National Rehabilitation Hospital: Statements

I welcome the Minister of State, Deputy Finian McGrath to the House. The Minister of State will speak first. Spokespersons may speak for five minutes. The Minister of State must be called on to reply at 7.05 p.m. and he will have five minutes to conclude.

I welcome today’s opportunity for statements on the bed closures at the National Rehabilitation Hospital. I thank Senator Victor Boyhan for raising this very important issue.

I have been informed by the Health Service Executive that the complexity of the medical conditions 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 National Rehabilitation Hospital reduced its existing bed capacity by 12 beds to enable the hospital to provide a safe and appropriate level of care to patients from within existing resources. Some eight of these beds are in the brain injury programme and four are in the spinal cord injury programme.

I have been assured that the Health Service Executive is actively working with the National Rehabilitation Hospital to optimise capacity in the hospital by positively attempting to address concerns regarding funding, along with the provision of specialist supports via the Health Service Executive’s clinical programmes division. I wish to inform the House that as an interim step to reinstating bed capacity at the National Rehabilitation Hospital the Health Service Executive is supporting the incremental reopening of four beds at the hospital, together with additional resourcing to support increased therapeutic inputs to all users of the hospital's services. This additional investment will support increased capacity at the hospital with effect from 1 June.

The bed capacity situation is made more difficult as a result of the challenges associated with discharging patients with complex needs. In this regard, the Health Service Executive supports the development of a dedicated post of liaison co-ordinator to further develop an integrated care pathway for spinal injuries patients. I am pleased to say that this position has been approved for 2017. This post will be key to supporting patients in their timely discharge to the next phase in their rehabilitation and will also contribute to optimising bed capacity at the hospital.

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 current time is the redevelopment of the campus at the hospital. There has been good progress on this redevelopment project which will provide a purpose built 120 bed facility, with integrated therapy and support services on the campus. This will include support therapies for paediatrics and acquired brain injury wards, a hydrotherapy unit, a sports hall and a temporary entrance. Planning permission has been awarded and it is expected that the appointment of the successful contractors will be approved by the national rehabilitation board and the Health Service Executive in June, and that construction will commence thereafter.

The area of neuro-rehabilitation is a priority for the Government. A Programme for a Partnership Government includes a commitment to publish a plan for advancing neuro-rehabilitation services in the community. The Health Service Executive’s national service plan for 2017 has identified a number of priority actions in this area. They include finalising and progressing implementation of the framework for the neuro-rehabilitation strategy. Full implementation of the strategy will, of necessity, be a longer-term project. The Department has agreed with the HSE that the focus initially will be on the implementation of the strategy in the community, which is in keeping with A Programme for a Partnership Government.

The development of the framework will include the strategic direction of the National Rehabilitation Hospital, as well as Peamount Hospital and the Royal Hospital in Donnybrook. It is in the context of the development of the framework that the resource requirements of the National Rehabilitation Hospital will be established. These requirements will be further considered as part of the Estimates process. I thank the House for the opportunity to address these issues and I look forward to hearing the contribution of the Senators.

I warmly welcome the Minister of State and thank him for coming to the House to respond to the opportunity presented to him last week. He has come here willingly, as he always does, and I want to acknowledge that any time the House makes a request to the Minister of State, he responds positively and brings information with him. The more information he can bring us, the more we will invite him to come.

I acknowledge what the Minister of State said in terms of facilitating another four beds in the hospital. We need to go back a little bit. I have spoken with the authorities in the hospital at great length. In the past 12 months, I have raised the issue of the National Rehabilitation Hospital in Dún Laoghaire more than any other issue in the Seanad. I have been reliably informed that patients with spinal and brain injuries are waiting for life-changing treatments and many feel they are being left in limbo.

We have to get the context right. This week 209 patients are waiting to go into the National Rehabilitation Hospital. Those facts have been provided by the hospital. Its representatives are listening to today's debate. I spoke to someone an hour ago who was checking the time of the debate. That is very important.

We know these patients are holding up acute beds in general hospitals. Where does all that fit in with the hospital policy of the Minister of State and the Government? Are we for real? Since January, 12 beds in the hospital were cut on the watch of this Administration which told us it is absolutely committed to a national strategy for the rehabilitation of people with brain and spinal injuries. As the Minister of State correctly said, the 12 beds concerned relate to spinal and brain injuries. They are life threatening conditions and the hospital staff are frustrated and disappointed about what is happening.

