Martin Daly: Warns Stroke Care Plateau, Rehab Bed Shortages

Thank you, Mr Tierney and Mr Gloucester, which are teams from the Department of Health and the HSE. I suppose I can't go by, I have a short time frame here. The National Office of Clinical Audits report on stroke care in Ireland, it's sort of disappointing. There's been a lot of improvement in stroke care over the years. We see that the pace has not kept in terms of beds. Even where there are beds, patients aren't getting those beds. So you have stroke beds in a hospital, someone's admitted with a stroke and they don't get into a stroke bed. Even if they do get into a stroke bed, they're not getting the length of time in that stroke bed that they should be getting. The National Clinical Audit lead, Professor Joe Harbin, said there's a plateau has been reached around some areas of stroke treatment. Every hospital has a stroke unit, but too few patients are actually being treated in them. We have issues around, and I want to recognise, by the way, there is almost no private acute stroke care. So the public system is the go-to, and this is a devastating illness. I suppose the ask is, what are the HSE department doing in terms of creating additional capacity, making sure that the capacity that there is utilised fully for people who need it, especially with this devastating illness, and that the supports are there to get them out of hospital, because early discharge support, I think it's something around 12%, which means that people are stuck in hospital when they should be out in the community receiving care. Just before I ask Dr Henry on the clinical side, as recently as yesterday, I was in Cork, dealing with many issues, this being one of them. And I think it is important to say, and I think the audience recognise, major progress has been made in Ireland in terms of successive outcomes for people with stroke, and the response in the first few hours, and thrombolectomy, and so on. The approach that's been taken next year by the Minister is allowing an amount of each region to look at the different places it has deficits. In some cases, that will be in the response to breast cancer compared to their peers. In some areas, it will be stroke. And so there is always further investment in the health service that's going to support continued improvement. And there is a geographical disparity. The West of Ireland has a dirt of newer rehab beds. I mean, literally, it's a black spot. There's none. And so, and what was really interesting was, there was a rehab unit promised to Roscommon University Hospital in 2015, a budget attached to it, and it surreptitiously disappeared from the capital plan in 2024, only after some lobbying it's back on the plan. I mean, to me, that doesn't give me much confidence. Sure. No, I accept there's a way to go, and I think to be wrong with me to dispute that, I would say to you, I think the approach we're taking to giving the regions a chance to bring themselves up to a level in a number of services, it's the first time it's ever happened in that way. I'd have a lot of confidence it'll take us a distance. It'll take time to get there. But I would say we are heavily focused on the patient flow journey for stroke, because equally the egress from those beds to allow others in is critical, and that's one of the issues I was dealing with yesterday. I don't know if Dr. Henry wants to. Just so I could say that it's an area of bigger interest, my own specialty, but in many ways the audit, which highlights a lot of good progress too, highlights that in a way we've become, the problems we've developed now are as a consequence of rapidly expanding acute stroke provision. Without interrupting, because I'm on a short space of time, a patient comes into a hospital with a dedicated stroke unit and doesn't get into a stroke bed. That's a problem. There's situations around not adhering to standards, significant staffing shortages, not having enough consultant ward rounds. These aren't issues of capacity. These are issues of organisation. On standards, there's some significant approves noted to bring balance to your comments, including the swallowing assessment gone from 68% to 81%, a very important and basic standard of stroke units. The fact that 22 hospitals now, or 24 hospitals, have established stroke units, we provide 24-7 thrombolysis in those hospitals. I know, but I just want to say the report does, but many do not comply with defined standards. That's an issue of management and governance. And you're not reaching your targets in terms of people accessing a stroke bed and getting into a stroke unit. So I think we just need to accept those facts and then to move on. And I do accept there have been improvements. I'm not saying there hasn't been massive improvements in the last 20 years. Because I've short time, I just want to move on. Now, mental health services. In County Roscommon in 2016, there were 80 community step-down beds in the community for people who had long-term mental health issues, who had additional social and addiction issues. All of those beds are gone. Simply gone. They were decided to go into, it was decided to change policy. They're going to local authority, housing, and be supportive of wrap-up services. On the election campaign, I met two of those unfortunate citizens going around, literally being fed at the local supermarket free of charge because the manager felt sorry for them. Couldn't manage their money. Can't manage their lives. What happens to people in those situations? They end up in three situations. You end up with the acute services unit in Roscommon University Hospital, 24 acute beds. Eight of them were taken up by people who should have been in the community, but there was no appropriate setting for them. It's gone down to 25% now. We know internationally what happens with people who have chronic mental health issues associated with social and addiction issues. They end up in three places. They end up either in our health service in a community setting, they end up homeless or they end up in prison. I want to know why there has been no replacement of those community-supported homes in County Roscommon. Okay. And I'm not familiar with what it's like today, but I did manage the service there for a year when the mental health service was at its greatest crisis with the Mental Health Commission. And in fact, I brought in an external investigation from Northern Ireland because of very serious issues there. And some of those units that you referred to that were there were not of themselves equally good places of care. And I need to be very clear about that. That said, that shouldn't be an excuse for an absence of an appropriate level of service for people. People with mental health, particularly enduring mental health illness, they can be accommodated in various housing bodies and local authorities' games, but they can and should be supported to their level of dependency. But we still do have a level of need for some inpatient higher support levels for people or high support units or houses. And I hate interrupting you because I know you're... I thank you for your answer. Can we confirm that the replacement unit, the replacement acute psychiatric unit for Roscommon University Hospital with the car park will be going ahead? There are rumours that it's going to be... the funding will be seconded somewhere else. I need to check what the capital plan is going to say in two or three weeks' time. But I'm not familiar with the individual data. I think we need to give you a written answer on that. And I promise you... It was planned. It's gone to planning stage. That's what I've been told. Well, I'm not aware of any reason to pull anything that's gone to planning. But to be fair to you and to the Minister, the capital plan for 26 isn't published yet. I need to give you a letter for that. But I will do that very much. Thank you. Thank you to you. And finally, we talked about productivity within our health services. Digitalisation remains big. And I know you've referenced it in both of your commentaries. But I have to say, doing a bit of research on where we are in the European Union, we are a laggard. Not by a few percentage points. We are a laggard. The home of Facebook, the home of TikTok, the home of all of these international... The expertise we have in this jurisdiction. And we are a laggard by not just... We are off the chart. That's the chart. Combined. Off the chart. So I'm just asking... You've addressed some of it, but I do think it's something that needs to be taken seriously. We need investment in our digitalisation of our health services. Thanks, Deputy. Your time is up for that. And we have a dedicated session coming up on that in a number of weeks. So good.