Stroke Action Advocacy 2010

Cost of Stroke Report

In September 2010, the Irish Heart Foundation published The Cost of Stroke in Ireland – estimating the annual economic cost of stroke and transient ischaemic attack in Ireland. Prepared by the ESRI and the Royal College of Surgeons in Ireland, the report is the most comprehensive research ever carried out in Ireland on the economic burden of stroke and the potential cost benefits of service developments.

Report Findings

The total cost of stroke in Ireland is up to €1 billion.
40% of these costs are taken up by the bill for nursing home accommodation.
The report predicts that without decisive action the number of stroke cases in Ireland may increase by more than 50% by 2021 due to factors such as our ageing population, resulting in an increase of at least 50% in the overall cost of stroke to the economy.

While the IHF is primarily concerned to eliminate the human cost of avoidable death and disability, the report also clearly indicates that in purely economic terms existing services are bad value for the taxpayer.

Potential for cost savings in stroke services

By providing 95% access to stroke unit care, 650 stroke victims could be saved each year from death or dependency at a potential annual saving of up to €10 million.

Achieving a 20% rate of thrombolysis could also save up to 100 people annually at a saving of up to €3 million a year.
This could lead to a combined saving of 750 lives and €13 million.

Better acute stroke services will lead to almost instant savings because increased access to stroke units and thrombolysis will result in immediate improvements in outcomes and therefore lower demand for nursing home places.

The Report carries sufficient weight to place an onus on the Government and health authorities to make a clear judgment on the findings. Sufficient ring-fenced funding must be provided and the blockages to improvements in stroke services, such as the recruitment embargo, must be removed.

Lobbying

The Stroke Action team were busying lobbying around this document throughout October and in the lead up to the Budget. We met with the Minister for Health and Children and her officials. We held face-to-face meetings with some 35 TDs and Senators, including the health and older people’s spokespeople from each party. The Cost of Stroke Report was discussed in the Seanad and the Irish Heart Foundation appeared before the Oireachtas Committee on Health and Children on the 9th of November. [Watch it here, IHF on at 1.01].

Some highlights from the Health Committee...

Dr. Barry White (HSE National Director of Clinical Care): "The HSE has identified specific areas where it believes significant improvements are required in quality of, access to and cost effectiveness of stroke care. Based on national and international evidence, stroke is one area that requires urgent attention in this respect..... The publication of the Irish Heart Foundation report on the cost of stroke care is timely and fits into the programme’s work".

Dr. Joe Harbison (HSE Joint Clinical Lead on Stroke): "We agree with the Irish Heart Foundation report which is a valuable document in helping to understand the issues around stroke care. The report estimates stroke care costs between €700 million and €1.8 billion. The average cost per patient comes to €22,000 and the spend on nursing home care in Ireland is much higher than in other comparable countries. This is due to the lack of available specialist care and organised rehabilitation services........ If left unchecked, the number of people suffering stroke in Ireland will increase by more than 50% in the next ten years which will bring the cost to €1.5 billion".

Dr. James Reilly TD (Fine Gael spokesperson on Health): "This is an enormously important area and Mr. O’Shea’s presentation fairly well underscores the fact that the money that might be used to prevent stroke would be very well spent, not just in terms of the ethical issue of saving lives, but also as regards the financial situation in which the country finds itself".

Deputy Kathleen Lynch (Labour Party spokesperson on Disability and Equality): "At a time when we have to get value for money, it seems incredible there is not an acute stroke unit in every hospital. This makes no sense, given the numbers involved".

Deputy Jan O’Sullivan (Labour Party spokesperson on Health): "Having listened to the previous delegation speak about the allocation of funding, if someone was to do what they said and allocate funding on the basis of the outcomes achieved, one would certainly provide for thrombolysis, stroke units and the preventive measures mentioned. The delegations have the full support of the committee in what they are trying to achieve".