I thank the Minister of State for making arrangements and facilitating the opening of four events in the next month. We have a real issue; we have waiting lists. The situation needs to be kept under constant review. It will come as a disappointment to the staff, management, directors, doctors and clinicians in the National Rehabilitation Hospital that this is the best that can be done, but it is a positive start. I want to acknowledge the intervention of the Minister of State in those matters.

The Minister of State referred to two other issues in his statement. I am delighted to hear the hospital project has gone to tender, that tenders will be announced and that it is to be hoped construction will start. The Minister of State will recall me asking him on numerous occasions in the House about the redress indemnity scheme and the sisters who own some of the lands.

I am reliably informed that there are still issues around that. While I am not suggesting they are holding up the first phase of the redevelopment, there are issues as to the ownership of the lands. The Government is committing vast sums of money in investment at the rehabilitation site in Dún Laoghaire, which I welcome, but we need to be clear because we have seen this with other hospitals and schools where the religious are involved. I have no axe to grind with the religious and acknowledge their great commitment to health and education and other spheres of society and life, but we have to get this one right.

The Minister, Deputy Harris, went out there for half an hour and ended up spending an hour and a half. Everyone was thrilled with him and he was thrilled with himself. However, we are no further on. What is the story? Who owns this land? What commitments are there and have the nuns fully discharged these lands in line with their commitment to the State? I am privy to the conditions signed up to on these lands and am more than happy to make them available to the Minister of State. It is important before one brick is turned on the site, which I want to happen quickly, for the Minister of State to reassure the House or revert with supplementary information as to absolute clarity on the ownership.

I thank the Minister of State for coming to the House and welcome the four beds, which is a start but not good enough. It comes as a great disappointment to the staff there. I welcome the fact that the new hospital will start in June. The only outstanding issues are the remaining beds, which we can hopefully get reopened in the next few months, and clarification as to the full ownership of the site so that it can go ahead. Let us be sure that not one parcel of that land is sold for other development. There are a number of neighbouring industrial units and people want to buy that. The whole site must be ring-fenced for further expansion of the rehabilitation hospital services.

I welcome the Minister of State, Deputy Finian McGrath, to the House and thank him for visiting County Cavan yesterday where he was very well received and took on board everything that was put to him by the groups he met. I know he will come back to them with, hopefully, positive news. I thank Senator Boyhan for raising this issue not only this evening but on a number of other occasions in the House. It is a very important issue. While I accept the Minister of State's commitment to reopen four of the 12 beds which were closed, it is not acceptable that patients with spinal and brain injuries who are waiting for life-changing treatments are being left in limbo because the National Rehabilitation Hospital in Dún Laoghaire is unable to operate at full capacity.

The National Rehabilitation Hospital is the only hospital of its type in the country. It provides specialist rehabilitation services, inpatient, outpatient and day-patient services to patients with complex needs who have acquired a physical or cognitive disability as a result of an accident, illness or injury and require specialist medical rehabilitation services. I understand the hospital delivers excellent rehabilitation programmes with excellent patient outcomes. However, 50 extra staff are required to reopen the entire 12 beds. As we speak, 226 people are on a waiting list for treatment at the hospital. That puts in context the difficulties we face here. It is estimated that Ireland should have 270 beds, not 56, based on its population. Given the current waiting list, those figures seem to add up. It is also worth pointing out, as Senator Boyhan alluded to, that there are no rehabilitation beds outside Dublin in spite of a number of reports dating back to 2000 recommending that facilities should be provided in the Munster region at a base in Cork. The latest such report was in 2010.

Reinhard Schaler, the CEO of the pressure group An Saol, whose own son, Pádraig, suffered a severe brain injury in 2013 has referred to the closure of these beds and the inability of patients to seek treatment when they require. He said it is a denial of basic and universal human rights and I agree fully with him. I appreciate the commitment the Minister of State made this evening to open four of the beds which have been closed, but that is a drop in the ocean given the reality of the situation, the waiting lists and the number of beds we ought to have based on our population. I thank the Minister of State for coming to the House and I look forward to his response.

