Madam, - In the debate on the future development of health services, little attention has been devoted to services for stroke.
Stroke is the third leading cause of death, killing each year about the same number of Irish citizens as breast and lung cancer combined. It is the leading cause of acquired adult disability, with moderate or severe disability in 50 per cent of stroke survivors. It is the cause of 8 to 10 per cent of Irish A&E admissions and accounts for substantial direct and indirect healthcare costs. Caring for dependent stroke survivors often brings economic and social hardship to family members, particularly elderly spouses who are frequently in poor health and short of money.
Internationally, the best stroke care is provided by multidisciplinary health teams, co-ordinated as links in a "chain of care". Initial emergency care is provided by acute stroke neurologists and A&E teams, followed by hospital and community rehabilitation provided by skilled therapists and specialist physicians. Finally, prevention of further stroke in high-risk survivors is led by general practitioners.
Despite their importance, stroke health services are greatly underdeveloped in Ireland. Stroke was excluded from the 1999 National Cardiovascular Strategy and has not specifically benefited from the improvements in services which followed.
A national stroke strategy similar to the cardiovascular and cancer strategies is required urgently. Policy-makers and health administrators should immediately prioritise the creation of stroke units in all acute hospitals.
Consultant stroke neurologists should be appointed in sufficient numbers to provide proven emergency treatments within hours of stroke onset. The development of dedicated hospital and community rehabilitation units should be a priority. The Irish public deserves nothing less than a modern service that meets best standards of international stroke care. - Yours, etc,
Dr PETER KELLY, Consultant Neurologist and Director, Stroke Service, Mater University Hospital, Eccles Street, Dublin 7.