New research stresses limited stroke services

A LACK OF funding and staff ceilings are preventing the provision of a comprehensive stroke-management service in the community, local health-office managers with the Health Service Executive (HSE) have told researchers compiling the first national audit of stroke services.

The report, released today, highlights significant deficits in the care provided to stroke patients at all levels in the Irish health service.

The audit team looked at services in 37 hospitals across the State, and interviews were conducted with GPs, nursing home staff and a range of health professionals and local health-office managers on the services available. Over 200 patients and carers were also surveyed.

The researchers who conducted the audit for the Irish Heart Foundation say optimal stroke care requires protected beds in hospitals for stroke patients, but they found "there were only 12 designated stroke unit beds nationally".

The also noted that while stroke is a medical emergency, 44 per cent of patients reported delays in getting through A&E departments. One patient who was interviewed was waiting on a trolley for four days and nights before being admitted to a ward.

The report also notes acute rehabilitation was only available to one in four patients, and in general there was limited access to rehabilitation for younger stroke patients.

"Access to national services, such as the National Rehabilitation Hospital for patients under age 65, was described as limited owing to long waiting lists," it said.

The authors point to the false economy involved in not rehabilitating patients. They say it was estimated in the UK in the 1990s that an unrehabilitated stroke patient cost the UK health service £64,000 more than a rehabilitated patient over their lifetime.

The researchers found the follow-up of patients once they were released from hospital was sporadic.

"Resources and workload were cited as the primary reasons for being unable to guarantee this long-term management...The review of younger patients under 65 years with stroke was particularly difficult for occupational therapy owing to low numbers of community occupational therapists, insufficient budgets for aids and appliances, and the limited availability of home help."

On the audit's overall findings, the report concludes: "These findings will be a major cause of concern for people who have suffered a stroke and their families, and for health professionals and the community more widely.

"They point to the need for urgent investment in stroke services in Ireland. Commitment and resources need to be galvanised through an overarching policy, with designated funding and an urgent timeframe for the development of stroke services."

© 2008 The Irish Times

This article appears in the print edition of the Irish Times