Stroke patients who are discharged from hospital back into the community often face ‘chronic service shortages', which can have a devastating effect on their quality of life. However proper investment in community rehabilitation could make a major difference to these patients and save the State millions of euro, a new report suggests.

It is based on research carried out by the Economic and Social Research Institute (ESRI) and the Royal College of Surgeons in Ireland (RCSI), which found that 54% of stroke survivors - that is at least 3,000 people per year - could benefit from early supported discharge programmes.

This would reduce hospital bed days by 24,000, leading to an annual net saving of between €2 million and €7 million.

Early supported discharge is used in many countries worldwide and involves an intensive approach to rehabilitation. It is not usually available in Ireland.

The report notes that if it was to be properly introduced here, there would need to be a major investment in community staff, such as physiotherapists, speech and language therapists, occupational therapists and community nurses.

However, it points out that these staff could be funded by the savings made in acute hospital bed days.

"The analysis in this report supports a move to international best practice in stroke rehabilitation in Ireland, with the potential for better outcomes for patients from better care in the community. This could be achieved at a net saving in national health expenditure by freeing up acute hospital beds," commented the report's lead author, Dr Maev-Ann Wren, of the ESRI.

She insisted that there needs to be a shift in the balance ‘from over-reliance on hospitals to greater delivery of care in the community'.

Commenting on the findings, Barry Dempsey, chief executive of the Irish Heart Foundation, which commissioned and part-funded the report, pointed out that acute stroke services in Ireland ‘have been transformed in the last three years'. This has lead to a 13% reduction in mortality and a 28% reduction in the number of stroke patients being discharged to nursing homes.

"That means more people than ever are returning home after stroke, but community services to maximise their recovery have remained as bad as ever, with appalling quality of life consequences for discharged stroke patients.

"Stroke survivors currently face chronic service deficits - one in three have no access to physiotherapy and half can't get any speech and language therapy or occupational therapy. Just 11% have access to psychological services despite the often severe mental health impact of stroke and 36% pay privately for rehabilitation," Mr Dempsey said.

He believes that this new report shows how community services can be improved without concerns over costings.

Meanwhile, the report also found major regional variation when it came to stroke rehabilitation services, including access to various therapists, length of hospital stay and the availability of nursing home places. For example, the average length of stay for stroke survivors who are discharged to a nursing home ranges from 24 days in the HSE West region to 79 days in the HSE Dublin North-East region.

"This research proves again that it is far more expensive to provide bad stroke services than services that maximise good outcomes. Despite Ireland's economic collapse, health policymakers have had the courage to find extra funds to increase the lifesaving capacity of acute stroke services.

"Now they must act again to develop the community rehabilitation infrastructure that will improve the quality of life of thousands of stroke survivors and save the State money into the bargain," Mr Dempsey added.

The report, Towards Earlier Discharge, Better Outcomes, Lower Cost: Stroke Rehabilitation in Ireland, was also part-funded by the HSE.