My colleague, Minister White, was recently invited by the National Disability Authority to speak at the launch of this Report. This study is welcome as it provides comprehensive information on the impact of stroke for survivors and their carers.
Many developments in cardiac care have been brought about through various means including the National Cardiovascular Health Policy. This policy named “Changing Cardiovascular Health” covers from 2010 to 2019. It provides an integrated and quality assured approach for the prevention, detection and treatment of cardiovascular disease including stroke. Since 2010, significant improvements have been made with regard to access to acute treatments for coronary heart disease as well as the development of stroke units across the country. As Minister for Health, I was pleased to outline these at the launch of the Irish Heart Foundation Stroke day on 11th April last week.
Key elements of Stroke care now available include: New and existing stroke units provided with additional therapy, nursing and consultant posts; The Clinical Programme for Stroke continues its work to develop and disseminate care pathways and clinical protocols; A national 24/7 access to safe stroke thrombolysis through service development, telemedicine and training is already available in many hospitals with access protocols agreed for others; Ambulance access protocols are being developed by the Stroke Programme working in partnership with national ambulance service to agree and implement ambulance access protocols. Thrombolysis is now available to all acute hospitals admitting stroke patients and 9.5% of patients are being thrombolysed. This rate compares will with the best European figures and exceeds our target 7.5%.
The Stroke Programme estimates that the number of people with enduring disabilities as a result of stroke has decreased as the percentage of patients with stroke discharged from acute hospitals to nursing homes has dropped from 17.3% in 2009 to 14.5% in 2012. This is a positive outcome. The rapid increase in access to thrombolysis, from 3.3% in 2008 to 9.5% in 2012, has resulted in better outcomes for patients. The Stroke Foundation Education programme developed by the Stroke Programme and available to all staff caring for stroke patients is leading to improved patient experience of stroke service provision. Patients requiring more intensive rehabilitation are referred to the nearest available rehabilitation service, such as the Stroke Rehabilitation Unit, Baggott Street, Dublin Stroke Rehabilitation Unit, Louth County Hospital, Dundalk Hibernian Stroke Rehabilitation Unit, St. Mary’s Hospital, Phoenix Park Stroke Rehabilitation Unit and St. Finbarr’s Hospital, Cork.
Stroke rehabilitation can be provided in a number of settings, which range from specialised rehabilitation centres and departments in acute hospitals to outpatient and community settings. The establishment of managed clinical rehabilitation networks for neurological and prosthetic rehabilitation services in each of the 4 HSE Regions is proposed to facilitate the development of integrated quality rehabilitation services. Currently the only internationally accredited programme of specialist inpatient stroke rehabilitation is delivered at the National Rehabilitation Hospital in Dublin. However, the Programme’s Model of Care outlines that 4 regional hubs, which will have clinical and consultant leadership from a designated specialist in rehabilitation medicine, supporting existing neurologists and specialists in medicine for the elderly, be set up. It will include the National Rehabilitation Hospital (NRH) as the national hub and will also incorporate the setting up of Specialist Community-Based Rehabilitation Teams.
The implementation of the Department of Health’s National Policy and Strategy for the Provision of Neuro-rehabilitation Services in Ireland - in collaboration with the National Clinical Programme for Rehabilitation Medicine and its Model of Care - will provide for improved access to and quality of services for all patients requiring rehabilitation and their families.
Primary Care also plays an important role in stroke rehabilitation. The HSE’s National Service Plan 2013 provided for additional funding of €20m to strengthen primary care services (€18.525m for the recruitment of 264.5 primary care team posts and €1.475m to support Community Intervention Team development). The posts were allocated based on the analysis carried out by the HSE in identifying areas of deprivation and need. The additional primary care posts includes 72 Public Health Nurses, 40.5 Registered General Nurses, 47.5 Physiotherapists, 52.5 Occupational Therapists and 52 Speech and Language Therapists.
As of 6th March 2014, 199.5 posts have been filled or start dates have been agreed. The HSE is striving to have the remainder of the posts filled as soon as possible in 2014. Taken together, all these developments show that we have made significant progress in preventing stroke and its complications.