Dr. Niall Pender:

I thank the Senator for raising those issues. He is correct on both counts. Chronic and long-term pain or neurodisability is extremely common and it can be treated with a multidisciplinary pain management programme, but not everybody has access to those programmes and not everybody can get access to them in the region in which they live, as highlighted by the Senator in regard to Galway. The same issues arise across the country in local areas and local hospitals, where people have to fight extremely hard to get access to the services they need. Pain management and long-term, chronic pain in the context of neurodisability is horrendous. It is incredibly disabling. It disrupts people's lives and it means they cannot work. They struggle. As stated by the Senator, sometimes the pain is intermittent. Most of it is back pain, but it can involve headache and any other limb and joint pain arising from the injury and disability. I fully agree that these people need access quickly. That is part of the joined up thinking piece we want to bring together in the new rehabilitation strategy, no matter what the issue. There are a range of a complexities. It could be cognitive, pain or motor but usually we end up seeing a constellation of pain, physical disability, cognitive impairment and psychological distress or mental health problems. Those four issues are the pillars that people experience after a neurological injury or with a neurological disability. They need someone to guide them into the services and access to them.

The access piece for neurodisability is really challenging because these people do not know where to go or what services exist. To be honest, most people are thrown into these neurological disabilities without any knowledge. I have relatives and friends who have a family member with a disability asking me where they can get help for their relative. I cannot tell them, because I do not know; the information does not exist. It is heartbreaking to see people almost begging for help, desperate to get access to the help and resources they need, which is sometimes dependent on where they live or what their difficulties are. We need a process where people do not have to fight for access to services. When you have a family member with a neurological disability or any of the other disabilities we are hearing about today, the person dealing with it, the carer, may not have the energy to fight for the services. Many of these people suffer their own mental health problems. We know that the subjective and objective burden from care-giving is enormous, particularly in neurodisability. The subjective burden of dealing with somebody who has perhaps light chronic pain or a psychological difficulty is enormous. It cannot be seen, but it is hugely demanding. The caregivers also do not have time or the energy to go looking for services and to fight for them. Nevertheless, the first thing I hear from many of the people I see at my clinic is that they are exhausted trying to fight for services and that they have gone to everybody possible for help. Nobody should have to fight for services and their right to get treatment for their neurological condition or their disability when we know those treatments exist and that they are very effective.

I support 100% the Senator's remarks. For us in neurological disability, implementation of that document will help us start the ball rolling. We are still light years behind what I am hearing discussed today in terms of housing and the other issues. We are far behind that even now. The trauma plan has been instigated such that we will have excellent state-of-the-art trauma services for people following injury. More people are surviving and so more people will be left with long-term disability and difficulties from these injuries. We need to have somewhere for them to go and we need to have a clearly mapped out plan such that they do not have to fight and battle for services. We do not need to add to their disability. At this moment in time, the system around the infrastructure is increasing and adding to their disability when it does not need to. That makes the pain worse. It makes the emotional pain and the mental health worse as well. I wish I had a clearer answer. We have a pathway already laid out in the neurorehabilitation strategy, which will get us on the ladder and get scaffolding around people, but we still have a long way to go in terms of having the state-of-the-art services.