Need for urgent expansionof Midlands stroke services

Correspondence from the Hospital Manager at Regional Hospital Mullingar in response to a Dáil query has outlined the significant level of work being carried out by the acute stroke team, including 24 hour assessment, access to thrombolysis, and transfer pathways.

The acute stroke service commenced in 2007 providing a 24-hour acute stroke service for patients in the midland counties of Westmeath, Longford, Offaly and Laois. Since the start of acute stroke assessment, MRH Tullamore (2010), Portiuncula HospitalBallinasloe (c.2011), Navan (2020) and Naas (2023) General Hospitals have been included in ambulance Face Arm Speech Test positive (FAST+) bypass protocols for acute stroke management, with patients from their catchment areas now routinely brought by ambulance to RHM or other nearest receiving acute primary stroke centre.

This means that patients from Kildare, Meath, Leitrim and Roscommon as well as patients from Westmeath, Longford, Tipperary, Offaly and Laois may be brought as FAST+ calls by ambulance to RHM.

Independent TD Carol Nolan, who raised the matter in the Oireachtas, has welcomed a clarification provided by the HSE on the current configuration of acute and post acute stroke services at Regional Hospital Mullingar, while emphasising that urgent progress is needed to ensure equitable access for patients in Offaly.

Deputy Nolan acknowledged the commitment shown by staff in managing a substantial increase in stroke presentations from across the Midlands and neighbouring counties: “It is clear from the HSE’s response that Regional Hospital Mullingar is providing vital and often life-saving acute stroke care for a very large and growing population. “I want to acknowledge the dedication of the clinical teams who are delivering these services under considerable pressure.”

Deputy Nolan said the information provided highlights “ongoing gaps” that must be addressed if Offaly patients are to receive the same level of post-acute support available in other parts of the country,specifically around the development of the Early Supported Discharge (ESD) service for stroke patients who can be provided with specialised rehabilitation at home for medically stable patients.

“The HSE has confirmed to me that the ESD service will begin in the Mullingar area and expand outward, but that Offaly’s inclusion will depend on a future capacity review at some undetermined time in the future and additional staffing needs being met. We need a far greater level of certainty on both of those issues,” the TD said.

“While I appreciate the need for a phased and sustainable roll out, it is important to recognise that Offaly patients are already travelling significant distances for acute stroke care and should not face further delays in accessing rehabilitation support. Indeed, I have had constituents come to me after having to endure the nightmare of waiting for hours for an ambulance when their loved one showed all the signs of having a stroke.”

Deputy Nolan added that the sharp rise in stroke numbers, combined with acknowledged staffing shortages affecting data collection, underlines the need for a clear and resourced plan to ensure that Offaly is not left behind:

“I will continue to engage constructively with the HSE and the Minister to ensure that Offaly is fully included in the ESD service as soon as possible. The supports that are in place are deeply valued, but they must be matched with the capacity required to meet growing demand and to deliver equitable and timely care for all patients,” Deputy Nolan concluded.