Professor Orla Hardiman:

It is part of nursing professional development. It is wonderful that in the course of my professional career we have had a really good career structure for nurses. Talented clinical nurses no longer have to go into management to progress their careers. We have clinical nurse specialists, advanced nurse specialists and advanced nurse practitioners. The career trajectory for nurses when they come out of college is to undertake general training. Those who are interested then undergo specialist training at clinical nurse specialist level and can then to extend out to advanced nurse practitioner. We do not have many advanced nurse practitioners in neurology. We have some clinical nurse specialists. The level of expertise or specialisation of the clinical nurse specialists depends a little bit on where they are located. There are parts of the country where it is appropriate, for example, to have a general neurology nurse specialist, but there are other parts of the country or areas where the service is sufficiently mature that there is far more scope for people to specialise. For example, we have four specialist nurses in motor neurone disease funded by the HSE. We need more of them. Many of our hospitals have multiple sclerosis nurses because that is a relatively mature service, although still under-developed. Some hospitals have Parkinson's disease nurses. Some of the underdeveloped regional areas to which I referred have scope to put in neurology nurses who we could then help to support, mentor and specialise as the service grows in the context of the development of this hub model where we have a hub of specialist care providing the whole range of neurological services with a full multidisciplinary team in one of the ten hospitals I mentioned and feeding out into a notional population of 500,000, for example. The hubs would provide the basic level of care required for people with common or less common neurological conditions, while care for those with rare neurological conditions would be centralised in one or two major hubs of tertiary or quaternary referral. The level of nursing expertise would be determined by the needs within the hub.