I thank the Minister of State for coming to the House and I thank my colleagues, Senators Boyhan and Hopkins, for raising the matter on a number of occasions over the last number of months. I am extremely concerned that we have people occupying beds in other hospitals nationally who are waiting to get in for rehabilitation. Their families are putting us all under pressure, rightly, because they want to get the rehabilitation their loved ones require. My colleagues have outlined the fact that over 200 people are waiting to get in. As recently as today, I had to explain to a family that the earliest they would get into the hospital was September 2017. The issue must be prioritised.

It is sad that there is a lack of long-term planning, which is an issue I have raised consistently over the last number of years. While I welcome the fact that we are proceeding with the new development, the population is increasing and we need to do a great deal more long-term planning. When my colleague from Cork, Deputy Micheál Martin, was Minister for Health, there was talk of a new rehabilitation unit in the city. That is over 15 years ago, but very little progress has been made. We really need a centre of excellence outside Dublin, preferably in the Munster region, and we need to do long-term planning for that. I welcome the fact that progress has been made to open the additional four beds, but it is not enough or fast enough. We need to keep the pressure on to ensure that the maximum capacity is available.

I thank the Minister of State and Senator Boyhan, who has raised this issue consistently for quite some time, as have I. I first became aware of the fact that 12 beds were closed on 14 February last. From January until mid-May, we have had 10% reduced capacity at our National Rehabilitation Hospital in Dún Laoghaire. As an occupational therapist who has worked in rehabilitation for the past eight years, I am deeply frustrated. The evidence very clearly supports the need for people to have access to timely and specialist rehabilitation. It is comparable to a life-saving drug. People who are currently in acute beds need access to timely and specialist rehabilitation in order to have the best possible outcomes and to help improve their quality of life.

It is very positive that the rehabilitation unit planned for Roscommon hospital is being progressed. It is important to have a satellite centre of the NRH to cater for the needs of those who need rehabilitation in the west of Ireland. I emphasise strongly, as I have in the Seanad over the past number of months, the need for proper treatment and rehabilitation for those who need it. I am deeply passionate about that and will continue to raise it. While we are receiving somewhat positive news on the reopening of the four beds, we need those eight beds open now.

The Health Service Executive needs to respond to the work force planning document that was submitted by the National Rehabilitation Hospital and they need to act on it urgently.

I thank the Minister of State for coming before us. I remind people there is very positive news and the last Government allocated €7.85 million for the design and build of a stand-alone €10 million medical rehabilitation unit on the grounds of Roscommon hospital. The unit will operate as a satellite under the NRH. Almost a quarter of the patients treated at the NRH normally reside in the west region but there are no dedicated rehabilitation units there. Effectively, the design contract will go out to tender very shortly. This will certainly help in the coming few months and years in addressing the shortage of beds, notwithstanding the fact that there is a shortage. I welcome that four beds have been reopened and we must do more. This will be a major addition for Roscommon hospital and I invite anybody in the Seanad and Dáil to come to Roscommon and see all the good work that is ongoing. It is another allocation of €20 million from the last Government, and it is very good news.

I welcome the Minister of State and if his attendance in the Seanad were recorded, it would have a gold star. That also demonstrates the dire need for disability services in this country and the demands for them. I thank Senator Boyhan for raising the issue so we are allowed to discuss it today.

Patients with spinal and brain injuries are waiting for life-changing treatments and are being left in limbo because of the National Rehabilitation Hospital's not operating at full capacity. The Minister of State has cited the complex needs that have come about through new discoveries in medicine and rehabilitation therapy, which creates challenges for the hospital, leaving a reason to decrease the number of beds. There is also basically a lack of finance and resources being pumped into the hospital. The closure of 12 beds is horrendous for the individuals and families waiting for treatment. We know early intervention allows a person to be rehabilitated, meaning patients could achieve 80% of function, for example.

