Questions to Minister for Health: Early Supported Discharge programmes for stroke survivors

Questions to Minister for Health Leo Varadkar TD, Minister Lynch and HSE in advance of Health and Children Committee meeting 6 October 2015

Senator Jillian van Turnhout
To ask the Minister for Health if he will ensure that Early Supported Discharge programmes for stroke survivors are expanded by the HSE in 2016; what other actions he intends taking to develop community rehabilitation services for stroke survivors; whether he is concerned that the implementation plan for the National Neuro-Rehabilitation Policy and Strategy 2011-2015 has not yet been finalised with just four months left in its four-year lifespan; and if he will make a statement on these matters.

Currently there are 3 Early Supported Discharge (ESD) teams in Dublin North, Dublin South West and Galway respectively. These teams though small are functioning well.

The programme plans to increase the ESD teams over the coming years in larger urban areas first and then progress this expansion to less urban areas with a modified team to serve these areas, however resources are currently unavailable for this.

The National Policy & Strategy for Neuro-Rehabilitation 2011-2015 recognises the various possible challenges and the working group proposed an initial 3 year implementation plan.  Since the initial estimate of a 3 year implementation plan, the HSE has seen significant changes with the development of the Hospital Groups and the Community Healthcare Organisation configuration. This has changed the landscape within which services are to be configured to support implementation of this much needed strategy.

Currently, a steering group led by the HSE Social Care Division with representation from the National Clinical Programmes for Rehabilitation Medicine and Neurology, Department of Health, Primary Care, Therapy Professions & Neurological Alliance of Ireland has been assigned the task of developing an implementation framework for the National Strategy & Policy for Neuro-rehabilitation services. This group is working on finalising an implementation framework which will be released for consultation in Q4 2015.

The work of the steering group is overseen by an operational lead and a clinical lead with the group proposing a 2 phased approach to implementation which will begin at CHO level and expand to inpatient specialist rehabilitation services with connectivity across all service delivery sites.

The Model of Care of the National Clinical Programme for Rehabilitation Medicine (NCPRM) will be one of the primary reference points for the implementation of the Neuro-Rehabilitation strategy, given the importance in ensuring consistency and clarity in pathways to and across services.  The model of care of the NCPRM will provide a framework for the design and delivery of specialist rehabilitation services in the context of a strategy that addresses the broad continuum of services and supports required by those with neuro-rehabilitative needs.

The Model of Care for the NCPRM, which is currently being finalised post public consultation, details the role, function & benefits of these care teams, in line with the recommendations contained within the National Strategy & Policy for Neuro-rehabilitation Services in Ireland 2011-2015. This model of care proposes a 3 tiered model of specialist rehabilitation services namely complex specialist tertiary services, specialist in-patient rehabilitation units & community based specialist neuro-rehabilitation teams.

Both the National Clinical Programme for Rehabilitation Medicine and the National Policy & Strategy for Neuro-rehabilitation propose a needs-led service that meets the rehabilitative needs of people at acute, post-acute and community levels of people at all stages of the lifecycle who may benefit from medical, physical, cognitive, psychological and/or social Neuro-Rehabilitation service provision.

In this regard, it is not condition specific. While those who have suffered a stroke will be within the scope of this policy, services will not be exclusively for stroke survivors.