Colette Kelleher (Independent)
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I welcome the Minister of State at the Department of Health, Deputy Finian McGrath. I also welcome the increased health spending announced in yesterday's budget, particularly provisions for home-care services and people with disabilities. With more money, the major challenge now is to ensure that the announcement translates into the much-needed services and supports for people who need them. This matter relates to the 25,000 people in Ireland who are living with neurological conditions and who need rehabilitation every year, and their carers.

Despite spending more money than ever before on health care, there are still dire shortages in some services. I want to draw the Minister of State's attention to the lack of core services for people living with conditions such as stroke, acquired brain injury, multiple sclerosis and Parkinson’s disease. Every year, over 25,000 people need rehabilitation and most of them struggle to get the services they require. Many need specialist services with skilled multidisciplinary teams to support them on their rehabilitation pathway. Without access to core rehabilitation services, people are left with preventable disabilities, cannot return to work and are accommodated in nursing homes, which can often be completely unsuitable for their needs.

This problem is at crisis level because services are under-developed and under-resourced. People with neurological conditions report the following problems with neuro-rehabilitation services. They include problems with availability and waiting lists, inequities in access, lack of clear pathways, lack of co-ordination and significant problems in navigating the system. It is bad enough to have been diagnosed with a stroke but the person must then try to find his or her way through a system in circumstances where he or she needs help. Other problems include lack of support and training for family members, lack of skilled neuro-rehabilitation health care professionals and failures in the Department of Health and the HSE to drive the necessary change relating to the growth and development of neuro-rehabilitation services.

Recent media coverage has highlighted these issues and how people are suffering as a result. We have heard from people waiting over two years for a place in the National Rehabilitation Hospital as well as people travelling abroad for rehabilitation and, what is worse, losing any gains when they return due to a lack of appropriate neuro-rehabilitation services in the community. Many more never got the opportunity to get the rehabilitation they needed and lost a vital window of recovery that will impact them for the rest of their lives.

The case I am about to outline is just one example.Mr. Colm Griffin was 36 years old, healthy and fit, and a qualified engineer. As a result of corrective surgery on an aneurysm in 2015, he had a stroke. The left side of his body was affected and he could no longer walk, use his left arm or dress himself. He was unable to drive or go to work. In Cork University Hospital, he got access to physiotherapy and hydrotherapy but otherwise the facilities were very limited. In February 2016, he got a bed in the National Rehabilitation Hospital and completed 12 weeks of therapy. Although the individual therapists did their very best, his experience was one of deep frustration as there are huge limitations on the number of therapy hours there. He kept a timetable from that time and recorded an average of three hours physiotherapy over five days and just one hour of hydrotherapy. In addition, there was no access to the facilities after hours or at the weekend. Since he returned home, friends and family had to fund-raise to pay for private physiotherapy.

Ireland should have 270 inpatient beds for our population but we have less than half of that and none outside Dublin. We should have four regional inpatient specialist rehabilitation services nationwide but we have none. There should be at a minimum nine community neuro-rehabilitation teams nationwide, one in each community health organisation as a starting point, but there are only three, and these are only partially staffed. We have the lowest number of consultants in rehabilitation medicine anywhere in Europe.

The lack of specialist and community rehabilitation services is impacting significantly on other areas of the health system, as the Minister of State knows, exacerbating the problem of delayed discharges from our acute hospitals. The national policy and strategy for the provision of neuro-rehabilitation services in Ireland was published in 2011 and it is unacceptable that there has been little progress in the development of new services since its publication. A long overdue draft implementation framework for the strategy was finally released, five years later, in February 2016. The Neurological Alliance of Ireland and others have serious concerns with the draft framework, which lacks dedicated funding and any timelines. It also lacks accountability and the scope required to deliver real improvements that people need. It is essential that a revised plan is put in place.

I wrote to the HSE, which has stated that it has long appreciated the need to review the issue. That is hardly good enough after five years. I would like specifics on what plans the Minister has in place to secure the 270 inpatient beds. When will these beds be in place? When will we have beds outside of Dublin in places like Cork? What about the four regional inpatient specialist services and when will the Minister put in place fully the nine community neuro-rehabilitation teams? We have waited a very long time and the people with the conditions are really in need and at risk. I would like some specifics and clear timetable.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Kelleher for raising this very important issue. It is my first time debating with her so I welcome her to the Seanad and congratulate her on being nominated. We need voices like hers in the Seanad, particularly with respect to this morning's subject. I will respond here but I will speak to her later about issues relating to her question. I thank the Senator for raising the matter of inpatient and community neuro-rehabilitation services and improving the patient pathway from hospital to home. I welcome the opportunity to outline the current position in this regard.

