I thank the Chairman for inviting us and all the members present for their interest in the cause of stroke patients nationally. We believe that after many years of being ignored, their needs are beginning to receive the attention and action they deserve. I do not propose to go over some of the matters Dr. Harbison has alluded to, but I shall deal with some of the main points we want to make.
It is recognised internationally that in providing a concentration of medical, nursing and therapy services, stroke units can reduce the death and severe disability rate from stroke by 25%. Thrombolytic treatment can mean the difference between a patient walking out of hospital under his or her own steam within days of having a stroke, or spending the rest of his or her life in a nursing home. Therefore it is enormously important, as we have heard from Dr. Harbison.
Unfortunately, the deficits in relation to these services remain particularly bad in our view. According to HSE statistics, just 178 out the 8,000 that suffer acute stroke received thrombolytic treatment in the 12-month period to the end of March 2009, an overall rate of just over 2%. The HSE recognises that 20% could receive this treatment. In other words, just over one in ten people who could have benefited actually received it.
We do not know how many acute stroke beds there are in Ireland at present. The latest study, completed last July, states there are 140 acute and rehabilitation beds, but the Irish Heart Foundation's audit on stroke services, published in 2008, identified the need for 411 acute stroke beds. Although we cannot be sure what percentage of patients are treated in stroke units, it is probably somewhere between one in five and one in six. This compares to a rate of more than 90% in the UK.
Despite these appalling statistics, we believe we are on the brink of a real breakthrough in stroke care. The Government's new cardiovascular help policy sets out a blueprint for the development of truly world-class stroke services in Ireland, and we believe this has 100% support from the relevant stakeholders. Stroke has been prioritised by the HSE, which has put the right leaders in place to deliver change we believe. Nobody in Ireland is more committed to the cause of stroke patients than Professor Kelly and Dr. Harbison, who are here today.
Our strong concern, however, is that although we are informed that stoke is to be included in the HSE's 2011 service plan, the necessary funding will not be there to ensure effective change. To a large extent it boils down to money, and for a long time the sole remaining barrier to the elimination of avoidable death and disability from stroke was a genuine and legitimate uncertainty over the cost implications of the improvements that were needed. Even this has now been swept away we believe by the new report from the heart foundation, compiled by the ESRI and the Royal College of Surgeons in Ireland with the assistance of some of the country's foremost stroke physicians. It shows that the overall cost of stroke in Ireland is up to €1 billion, but by providing stroke unit care and the wider availability of thrombolytic treatment, 750 people could be saved from death or life-long dependency every year, at a cost saving to the Exchequer of €13 million. Over a ten year period the savings from these interventions alone would be up to €225 million.
To understand how lives and money can be saved simultaneously, we must look at how utterly dysfunctional the current system for delivering stroke care has become. It is so dysfunctional that the real money is only spent on patients after a point where they can realistically receive beneficial treatment. For example, the report shows that up to €96 million a year is being spent on acute services for stroke patients, but we are spending as much as €414 million on keeping stroke survivors in nursing homes without any access to rehabilitation. Think of this from a patient's viewpoint. In a frightening number of cases the patient must endure the double whammy of being left with an unduly severe disability because of not receiving the best possible acute services when he or she had the stroke, and then miss the chance of relieving the worst effects of it because he or she cannot access community rehabilitation services.
This is borne out in the report which reveals a national spend on community rehabilitation of less than €7 million annually. Frankly, this is very poor given the often complex needs of stroke survivors in terms of physiotherapy, speech and language therapy, occupational therapy and psychological needs. Indeed, when one considers that there are up to 46,000 stroke survivors in Ireland, this works out at just over €150 per person, enough perhaps to fund a single physiotherapy session in a whole year for people who are battling to put their lives back together. This represents appalling value for the taxpayer. In human terms it is a needless tragedy, but the potential gains in lives saved and disability reduced, not to mention reduced costs, are even bigger.
In addition, the statistics do not take into account that without decisive action now there will be a 50% increase in the incidence of stroke and its overall cost to the economy over the next ten years. Politicians receive many reports claiming that upgraded services will result in cost reductions at some stage in the distant future. In this case better acute stroke services will produce almost instant savings, because increased access to stroke units and thrombolytic treatment will result in immediate improvements in outcomes and therefore lower demand for nursing home places, which is the most expensive end of care. In the midst of economic distress and the short-termism this forces on decision makers, it could be easy for the cause of stroke patients to disappear from the radar. Also, there is a real danger that gains already made in developing stroke services could be swept away. In particular, the expected reductions in the numbers of contract nurses could have a very serious knock-on effect on stroke services. As regards the cost of stroke, the report shows that the better acute services are the more lives and money will be saved. However, the worse they are the more lives and money will be lost.
As a result we have asked the Government for nursing staff working in stroke care to be removed from the HSE recruitment moratorium and for at least €13 million in funding to be made available for stroke service developments in 2011. Any objective analysis of stroke services will show that saving a patient's life costs nothing. We want to ensure that never again will service deficits make patients feel their lives are worth nothing. Therefore, we exhort every member of the committee to support our aims and help us fight for the necessary services to be put in place.
