Adjournment Matter - Health Services

Friday, 2 July 2010

Seanad Éireann Debate
Vol. 203 No. 14

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Senator Cecilia Keaveney: Information on Cecilia Keaveney Zoom on Cecilia Keaveney I thank the Minister, Deputy Gormley, for being here. He might not be the appropriate Minister, but I appreciate his presence.

I am raising the issue around the efforts being made to promote stroke prevention information and awareness, bearing in mind that a couple of years ago the stage was reached
wherein heart attacks might be prevented through the raising of awareness. I am told we are more or less at the same level of awareness today, as regards stroke prevention.

Around 10,000 people will have a stroke in Ireland this year. That is approximately one every 45 minutes. One in every five persons will have a stroke at some time in his or her life. [994] Stroke is the third biggest killer in Ireland claiming over 2,000 lives every year. It has a higher death toll than breast, prostate and bowel cancer combined. Stroke is also the biggest cause of acquired disability and around 30,000 people are living with disabilities as a result of stroke.

Publication of the national cardiovascular health policy 2010-19 in May means historical progress in policy terms. It is recognised as a blueprint for the delivery of truly world class services in Ireland. However, there is no additional funding available for this preventative intervention. Implementing the report could eliminate avoidable death and disability from stroke in this country. Delivery of a comprehensive stroke service cannot be achieved without funding. The costs involved are small and much of the outlay will be recouped as a result of reduced numbers of stroke patients, shorter hospital stays and substantially lower nursing home costs due to lower levels of dependency.

The State is currently spending at least €500 million on stroke services every year. Eliminating avoidable death and disability does not have to cost more than this. Research commissioned by the Irish Heart Foundation, which is currently being conducted by the ESRI, is expected to show that following a relatively small initial investment, the development of world class stroke services in Ireland would be at least cost neutral and would possibly save the taxpayer money.

Stroke services are woefully inadequate in large parts of the country and in some places non-existent. For example, it is agreed that the death rate from stroke could be cut by 25% if all patients had access to stroke units. However, just 11 acute hospitals have any type of stroke unit. Thrombolysis is a clot busting drug that can have near-miraculous effects in preventing death and disability from stroke. The HSE says if services were better 20% of patients could benefit from such treatment. However, according to HSE figures, in the 12 month period to the end of April 2009, around 2% of acute stroke patients were thrombolysed. In large parts of the country it is either completely unavailable or only available to people who have a stroke from 9 a.m. to 5 p.m., Monday to Friday.

In the acute setting just one in four patients was recorded was having received rehabilitation according to IHF research. Stroke patients should be entitled to a minimum of 45 minutes of required rehabilitation five to seven days a week for as long as required. The reality is that no service is available to the vast majority of patients. Indeed even music therapy that can play a role in the issue of speech recovery, fails to gain professional recognition in this jurisdiction. We know what has to be done but funding needs to be available for vital improvements.

We spend around €500 million euro a year on what are perceived to be grossly inadequate stroke services. Improvements will carry some upfront costs in areas such
as stroke unit and thrombolysis provision, development of rehabilitation services etc. If there can be no new funding for stroke, there should be a reallocation of resources from the HSE’s €15 billion annual budget to develop a proper service for the country’s third biggest killer disease. By substantially reducing death and disability from stroke, substantial savings could make improvements cost neutral, freeing up hospital beds for patients with other less treatable diseases or conditions. In particular savings would accrue from reductions in the cost of institutional care, the length of hospital stay and the rate of readmission.

In a more general sense, given predictions of a 40% increase by 2020 in heart attack, stroke and other chronic conditions we urgently need to adapt our services and strategies to meet the changing face of cardiovascular disease, because although deaths may be falling, the prevalence of it is rising.

People of all ages need to be made aware of the risk factors for stroke and cardiovascular disease. They are very prevalent among the Irish population. Some 60% of adults over 45 years have high blood pressure, 80% have high cholesterol, 29% of all Irish adults are smokers, surprisingly a rise since the since smoking ban was introduced, and 61% of adults and about 20% of children and teens are overweight or obese.

[995]Effective awareness campaigns are needed in stroke prevention as are stroke clinics. I am told that stroke is as preventable now as heart attacks a decade or more ago. Can we afford not to review our spend and do the frontloading to stop the major trauma that is left in the wake of stroke for patients and their families?

Minister for the Environment, Heritage and Local Government (Deputy John Gormley): Information on John Gormley Zoom on John Gormley I thank Senator Keaveney for raising this matter which I am taking on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

Stroke is one of the leading causes of death in most developed countries. In Ireland it is estimated there are more than 10,000 acute strokes per year. We know stroke is a medical emergency. I am told that between 1 million and 2 million brain cells can be lost every minute a stroke goes untreated. There are now about 30,000 people and their families living with the effects of residual disability from stroke. There have been advances in recent years in investigation, treatment and rehabilitation after an acute stroke. Four out of ten patients now return home after an incident, while one in ten remains heavily dependent in long-term institutional care. However, the risk of recurrence is high, ranging from one third to one half of those who survive strokes.

