Erin McGreehan (Fianna Fail)
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I thank the Leas-Chathaoirleach, and the Minister of State is very welcome to the Chamber today. I wish to discuss the investment into community rehabilitation teams across the country, but more specifically with regard to my own community health organisation, CHO, 8, which County Louth is part of. As the Minister of State knows, CHO 8 represents Laois, Offaly, Longford, Westmeath, Louth and Meath. It has a population of 592,388. There are no local teams, as far as I am aware, to support patients who are really in need of suitable therapies. The national strategy for neurorehabilitation states that nine teams are required, but according to the Neurological Alliance of Ireland, only two have been delivered. Everyone deserves access, as the Minister of State well knows, to community neurorehabilitation teams. Investing in community neurorehabilitation teams provides function and well-being for patients, and the Neurological Alliance of Ireland has stated that every €1 spent on teams in the health services could potentially save €11.

The Minister of State is well across her brief and she speaks to an awful lot of patients who are in need of neurorehabilitation teams quite regularly. For the record, the neurological conditions are stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease. These can have a profound impact on a person's life. However, with the right support and medical intervention, these individuals can have opportunities to recover and have a far better quality of life.

Every neurorehabilitation team should have a specialised branch of medicine that would focus on comprehensive care for individuals with neurological conditions. These teams could consist of neurologists, physiotherapists, occupational and speech therapists and psychologists, among others, who would work together to assess the plan, and implement effective treatments and strategies tailored to the specific need of the patient. A lot of this is down to access, and we quite regularly talk at various meetings about people having access to adequate therapies in their own community. We all know the importance of not having to travel long distances to get therapies and treatments. To get therapies full stop is very important. Of all Ministers, I know that the Minister of State is at the very front of this.

I have met with a few multiple sclerosis patients from County Louth recently who have to travel to Dublin for treatments and physiotherapy because there is no neuro-specific care in their locality. This is obviously tiresome and costs a lot of money. They have to take time out of work or whatever to be able to. There is a burden from that travel, and it often takes the focus off the treatment and the recovery and on to that burden of having to travel. It is added stress.

I look forward to the Minister of State's response, because she knows. I do not have to convince her of the importance of therapies for people who have a neurological condition. There is a proven result when we have proper care and intervention, and we have seen it time and again. For many years, this area has been ignored, but the Minister of State is not one to ignore a challenge, and I look forward to listening to her response.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Leas-Chathaoirleach and the Senator for giving me the opportunity to address this important issue in the House this afternoon. The programme for Government, Our Shared Future, includes a commitment for advancing neurorehabilitation services in the community.The HSE is leading on the implementation framework in respect of recommendations of the national policy and strategy for that provision of neurorehabilitation services in Ireland 2011 to 2015. The implementation framework for the neurorehabilitation strategy was launched in February 2019 and provides guidance for the development of specialist neurorehabilitation services across the continuum of care from acute, to post-acute, and community services. I am delighted the Senator raised this because I read in the Meath Chroniclelast week that Ms Sorcha Burke, or maybe Ms Sorcha Boyle, I do not know which, lives in Ardee, County Louth. She is an multiple sclerosis, MS, sufferer and she talks very clearly as to the need for the community neurorehabilitation teams. I met the Neurological Alliance of Ireland, NAI, in 2023 in relation to their pre-budgetary submission. It represents 34 organisations. Senator McGreehan mentioned some of those organisations and the Neurological Alliance of Ireland also represents the likes of the Brain Awareness Week, the Huntington's Disease Association of Ireland, Bloomfield Health Services, Cheshire Ireland, Chronic Pain Ireland, and many more, 34 organisations. Their ask for budget 2023 was to appoint 20 additional nurse specialists across adult neurology. Not only did I appoint 20, I appointed 28.

That does not sit under my brief it is the Minister for Health's brief believe it or not but because it was such an important part within the strategy the acute services needed to be connected to the community to work the strategy correctly. I actually paid for 28 neuro nurses from my own budget into acute. That is done.

The next piece was to fully resource at least four of the seven required community teams in neurorehabilitation. That was at a cost of €1.8 million. I have appointed the €1.8 million so I have fully funded CHO 2 and CHO 4. I discovered why CHO 6 and CHO 7 were not fully operationalised. The reason they were not fully operationalised was that under proper clinical governance what was provided for funding in budget 2019 and probably 2020, before we hit Covid-19, was actually not proper clinical governance. Five people on a team was not enough, a minimum of ten was needed. Guess what I have done? From unspent money this year I will award the additional funding to step up the teams in CHO 6 and CHO 7. I have worked very closely with Mr. Brian Higgins and the HSE, which is under reform. To be fair to Mr. Higgins he worked in Bloomfields so he has a great understanding of the value of community neurorehabilitation teams. He and the HSE understand the connection between the acute piece, the community piece, and actually living one's best life in their community and being supported in their community. That is why we are stepping up and the advertisements has taken place for CHO 2 and CHO 4 as we are talking. Any unspent funding will go towards the recruitment and stepping up of CHO 6 and CHO 7.

That is the four CHOs reached. The way Mr. Bernard Gloster is operating since 1 January 2023 is that we will have six regional health authorities, RHAs. Why would I fund nine when there will be six? We need to keep it married correctly. What I will commit to doing is, the NAI need to relax on their campaign, and their marketing, and everything else like that. This is a Minister of State who has her hand on the pulse and knows exactly what she is doing, working with reform, delivering on implementation of the framework and the strategy into which they all fit in, but also actually expanding the teams. If it means we need to have 45 people on a team, which was what on consultant told me, we will have 45 on a team. That is where we have to start at ground level. I will conclude in the next part.

Erin McGreehan (Fianna Fail)
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I would almost cede my time to the Minister of State because what she is doing is incredibly impressive, as is across all her brief. The Minister of State, Deputy Rabbitte, has always had her hand on the pulse of what is going on at a local level and national level regarding disability care, neuro teams, and all of that. I am scrambling to take notes on all of what she has been doing over the past couple of months and I will continue the conversation, and my scribbling, during her next contribution.

Anne Rabbitte (Galway East, Fianna Fail)
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I have a lot to say on this matter because I seldom I get out to speak about it. Community neurorehabilitation is incredibly important and when one talks about the strategy, what we want is people to come out of the National Rehabilitation Centre, NRH. What we want is people to come out of long-term residential care to be supported in the community. That is the priority. What we do need to do is work to the strategy.I have to be fair to the Minister, Deputy Michael McGrath. I put this proposal to him last year as part of the budgetary process. I had to make difficult decisions and I focused on neurology, with the appointment of 28 neurology nurses at a cost of €1.4 million and the two teams at €1.8 million. They were prioritised within my budgetary line. The next step was to speak to Brian Higgins and Anne Ennis to understand why it was not working in CHO 6 and CHO 7. That was a vital part of the engagement in the context of the need to fund another ten people to have the critical piece.

The next matter I am addressing is the lack of a paediatric neurology strategy. We need to ensure children who live outside the beautiful M50 commuter belt, as the Senator and I do, and have to go to Temple Street or Crumlin children's hospitals are supported. We need to ensure those children are supported in Galway, Cork, Clare and everywhere else in the country. As I am developing a paediatric neurology strategy in budget 2024, people can relax in that regard.