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Seanad Éireann · 2022-11-30

Part of Commencement Matters

Health Services

FG Mary Seery Kearney · Nominated by the Taoiseach · Acting Chairperson

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Summary of this debate

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It is the provision of community neurorehabilitation teams. If we go back to the 2019 implementation framework on a national strategy and policy for the provision of neurorehabilitation services in Ireland, integral to it is the provision of inpatient and community-based neurorehabilitation services. It also describes a managed clinical rehabilitation network demonstrator project which is currently progressing through the development of post-acute and community neurorehabilitation services across CHO 6 and CHO 7.

I am also informed by the HSE that a location for the community neurorehabilitation team has been agreed in CHO 7. My understanding of the implementation model was that CHO 6 and CHO 7 would be the locations for the two demonstrator projects.

Built by scoring every sentence in the debate on how distinctive its language is, then quoting the highest-scoring ones back word for word and in the order spoken. Nothing is paraphrased or invented — if a sentence appears here, it was said in the chamber. Drawn from 1,253 words across 4 contributions by 2 speakers.

Most used terms in this debate

How often each word appears across the whole debate, ranked by how distinctive it is to this debate rather than common to all parliamentary language.

neurorehabilitation 16
cho 14
demonstrator 6
teams 9
neurological 4
team 9
implementation 9
strategy 8
recruitment 6
services 10
community 9
impediment 3

The full debate

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FG Mary Seery Kearney this contribution

I welcome the Minister of State, Deputy Noonan. I have spoken with the Minister for Health this morning and I appreciate that he is before the Oireachtas Select Committee on Health to discuss the Estimates. In recent days I have received an awful lot of emails relevant to the matter I am raising and I am grateful to the Cathaoirleach for choosing it for discussion. It is the provision of community neurorehabilitation teams.

If we go back to the 2019 implementation framework on a national strategy and policy for the provision of neurorehabilitation services in Ireland, integral to it is the provision of inpatient and community-based neurorehabilitation services. To put everyday language on this, neurorehabilitation is designed for people with diseases, injuries and disorders of the nervous system. These can be acquired injuries, for instance, arising from stroke or an acquired brain injury. It can also be for people with multiple sclerosis or Parkinson's disease.

We can see that having a team keeps people at home for as long as possible if they have a progressive disease or illness that will bring them to being less able. Having a community team is essential for this purpose. When people are in hospital following a stroke or because of an acquired brain injury, the community team is the link that enables them to come home. In every way it makes much more sense to have community neurorehabilitation teams.

I am specifically asking about community healthcare organisation, CHO, 7 because it is my area. It includes the constituency of Dublin South-Central. Part of the implementation framework was to have a team in every CHO district throughout the country. My understanding, on which I seek clarification from the Minister of State, is that only two of the nine teams have been delivered. I would value an update on this. We must ensure we have a plan or a timeline.

What are the impediments stopping this from happening? It is important. Having the teams in place makes sense. One of the people who wrote to me made the point that for every €1 spent on these teams, the health service saves €11. The evident need for beds in hospitals is all the more reason to have a community-based service that provides supports in a person's home. That is important.

As regards the national strategy, I refer to recent advocacy and presentations relating to having neurological nurses at the likes of St. James's Hospital. There was only one such nurse there at one stage. The situation elsewhere may be similar. The inpatient service is not being provided to the extent required and neither is the community-based service and, as a consequence of that, people are spending far longer in hospital than required or are going into hospital earlier than necessary. Those people could be supported in the familiar surroundings of their own homes. In cases involving an impediment that may be growing, as may arise with multiple sclerosis, and the fears and everything else that come with that, having that support in one's own home is essential. I look forward to hearing what the Minister of State has to say.

GP Malcolm Noonan

I thank the Senator for raising this issue. I know MS Ireland has been campaigning on it for a long time. I apologise for the misprint in the date on the written version of my reply that has been circulated.

The implementation framework for the neurorehabilitation strategy was launched in February 2019. It provides guidance for the development of specialist neurorehabilitation services across the continuum of care - from acute to post-acute and community services. Neurorehabilitation services play a critical role in supporting recovery of those with neurological conditions or maximising their ability, or both.

The HSE is aware from its mapping exercises that there is a dearth of neurorehabilitation services at both inpatient and community levels. The plan to address this is described within the implementation framework, referenced by the Senator, for the neurorehabilitation strategy. It outlines a ten-step approach that will see each CHO introducing a local implementation team to oversee and guide the implementation process. It also describes a managed clinical rehabilitation network demonstrator project which is currently progressing through the development of post-acute and community neurorehabilitation services across CHO 6 and CHO 7. The funding provides for five whole-time equivalents in each team, consisting of senior physiotherapist, senior occupational therapist, senior speech and language therapist, senior clinical psychology and administrative staff. The introduction of the first managed clinical rehabilitation network is hoped to be an exemplar for the national roll-out of the neurorehabilitation strategy.

The Senator's question relates to CHO 7 specifically. As outlined, it is one of the two areas included in the demonstrator project. The HSE advises that it is currently working on a governance model for this team and expects to commence recruitment immediately. I am also informed by the HSE that a location for the community neurorehabilitation team has been agreed in CHO 7. This team will be based at Peamount Healthcare.

I assure the Senator that the Minister of State with responsibility for disabilities is totally committed to the implementation of the neurorehabilitation strategy and is very aware of its importance for people with neurological conditions. The Senator has spoken to the Minister for Health and he has given her assurances similar to those put forward in this reply. It is welcome news that we are making progress in this regard.

FG Mary Seery Kearney

I thank the Minister of State. My understanding of the implementation model was that CHO 6 and CHO 7 would be the locations for the two demonstrator projects. To clarify, nothing is in place as yet but those CHO areas will be the locations for the first demonstrator projects. That is my understanding, based on the reply of the Minister of State. Are there recruitment issues? Is there a shortage of candidates for recruitment to the five disciplines required for the teams? There is a chronic shortage of staff in the child services in CHO 7. The disability teams are at less than 30% staffing. Is that an impediment to progress in this context? Speech and language therapists are required for these teams and they are also required in children's disability services. Is there an impediment in the context of recruitment? Is there a timeline for when this will be delivered?

GP Malcolm Noonan

I reiterate that the Government remains committed to implementation of the neurorehabilitation strategy and the current demonstrator project for CHOs in CHO 6 and CHO 7. Delivering on this commitment, additional funding was provided in budget 2023 for neurorehabilitation. Funding will provide for the continued roll-out of the strategy in two more CHO areas. The exact location of these two teams is currently being considered by the HSE and a final decision will be made having regard to a range of factors. In addition, new development funding was secured for the recruitment of 23 whole-time equivalent neurology nurses. These positions will be based in neurology hospitals across the country and will provide care and support for people across a range of neurological conditions.

The Senator asked several supplementary questions. If it is okay, I will ask the Department to respond to her on them. There are recruitment constraints in the context of this issue, as is the case right across the health services. Those challenges notwithstanding, the intention is to move on these demonstrator projects as soon as possible. As regards specific timelines, I will ask the Department to revert to the Senator with a more detailed response.

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