Minister Reilly Speech at the opening the 17th Irish Heart Foundation Annual Stroke Conference
Good morning Ladies and Gentlemen,
I want to thank the Irish Heart Foundation for inviting me here today to officially open your Annual Stroke Conference.
The issues of stroke prevention and stroke treatment are of vital importance to the medical profession and more importantly to the patients we care for.
Conferences such as this one today provide us with opportunities to enhance our understanding of this life threatening and debilitating condition.
In recent years significant progress has been made in the treatment of strokes resulting in better outcomes for many patients.
Shortly after becoming Minister for Health, I asked for an improvement in thrombolysis rates to be prioritized.
A target was set to increase the rate of safe thrombolysis from 1% to 7.5% by the end of 2013.
Since 2010 there has been a ten-fold increase in the rate of safe thrombolysis.
I am pleased that the HSE recently reported a national stroke thrombolysis rate of 10.5% for the third quarter of 2013, which exceeds targets and is comparable to rates internationally. The HSE is also reporting a 9% reduction in deaths from stroke.
This is having a real impact for patient safety and their quality of life.
185 less patients with ischaemic stroke have been discharged to Nursing Homes. The original business case proposed an estimated reduction of 110 Nursing Home discharges per year by end 2013 with an estimated saving of €16.5 million. This target has also been been exceeded, with an estimated accumulated saving of €19.3 million achieved.
This is evidence that the number of people with enduring disabilities as a result of stroke has decreased.
There is now access to safe stroke thrombolysis in 23 hospitals around the country on a 24 hour a day, 7 day a week basis. This continues to be rolled out.
Ambulance access protocols are in place for other hospitals where acute stroke patients are taken to the nearest hospital providing 24/7 thrombolysis.
Further developments in training are ongoing through the Thrombolysis Training programme.
The Stroke Foundation Education Programme has been developed and rolled out through the Centres for Nurse Education. The programme empowers all care staff to provide better care and information to stroke patients leading to improved patient experiences.
TRASNA (Telemedicine Rapid Access for Stroke and Neurological Assessment) is being implemented. Both the Mater and Cavan hospitals’ TRASNA are operational since May; AMNCH and Naas will switch to the new system in the coming months.
The HSE National Ambulance Service has worked in partnership with the Irish Heart Foundation whereby Emergency Ambulance Vehicles double as mobile billboards to improve public awareness of stroke symptoms and boost IHF F.A.S.T. Stroke Campaign.
The implementation of the Department of Health’s National Policy and Strategy for the Provision of Neuro-rehabilitation Services in Ireland – in collaboration with the National Clinical Programme for Rehabilitation Medicine – will provide for improved access to and quality of services for all patients requiring rehabilitation.
Stroke rehabilitation is provided in a number of settings, which range from specialised rehabilitation centres such as the Stroke Rehabilitation Unit at Baggott Street, or St. Finbarr’s Hospital, Cork, to departments in acute hospitals and outpatient and community settings.
The establishment of managed clinical rehabilitation networks for neurological and prosthetic rehabilitation services in each of the 4 HSE Regions will help to develop integrated quality rehabilitation services.
This will support existing neurologists and specialists in medicine for the elderly. It will also incorporate the setting up of Specialist Community-Based Rehabilitation Teams. All of these services and supports will work together to provide the best and most appropriate care in terms of location and service.
While all of the aforementioned is positive and encouraging in the treatment and rehabilitation of those who suffer strokes, there is no doubt that prevention is always better than cure and that is where I come to the challenges we are still faced with.
Strokes, like many other acute health issues, can be the result of other chronic diseases. The management and, more importantly, the prevention of these illnesses is an area where we still have a great deal of work to do.
At present it is estimated that three quarters of healthcare expenditure in Ireland relates to chronic diseases. In real terms, this translates to 80% of GP consultations and 60% of hospital bed days. Chronic disease accounts for two thirds of emergency medical admissions to hospitals.
It is forecasted that chronic conditions will increase by around 40% between 2007 and 2020 as a result of the ageing population and the impact of lifestyle factors. This is not sustainable from a cost or hospital capacity perspective in future years.
It is also something we need to tackle effectively for the sake of the long term health and quality of life of our citizens. A new model of structured integrated care involving primary care with an emphasis on prevention is vital in this regard.
We must act now to prevent these chronic diseases developing into acute and debilitating conditions with potentially fatal outcomes. We need to think differently about how our health systems treat chronic diseases.
In this regard the health service is developing chronic disease management programmes to manage patient care in an integrated manner, resulting in best possible health outcomes, enhanced clinical decision making and the most effective use of resources.
The Government is committed to a major enhancement of primary care services as part of the move to Universal Health Insurance.
