HSE audit finds lack of rehabilitation services for stroke patients

Stroke outcomes deteriorate as review into post-care points to staffing deficit

 Jillian Boyle who suffered her first stroke at 32: “After that initial burst, the help you get is watered down. They want to discharge you as soon as possible. The minute you go out of the system, you’re down at the back of the queue.” Photograph: Barry Cronin

Jillian Boyle who suffered her first stroke at 32: “After that initial burst, the help you get is watered down. They want to discharge you as soon as possible. The minute you go out of the system, you’re down at the back of the queue.” Photograph: Barry Cronin

 

Three out of four of the country’s rehabilitation hospitals admit they are unable to provide stroke patients with the recommended level of therapy they need, according to a HSE audit.

Just one in four has a dedicated stroke unit and 60 per cent lack a stroke specialist to oversee rehabilitation. Less than one in three units has access to psychological services.

In addition, the vast majority of the 26 hospitals that took part in the study have no access to community rehabilitation teams to continue therapy that is essential to assist recovery for patients after they are discharged home.

The study by the Irish Heart Foundation (IHF) and the HSE’s national stroke programme is the first to examine post-stroke care in Ireland and follows on a national audit of stroke care published earlier this year. This showed a 25 per cent reduction in deaths from the condition in seven years but also pointed to deficits in staffing.

“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 to accommodate patients, or the specialist nursing, therapy and medical staff we need to care for them,” said the HSE’s national clinical lead for stroke, Prof Joe 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.”

He said: “Deficits in allied health professionals range from 40 per cent to 80 per cent in acute hospitals and are at least a third lower in most therapy areas in our rehabilitation hospitals compared to the UK.”

Outcomes

As a result, stroke outcomes, apart from the death rate, deteriorated last year, for the first time since the national stroke programme was created.

“This is not unexpected in view of the current level of fixed and insufficient resources and an increasing number of patients,” said Prof Harbison.

Despite a recent increase in strokes affecting people of working age, the audit found only 27 per cent of hospitals provided any assistance to patients in returning to work and just half provided training for managing the consequences of stroke after discharge.

It also showed major organisational deficits across the rehabilitation hospital network. For example, half of the hospitals could not provide accurate information on the numbers of stroke patients they admitted or discharged in the previous year, while bed access was restricted based on age in 12 of the 26 hospitals audited.

IHF head of advocacy Chris Macey said the audit confirmed the grim reality of rehabilitation services for stroke patients in Ireland .

“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.”

Case study: ‘After that initial burst, the help you get is watered down’

The first indication that Jillian O’Boyle was suffering a stroke came when her knee suddenly gave way at work.

It was a busy Friday in November, 2010, and O’Boyle, who lived in Athboy, Co Meath and was 32 at the time, thought little of it.

Within days, however, she had lost the feeling in her lower legs and found herself in intensive care in hospital. Due to an autoimmune disorder that caused the stroke, she was unable to speak, suffered from facial paralysis and had difficulty moving on her right side.

She was transferred from her local hospital to Beaumont, where she spent two months. This was followed by three months in the National Rehabilitation Hospital in Dún Laoghaire.

Stroke happens in an instant but recovery, where possible, is a lifelong process. O’Boyle says the first year was “brilliant” in terms of the rehabilitation services she got. Months of intensive physiotherapy, speech and language therapy and occupational therapy helped her relearn how to speak and move.

The first words took weeks to come out. Then she learned to walk again, at least as far as the distance between the wheelchair and the car. Within two years, with the help and support of her husband Fergus, she had realised her goal of completing the mini-marathon.

“But after that initial burst, the help you get is watered down. They want to discharge you as soon as possible. The minute you go out of the system, you’re down at the back of the queue.”

Although she has suffered further strokes since, which undid much of the progress made, Ms O’Boyle started from scratch again and has continued her recovery. “They wanted me to go to rehab but I said no. I’m very headstrong. I knew what I wanted to do for myself.”

Today, her speech is clear and she can walk slowly, though her movement on the right side remains problematic.

“I’m a fighter, so I am. You have to be,” she says. A major problem is the lack of support services for stroke survivors in the community. She hasn’t seen an occupational therapist in several years, largely because cover is not being provided when staff go on maternity leave, she says.

She says her biggest wish is for more stroke beds to be provided across the regions, and for more rehabilitation services, delivered to patients in their homes.