Underfunded stroke services unable to cope with increasing stroke rate


Irish Heart launches Manifesto blueprint aiming to eliminate preventable death and disability from stroke

News Release, 11th April 2017

Major advances in acute stroke care – responsible for saving more than 200 extra lives a year and reducing the rate of severe disability by more than one quarter – are being lost because already under-resourced services cannot cope with growing numbers of patients being struck by the disease, the outgoing head of the HSE’s National Stroke Programme, Professor Joe Harbison said today.

He was speaking at the launch of Irish Heart’s new Stroke Manifesto[i], a 12-point blueprint developed in association with experts from all the professional bodies providing stroke care in Ireland developed to show how preventable death and disability from stroke in Ireland could be eliminated without increasing the direct cost of the disease to the State.

TV presenter and homecare campaigner Brendan Courtney also spoke about the wasteful and inhumane system that hinders the ability of stroke patients to return home after hospital discharge.

Professor Harbison said that after five years of dramatic improvement, stroke patient outcomes were in decline due to the double effect of persistent service deficits and a rapid growth in the rate of stroke in Ireland which is estimated to soar by a further 50% in as little as the next eight years.

“We are heading for a crisis. Our stroke services can’t even deal with the numbers we have now, let alone the surge in cases that has already started due to our ageing population. We don’t need extra money to fix things – we just need to invest in treatment so we don’t have to send so many patients unnecessarily to expensive nursing home care,” said Professor Harbison.

The Irish Heart Manifesto sets out a rationale for upfront investment in acute, rehabilitation and community services that have been proven to reduce death and disability rates among stroke patients, as well as cutting service costs. For example, whilst stroke units are twice as effective as coronary care units in reducing death and severe disability, no hospital in Ireland has a unit that’s resourced to minimum international standards.

In addition, whilst Early Supported Discharge programmes are still only being provided by a handful of Irish hospitals even though they have proven over many years in Ireland and internationally that providing therapy in patients’ own homes rather than in hospital results in better outcomes at less cost.

Said Irish Heart head of advocacy, Chris Macey: “This is not a wish list, these measures are largely deliverable within the funding restrictions imposed on the health services. Many are considered to be basic standards of care in other countries. Together we believe they can eliminate preventable death and disability without any increase in overall costs.

“The need for action to develop rehabilitation services is particularly critical. More people than ever before are living with the effects of stroke. We are saving more lives because of acute service improvements, only to squander patients’ recoveries because we refuse to deliver the therapy services either in hospital or in the community that will help them regain their lives[ii].

“Irish stroke services compare well internationally in the vital early period after stroke occurs. But as soon as a person’s life is saved they typically start to regress through poor access to basic therapies in hospital. In therapy terms, patients effectively walk off a cliff after they pass through the hospital gates – virtually no vital physical, communication or psychological services are available unless they can afford to pay themselves.”

Brendan Courtney, who has become a high profile advocate for better homecare provision following his documentary detailing his family’s struggles to get his father home after a stroke, said he was shocked that the rate of return home among stroke patients is actually falling given the proven personal benefits, the lower costs and the overwhelming majority of people who wanted to live at home rather than in nursing homes.

Mr Courtney said: “We know the current funding system that forces people into nursing homes and reduces their ability to return home is wasteful and inhumane. But I’m absolutely appalled that deteriorating hospital services are also driving more patients into long-term care when it would be cheaper to meet their wish to stay at home. When are we going to start putting patients first?”

Professor Harbison said that the 2.3 per cent increase in nursing home discharges recorded in 2015 had increased long-term care costs by an estimated €17.3 million – which is equivalent to paying for about 1.6 million hours of homecare at current rates.

He added that over the four preceding years, the National Stroke Programme was responsible for reducing nursing home costs by €30 million a year.  If the HSE spent €15 million a year on providing the 200 extra therapists required to staff stroke units properly, not only would these cost reductions be restored, but stroke services would be enabled to gear up to deal with the accelerating upsurge strokes facing our hospital system.

Prof Harbison said: “Tonight hundreds of people will sit down to dinner with their families because of service improvements delivered by stroke teams in every corner of the country in the last six years. A great deal more will not be in their own homes, but forced to live away from their families in long-term care because we ultimately didn’t do enough for them.”


Media queries to;

Conor George, Communications Officer, Irish Heart, Main Switch: 01-6685001, DL: 01-6346918

Caroline Cullen, Communications Manager, Irish Heart, DL: 01-6346908, Mob: 086-6049282

Pictures taken by Photocall Ireland at 10am.

Media interviews available:

• Chris Macey, Head of Advocacy, Irish Heart
• Brendan Courtney
• Prof Joe Harbison, outgoing Head of HSE National Stroke Programme
• Stroke survivors

[i] Stroke Manifesto Summary
1. Every hospital treating acute stroke has a properly resourced stroke unit
2. Standardisation of 24/7 clot busting thrombolysis in every hospital treating acute stroke.
3. Access to clot removal therapy thrombectomy to all stroke patients regardless of geographical location.
4. Immediate investigation, assessment and treatment of all mini strokes.
5. Timely access to appropriate levels of in-hospital rehabilitation for all patients.
6. National roll out of Early Supported Discharge where patients receive therapy at home rather than in hospital – an approach that delivers better outcomes and reduces overall costs.
7. Greater access to community rehabilitation with equality of access nationally.
8. A legal entitlement to homecare when appropriate for all patients.
9. The development of a properly resourced Stroke Register.
10. Investment in stroke prevention, particularly awareness and screening programmes for high blood pressure and atrial fibrillation (the most common form of irregular heartbeat)
11. State funding for FAST awareness.
12. Development of supports enabling stroke survivors to maximise their recovery and contribute fully to the life of their communities.

[ii] The Irish Heart Foundation’s Cost of Stroke in Ireland research showed that out of a direct cost of stroke to the State of up to €557 million per annum, as much as €414 million was spent on long-term care for stroke patients and less than €7 million on community rehabilitation programmes to help them remain living at home.



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