Oireachtas Joint and Select Committees

Tuesday, 11 February 2014

Joint Oireachtas Committee on Health and Children

Neurological Health Issues: Discussion

5:55 pm

Photo of John CrownJohn Crown (Independent) | Oireachtas source

I welcome my professional colleagues, other representatives and Mr. Lawless. I have a number of very focused questions. In common with most parts of the health service, neurological services such as neurosurgery, neurorehabilitation and neuropathology, are grotesquely understaffed by any international comparison. I will ask some specific questions on that. I do not want anybody to think that any part of me is criticising my professional colleagues or colleagues from other professions. They do extraordinary and heroic jobs under very difficult circumstances in which they have been placed by successive Governments and by the permanent government, which has historically had a very unrealistic view of how a health service should work. This view is coloured virtually entirely through the prism of Her Majesty's National Health Service which, for all its glory, is by modern, western standards, not the standard we should emulate.
I would like to address some questions primarily to Dr. Doherty and Professor Hardiman and they will probably need to get their pens out. How many neurologists, neurosurgeons and neurorehabilitation consultants are there per head of population in Ireland? What is recommended by the local professional authorities? What would the numbers be, in so far as they know, for the UK, continental Europe and North America?
Like Deputy Ó Caoláin, I have mentioned neurorehabilitation in other fora over the last year, specifically regarding Dún Laoghaire, which I mentioned in the Seanad last year. Compared to other countries, Ireland has approximately 60% to 70% of the number of neurorehabilitation personnel per head of population that would be found in the UK. We have one fifth of the numbers that would be found in general in continental Europe. The number of beds we have per head of population is 10% of that which is available in France. That is just one example. I strongly suspect that for all the other disciplines our numbers are similarly low.
Speaking from the perspective of my day job, I have always been troubled by the adequacy of neurosurgical services in Ireland. This is not because I have any problem with the quality, competence, dedication and diligence of the people who work on the front line in Beaumont, Cork and other units but because they are grotesquely under-provided and it has always been my impression that as a result of this a series of Band Aids has been put over an inadequate service. Let the witnesses correct me if I am wrong. Is it appropriate that ambulances in Dublin can take somebody potentially with head trauma to a hospital were neurosurgery may not be available?
In Dublin neurosurgery is available in only one hospital. Most of the acute hospitals which are on call for neurosurgical trauma and sudden catastrophic neurosurgical events such as brain haemorrhages will not have the expertise on campus. This means, by definition, that in five out of six hospitals to which patients will be brought, if they have such a problem which requires that backup, there is a built-in delay and triageof having people at a remote site trying to deal with a problem telemetrically by assessing scans that have been forwarded over. If one of my precious family members had a neurosurgical catastrophe, I know the kind of service I would like them to have and the kind of service they would have. I do not believe this is the service that is routinely available to people who dial 999 and are brought to hospital in an ambulance. We need to seriously look at that situation.
I met Mr. Lawless and he is obviously somebody about whom it will be said that he is bearing a personal grudge or acting as a crank. I will not speak about the specifics of what happened in Beaumont Hospital. However, the general perception that somebody could examine how a person with neurosurgical potential catastrophe in Ireland is dealt with and find the situation to be wholly inadequate is very plausible. I am sorry about that. I am not pointing fingers at individual people or units, but we do not do this very well. One of the reasons this meeting is happening today is because I suggested it, and one of the reasons I suggested it is because I met Mr. Lawless. Mr. Lawless was, to an extent, singing from a hymn sheet from which I had been warbling a few bars to myself over the years.
I am a little troubled by this. Identifiable individuals have a right to their reputations. Publicly funded bodies do not, be it St. Vincent's University Hospital or the board of that hospital, Beaumont Hospital, HIQA, the HSE, the Department of Health or any other entity. Recently we had the absurd situation where a respected medical journalist, Dr. Ruairí Hanley, wrote a piece about the problems with medical cards and got a threatening letter sent by a PR spokesperson for the HSE. The HSE should have no PR spokespersons. Public servants should speak for themselves on their own track records. They should not spend taxpayers' money to hire people whose primary purpose is not to foster communications but to defend their reputation. It has a chilling effect.

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