Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I am pleased my constituency colleagues, Deputies Harkin and Martin Kenny, are in the Chamber because I know they agree very much with what I am calling for today, which is the immediate recruitment of an additional four clinical nurse specialists in neurology. As the Minister of State is aware, the Neurological Alliance of Ireland has highlighted that we are 100 neurological nurses short of the HSE's own model of care, not to mention national best practice. This is costing the HSE a great deal of money in the context of additional and unnecessary admissions, adjustments to care and medication. There are only 42 whole-time equivalent specialist neurology nurses in the country, but we need in the region of 142.

In the north west of the country we have Sligo University Hospital in our constituency and Letterkenny University Hospital. They offer services in the north west to a population of approximately 500,000 people. We have the highest incidence in the country per capita of multiple sclerosis. There are 2,000 people on the waiting list in the region and approximately 24,000 nationally. As it stands, we have two neurologists and we should have seven. We have no neurophysiologists and we should have two. We have two multiple sclerosis nurses when we should have three to cover over 1,000 people dealing with multiple sclerosis. We should have one movement disorder nurse and although we have one, it is shared with four geriatricians, so, in effect, it is 20% of one. We have two epilepsy nurses when we should have four. We should have three headache nurses but we have none. We should have one rare disease nurse per 500,000 of population but we have none. There are also issues around administrative support.

The reality is if we recruited these nurse specialists in neurology, we could have nurse-led clinics, rapid access clinics, telephone advisory consultations and outreach. This would significantly improve the quality of care at lower cost, mainly by preventing unnecessary admissions to advice, information, support and counselling with the appropriate safeguards and adjustments in medication.

In preparing for this year's budget, the clinical programme asked for approval for 16 out of the shortfall of 100 posts. There is a very strong rumour it will not even get approval for one post. This is in a year where money was no object and no expense was spared. Approximately €20 billion is being made available to the HSE and the Secretary General gave himself an extra €81,000 in pay, such is the importance of the distribution of that money to the HSE. Approximately €460,000 is being paid to the head of the HSE. I am sure all of them are doing a wonderful job, but the reality on the ground is that where it counts in terms of clinical care for the patients, which is what all the money is for, what is the problem in recruiting and paying four additional neurology specialist nurses for our area? As it happens, it is the area represented by three of the four Deputies in the Chamber now.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputy MacSharry for raising the matter of the recruitment of additional nurse specialists in neurology for Sligo University Hospital.

The issue has come to the fore as part of a national campaign organised by the Neurological Alliance of Ireland. I could be standing where the Deputy is standing and raising the exact same issue about the south east. I compliment the alliance on bringing the challenges its members are facing to the fore.

Neurology nurse specialists play an important role in triaging, assessing and providing ongoing support to neurological patients. This in turn builds capacity within neurological services and allows for more timely access to efficient, equitable and quality care for patients. I met a group of three consultants regarding Huntington's disease yesterday, which falls under this area also.

The national clinical programme for neurology, in conjunction with the Neurological Alliance of Ireland, completed an all-Ireland survey of neurological services in 2020. The survey highlighted that although all neurological centres have access to a designated clinical nurse specialist and-or an advanced nurse practitioner, the total number of neurology nurse specialists is significantly below, as the Deputy said, what is recommended by international guidelines. The national clinical programme recognises the need to address this deficit to ensure the provision of efficient and timely care.

An additional 16 clinical nurse specialists and advanced nurse practitioners have been sought for 2022, as the Deputy stated, across different specialties and hospital groups. While a final decision on funding is currently awaiting finalisation of the HSE service plan, the additional posts sanctioned will initially address the areas of greatest geographical inequity, and the sub-specialties that are most in need. Plans to increase the overall number of neurology nurse specialists incrementally will then be developed to address the remaining needs.