I refer to the group that has been set up because of the frustration and lack of resources and timely intervention. It is "We Need Our Heads Examined", and the Minister of State met its representatives. One of our councillors, Ms Natalie Treacy, acted on its behalf, and her mam had a brain injury after a fall. She was told if there was immediate treatment, 80% of her mam's function would return. She is a wife, a mam, a worker, a grandmother. She waited two years, from June 2015 to this week, to commence her treatment, which is completely unacceptable. The woman will now only get 20% of her function back, and that goes for so many of our needy patients throughout the country.

I am "Dubcentric" I suppose but the fact there are only 100 or so beds that are only available in Dublin is detrimental to the rest of the country. People have to access those beds from Donegal, Kerry and the far west and are at much more of a disadvantage than the Dubs, who find it difficult enough to access this. An additional four beds are welcome but again it is a piecemeal approach and pretty miserly, considering our need. We probably have the fewest interventions and smallest capacity in Europe but there was a promise in 2008 of building a state-of-the-art facility that would have been the largest and most effective in Europe for rehabilitation purposes. That has not come to fruition. We need to prioritise our health needs and get people back to full function as soon as possible, allowing them to continue within families and communities.

The emphasis will be on the community model and I applaud the Minister of State on that, as it is the way to go. Given what we have had in mental health services with A Vision for Change and the closure of hospitals, with nothing in place in the community, I am slightly cynical. I hope the Minister of State will not rob from hospitals to give to the communities but just give to the communities. The service in its entirety is required in both inpatient and community-based facilities for our people. I wish the Minister of State well and thank him for coming in. I thank Senator Boyhan for raising the issue; he will raise it again and again until either he is dead or we resolve it.

I hope it is the latter.

I welcome the Minister of State to the House and the debate on the National Rehabilitation Hospital. This is an issue I have raised in this House, along with colleagues, a number of times and I am delighted to see time dedicated to this issue again. When I raised this issue back in October, the Minister of State, Deputy McGrath stated:

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.

This is June and beds have been closed since then. Are we meant to be happy, grateful and encouraged with four beds being reopened? I cannot share the generosity of colleagues in saying this can be in any way good enough for people. The services at the National Rehabilitation Hospital are inadequate to meet the needs of the Irish people. We are letting people down, often at their most vulnerable point, and we should have 270 specialist beds, let alone talking about reopening beds that have closed. With regard to the proposed development and liaison officer, the proposed redevelopment has not even happened. It will only be 120 beds in any case. Thank goodness we have people of persistence and determination and the likes of the Neurological Alliance of Ireland and its excellent campaign, supported by 17 neurological charities, including We Need Our Heads Examined, to keep us focused on this. I had much more to say but there is a continuous pathway of services and supports needed for people on their neuro-rehabilitation journey. There is a vital window in which to provide neuro-rehabilitation following conditions such as stroke and acquired brain injury. As Senator Hopkins knows, people lose functionality with every minute they do not get that rehabilitation.

What plans does the Minister have in place to secure the 270 beds we need? Will they all be put in place after we get the 120 beds? Will we have any beds outside Dublin? If one is miles away from one's family, with a terrible condition, it is simply not good enough. There is also a need for community supports to be built. What plans does the Minister have to put the four regional inpatient specialist services in place? When will we get the fully staffed nine community neuro-rehabilitation teams? How much longer can the 25,000 people wait when they are suffering enough with their condition without access to a decent service? I cannot celebrate a paltry four beds tonight. It is better than going backwards but it is surely not good enough.

I will be curt without being unpleasant to anybody. I thank the Minister of State for being here. The point has already been clearly made that with the people waiting to get in, it is not just that their life is on hold but their opportunities are going backwards at a rate of knots. It is a massive issue, as has already been said. I thank Senators Boyhan and Kelleher, who have pushed this, as well as the Neurological Alliance, for their work.

The complexity of medical conditions of patients referred to the NRH in recent years has increased. It could have been anticipated. There was a strategy to deal with people who have suffered strokes and other conditions going back 20 years. If fewer people were dying as a result of these conditions, there would be more people with legacy issues. I am not trying to be cynical.

Will somebody else be robbed in some other place in order to get the beds back incrementally? I sense that we take the fire engine to one place and take it from wherever it was.

The Minister of State referred to the neuro-rehabilitation strategy. There is no outcome action set out in it. There is an extra process, another process around the framework and a commitment involving the Department and the HSE that when this whole thing gets going, it will have a community focus. That, however, is selling us a pup at this stage. There is actually nothing stating there will be an outcome action for people. There is an honest-enough reference to consideration in the Estimates process.

