No stroke aftercare available to victims
Just one in four rehabilitation hospitals have a dedicated stroke unit, 60% do not have a stroke specialist to oversee rehabilitation, and less than one in three rehabilitation hospitals have access to psychological services.
The vast majority of the country’s 26 rehabilitation hospitals do not have links with community rehabilitation services meaning patients cannot receive rehabilitation therapy after they leave hospital.
This latest HSE and Irish Heart Foundation (IHF) audit — the first study of post-acute stroke care in Ireland — follows another report on acute stroke services earlier this year which also showed major medical, nursing and therapy staff deficits in spite of a 25% reduction in stroke deaths in seven years.
IHF head of advocacy Chris Macey said the audit confirmed that rehabilitation services for stroke patients “are grossly inadequate at every stage in the patient’s treatment whether in acute hospitals, rehabilitation hospitals, or in the community”.
“Whilst more people than ever are surviving stroke, they are being denied the opportunity to make the best recovery possible by a chronic dearth of vital therapy services,” he said.
The HSE’s national clinical lead for stroke, Joe Harbison, warned that stroke figures are increasing.
“The incidence of stroke in Ireland is rising by about 350 extra cases every year, but we still have a severe shortage of stroke unit beds or the specialist nursing, therapy and medical staff we need to care for these stroke patients,” said Prof Harbison.
“We have only about half the acute stroke unit beds we need to meet international standards, and this audit shows an even lower proportion of specialist rehabilitation beds.”
According to the previous study by the HSE and IHF, staff shortages range from 40% to 80% in acute hospitals. The number of health professionals providing therapies to stroke victims is a third less than in the UK. Elsewhere in Western Europe, supported discharge teams are a basic element of treatment. There are only three such teams in this country and they are under resourced.
Prof Harbison said “stroke outcomes, apart from mortality, deteriorated last year for the first time since the creation of the national stroke programme”.
“This is not unexpected in view of the current level of fixed and insufficient resources and an increasing number of patients,” he said.
Despite a recent increase in working-age strokes, only 27% of hospitals provide assistance to patients in returning to work, while just half provide training in managing the consequences of stroke following discharge.
Stroke research fellow at the national clinical programme for stroke, Paul McElwaine, said: “It makes no sense at all that we have significant investment of expertise and resources to save patients’ lives after a stroke, but then fail to follow through with basic therapy services that will help them recover?”