The national clinical programme for neurology recognises the value that skilled and highly trained nursing staff add to neurological services. It has endeavoured to endorse this by focusing its current work streams and initiatives around nurse-led clinics, nurse liaison services and outreach programmes. Examples of this include the headache programme and epilepsy outreach programme, both funded under the Sláintecare innovation fund.

These programmes involve reconfiguration of the management of these conditions, enabling clinical nurse specialists and advanced nurse practitioners to lead and co-ordinate care of these conditions in the community. This reduces reliance on consultant neurologists and tertiary services, in turn reducing waiting lists, allowing more timely access to services and improving the overall quality of care.

The north-west regional consultant-led neurology service is based in Sligo University Hospital with a regional commitment to Letterkenny University Hospital. The existing nursing staff currently in place at the neurology service at Sligo University Hospital includes two advanced nurse practitioners in epilepsy, three clinical nurse specialists in neurology and one candidate advanced nurse practitioner in movement disorders employed through community healthcare organisation services, working across both Sligo University Hospital and Sligo-Leitrim community services.

In addition to the two existing consultant neurologists in place, the national clinical programme for neurology has recommended the appointment of a third consultant neurologist to help fulfil the neurology care needs of the population of the north west. This post is expected to be filled in 2022.

The bottom line today is in relation to the additional 16 clinical nurse specialists and the advanced nurse practitioners across different specialties with a final decision pending. I give the Deputy a commitment I will raise it with the Minister, Deputy Donnelly, because it is one I am hearing about all over the country.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I thank the Minister of State for the reply. As she said, she could quite easily be standing where I am today and if she was, I doubt she would be happy with that response. I am conscious that undoubtedly if it was her constituency, she would be very much focused on trying to get the issue sorted. I appreciate where she is coming from. Two problems arise. The first is 16 additional nurses were sought as part of budget 2022 with the decision pending in February for the service plan. It has become the practice that the HSE service plan is published sometimes as far into the year as June or July, which is laughable. No business could do that, certainly not one with €20 billion in resources. One hits the ground running on 1 January and recruits 16 additional nurses, otherwise it is the service plan for 2023 or 2024.

The other problem is the bottom line that we have less than 50% neurology nurses who are required in the country and the same is the case in Sligo even though we have the highest incidence of multiple sclerosis per capita in the country. There is no urgency about this to the effect that we should get this sorted and get these people recruited. If the Minister of State was to adopt the business analogy I used, she would save money because it would cut admissions, free-up otherwise much needed acute beds that are there for other reasons, and eat into the 2,000 on the waiting list, bearing in mind that within the region there are 10,000 with neurological conditions and 800,000 nationally. We need to focus a little better on this issue.

I should have mentioned my constituency colleague, the Minister of State, Deputy Feighan, who I am sure would agree with this. However, talk is cheap. We could all acknowledge the need and all the rest of it, but where is the recruitment process and the staff? I am sure the Neurological Alliance of Ireland does not want accolades or congratulations. Like the rest of us, its members want to see results.

Mary Butler (Waterford, Fianna Fail)
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I appreciate the Deputy's contribution on the neurological service at Sligo University Hospital. I can read a script here and read out the commitment to the national clinical programme for neurology, to meeting the needs of patients, as illustrated by the proposed appointment of a third consultant neurologist to help fulfil the neurology care needs of the population of the north west, but it needs to be backed up, as the Deputy said, by the nurses.

The commitment of the Government to the provision of quality healthcare in Sligo University Hospital is underlined by the project for a multistorey ward block. This is currently in detailed design stage and will consist of two additional 21-bed wards with single en suite rooms. I will give the Deputy a commitment that I will raise that issue with the Minister, Deputy Donnelly, this week and I will raise it with the Minister of State, Deputy Feighan. I am aware of the demand for these nurses. We have to start incrementally. I remember when I was fighting very hard to get dementia advisers in place and we had eight. We built on it year on year and we ended up with the 28 we needed. I will give the Deputy the commitment I will raise this issue as soon as possible and, hopefully, we can get such provision included in the service plan for 2022.