Seanad debates

Thursday, 29 January 2009

1:00 pm

Photo of Pat MoylanPat Moylan (Fianna Fail)
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I welcome the Minister of State, Deputy Wallace, to the House.

Photo of Brian Ó DomhnaillBrian Ó Domhnaill (Fianna Fail)
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I raise the issue of the neurology service in the Health Service Executive north-west region. This is a matter of concern to MS Ireland, which is located in Donegal. MS Ireland brought the matter to my attention, as did other patients seeking appointments for this service in Letterkenny General Hospital and in Sligo General Hospital.

There is one consultant neurologist for the HSE north-west region located at Sligo General Hospital. It has been well documented that neurology services in the Republic of Ireland are under-developed generally in comparison to other European and developed countries. Neurological disease affects approximately 700,000 people in Ireland. Each year, 44,000 new patients are diagnosed with neurological problems. Stroke is the third most common cause of death and the leading cause of disability in this country. With an ageing population, neurological diseases such as Alzheimer's and Parkinson's will become an even more serious public health issue in the future.

There are 21 consultant neurologists and five consultant neurophysiologists in the public service in the Republic of Ireland. In April 2003, the report by Comhairle na nOspidéal, the National Hospitals Office, on neurology and neurophysiology services recommended one consultant neurologist per 100,000 of population, with a suggested total of 39 in the Republic, which would translate into approximately 42, given the 2006 census figures. The recommendation for clinical neurophysiology was for a total of nine consultants compared to three in 2003. The current figure is five neurophysiologists in the Republic.

The consultant neurologist at Sligo General Hospital is doing a tremendous job. He rotates between Sligo General Hospital and Letterkenny General Hospital. I pay tribute to that consultant neurologist for the work he is doing but he cannot do that work alone because the population of the region is 250,000. Based on the Comhairle na nOspidéal report of 2003, there should be 2.5 neurologists in an area catering for 250,000 people. I am calling for the appointment of a second consultant neurologist to cover the Letterkenny-Sligo area, the north-west area, to ensure that the backlog of appointments is cleared.

The demands on the service are overwhelming. Between the two hospitals, Letterkenny General and Sligo General, there are almost 900 people on an outpatient waiting list, with an estimated waiting time of at least 18 months for routine appointments. That list includes patients who to date have been treated in neurology services elsewhere in the country and who have a reasonable expectation that the treatment can be continued locally now that a neurology service has commenced.

I welcome the fact that there is a consultant neurologist at Sligo General Hospital. However, that consultant is under increasing pressure to deal with the demand. The Department of Health and Children and the HSE should consider the appointment of the second neurologist in the north-west region and adopting the recommendations made in the 2003 Comhairle na nOspidéal report.

There are many other people on waiting lists for EEG appointments etc. The north-west region is only one example; it is the area for which I am fighting. I ask that the people on the waiting list from Donegal and the west region be facilitated by the appointment, based on a recommendation from Comhairle na nOspidéal, of a second neurologist in the north-west region.

I thank the Minister of State, Deputy Wallace, for coming into the House to take this Adjournment matter and look forward to her response.

Photo of Mary WallaceMary Wallace (Minister of State with special responsibility for Health Promotion and Food Safety, Department of Health and Children; Meath East, Fianna Fail)
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As we are in the form for praising each other I would like to say that the Senator's contribution was well researched and that he presented an excellent case. As I read through the report before me, I find that his thought process is similar to the position of the Department of Health and Children and the Health Service Executive on developing these services throughout the country. There has been a slight improvement in the statistics also, which will be a help.

I am responding on behalf of the Minister, Deputy Harney. The Minister has identified the development of neurology services as a policy priority. Additional revenue funding of €7 million was provided to the HSE in 2006 and 2007 for the development of services in the area of neurosciences, which comprises neurology, neurophysiology and neurosurgery, as the Senator has said. This has allowed the HSE to appoint additional consultant neurologists, which included the appointment for the first time of the neurologist the Senator referred to at Sligo General Hospital. That post was filled in early 2008 and provides neurology services to the north-west region.

Of the development funding for the provision of neurology services in the north west, €80,000 has gone towards the establishment of a pilot tele-neurophysiology link which is in operation between Sligo General and Beaumont hospitals. This has facilitated patients in receiving their EEGs locally, thus avoiding the need for them to travel to Galway or to Dublin.

Nationally, this investment has helped to increase the number of approved consultant neurologist posts, which now stands at 24 compared with 14 in 2003. In addition, we have moved to a position where we have seven approved consultant clinical neurophysiologist posts, an increase of four approved posts since 2003. The Senator is encouraging us to appoint more people and the statistics are moving in an upward direction.

The HSE has undertaken a national review of neurology services to improve integration of services and optimise patient outcomes. It took particular account of likely future levels of demand and rapid technological advances in the area. Following consideration of the outcome of the review, the HSE decided to seek an external expert opinion on the model of care proposed to ensure the recommendations were properly aligned with the HSE transformation programme. The expert panel expects to conclude its work within the next three months, after which time the HSE can proceed to the implementation phase and arrange for publication.

Government policy is to have a consultant delivered rather than a consultant led service. The new consultant contract is designed to support this and, as in many areas of our health services, service improvements will depend to a much greater extent on the ability to successfully mobilise and re-configure existing resources than on additional funds.

The creation and funding of further consultant posts will be driven by service priorities, as reflected in the HSE's annual service plan, and in particular the policy of achieving a better balance between the numbers of consultants and non-consultant hospital doctors. There is to be a significant reduction in the number of non-consultant hospital doctors employed in each of the years 2009, 2010 and 2011. This would generate savings that would be used to fund the recruitment of additional consultants. I thank Senator Ó Domhnaill for raising this important matter.