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Recruitment curbs and financial difficulties are among the barriers, a new report reveals today. In 2023 the Early Supported Discharge (ESD) service was provided to13pc of stroke patients in Cork University Hospital, but 30.9pc in Tallaght University Hospital and 30.5pc in St James’s Hospital. Other hospitals with the service included Sligo University Hospital with 28.9pc benefiting and 23pc in University Hospital Limerick. In Our Lady of Lourdes Drogheda the figure was 24pc, with Galway University Hospitals at 19.8pc and the Mater Hospital at 19.2pc. Several hospitals only established the service that year, including Connolly Hospital which set it up in December that year at 4pc, and St Vincent’s Hospital at 10.3pc . Dr Ronan Collins from Tallaght Hospital, the HSE lead on stroke care, said: “There have also been significant advancements in stroke recovery in Ireland. “Early Supported Discharge is an initiative in which stroke survivors can have therapy, social work and nursing support at home so that they can leave the hospital earlier. "This allows patients to be more independent and are more likely to avoid long-term residential care. It also improves bed capacity across stroke units, with more than 800 stroke survivors benefiting from the initiative in 2023. On average, 22pc of stroke survivors are discharged with early supported discharge.” The HSE report said in 2023, there were 11 ESD teams. The HSE National Stroke Strategy calls for 21 teams to be established by 2027. The goal is that they would cover more than 90pc of stroke units and provide ESD to a predicted 996 people per year. “The activity of the existing ESD teams already surpasses projections for this point of the service rollout, reflecting the high demand and clear value the ESD model has… More people than ever are availing of ESD, with over 800 people receiving ESD in 2023 alone.” The report, published on World Stroke Day, said further resourcing is required to ensure all teams have a suitable skill mix to manage the ever-increasing complexity in patient needs. More than 1,500 people availed of ESD services during 2022 and 2023 combined. The 827 participants in 2023 were the highest to date in Ireland. “Given the known positive clinical gains associated with availing of ESD, this ongoing upward trend is very encouraging, and reflects both national investment and the local embedding of ESD within stroke pathways,” it said. Teams unable to currently deliver greater than the target 20pc of discharges to ESD are those where staff resourcing is very significantly below projected demands. Or where the service had to pause or cease for a period, such as St Vincent’s Hospital, which paused while transitioning between temporary and permanent funding for recruitment reasons. This was sometimes due to a lack of Clinical Nurse Specialists, Medical Social Workers and Therapy Assistants. On other occasions it was due to a funded position having fallen vacant due to staff turnover or leave. By late 2023 the impact of the HSE recruitment pause meant several teams were experiencing a reduction in staffing, due to vacancies arising within ESD, or staff being called upon to divide their work time across ESD and in-patient work.