The programme for 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. As part of a review of how specialist rehabilitation services are accessed and provided, the HSE and the Department of Health jointly published the National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland 2011-2015. In addition, the rehabilitation medicine programme was established within the clinical strategy and programmes directorate of the Health Service Executive.

With regard to the update, a steering group, led by the HSE social care division, has circulated a draft implementation framework for the national policy and strategy for neuro-rehabilitation services for consultation to members of the steering group and stakeholder agencies. This implementation framework will guide and oversee the reconfiguration and development of neuro-rehabilitation structures and services at national and local level. The framework outlines key issues, themes and considerations. It makes particular reference to the need to reconfigure and develop community services within the HSE's community health care organisations and inpatient specialist rehabilitation services. It is planned that implementation of the neuro-rehabilitation policy and strategy will involve reconfiguration and development of resources with the community health care organisations to establish specialist neuro-rehabilitation teams within each area. Second, it will involve reconfiguration and development of specialist inpatient rehabilitation services 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 to be managed clinical networks. Moreover, 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; and managed networks will link closely with the National Rehabilitation Hospital, community rehabilitation teams, primary care and acute hospitals in their areas.

Specialist inpatient services are concentrated at a national level in the National Rehabilitation Hospital. The hospital provides a comprehensive range of specialist rehabilitation services to adult and paediatric patients. These are patients who, as a result of accident or injury have acquired physical or cognitive disability and require specialist medical rehabilitation. Effective rehabilitation draws on a broad range of disciplines to meet the particular needs of individuals. The objective is to assist with returning to life in the community with confidence. Approximately 1,000 people are treated on an inpatient basis at the hospital each year and approximately 5,000 people are treated on an outpatient basis. Many patients have a lifelong association with the hospital.

The Government has also announced a major capital development of the National Rehabilitation Hospital. The project will deliver a 120 replacement bed ward block. It will include support therapies to paediatrics and acquired brain injury patients, a hydrotherapy unit and a sports hall. Its completion is the priority project in rehabilitation medicine. It is envisaged that the implementation of the national policy and strategy for the provision of neuro-rehabilitation services, along with the investment in the National Rehabilitation Hospital, will greatly contribute to improved care pathways for patients from home to hospital.

This is a priority service issue and I am working very closely with the Minister, Deputy Simon Harris, on it. There has been talking about this for too long. We want to push on the agenda. I will respond to further questions. The Minister and I feel very strongly that we must invest in this and do the job.

Denis O'Donovan (Fianna Fail)
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We are well over time with this matter.

Finian McGrath (Dublin Bay North, Independent)
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I apologise.

Denis O'Donovan (Fianna Fail)
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The 12 minutes are up already so the Senator should be brief. The trouble arises if we allow more than 12 minutes for one topic and not another, as people may complain.

Colette Kelleher (Independent)
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I take the point. It is a great policy but it was meant to run to 2015 and we are now in 2016. There is an implementation plan, a framework, a steering group and reconfiguration. When will all these translate into inpatient beds and community teams, and when will the developments in the hospital be completed? Is there enough in the budget this year to do all of this? Should we see it fully implemented by the end of 2017?

Finian McGrath (Dublin Bay North, Independent)
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We have enough in the budget, particularly with the increases in this year's budget. Our problem will be the competing elements within the budget. The Senator can take it from me that this is a priority issue. I agree with her that this must translate into action in delivering the services. We have the plans and focus so it is up to us who are in a position to push it along. I accept that services are underdeveloped and hanging around for another two years would not be acceptable. I give that commitment but I will go back to the Minister, Deputy Harris. Both of us will work on the issue. I hope to see some serious movement before Christmas. There is extra funding available.We are all, including me, competing for different slices of the pot for disabilities. This is within that sector. I will do my best and give a commitment today, given that we need to have these services developed. These are people with major issues in their lives and we must do something about it.

Denis O'Donovan (Fianna Fail)
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I am sure Senator Kelleher will revisit it in the new year if progress is made.