OPENING ADDRESS BY PRESIDENT McALEESE AT THE NRB CONFERENCE ON ‘MEDICAL REHABILITATION’
OPENING ADDRESS BY PRESIDENT McALEESE AT THE NRB CONFERENCE ON ‘MEDICAL REHABILITATION – QUALITY CARE IN THE 21ST CENTURY’
Chairman, Ladies and Gentlemen.
Many thanks for your warm welcome. I would like to express my thanks, at the outset, to the National Rehabilitation Board for their invitation to give the opening address at this important conference.
I know that many of you here today, both speakers and participants, have travelled from overseas to join us for this conference, the first to address the quality of medical rehabilitation in Ireland. I would like to wish you a particular “Céad Míle Fáilte”. I have no doubt that your experience and expertise will be invaluable in our search to constantly improve and develop the range of rehabilitation services in Ireland. We are very grateful that you have come to share your wisdom with us and hope your stay will be an enjoyable as well as an educational one.
As we approach the end of this Millennium, it is appropriate to reflect on the advances that have taken place in medical care, particularly in this century. Many of the developments we have seen in our lifetime would have been the stuff of science fiction just a few generations ago. They have immeasurably improved the length and perhaps more importantly, the quality of life enjoyed by millions of people.
The changes that have occurred in medical rehabilitation are a sound example of these extraordinary developments. Prior to the Second World War, the prevailing view of rehabilitation was essentially non-interventionist: individuals who had had serious illness or surgery, were left follow the process of natural healing.
Modern concepts of the speciality grew from the experiences of the Second World War which, tragically, created huge numbers of severely disabled young adults whose slow convalescence placed huge strains on the available medical and social resources. During the 1940’s, studies carried out in the United States demonstrated that rapid mobilisation of appropriate medical services following surgery produced marked benefits, when compared with the earlier approach of non-intervention. Later developments on both sides of the Atlantic, saw the recognition of rehabilitation as a separate speciality, with the development of centres of excellence in areas such as spinal cord injury and amputee management. We began to discover the extent to which the process of rehabilitation was amenable to management, support and control.
We in this country were fortunate enough not to experience the scale of chronic disability suffered by our European neighbours, though recent years particularly in Northern Ireland have produced a tragic legacy of disability. It is not surprising, however, that for historical reasons medical rehabilitation has been a relatively small speciality in Ireland. This does not mean, of course, that examples of high quality service do not exist. The excellent National Rehabilitation Hospital in Dun Laoghaire, for example, has built up a strong competence in the area which is comparable to the best in Europe.
While rehabilitation is perhaps most commonly associated with injuries caused by accidents, it can lead to exceptional improvements in the standard of life for children with birth defects. The Central Remedial Clinic and organisations such as the Cerebral Palsy Institute have been at the forefront in dealing with this aspect of rehabilitation. It has also been recognised that people who have had a stroke or suffer from Alzheimer’s disease can greatly benefit from rehabilitation services.
As a result of these changing and expanding needs, it is important that there be a more coherent approach to policy making in respect of rehabilitation services. It was with this in mind that the National Rehabilitation Board, which advises the Minister for Health and Children on disability issues, appointed the National Advisory Committee on Medical Rehabilitation in 1993. It is the report of that Committee which provides the background and context for this conference. I understand that in carrying out its work, the Advisory Committee was greatly assisted by colleagues from other European countries and from the United States. It is very encouraging to see international co-operation of this kind, through which we in Ireland can benefit from cutting-edge knowledge and expertise around the world. These issues cross frontiers and the pockets of wisdom held in one place are gifts easily transported to another if there is sufficient generosity of spirit.
The report emphasises the need for greater co-ordination and co-operation between educational institutions and statutory and voluntary agencies involved in the delivery of medical rehabilitation services. A key element in boosting the range of rehabilitation skills at the acute general hospital level and in the provision of services at community level, is training. Universities and training centres therefore have an essential role to play in educating medical students and health professionals in the principles, concepts and practice of medical rehabilitation. I have no doubt that this conference, which will focus on the philosophy of medical rehabilitation, academic and training issues, and key service components, will further inform and provide impetus for the implementation of this report. Hopefully, too, it will promote a deep commitment to lowering the barricades of discipline and institution which can impede the free flow of information and mutual understanding.
It is appropriate that the theme of this conference should be Quality Care in Medical Rehabilitation in the 21st century. The development of medical rehabilitation as a speciality in the 20th century was largely supply driven – it arose from the need to find a way to speed up the traditional convalescence process which was putting such strain on medical services. That criterion is still a major factor in the further development of services, perhaps even more so, as medical care becomes more expensive. This does not mean that the needs of patients are forgotten – a faster and more effective recovery from the trauma of illness or surgery is clearly in the patient’s best interests. But it is essential that the human, rather than financial dimension, remains at the forefront of medical rehabilitation. Our hope is that in the 21st century, the focus will be emphatically on the needs of patients and their families. With a deeply rounded and holistic view of those needs I have no doubt that this conference will help ensure that this is the case.
Before concluding, I would like to pay tribute to the staff and Board members of the National Rehabilitation Board for their vital contributions over the past 32 years to services for people with disabilities. As many of you may be aware, the functions of the Board are being transferred later this year to a variety of other bodies. We owe a big debt of thanks to those who have carried the baton of care this far.
The tasks performed by the Board have become increasingly more complex and demanding, particularly in recent years. It is a mark of the professionalism and dedication of everyone associated with the Board that it met those challenges head-on with the commitment and energy that has characterised its work since its inception. Indeed the organisation of this conference, at a time of great change, is indicative of that commitment.
I wish you all every success in your work and deliberations over the next two days and I am sure that the outcome of this conference will form the basis for greater advances in the area of medical rehabilitation in Ireland in the 21st century. May you leave this conference renewed and re-energised in your vocation by what you have seen and heard. May you make many friendships and create a new folio of shared and happy memories to sustain you in what is difficult but essential and rewarding work.