Youth for more neurorehabilitation nurses. They are directly related to post-hospital supports. There will be an expansion there. We are hiring more consultants next year. The clinical strategies, including the stroke strategy, will undoubtedly benefit from that. We are fully staffing all the hospitals to safe staffing levels and all patients, including stroke patients, will benefit from that increased level of service.

David Cullinane (Waterford, Sinn Fein)
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The reason we tabled the questions the way we did is to cut through all of the spin and essentially lay bare the consequences of a Government that does not properly fund our health services. As Minister for Health, the Minister knows a huge mistake was made in not properly funding the health services even to stand still but what is worse is that if we do not provide new funding each year, particularly for these strategies, we lose a year. We stand still. With the greatest of respect, funding coming from other Departments for other areas does not make up for the fact that we have lots of consultant posts and allied healthcare professional posts that are needed in stroke units right across the State, which will not be filled next year. To me, that is a mistake. This is only one part of the health service. I could have picked lots of different elements of the healthcare system that will suffer because of this. I am very concerned. The figures I have received from the Irish Heart Foundation show that 600 more patients will not be admitted to an adequate stroke unit next year as a direct consequence of no new funding coming into that stroke strategy. While the foundation welcomed the strategy and was happy and pleased that it was in place, it is a real disappointment to it and, I would imagine, to stroke survivors and patients, that there is no new funding for new measures. That will have consequences for patients.

Stephen Donnelly (Wicklow, Fianna Fail)
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We will probably be repeating ourselves a bit this morning. There is not the level of funding next year for the same pace of roll-out of the strategy that I and the Deputy would like to see. However, there is significant funding in there to enhance services. We are both agreed that safe staffing makes a difference. It makes a difference to patients and that includes stroke patients. That is expanding. We are both agreed that bringing down the inpatient day-case waiting lists is going to make a big difference to all patients. It is going to take pressure off the hospitals. The six new surgical hubs are fully funded, including one in the Deputy's constituency. We are all agreed that we need more beds and that those beds will make a difference to patients and 162 new beds are funded. I think the Deputy is in agreement with me on the benefits of the chronic disease management programme run by GPs. Hypertension is now being added to that as the fourth condition.

It is an important measure and it has been funded, which speaks directly to prevention of stroke.