11th January 2012
I raise the issue of stroke rehabilitation services. An estimated 10,000 people will suffer a stroke in Ireland in 2012 and approximately 2,000 will die as a result, making strokes Ireland’s third biggest killer.
Stroke is the single biggest cause of severe disability and up to 50,000 people are living in communities with disabilities as a result of a stroke. In September 2010, the Irish Heart Foundation published the “Cost of Stroke in Ireland” report, which was compiled by the ESRI, which showed that the wider availability of stroke units and clot-busting treatment countrywide would reduce the number of deaths and cases of permanent severe disability from stroke by at least 750 a year. It would save the State approximately €230 million in the next decade, mainly due to the reduced need for nursing home places. These findings were accepted by the HSE and the Government and specific funding was provided by the HSE’s 2011 service plan to pay for extra consultant, nursing and therapist posts to deliver significant improvements to acute services.
The report also painted a stark picture of the deficits in community rehabilitation facing stroke survivors after their hospital treatment has been completed. No action has been taken to rectify these deficiencies.
The ERSI calculated that the direct annual cost of stroke is up to €557 million, of which as much as €414 million is spent directly on nursing home care. However, only €7 million is being spent on community rehabilitation services that could keep more of Ireland’s 50,000 stroke survivors living in their own homes and, thereby, improving their quality of life and also reducing costs. In effect, the vast majority of money for stroke is spent after the point at which it could help people the most. An average of less than €140 is spent on the rehabilitation of each stroke survivor which is only sufficient to pay for a couple of physio sessions each year for people with often very complex physical, communication and psychological needs.
As no doubt the Minister will be aware, the National Audit of Stroke Care, which was also carried out by the Irish Heart Foundation, looked at the extent of effects of stroke on people. It showed that almost half had a weakness on one side of their body, 22% were unable to walk, more than half needed assistance with activities in their daily life, 32% have depression and a further one third have cognitive impairment. That clearly shows that, more than any other disease, stroke can strip away people’s dignity and make them dependent on others, often to carry out basic personal tasks.
The improvements to acute services are saving lives but we cannot ignore the quality of life of survivors when their hospital stay has come to an end. In addition to the human implications, it does not make economic sense. That is what surprised me when I looked at this issue. This is not about increasing funding. This is about where we are placing the funding.
Those who have had a stroke and their carers need to be able to access a range of services after they have left hospital. Many stroke survivors will need further community based rehabilitation such as physiotherapy, speech and language therapy, occupational therapy, clinical psychology, and nutrition advice and input. Currently, few stroke survivors have access to this type of care and, therefore, their lives are dramatically affected.
My questions for the Minister are whether he accepts that there is a clear case for the provision of rehabilitation services for stroke survivors and others with neurological conditions and that the provision of such services would be cost effective. The Minister of State, Deputy Kathleen Lynch, announced that there will be shortly publication of a neuro-rehabilitation policy, but will funding be provided for the implementation of this policy to accompany it? If the funding is not provided, how will the policy be introduced and how will the suffering of stroke survivors and others in desperate need of rehabilitation be alleviated in the years to come? Does the Minister intend to support the carrying out of research into the cost benefit of rehabilitation to follow up on the Irish Heart Foundation’s Cost of Stroke in Ireland report?