Seanad debates

Wednesday, 21 February 2018

Commencement Matters

Neuro-Rehabilitation Services Provision

10:30 am

Photo of Victor BoyhanVictor Boyhan (Independent)
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I thank the Cathaoirleach’s office for facilitating this Commencement matter today. I welcome the Minister of State, Deputy Jim Daly, to the House. I have raised the issue of the National Rehabilitation Hospital approximately 14 times in the House, yet I have only been here for about two years. I live close to the hospital and I know many of the staff who work there and have personal direct contact with them, meaning I am on the inside track, despite what people on the professional side of the service and the executive might say. I also know some of the patients. I am very familiar with the service, having lived right next door to the hospital until a few months ago. When I am persistent in asking the questions, I invariably know the answers already. However, I have a job to do which is to come into this House to ask the Minister of State to explain.

To be fair, the Minister for Health and the Taoiseach recently turned the sod at the hospital for a phase 1 development. My real concern, however, is that in January 2017 the hospital took a decision to close 12 beds. The Department seems to be somewhat confused and cannot understand why it took that decision. The Department, rightly, is of the view that the hospital's resources and their deployment are a matter for the day-to-day operation of the hospital. Between all that, the Minister committed to engage with the hospital administration. The last I heard was that officially seven, possibly eight, of the beds were open. Despite meeting the Taoiseach and the Minister on the site at the opening of the new development, as well as several other Ministers, I was assured the beds would be open in a matter weeks. They too were alarmed and concerned by this.

The key issue is that there is a substantial waiting list to get into both day and residential services in the hospital. A substantial number of these people on the waiting list are holding beds in acute hospitals where we have a crisis with bed provision. I am putting this on the agenda today just to keep the focus on it. We need confirmation as to how many beds will be reopened and some assurance as to when that will happen. It is important that we get these beds back in service.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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There is not a more important resource we could be discussing here. Nobody will appreciate the importance of this resource until their own family requires its services. On behalf of everybody in the State, I thank Senator Boyhan for raising this important issue and for giving me the opportunity to respond to it.

The HSE has advised that the complexity and acuity of patients referred to the National Rehabilitation Hospital for rehabilitation programmes has increased in recent years, resulting in greater challenges for the hospital. In response to this situation, management at the hospital took the decision in late 2016 to reduce its existing bed capacity by 12 beds in order to enable the hospital to provide a safe and appropriate level of care to patients from within its existing resources. Eight of these beds were in the brain injury programme and four in the spinal cord system of care programme.

The Department of Health has been assured that the HSE has been actively engaging with the National Rehabilitation Hospital since this time with a view to optimising capacity in the hospital and to address ongoing concerns regarding funding. It should be noted that the bed capacity situation is made more difficult as a result of the challenges associated with discharging patients with complex needs.

I am pleased to report that the situation at the hospital has improved significantly in recent months. In September-October 2017, funding was secured to reopen four of the closed beds. Two brain injury programme beds were reopened in September, while in October another brain injury programme bed reopened along with one bed in the spinal cord system of care programme. In late December 2017, additional funding was secured to reopen a further two beds in the brain injury programme, through the assistance of the HSE’s national social care division as part of its winter planning strategy 2017-2018.As things currently stand, a total of six beds have re-opened at the National Rehabilitation Hospital, five of which are in the brain injury programme and one of which is in the spinal cord system of care programme.

The Government recognises the excellent rehabilitation programme which the National Rehabilitation Hospital delivers and the hospital’s excellent patient outcomes. In terms of capital developments, the priority at the present time is the delivery of replacement accommodation at the hospital. This development will see the existing ward accommodation replaced by a new fit-for-purpose ward accommodation block of 120 single en suiterooms with integrated therapy spaces, a new sports hall, a hydrotherapy unit and a temporary concourse as well as clinical and ancillary spaces. It will be a major enhancement for rehabilitation services in the country and will have a direct and significant impact on patient recovery by providing an optimal ward and therapeutic environment for patient treatment.

Construction works are currently under way and the new development is expected to be operational in 2020. Funding for phases I and II of this major redevelopment project was included in the Government’s recently announced Project Ireland 2040 policy initiative as part of an overall €10.9 billion strategic investment in health. The model of care proposed in the strategy is a three-tiered model of specialist rehabilitation services, that is: complex specialist tertiary services; specialist inpatient rehabilitation units; and community based specialist neuro-rehabilitation teams.

As a first step, a managed clinical rehabilitation network demonstration project is in development to establish collaborative care pathways for people with complex neuro-rehabilitation care and support accommodation needs. The National Rehabilitation Hospital will be participating in this demonstration project, along with Peamount Healthcare and the Royal Hospital Donnybrook.

Photo of Victor BoyhanVictor Boyhan (Independent)
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I again thank the Minister of State, but we have made no progress. I ask him to look at all of the written replies. We were told that seven beds had been opened, but it now appears the figure is six. I was correct. For little over a year, the Government has presided over the closure of 12 beds at a time when there is a crisis in the hospital sector. We have now been told there are only six beds. Nowhere in the response from the Minister of State has he said that he will open the remaining six beds. I will commit to circulating this to the media today, in particular in Dún Laoghaire. It is a very strong area for the Government, given that three of the four Deputies there are Fine Gael members. This is a major issue there, but it is also a national issue. I will have to make this a political issue week in and week out in here and also locally.

I want to acknowledge the Minister of State's reference to the new capacity building. It is correct that there are 120 beds in the National Rehabilitation Hospital today. A new development will provide 120 beds and the old building will be knocked down. There will be no increase in bed capacity.

Last night I had a look at Project Ireland 2040. I note the suggestion that it deals with this issue. I understand, having engaged with the Minister a few days ago, that this is part of phase II, which is to be welcomed. It is marvellous and I want to acknowledge that, but we have a crisis if we cannot reopen the six rehabilitation beds. We all have to pull together and work to reopen the beds. There is a bed capacity crisis in the hospital. I will come back here next week with the statistics on the number of people waiting because the only way this issue will be dealt with is if I stand here every day, call out the waiting times in the National Rehabilitation Hospital and repeat that six beds are empty. That is the only way to bring attention to the issue. I do not want to be difficult. The issue is important and I do not doubt the commitment of the Minister or Minister of State. We have to get the six beds open, and I would like to think we could have them open within a month.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I again thank the Senator. I have no difficulty whatsoever with his sincerity and commitment to this issue. As I said at the outset, I sincerely welcome it. Anybody who has ever had any experience of the National Rehabilitation Hospital and has waited to access a bed knows the trauma that inflicts on a family at a very difficult time. I support the Senator wholeheartedly in his endeavours and encourage him to continue raising this issue.

Our job as public representatives is to identify issues of real importance to people, and make sure we raise those issues in fora such as this and ensure we get progress. I very much welcome his efforts and will work with him to ensure we can reopen the remaining six beds. As I said at the outset, this is a complicated health and safety issue. It is not a straightforward case of opening beds as happens in other areas. That does not mean it cannot be done and that the necessary resources and assistance cannot be provided. I will help the Senator every step of the way.