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Inadequate funding structures leading to poorer outcomes for rehabilitation patients — report

The report, Integrated Care Pathway for the Management of Spinal Cord Injury, calls for improved funding structures for patients requiring specialist rehabilitation and is highly critical of current systems.

Published recently, the report by the National Clinical Programme for Rehabilitation Medicine sets out the recommended clinical integrated care pathway for patients with spinal cord injury.

The annual incidence of traumatic spinal cord injury in Ireland is 12-to-15 per million population per year.

Last year, there were 125 new cases of non-traumatic spinal cord injury recorded in Ireland (incidence of 26.1 per million). The two most common causes are degenerate spinal conditions (due to spinal stenosis or disc prolapse) and cancer metastases, the report reveals.

Around half of spinal cord injury patients will have an outcome of tetraplegia. In Ireland, there could be up to 62 patients presenting with tetraplegia annually, the report suggests, and of those, one-to-two patients could potentially be dependent on long-term ventilation post-spinal cord injury.

“The unfortunate outcome for these patients is all too often long-term care in an acute hospital. This is wholly unacceptable for the person, and also for the health service, where acute beds are in huge demand,” the report states.

“Current funding and payment structures do not incentivise the delivery of rehabilitation in a timely or comprehensive manner. Current funding streams lead to delayed rehabilitation and delayed transfers within the system, which leads to suboptimal outcomes, inappropriate care in the wrong setting and increased stresses on patients and families.”

A funding structure that reflects “ethical principles and supports desirable patient pathways is essential”, according to the report. Patients with complex needs should have a centralised funding stream, it adds.

“There needs to be a whole-system approach to funding which supports the patient journey from acute hospitals, disability services and long-term care. Currently, funding to support the discharge of patients home is applied for through [the] social care division. Without this funding in place, patients remain in either acute hospitals or [the] National Rehabilitation Hospital as a delayed discharge. This is an inappropriate use of both these resources and an unacceptable outcome for patients,” the report states.

“Disability services are dependent on local services/budgets funding care packages, which can often be considerable. This local decision-making leads to significant variance in patient experience, as local managers struggle to absorb these often-time high-cost packages while continuing to fund routine services. This variation can be seen as an injustice to those who don’t receive funding and are thus forced to remain in an acute hospital setting in the long term.”

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