Robust, funded rehab care needed urgently
Sir — Alan O’Keeffe’s article ‘Young people with brain injuries face a lifetime in care homes’ (Sunday Independent, October 14) was excellent. It is bitterly disappointing that, yet again, the implementation of the National Neuro-rehabilitation Strategy (published in 2011) appears not to have been deemed a priority by Government. This in the face of overwhelming unmet demand for neuro-rehabilitation services in our health care system.
This demand will only increase in the future with our ageing population and improved survival from major trauma and other severe illnesses.
Ireland fares the worst in Europe in terms of specialist rehabilitation resource. I am one of only 12 rehabilitation consultants in Ireland; by European standards a country of our size should have at least 25.
The National Rehabilitation Hospital (NRH) provides specialist in-patient rehabilitation services for the whole country, but has only 110 beds; it needs at least 270. While the NRH campus is being rebuilt and modernised, the new hospital will not provide additional capacity in the short to medium term.
Patients with severe neurological disability with complex rehabilitation needs will continue to wait an unacceptably long time in acute hospitals to access in-patient care at the NRH. When they are eventually admitted, they receive a maximum programme of three months, arguably too short in many cases.
Patients are then discharged/ transitioned to the community services which are grossly underresourced to meet their ongoing rehabilitation and care needs. Many do get home, but others with severe disability do need longer-term residential care and maintenance rehabilitation.
These individuals frequently require repatriation to their referring hospital while awaiting HSE funding of their essential, often substantial, care packages.
Returning to the acute hospital is always the worst outcome for a patient after rehabilitation and is completely inappropriate when there is ever-increasing demand at the emergency department front door for acute beds.
The tragedy is this scandal is not new; my senior consultant colleagues have been advocating tirelessly over the years for improved services, as have Acquired Brain Injury Ireland, Headway, Neurological Alliance of Ireland, and others.
The HSE/RCPI National Clinical Programme for Rehabilitation Medicine has done excellent work and its recently published Model of Care sets out a blueprint for specialist rehabilitation services in Ireland with a ‘hub and spoke’ model incorporating the NRH, at least four regional rehabilitation centres and seamless community rehabilitation services in a managed clinical network.
We urgently need to implement this model of care and establish regional in-patient rehabilitation units, community rehabilitation services and longer-term care and support for people living with enduring disability.
To make this happen, we need robust political commitment, funding, and provision of manpower and infrastructural resource.
If not, Ireland will continue to languish at the bottom of the European league table, and my consultant colleagues and I will face the rest of our professional careers apologising to distressed patients and their families for our grossly inadequate system of care.
To quote the Neurological Alliance of Ireland, “we need our heads examined”. Raymond Carson MB, FRCPI Consultant in Rehabilitation
Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7