Brendan Smith (Cavan-Monaghan, Fianna Fail)
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1253. To ask the Minister for Health his views on the implementation to date of the national stroke programme; and if he will make a statement on the matter. [38685/17]

Simon Harris (Wicklow, Fine Gael)
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The National Clinical Programme for Stroke (NCPS) has been in place since early 2010. The vision of the programme is to design standardised models of integrated care pathways for the delivery of clinical care to ensure sustained quality clinical operational management. Overall, the NCPS aims to improve quality, access and cost-effectiveness of stroke services in Ireland.

The majority of strokes are caused when blood clots travel to a blood vessel in the brain and block the flow of blood to that area. Clot-dissolving treatment (thrombolysis) can contribute to improved outcomes for treated patients, with one-third experiencing important improvements in their ability to walk or self-care and other possible disabling conditions caused by the stroke with sometimes complete reversal of the effects of the stroke. More recently a new therapy, Thrombectomy, has been developed where people with the most severe strokes can have their strokes treated by skilled interventional neuroradiologists who remove the obstructing clots via their blood vessels. This has been shown to halve the mortality and disability from such strokes in some patients.

Some of the achievements of this programme to date include:

National 24/7 access to safe stroke thrombolysis

Emergency thrombolysis is provided to patients in all parts of the country, via improved hospital and ambulance protocols, health professional training and the appointment of new stroke physicians. The national stroke thrombolysis rate has increased from 1% in 2006 to a current rate of 12% (2016).

The NCPS has developed a number of initiatives including a telemedicine programme to allow delivery of expert thrombolysis therapy in smaller level three hospitals. It has been involved in the training of over 250 doctors nationally to deliver thrombolysis therapy and has participated in a training programme for Stroke in the Royal College of Physicians of Ireland.

Improved access to stroke unit care

Access to stroke unit care has been shown to improve stroke patient outcomes through reduced mortality rates, reduced dependency and shorter lengths of stay in hospital by patients. Since the commencement of the NCPS, nine new stroke units have been opened, bringing the total number of stroke units in acute hospitals to twenty-two. Two further stroke units are currently in development with a third at planning stages.

Admission to a stroke unit is a National Key Performance Indicator. In 2016, 65.6% of Stroke patients were admitted to a Stroke Unit.

Early Discharge of Stroke Patients

It has been recognised internationally that Early Supported Discharge of stroke patients from hospital, improves outcomes, reduces need for long term care and increases acute hospital capacity by freeing up beds. It is estimated the 10-25% of patients could benefit from an ESD service.

The programme has helped establish 3 small but effective ESD teams in Dublin and Galway. In 2016, 137 patients were discharged to ESD services representing 15.6% of total stroke discharges. It is estimated that there was an average reduction in length of stay of 10.4 days per ESD patient.

Funding for increasing capacity in the three operational sites has been secured for 2017 with further funding secured to support the establishment of two further teams in University Hospital Limerick and Cork University Hospital. Recruitment of these ESD staff is on-going. University Hospital Limerick is due to commence its ESD Service on 11/9/17.

Emergency Endovascular Therapy – Thrombectomy

Thrombectomy is an emergency endovascular procedure that permits patients with severe strokes caused by clots occluding the major vessels of the brain and neck to have these clots removed using specialist devices. HIQA has completed a Health Technology Assessment which finds that this intervention is value for money. Full report of the HIQA HTA can be found at: .

Provision of emergency endovascular thrombectomy remains highly specialised in Beaumont Hospital and Cork University Hospital and this model has been endorsed by the HSE, Acute Hospital Division with a view to a third centre when numbers increase as expected.

To date, the number of patients undergoing this procedure has risen annually, on average almost 50% increase each year: 2015=122 cases, 2016=172 cases, 2017 – end of August=154 cases. These patients have been referred from 20 different hospitals around the country.

Stroke Prevention

NCPS has completed an Atrial Fibrillation Screening Study in partnership with the acute hospitals and primary care division. One hundred GPs in Galway and Sligo/Leitrim participated in the study to assess the feasibility of opportunistic screening for the common cardiac arrhythmia atrial fibrillation in general practice. Atrial Fibrillation causes about one-third of strokes in Ireland and a Health Technology Assessment by HIQA has shown that opportunistic screening for Atrial Fibrillation in general practice is likely to be highly cost effective in Ireland. Such a screening protocol is in discussion as part of the new GP contract negotiations. If introduced, Ireland would be the first country in the world to introduce such screening. Further information can be found at: .

Further developments will be subject to the estimates process.