People are waiting to get in but whenever they get in and go through, if ever, they will be waiting to get out and go back to a home and community that can properly take care of them, including to a house that will be accessible, etc. There are major issues.

I ask the Minister of State to make sure, in respect of a Department in which he has an interest, the Department of Justice and Equality, the issue of traffic enforcement is addressed. Every single accident prevented helps, as does stronger enforcement of the traffic code.

I thank all the Senators for their contributions to this very important debate. It is clear from the exchanges in the House this evening that we agree that the work of the National Rehabilitation Hospital is critical to the care of people who require its services. I share the Senators' frustration. A detailed workforce planning document has been prepared by the hospital and is under consideration by the HSE.

Neurological illness or injury has significant implications for the individual and their family and impacts on their social, educational, vocational and recreational participation. The National Rehabilitation Hospital provides complex, specialist rehabilitation services to patients who, as a result of an accident, illness or injury, have acquired a physical or cognitive disability and require specialist medical rehabilitation. The HSE has given me a commitment and has undertaken to discuss the cases the Senators have raised tonight with colleagues throughout the organisation to ascertain the key challenges in discharging these patients. The hospital has a reputation for excellence - I accept the Senator's comments in this regard - and provides patients with every opportunity to meet their rehabilitation goals, through personalised treatment plans delivered by consultant-led teams whose members are expert in their fields.

The rehabilitation programmes at the National Rehabilitation Hospital are tailored to meet the individual needs of adult and paediatric patients in the following areas of speciality: brain injury; spinal cord system of care; prosthetic, orthotic and limb absence rehabilitation; and paediatric family-centred rehabilitation. I re-emphasise the Government's commitment to the area of neuro-rehabilitation. The development of the new 120-bed National Rehabilitation Hospital on the existing hospital campus is a priority. The design will be patient centred and based on the principles of empowerment, dignity, privacy, confidentiality and choice. It is expected that the National Rehabilitation Hospital board and the Health Service Executive will approve the appointment of the successful contractors in June. This will be a major enhancement of rehabilitation services in the country. It will have a direct and significant impact on patient recovery, by providing an optimal ward and therapeutic environment for patient treatment at the hospital.

I anticipate that the ongoing engagement by the Health Service Executive with the National Rehabilitation Hospital regarding the latter's resource requirements and the initiatives I outlined in my opening statement will be effective in supporting increased capacity at the hospital. As part of its work on the development of an implementation framework for the neuro-rehabilitation strategy, the Health Service Executive has committed to undertake a mapping and gap identification exercise for the country as a whole in order to establish a clear picture of where specialist rehabilitation services are currently being delivered and where the demands are for these services. The Health Service Executive's social care division and the National Clinical Programme for Rehabilitation Medicine will work together to form an action plan, under the HSE's clinical strategy and programme division. A national steering group made up of stakeholders representing all the interested parties will be responsible for the governance and implementation of the action plan. I believe that the Government's commitment in A Programme for a Partnership Government, along with the priority actions in the area of neuro-rehabilitation identified by the Health Service Executive in its national service plan for 2017 will have a positive impact on the development of these services into the future and on the lives of those people with neurological illness or injury.

On the matter of ownership, under the redress scheme, the Congregation of the Sisters of Mercy proposes to transfer the ownership of the lands and buildings to the HSE. The congregation has initiated the process to secure the consent of the Minister to the transfer but the process within the Department is at a very early stage. The future management and operation of the hospital are also part of this very complex proposal, which, in order to ensure that the National Rehabilitation Hospital will continue to provide health care services on behalf of the State, includes a proposal that the transfer be followed by a partial lease-back. Under the redress scheme, the transfer to the HSE will take place.

The Senators have raised many issues in this debate and it is my duty, as Minister of State with an interest in disability, to raise their concerns and the issues raised with the line Minister and the rest of the Government. I thank the Senators for the opportunity to address these issues this evening and for their valuable contributions to this important debate.

The Seanad adjourned at 7.05 p.m. until 10.30 a.m. on Wednesday, 24 May 2017.