Professor Orla Hardiman:

Deputy Ó Caoláin and Senator Crown asked the same question on the number of neurologists we should have. It is a difficult question. In Ireland we have approximately one neurologist per 117,000 people. Dr. Doherty did a quick calculation and in the UK there is approximately one per 80,000 people. The difficulty with the question on what is the remit of neurology is the remit is quite wide. The biggest neurological problem we have is stroke, which falls somewhat in the remit of neurology and somewhat in the remit of medicine for the elderly. If stroke is included as part of the remit of neurology we are grossly underresourced and undersupported. To have one per 100,000 people we should have 45 neurologists and to have one per 80,000 people, which would be equivalent to the UK, we should have 54. We would need another group of specialists with expertise in stroke and it should include neurological support.

Dr. Doherty will probably develop the point that a neurologist in isolation is not a particularly helpful animal. We are pretty good at making diagnoses but to implement the best care we would like to have for ourselves and our families we should be part of a team, which brings us to the employment embargo which is a huge problem. The model by which we deliver care should change to a multidisciplinary form whereby we are part of a multidisciplinary team. We would need another ten or 20 neurologists to make the team work, but it would not work without the other disciplines. Dr. Doherty has described a very good model on the important role highly-trained clinical specialist nurses and nurse practitioners can play in the delivery of care.

We have a tangible request to make of the committee with regard to medical cards, which is to investigate the formula used to define the difference between the means test for the medical card and the discretionary medical card. We have been informed a financial mechanism or metric is used in the HSE with regard to the difference when somebody exceeds the mean but falls into the discretionary category. We would like to know the health economic basis of the metric. It is a tangible question on which we would like the committee to come back to us because we would like to test it with our own health economic analysis. I will leave the committee with this very simple question.