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Dáil Éireann - Private Members Business (Fianna Fáil)
Wednesday 6 December 2017


“ That Dáil Éireann:

notes that:

—    the World Health Organisation in a 2004 report on neurological conditions described these conditions as the greatest public health challenge facing public health systems in developed countries worldwide;

—    the United Nations Convention on the Rights of People with Disabilities calls on countries to ‘strengthen, organise and extend rehabilitation services’ for people with disabilities;

—      over 25,000 Irish people each year struggle to get the neurorehabilitation services they need to prevent disability and support recovery from conditions including stroke, acquired brain injury, multiple sclerosis and Parkinson’s disease;

—    the National Policy and Strategy for Neurorehabilitation Services (neurorehabilitation strategy) was published by the Department of Health and the Health Service Executive (HSE) in 2011, with an implementation plan promised within six months but still unpublished six years later;

—    the Minister for Health in February 2017, requested an implementation plan to be published by the end of June 2017, but a working group to develop the plan has not yet been put together and this is the second deadline announced and missed in 2017 as the HSE will not deliver the plan by December 2017;

—    it is estimated that only one in six people who need specialist rehabilitation services in Ireland can access them;

—    as a country, we lag far behind the rest of the developed world when it comes to neurorehabilitation services;

—    Ireland has less than half the number of specialist rehabilitation beds recommended for its population;

—    Ireland has the lowest number of consultants in rehabilitation medicine in Europe;

—    despite the recommendations of numerous reports and decades on from when the issue was first highlighted, there is still no dedicated specialist medical rehabilitation unit for people with a neurological disability in the south of Ireland; and

—    in June 2016 the Neurological Alliance of Ireland and sixteen member organisations launched a campaign ‘We Need Our Heads Examined’ to increase political awareness and call for investment in neurorehabilitation services;

agrees that:

—    there is an overwhelming lack of neurorehabilitation services at all stages of the pathway for a person with a neurological condition;

—    at the bare minimum, there should be one dedicated specialist neurorehabilitation team per Community Health Organisation (CHO), yet only three such teams are in place and are not even fully staffed, and not one new team has been put in place since the Neurorehabilitation Strategy was published in 2011;

—    where services do exist, they are underdeveloped, under-resourced and patchy;

—    there are long waiting lists and access to services is largely based on a geographical lottery; and

—    people with neurological conditions:

—    spend significantly more time in hospital than is necessary;

—    live in inappropriate settings such as nursing homes for older people or psychiatric facilities or at home with families who cannot cope;

—    largely lead lives of exclusion and isolation, distanced from social, community and economic life;

—    have families who equally experience significant burden and isolation; and

—    are forced to travel abroad to get the services they need; 

 accepts that:

 —    the demand for neurorehabilitation services is growing, with our ageing population and with increased survival rates of people with a neurological disability, but services are completely insufficient to meet current needs;

 —    the lack of neurorehabilitation services is having a devastating impact on people with neurological conditions and their families, resulting in unnecessary disability and inability to live to their full potential in their community;

 —    to optimise the gains for individuals, neurorehabilitation services must be provided on a timely basis and in a seamless fashion by a range of providers using a multidisciplinary approach;

 —    the piecemeal and patchy nature of the current services mean that people lose gains they make at another stage of the pathway if they cannot move seamlessly from one service to the next;

 —    many people with a neurological disability end up in nursing homes but residents in nursing homes cannot access community neurorehabilitation services and this is despite evidence that provision of neurorehabilitation in nursing homes can improve outcomes including discharge home; and

 —    the lack of neurorehabilitation services is a major factor in our Emergency Department crisis and delayed discharges with the National Clinical Programme for Rehabilitation Medicine noting that the lack of neurorehabilitation services may be responsible for up to forty per cent of delayed discharges; and

calls for:

 —    dedicated, multi annual investment in forthcoming budgets in order to develop neurorehabilitation services, particularly in the community, in response to significant unmet needs and decades of neglect and underinvestment;

 —    the publication of an implementation plan for the neurorehabilitation strategy by the end of March 2018, with a clear timeframe for implementation, mechanisms to ensure governance and accountability at the highest levels of the HSE and by the Minister for Health and the Department of Health and a scope of service that provides a holistic response to all neurorehabilitation needs, in line with the recommendations of the neurorehabilitation strategy;

 —    the establishment of dedicated community neurorehabilitation teams in each of the nine CHO's; and

 —    investment in 2018, to target current waiting lists in the community following the outcome of a HSE mapping exercise earlier this year.”

 —     Margaret Murphy O'Mahony, Billy Kelleher, Bobby Aylward, John Brassil, Declan Breathnach, James Browne, Mary Butler, Thomas Byrne, Jackie Cahill, Dara Calleary, Pat Casey, Shane Cassells, Jack Chambers, Lisa M. Chambers, Niall Collins, Barry Cowen, John Curran, Stephen S. Donnelly, Timmy Dooley, Sean Fleming, Pat the Cope Gallagher, Seán Haughey, John Lahart, James Lawless, Marc MacSharry, Micheál Martin, Charlie McConalogue, Michael McGrath, John McGuinness, Aindrias Moynihan, Michael Moynihan, Eugene Murphy, Darragh O'Brien, Jim O'Callaghan, Éamon Ó Cuív, Willie O'Dea, Seán Ó Fearghaíl, Kevin O'Keeffe, Fiona O'Loughlin, Frank O'Rourke, Anne Rabbitte, Eamon Scanlon, Brendan Smith, Niamh Smyth, Robert Troy.

[01 December, 2017]