Professor Orla Hardiman:

I would take issue with the Deputy. For neurological care, the public sector is better. There is not necessarily a multidisciplinary team within private hospitals. The private hospitals are within the private sector and they serve a very important purpose in Ireland because of the difficulties we have with capacity. However, multidisciplinary teams, which is what most people with neurological conditions benefit from, are in the public sector. People with neurological disability are much better off within the public sector, warts and all.

With respect to the training of specialist nurses, as mentioned earlier, it is an attractive career path for nurses. They come from the staff nurse grade usually to clinical nurse manager, CNM. There are a number of grades for CNM and then they move on to clinical nurse specialist and then to advanced nurse practitioner. There is a very clear career path for people in nursing and it is very attractive. When we recruit for nurse specialists in neurology, we get a good field and there is a lot of interest.

Specifically relating to the mid-west, it is a success story and there are a number of reasons why that is. When I took up the position of clinical lead for neurology, Ms Rogers and I did a tour of the country and visited all of the neurology hubs and chatted with our colleagues about the needs. One of the things that was very impressive to both of us was the quality of the neurological service in Limerick and the commitment of our colleagues in Limerick to the development of services and the expansion of services. There is also the commitment of the University of Limerick to the delivery of neurological care and the facilities that are available within University of Limerick in that regard. Clearly, there is a lot of work to be done with my colleagues, of whom there will soon be four, with the third recently appointed and a fourth coming. It still needs a lot of investment but it is an area we should look to in order to learn how best to develop original services.

The Limerick services are advantaged by a very good neuro-rehabilitation team, with whom they engage closely. They also benefit from people like Professor Susan Coote, who is linked with the University of Limerick but is also an expert in multiple sclerosis physiotherapy. Professor Coote was awarded a Sláintecare pilot project demonstrating the benefits of virtual rehabilitation for people with multiple sclerosis, and that is being mainstreamed now. Nonetheless, it goes back to our issue around service level agreements and the need to be able to generate a good service level agreement with the voluntary sector.