Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

We had difficulty at the outset, which I encountered very quickly, apart from having no money which was the biggest difficulty of all, as there was a difference of opinion as to how it should be delivered. It is very difficult to say to one specialist that what he or she is saying is wrong and say to another specialist that he or she is right. There was a clear difference of opinion as to how it would be delivered. This is why the implementation plan and the national clinical programme are so important.

The report, National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland 2011–2015, made a number of recommendations for services for people with rehabilitation needs, including clinical, therapeutic, social, vocational and community supports. Following the development of the report, the Health Service Executive established the rehabilitation medicine clinical programme. The scope of the programme covers the whole of the patient's journey from self-management and prevention through to primary, secondary and tertiary care. This provides a national strategic and co-ordinated approach to a wide range of clinical services. The programme includes the standardisation of access to and delivery of high-quality, safe and efficient hospital services nationally as well as improved linkages with primary care services. This is where the dispute arose with regard to whether it was better to do it within the community or whether it should be attached to an acute hospital.

The rehabilitation medicine clinical programme is nearing completion of a model of care for the provision of specialist rehabilitation services in Ireland, which will be the basis for the delivery of the service. The HSE disability services division has a role in certain key aspects of neuro-rehabilitation services, primarily the provision of community-based therapy services and personal social services. The disability services division will use the recommendations of the value for money and policy review of disability services to focus on disability funded rehabilitation services and enable reconfiguration of existing provisions through the establishment of demonstration sites. Close links will be maintained with the rehabilitation medicine clinical programme to ensure there is no duplication of effort and that all initiatives receive optimal support. Demonstration sites have been identified by disability services and mapping has commenced.

Having regard to the foregoing details, it is not accurate to say that no element has been delivered. A national steering group, chaired by the Health Service Executive social care division, has been assigned the task of developing an implementation framework for the national policy and strategy for neuro-rehabilitation services. The steering group includes representation from the national clinical programmes for rehabilitation medicine and neurology, the Department of Health, primary care, therapy professions and the Neurological Alliance of Ireland. Once the implementation framework has been agreed by the steering group, it will then go for consultation to the wider stakeholder interest groups. Following consultation, the framework will be revised and will guide and oversee the reconfiguration and development of neuro-rehabilitation structures and services at national and local level. The HSE is very aware of the needs of people with neurological conditions - how could it not be - and will continue to work towards improved services, making best use of available resources.

The disability sector is now connecting, and yesterday I met Enable Ireland which could play a very big part, and we all know the other non-governmental agencies with a particular interest in this area. The new hospital in Dún Laoghaire is on its way and it will provide not only outreach therapies but additional beds. It should have been done ten years ago, and the Senator and I know this, but with regard to thrombolysis, while prevention in accident and emergency department has played a significant role, much more needs to be done.