Thankfully, mortality rates from stroke have fallen considerably in recent decades. However, with longer life expectancy after stroke and an aging population, it will continue to pose challenges for individuals, families, communities and the health service for years to come. It is impossible to talk about strokes without considering cardiovascular health as a whole. Ireland’s first cardiovascular health strategy, Building Healthier Hearts, unveiled in 1999, was among the first national strategies to be launched internationally. The Government took a strategic approach to the development of cardiovascular services. Since the launch of Building Healthier Hearts, more than €60 million in additional annual funding has been allocated to its implementation. This annual funding has supported a wide range of new services and initiatives. The national audit of stroke care, published in April 2008, provided the country’s first overview of stroke services in hospital and the community. The audit, which was commissioned by the Irish Heart Foundation with the support of the Department of Health and Children, highlighted a number of areas where clinical care and the organisation of stroke services should be developed and improved. Work has commenced on addressing some of the issues identified in the stroke audit. By the end of 2009 stroke units had been set up in 12 hospitals providing multidisciplinary care, including thrombolysis. Progress has clearly been made but more needs to be done. Other initiatives worth noting include the training of emergency medical technicians and fast tracking of patients with suspected stroke. This initiative is already in some areas and there are plans to extend it further. Comprehensive guidelines for the acute hospital care of patients with stroke are in development by the council on stroke of the Irish Heart Foundation with the intention of agreeing and disseminating guidelines appropriate to Ireland.

Since the publication of Building Healthy Hearts in 1999, there have been many changes. The health service structures, Ireland and lifestyles have changed while technology has developed.

It was clear we needed to plan for the future taking into account these changes. It was for these reasons the Minister for Health and Children, Deputy Mary Harney, established the cardiovascular policy group in September 2007 to develop a new policy framework for the prevention, detection and treatment of cardiovascular disease, including stroke.

The policy group considered the stroke audit findings and addressed the issues raised including prevention in the primary care setting, rapid access to diagnostic services, the configuration of stroke services which includes stroke units, the provision of thrombolysis, as well as models for rehabilitation and discharge planning.

The policy report, Changing Cardiovascular Health: National Cardiovascular Health Policy 2010-19, was launched by the Minister on 10 June last. It addressed the spectrum of cardio[996]vascular disease including prevention and management and how these are integrated to reduce the burden of these conditions. The Minister was anxious a tangible implementation plan would be developed to give effect to the policy and that the HSE will focus on what can and should realistically be achieved in the current economic climate.

The implementation plan, currently under development by the HSE, will specify the networks for cardiovascular disease, the local and regional or comprehensive centres that comprise networks, pre-hospital emergency care, stroke units and the clinical leadership to give effect to these. It is expected this work will be completed by October this year.

Everyone in the health care sector has a role to play, for example, involving primary care in developing multidisciplinary rapid assessment TIA clinics for mini-stroke to prevent these from progressing into full stroke cases. The policy identifies the need for primary care teams to support patients with or in danger of developing cardiovascular disease including stroke and involves new ways of preventing and treating patients with the disease.

Primary care teams are ideally placed to prevent strokes through the detection and management of raised blood pressure and through the provision of anti-thrombotic therapy for those with atrial fibrillation.

While public information and awareness campaigns come within the HSE’s remit, I acknowledge the role played by the Irish Heart Foundation as a leading provider of information on stroke awareness. Through a variety of campaigns and services, the foundation endeavours to reach all high risk groups and educate them on the importance of healthy lifestyle behaviours in helping to prevent stroke and cardiovascular disease.

Earlier this year, the Irish Heart Foundation launched its FAST campaign to raise awareness of the warning signs of stroke and the need for emergency treatment in hospital for anyone who suspects they have had a stroke. The FAST acronym refers to the main symptoms of stroke — Facial weakness, Arm weakness and Speech problems, along with the warning that it is Time to call 999.

The Government will continue to support efforts to create greater awareness around the preventive measures and positive lifestyle behaviours needed to allow people live healthier lives. The new cardiovascular and stroke policy has been launched in a challenging economic climate with little prospect of additional resources. Much, however, can be done to advance the policy. The Department of Health and Children and the HSE will continue to work in tandem with the Irish Heart Foundation and others to improve public understanding of stroke.

Senator Cecilia Keaveney: Information on Cecilia Keaveney Zoom on Cecilia Keaveney A small investment in this area could give large yields in prevention. There are many rapid response units dealing with heart attack prevention courses. Maybe the Department, along with the Irish Heart Foundation, could consider integrating a course in stroke prevention awareness.

The Seanad adjourned at 5.35 p.m. until 12 noon on Tuesday, 6 July 2010.

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