Dr. Barry White: "...starting with that posed by Deputy Reilly as to the reason there are so few stroke units, the answer certainly is that there are not enough stroke units in place. One reason we established the programme is to have a sustained focus on this area. There is certainly a lack of consultant expertise staff in some of those areas.
It is an area in our health care system which requires urgent attention".

Action in the Dáil

The TDs we met tabled dozens of parliamentary questions on stroke services. Here are some of the questions put to the Minister for Health and Children and the Minister of State with Special Responsibility for Older People and Health. 30th of September, Noel Ahern TD asked the Minister for Health and Children if there will be ring fenced funding for stroke based on the cost of stroke in Ireland report. Full text of PQ.
5th of October, Michael McGrath TD asked the Minister for Health and Children the position regarding a stroke unit in HSE South. Full Text of PQ.
12th of October, David Stanton TD asked the Minister for Health and Children her views on the Irish Heart Foundation Cost of Stroke Report and its cost saving potential. Full text of PQ.
27th of October, Dr. James Reilly TD asked the Minister for Health and Children if stroke care will be removed from the Moratorium on recruitment in view of the publication of the cardiovascular health policy. Full Text of PQ.
11th of November, James Bannon TD, Richard Bruton TD, and Dr. James Reilly TD asked the Minister for Health and Children about the provision of thrombolysis in Irish hospitals and the number of stroke units. In her reply, Áine Brady, Minister of State with Special Responsibility for Older People and Health Promotion stated that 6 hospital now have an acute stroke unit and 9 have a combined acute and rehabilitation unit. She also stated that “work is now under way to define standards for acute stroke care consistent with international definitions to support continuous improvements in acute stroke care”. Full Text of PQs.
13th Januray 2011, Arthur Morgan TD asked the Minister for Health and Children about the implementation of the recommendations on stroke in the Cardiovascular Health Policy. In her response, the Minister outlined the service improvements due to take place under the new HSE service plan 2011. "Two or three stroke hospital neworks has been proposed by each of the 4 HSE regions. The programme also "provides for the establishment of a further 9 acute/rehabilitation stroke units" and "continuous improvements in prevention and in acute stroke care - stroke units, thrombolysis and rehabilitation". Full Text of PQ.

Action in the Seanad

The Cost of Stroke report was also raised in the Seanad on the 19th of October, 2010 by Senator Ronán Mullen.

"The Irish Heart Foundation has commissioned an excellent report done by the ESRI and the Royal College of Surgeons in Ireland on estimating the annual economic cost of stroke. We can say that the jury is no longer out. It is quite clear that we can have better stroke care in this country, saving 750 people a year from either death or disability, while at the same time making some savings. It 650 people were to have access to acute stroke units, with another 100 people having access to thrombolysis, there could be a saving of €13 million. More than this, much unnecessary misery, heartbreak and disability could be saved.
It is important to have the Minister in the House to speak on this topic. A decision must be made if the aim is to be realised to ensure adequate nursing staff to bring about the necessary change in the short term. There must be a certain ring-fencing of funding for stroke service developments. Just because we are talking about taking a great deal of pain in this country over the next number of months, it cannot mean that we close our eyes to any necessary extra expenditure in areas where lives and expenditure can be saved in the longer term".

Success

The HSE published their service plan for 2011 and the stroke programme is included in areas that will be implemented and receive funding this year. The plan outlines the development of 9 stroke units around the country with 24/7 thrombolysis and 45 extra staff post for stroke; the funding allocation is €4.2m. This is a great start towards improve stroke services in Ireland. You can read the full HSE plan here.

Plans for 2011....

Stroke Action will continue to lobbying on the findings in the Cost of Stroke report. With an election coming up will be calling on our campaign network to ‘ask the canvassers’ about how they would improve stroke services if they were elected. We will also continue to work with the HSE to bring about the implementation of a National Stroke Programme in the coming years.

Get involved!

We will be drawing up questions to ask the canvassers in the lead up to the election but this is also a good time to write to your local TDs - who are looking for your vote - and ask them to meet with them to discuss stroke services in your area. Remember your vote makes you the voice for stroke in your local area!