HSE accused of leaving brain injury patient in limbo over rehab

Paul De Ferreira has been unable to move to a community facility because of funding

People with acquired brain injuries are being detained in acute hospitals and similar institutions longer than is necessary because of a funding shortfall, a charity has claimed.

Acquired Brain Injury Ireland said the case of a man who continues to remain in the National Rehabilitation Hospital though he is ready for discharge is "not untypical" and becoming more common.

Paul De Ferreira (36) from Clondalkin, Co Dublin, suffered severe brain injuries when he fell off his quad bicycle in October 2016.

Mr De Ferreira has frontal lobe damage and last November had two titanium plates put into his head.

He has been in the National Rehabilitation Hospital (NRH) for the past nine months and a place has been found for him at the Acquired Brain Injury Ireland site in Lucan. The hospital has a waiting list of 200 people and Mr De Ferreira was waiting a year to get into it.

The hospital says he is now ready to be discharged to a step-down facility to continue his rehabilitation. But funding has not been released by Health Service Executive (HSE).

However, Mr De Ferreira's father Ronnie Spadaccini said the delay in discharge means that his son is being left in limbo.

“The HSE are determining the future of my son. He has a wife and two children,” he said.

“My son has paid all his taxes, his dues and his insurance and he is getting nothing back. The HSE has a lot to answer for. It is not the hospitals which are delaying these beds. It is the HSE.”


Mr De Ferreira said he had to get in a privately paid occupational therapist into Tallaght Hospital. "It's been a fight from the start. When you call them, they ignore you."

Acquired Brain Injury Ireland national services manager Donnchadh Whelan said a lack of HSE resources results in people affected by brain injuries becoming "stuck on the pathway to recovery and independence, unable to progress to community neuro-rehabilitation in a timely fashion".

He suggested the cause of it was budgetary structures where each HSE area has budgets set to specific categories such as older persons, children or disability. “These budgets are often not enough to meet demand and so in effect, they are already spent,” he explained.

“This removes any responsiveness to new need and because funding doesn’t follow the person, in order to free up funding, either someone else has to lose it or additional funding has to be found.

“This has unfortunately resulted in people remaining static in acute hospitals and other institutions that are no longer appropriate for them.”

Finite resources

In response, the HSE said it was “acutely aware” of the demand to access neuro-rehabilitation services and supports. “Every effort is made to facilitate patients being discharged from the NRH as soon as is possible but resources are finite and unfortunately, there are waiting lists.”

The HSE said the implementation of a national neuro rehabilitation strategy is a priority. The strategy describes a “hub and spoke” model of service where the NRH will be the national rehabilitation centre with a number of regional centres across the country enabling people to be cared for closer to their own homes.

A capital investment programme, which will see the building of 120 single ensuite rooms at the NRH, is being developed at a cost of €15 million.

The HSE said a framework to deliver these rehabilitation services has been finalised and will be submitted to the Minister for Health as part of the process to seek funding for 2019 and beyond.