Speech Material for Minister O´Malley – Conference on Rehabilitation Services in Ireland
Good morning Ladies and Gentlemen, I am very pleased to be here this morning at the opening of this Conference – Rehabilitation Services in Ireland – the way forward. As Minister for State with special responsibility for disabilities – a new portfolio, I am particularly grateful for the opportunity to not only speak with you about the future development of medical rehabilitation in Ireland but also to listen and learn about what you see are the future development needs for this sector. As the vision of the Health Strategy Quality and Fairness – A Health System for You says the agenda in the “A health system that encourages you to have your say, listens to you, and ensures that your views are taken into account”. In the spirit of partnership it is important that we uphold this vision and share and learn from one another in making for a better health service for all.
In 1997, my Department received the Report of the National Advisory Committee on Medical Rehabilitation (which was established under the auspices of the National Rehabilitation Board). The review, which was undertaken was the most comprehensive of medical rehabilitation ever undertaken in the State and while the report, acknowledges the strengths of many aspects of medical rehabilitation services in Ireland; it also identifies many deficiencies in the system.
The goals and priorities for development highlighted by the Report include the following:
- The enhancement of the status of medical rehabilitation in medical schools and teaching hospitals as well as postgraduate institutions.
- The adequate staffing and resourcing of the speciality of medical rehabilitation, in all of the major acute hospitals in each of the large population centres.
- Ensuring that particular attention is given to the 18-65 year olds with chronic disability.
- Developing community based rehabilitation services in a planned manner.
- Providing sufficient consultant and ancillary manpower in neurology to facilitate the early assessment and management of acute and chronic neurological disease.
The Report also highlights the need to have consultant-led medical rehabilitation services and stipulates that community rehabilitation services should have close links with the hospital based services in the area.
Following on from that report, the Health Strategy 2001 commits the Department of Health and Children to preparing an Action Plan for Rehabilitation Services and it states that ‘the purpose of such an action plan would be to help hospital patients return to normal life in the Community. The Action Plan will set out a programme to meet the existing shortfalls in service provision and to integrate specialised facilities with locally based follow up service.’
As a result of this commitment, my Department is now working towards the development of such a plan. As a first step along the way, the Department of Health and Children is carrying out an exercise of consulting with the health boards with a view to establishing the current position in relation to rehabilitation services. I can report that this consultation exercise is nearing completion and that the responses and outcomes are very positive in the main. I wish to acknowledge the work already been undertaken by the service providers in developing local based medical rehabilitation services.
This Conference is being held at a most opportune time and I am particularly pleased therefore that the title of this conference is “Rehabilitation Services in Ireland – the way forward – Developing A National Strategy for Rehabilitation in Ireland”. I view this conference as being an extremely important platform to debate and explore the issues around medical rehabilitation services and to identify key service areas for development and inclusion in the action plan.
The term Rehabilitation is a broad-based term that covers many disciplines and service areas. The 1997 Report of the National Advisory Committee states that ‘effective rehabilitation draws on a broad range of services to meet the particular needs of patients, with the objective of helping patients return to normal life in the community. There is a shortage of in-patient and community-based rehabilitation services, with the result that acute hospital beds are being inappropriately used for these services. Rehabilitation services have an important role for people with physical disabilities, including the young chronic sick (those requiring constant nursing care or with an acquired brain injury). Rehabilitation spans many disciplines and areas of responsibility. It is a complex area with much scope for development. As a result, it is crucial that we all work together with the aim of achieving as comprehensive a plan as possible and one that targets the areas most in need of development.
While the Recommendations of the NAC Report have not to date been encompassed in a structured action plan, there have nonetheless been many developments that have taken place in recent years that contribute in an overall sense to the development of Rehabilitation services.
In the area of Mental Health for example, progress has been made with regard to the Rehabilitation of Long Stay Patients. In recent years there has been a substantial reduction in the number of inpatients in psychiatric hospitals. While some of this decline is due to mortality of older longstay patients, much of it is due to the replacement of longstay wards in our old mental hospitals by modern community-based residences. The continuing decline in the number of in-patients corresponds to an increase in the provision of a range of care facilities based in the community to complement in-patient services. In December 1984 there were 12,484 patients in psychiatric hospitals and units compared to 4,230 at 31 December 2000. The number of community residences established in 1994 stood at 368 providing 2,685 places but by 2000 the number of residences had increased to over 400 providing over 3,000 places. In the same period the number of day hospitals and day centres increased from 159 to approximately 200.
In his annual reports, the Inspector of Mental Hospitals has recommended that patients who have spent long periods in psychiatric hospitals require specialist attention from dedicated teams to plan their reintegration into the community. Health Boards are presently in the process of developing multi-disciplinary rehabilitation psychiatric services to meet this need.
Looking through the programme for the conference, I note that one of the presentations is entitled “Recommendations from the Rehabilitation Advisory Groups – Is Anyone Listening?” I note the title of this presentation in particular because, as I have already said that is why we are here, to listen and learn. We are very fortunate to have such a range of experts, both National and International present at this Conference and I realise that you are the people who have the greatest insight into how the services currently work, the gaps in provision and how the services could be developed in the future.
I therefore would ask all of you to consider over the next two days, what actions need be to identified in the plan, who is best placed to carry out those actions and what timeframe they might be achievable in. It is very important that the action plan that is developed sets down realistic achievable targets. I would also ask you to be imaginative in your approach in looking at how to develop the services. We should be conscious of our own uniqueness, of the demographics and changing face of Ireland while at the same time seeing how we can build on what we already have and know. We should be cognisant of the changing face of health care and that other element of the vision of future health care in Ireland – “A health system that supports and empowers you, your family and community to achieve your full health potential”. I ask you to explore that vision when considering the future of medical rehabilitation in Ireland.
I am also aware that in recent times, the Department has received submissions from varying sources proposing the development of rehabilitative services in their area. While these proposals are welcome, it is important that they are considered in the overall context of how services will be developed on a national basis. Therefore, once the national action plan has been developed, the Department will be better placed to give consideration to those proposals.
Finally, I would like to re-emphasise how influential the output of this Conference can be in terms of developing National policy. All that remains is for me to wish you every success with the conference and to thank both the Eastern Regional Health Authority and the National Rehabilitation Hospital, for their efforts in organising this conference and for inviting me here today to deliver this address.