The National Clinical Programme for Stroke 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 programme aims to improve quality, access and cost-effectiveness of stroke services in Ireland.
The programme can point to many improvements in Stroke care since its inception. The HSE has previously advised my Department that emergency thrombolysis is provided now to patients in all regions of the country by improved hospital and ambulance protocols, health professional training and the appointment of new physicians.
There is national 24/7 access to safe stroke thrombolysis, the rate of which has increased from 1% in 2006 to a current rate of 13%. This exceeds the national target of 9%.
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 National Clinical Programme for Stroke, nine new stroke units have been opened, bringing the total number of stroke units in acute hospitals to twenty-two. This is a major improvement from the first national stroke care audit report in 2008 which reported one stroke unit in the country.
The programme has also developed a range of care pathways to assist the streamlining and standardisation of stroke care delivery.
The cost objectives of the programme have also been met with more stroke patients experiencing improved clinical outcomes. Examples include:
- Less stroke patients are dying in hospital: The rate has dropped from 16.2% in 2009 to 14.1% in 2014 – an overall percentage reduction of 12.9%;
- Less stroke patients are discharged to nursing homes – and therefore with improved disability outcomes: This has reduced from 17.7% in 2009 to 13.8% in 2014 – an overall percentage reduction of 22.1%;
- More stroke patients are discharged directly to home from acute hospitals: The rate has increased from 50.7% in 2009 to 51.6% in 2014;
- The median acute hospital length of stay for stroke has fallen from 10 days in 2009 to 9 days in 2014, with an estimated 19,000 bed days saved in the 2011-2014 period.
This is all good news for stroke patients.
The HSE has advised my Department that funding for developments are considered annually and submitted to the Department of Health as part of the service planning process. The HSE will be starting this process in the coming weeks for 2018. Requests for allocation of dedicated funding for the Stroke Register will be considered in the context of the Estimates Process for 2018.
