Concerns surrounding the lack of a resourced domiciliary ventilation programme were escalated to the HSE Chief Clinical Officer (CCO), and have led to the submission of a multi-agency business case, the Medical Independent (MI) has learned.
In February 2025, Dr Cara McDonagh, Medical Director of the spinal cord system of care programme, National Rehabilitation Hospital (NRH), Dublin, highlighted that clinicians in spinal injury care were “increasingly concerned” about the “lack of a properly resourced and funded domiciliary ventilated patient programme”. She raised the issue in an email to Dr Vida Hamilton, Regional Clinical Director of HSE Dublin and South East. The records were released by the health region under Freedom of Information law.
The situation meant there was “no provision for follow-up of patients that are ventilated at home, some who also have phrenic nerve stimulators”. Among the issues raised by Dr McDonagh was the lack of a pathway for “specialist nursing input” in the home and no provision for respiratory follow-up or surveillance.
An NRH spokesperson told MI: “A business case was submitted to the HSE from the Dublin and South East regional health authority in mid-2025 requesting significant additional clinical resources to ensure the safe domiciliary and community care. The NRH was just one agency involved in this submission.” The NRH does not have clinical governance for the care at home of patients with spinal cord injury on domiciliary ventilation.
In 2023, HIQA published a health technology assessment of domiciliary invasive ventilation for adults with spinal cord injuries. The results supported the development of a national clinical pathway extending into the community. This pathway should also have an overarching clinical governance framework. However, this has not been funded by the HSE to date.
Dr McDonagh’s email also noted her awareness of an increasing cohort of patients who were ventilated at home and transitioning from paediatric services. MI understands this relates to a wider population of patients requiring ventilatory support, including those with neuromuscular, respiratory, cardiac, and lung conditions.
According to the records, Dr Hamilton raised these issues with CCO Dr Colm Henry, and it is understood a meeting with clinicians subsequently took place.
When contacted by MI, a HSE spokesperson also referenced the aforementioned business case. The spokesperson said the NRH is involved in the outpatient care of nine adult patients who are ventilator dependent. One patient “resides in a model 3 hospital”, and eight patients are living at home and “in receipt of substantial home care, environmental adaptation and equipment packages”.
The HSE was “aware of the need to establish an ongoing annual service/maintenance programme” for phrenic nerve stimulator devices prescribed for domiciliary care and was working with the company to address this.
The HSE holds data on children with complex healthcare needs who receive a paediatric home care package (PHCP) and require domiciliary ventilation. Some 30 children with a PHCP are on invasive ventilation at home and 78 children are on non-invasive ventilation. Additionally, 399 children access non-invasive ventilation via Children’s Health Ireland.
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