Professor Orla Hardiman:

Yes, that is very much a live issue. I thank the Deputy for raising it. Looking at the waiting lists for neurology, and we have done some due diligence on this, approximately 25% to 30% of people on the waiting list are there for a headache or headache-type disorder. Clearly, that is of concern because when people get headaches people think that they might have a brain tumour. It has been the case up to quite recently that the process of investigating headache would require diagnostics. If people have health insurance they can buy a scan, but obviously that is not appropriate. We should be able to provide access to diagnostics for everybody in an equitable way.

In the past year or 18 months, the HSE has developed a programme whereby primary care practitioners, through the National Treatment Purchase Fund, can now access diagnostics within the community. That should start feeding into the need for diagnostic services and specialist opinion. In addition to that, the development of the Sláintecare implementation programme should help to reduce the level of the waiting list for that 25% to 30% of people who are waiting because of headache. Furthermore, when we look at the reason we have waiting lists, we look at thing like the new-to-return ratio in clinics. That is quite variable as well, depending on the type of clinic. For some clinics' specialist services it is very appropriate that there would be many return patients, multiple sclerosis, motor neurone disease or Parkinson's disease being a case in point, but in other instances there might be other ways of managing the disability. Headache is a good example of that. Epilepsy is another good example. We could build a service whereby the other specialty services, particularly specialist nurses, working closely with the voluntary sector, can implement a programme of self care with professional support. We have been exploring that with the Sláintecare-funded migraine programme and have demonstrated that it can be very beneficial. There is also a programme for epilepsy that does that.