Brian Ó Domhnaill (Fianna Fail)
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I am delighted to have this opportunity to raise on the Adjournment the issue of neurological services in the north west. This issue was brought to my attention by MS Ireland which has an office in Donegal from which it provides a service for the north west. I also raised this issue on the Adjournment in February 2008.

This issue relates to the need for an additional consultant neurologist in the north west. Currently, there is one consultant neurologist for the HSE north-west region. That consultant is located in Sligo General Hospital. It has been well documented that neurological services within the State are underdeveloped generally in comparison with other European and developed countries. Neurological disease affects approximately 700,000 people in Ireland. Each year approximately 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 our ageing population, neurological diseases such as Alzheimer's disease and Parkinson's disease 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 within the State. In April 2003, a report published by Comhairle na nOspidéal, the National Hospitals Office, on neurological diseases and service provision recommended one consultant neurologist per 100,000 people within the State. That suggests there should be 39 such posts within the Republic of Ireland, and following the last census figures, that figure would increase to more than 40. The report's recommendations for clinical neurophysiology is for a total of nine consultants compared with three in 2003. That would leave a shortfall of 30, which is obviously having an effect on the north west.

The demands on the service in the north west are overwhelming. On MS Ireland's books alone, there are 700 or 800 patients in the region who utilise its services. There are more than 1,000 people on the outpatient waiting list at Sligo General Hospital to see the consultant neurologist, who travels between Sligo General Hospital and Letterkenny General Hospital, and I understand he is in Letterkenny General Hospital one day a week. There is an 18-month waiting list to see that consultant. The consultant neurologist in Sligo General Hospital is not necessarily responsible for diagnosing the patients. They are diagnosed more often than not in Dublin or in Galway. The difficulty arises in terms of the waiting list of patient referrals, following their initial diagnosis, to see the consultant neurologist for regular appointments. That 18-month waiting list is unacceptable and must be dealt with. Some work was done by the HSE to try to rectify the situation with the making available of additional assistance.

I raise this matter on behalf of multiple sclerosis patients, especially in Donegal where there is a large number of MS sufferers, many of whom I know who are experiencing major difficulties. When one is diagnosed with MS it is a life-changing experience. Those patients and their families experience difficulties, which would be eased if, following their diagnosis, the waiting list was reduced somewhat.

I know of patients who were diagnosed in recent months who are now on a waiting list and there is a massive backlog. It would be helpful if that waiting list was dealt with by the appointment of a second consultant. I would like to pay tribute to the consultant in Sligo General Hospital, Dr. Murphy, who is doing an excellent job. He is available to the families concerned but resources dictate the level of service he is able to provide. I have no doubt he would warmly welcome the appointment of a second consultant neurologist to assist him in reducing the waiting list from 18 months to a more reasonable waiting time.

Pat Carey (Dublin North West, Fianna Fail)
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I thank the Senator for raising this issue, which I note from his presentation he clearly understands and with which he is heavily involved. As he did, I pay tribute to all the professionals who work with different groups in the medical and paramedical areas.

I am responding to this matter on behalf of the Minister for Health and Children, Deputy Mary Harney, and I will outline the position. The Minister has identified the development of neurology services as a policy priority in recent years. Additional revenue funding of €7 million was allocated to the Health Service Executive in 2006 and 2007 for the overall development of services in the area of neurosciences, which comprises neurology, neurophysiology and neurosurgery. Nationally, the investment in recent years has helped to increase the number of approved consultant neurology posts, which now stands at 25 compared with 14 in 2003. In addition, there are seven approved consultant clinical neurophysiologist posts, an increase of four since 2003. As part of these service developments, the HSE appointed a consultant neurologist to Sligo General Hospital in early 2008, as the Senator said. The post 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 between Sligo General Hospital and Beaumont Hospital. This has facilitated patients in receiving their EEGs locally, thus avoiding the need for them to travel to Galway or Dublin. The HSE has conducted a national neurology needs assessment. This sought to identify the current provision and future requirements of the health system for neurology services. The strategic review was overseen by a multidisciplinary steering group, chaired by an assistant national director of population health. The executive sought external expert opinion from international neurologists to ensure the conclusions of the review were aligned with the HSE transformation programme. The advice of the external experts is being considered by the HSE prior to finalisation of the strategic review.

Government policy is to move from a consultant-led to a consultant-delivered service, with increased availability of senior clinician decision makers to treat and discharge patients. The new consultant contract is designed to support this way of working and, as in many areas of our health services, service improvements will depend to a much greater extent on the ability to mobilise and reconfigure existing resources successfully than on the provision of additional funding.

The creation and funding of further consultant posts will take place in line with the service priorities identified in the HSE's annual service plan, while taking account of the resources available and the policy of achieving a better balance between the numbers of consultants and non-consultant hospital doctors. The further development of neurology services in the north west must be considered in this context.

On behalf of the Minister, I assure the House of the Government's continuing commitment to the further development of neurology services as a key element of an integrated, high-quality health service for the future. I assure the Senator that I will bring his concerns to the attention of the Minister and ask her to liaise with him and his colleagues on the matter.

Brian Ó Domhnaill (Fianna Fail)
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I thank the Minister of State for that.