Implementing stroke services

 

Sir, – In your editorial of August 31st, your leader writer asserts that our healthcare system is characterised “more by inertia than by action” in the way we plan and implement stroke services. It is true, having come through a period of austerity, with considerable cutbacks in health, that the health service faces considerable challenges in addressing the increasing demands of stroke disease.

However, these are challenges that are not limited to stroke disease but to many other areas of healthcare. This will continue to be true in a society that is (thankfully) increasingly ageing. Despite the challenges, it is important that the work and achievements in developing stroke services over the past 10 years are acknowledged. Despite the difficult economic environment over the past number of years, our National Clinical Programme for Stroke, led by Prof Joe Harbison and Prof Peter Kelly, has overseen significant improvements in the delivery of services and the outcome for patients.

The Second National Healthcare Quality Report System of 2016 showed significant decreases in in-hospital mortality for stroke of between 21 per cent and 25 per cent over the period 2015 to 2016. Ireland now has 22 stroke units in our healthcare system with the planned opening of another unit in Kerry in the coming months. The HSE is engaging with the three remaining hospitals without a unit to ensure that such important services are put in place as quickly as possible.

National rates for thrombolysis (“clot-bursting”) therapy have increased from 1 per cent in 2006 to 12 per cent in 2016. We have established three early supported discharge teams and have extended the funding this year to establish two more units in Cork and Limerick.

These improvements resulted from the hard work and leadership of the National Stroke Programme, combined with the dedication and commitment of many healthcare professionals and managers in individual hospitals throughout the country.

While much work has taken place in stroke care, much more work needs to be done, particularly in the provision of timely rehabilitation and the expansion of exciting new interventions such as thrombectomy (surgical removal of clot).

Our experience in Ireland is that we best address these challenges with a shared vision and a collaborative approach leading to implementation throughout our health service. – Yours, etc,

Dr COLM HENRY,

National Clinical

Adviser Acute

Hospitals, HSE;

Dr RONAN COLLINS,

Clinical Lead,

National Stroke

Programme,

Dublin 8.