This commitment was evidenced by the inclusion in the HSE’s National Service Plan of additional funding of €20m to strengthen primary care services (€18.525m for the recruitment of 264.5 primary care team posts and €1.475m to support Community Intervention Team development).
The additional primary care posts provided for include 72 Public Health Nurses, 40.5 Registered General Nurses, 47.5 Physiotherapists, 52.5 Occupational Therapists and 52 Speech and Language Therapists.
As of 6th March 2014, 199.5 posts have been filled or start dates have been agreed. The HSE is striving to have the remainder of the posts filled as soon as possible in 2014.
To help prevent many of these chronic conditions developing in the first place, my Department has also embarked on a framework for improved health and wellbeing. We have implemented a national Framework for action to improve the health and wellbeing of the population of Ireland over the coming generation.
Healthy Ireland supports a whole of government approach to address the factors which impact health and well-being, many of which fall outside the health sector. These include housing, transportation, education, workplaces and environment along with an individual’s socio-economic status. We aim to have a collective response to the risks that threaten Ireland’s future health as well as its economic recovery.
We are now well aware that there are four main risk factors for numerous chronic and acute conditions: tobacco use, harmful use of alcohol, unhealthy diet and lack of adequate physical inactivity.
Smoking is the greatest single cause of preventable illness and premature death in Ireland. I am pleased to say the significant tobacco control measures that we have already introduced are delivering tangible results. Over the past decade, the bans on smoking in the workplace, tobacco advertising, sales of packs of 10 cigarettes and point of sale display of tobacco have resulted in 3,726 fewer smoking related deaths than would have been expected if these measures had not been implemented.
Research has shown these measures also delivered reductions in ill-health in the general population including:
- a 26% reduction in ischaemic heart disease
- a 32% reduction in stroke, and
- a 38% reduction in COPD
Last year I also introduced regulations which make graphic warnings mandatory on cigarette packs. Further actions are planned.
Tobacco Free Ireland, our new tobacco policy, sets a target of Ireland being tobacco free by 2025.
The revised Tobacco Products Directive was a priority for Ireland during the Presidency and I strongly supported it and its progression during 2013.
I am proceeding with drafting a new Public Health (Standardised Packaging of Tobacco) Bill. Research has shown that standardised packaging can reduce the appeal of tobacco products and increase the effectiveness of health warnings.
We are also working towards introducing legislation to prohibit smoking in cars where children are present.
We are looking at the future regulation of the tobacco retail environment, in order to put in place a more effective way of regulating who sells tobacco products and where these products are sold.
Alcohol – In tackling the many issues surrounding the misuse of alcohol, the EU Alcohol Strategy has been helpful in framing policy proposals and I wish to express my support for the formulation of a new strategy to help deal with harmful drinking.
My department will be drafting legislation to deal with this phenomenon. Its provisions will include minimum unit pricing and the regulation of marketing and advertising – an area in which the EU member states can achieve much together.
Obesity – the EU has also been helpful in the ongoing fight against the impact of obesity. The EU Action Plan on Childhood Obesity – an initiative of mine under the Irish EU Presidency – was endorsed by Member States at the Greek Presidency conference on Nutrition and Physical Activity on 24/25th February. A joint EU Action Committee will be established next year and Ireland will take the lead on one of its Work Packages.
In Ireland, I established the Special Action Group on Obesity (SAGO) and this group is progressing a number of actions including an Obesity / Nutrition Policy; measures to restrict the availability of High Fat, Salt and Sugar foods and drinks and the provision of calorie information on menus. Reference FSAI MenuCal launched this week.
A physical activity plan is also being developed by Healthy Ireland.
All of the initiatives and developments I’ve spoken about this morning demonstrate a genuine commitment to improving the health of our nation and the treatment and services we provide for those suffering from chronic or acute illnesses. Yes, there is still a great deal to do but we have made significant progress in a number of areas and we are working to sustain and improve on everything we have achieved to date.
The Council on Stroke of the Irish Heart Foundation continues to be a catalyst for action and I want to thank you for all of the input and support you provide to ensuring this vital area receives the focus and attention it deserves. Your expertise and focus has been instrumental in delivering some of the improvements in treatment and services I’ve spoken about this morning.
I have no doubt that today will give you all a marvellous chance to build on those achievements by sharing knowledge and experience and learning from the world-leading educators in stroke care present here at the conference.
Together we share one primary goal: to continue to work on measures to improve primary and secondary prevention of stroke and to ensure that all those affected by stroke receive optimal treatment and avail of the many recent advances in stroke care.
I hope you all have a very enjoyable, productive and enlightening day. Thank you for your attention.