I thank the Chairman and members for inviting us to meet them today.
We have been working on bringing to the Government's and the public's attention the severe constraints in managing patients with rheumatological conditions. I will now provide details of the type of patients we treat and those about whom we are most concerned, who, we believe, are losing out in terms of current health service structures.
The largest group of patients we treat on an ongoing basis is comprised of those with rheumatoid arthritis. Most people have met individuals with rheumatoid arthritis, which is an extremely painful and disabling condition. Patients with this condition suffer severe pain and cannot function. Many of them are afflicted by profound stiffness. Some patients who come into our clinic at 10 a.m. might need to get up at 4.30 a.m. so that their joints are loose enough to allow them to travel to the clinic. Untreated, rheumatoid arthritis leads to ongoing disability. It was traditionally thought that when a patient's condition became quite bad, disease modifying drugs would be prescribed in order to try to help them. We now know there is sound evidence in the relevant medical literature that these patients need to be treated early in order to prevent disability and deformity and to allow them to maintain their functional status in life.
This is a disease that occurs at all ages. Young mothers come into our clinic who are unable to hold their babies, lift them out of their cots or look after their families. A total of 50% of people who are diagnosed with rheumatoid arthritis are out of the workplace in five years. That is a frightening statistic. If we can identify those with the problem at an early stage, we can treat them with disease modifying drugs such as methotrexate, which works well for the vast majority of patients. Newer agents are now available for those patients who are recalcitrant to this treatment.
How can we equate the fact that early diagnosis and treatment are critical in respect of this disease with the fact that there are waiting lists of up to four years in the west? That is an appalling indictment and it is negligent, from a medical and every other point of view, that this position should be allowed to obtain.
The other group, the members of which it is important that we should treat early, is comprised of those with auto-immune disease, of which systemic lupuserythematosus is an example. The latter occurs in women of childbearing years. It can be a mild disease but if it goes unrecognised and untreated, it can be fatal. The disease affects the brain and kidneys and can cause people to go into renal failure. However, it is treatable if it is recognised and monitored. The people it affects are young women with young families. I do not want to appear to be displaying a female bias, but these patients really need to see rheumatologists at an early stage. It is a rare enough condition and those involved in general medicine may not be aware to look for it.
The health strategy placed huge emphasis on ageing. We are an ageing population and osteoarthritis is a condition that affects all of us. If one looks at the cartilage of a person of 40 years of age, one will see the early signs of degeneration. We are all going to get it. However, simple measures such as advice and early intervention can keep people mobile and functional at home and help prevent disability. A badly frozen shoulder can be enough to make an elderly person require long-term care because they cannot look after themselves. If we can get these patients early and treat them, we can prevent this disability. It is not just aches, pains and groans with which we deal.
When the health strategy was published, we were astounded that there was no mention of rheumatology. The Irish Society of Rheumatology, therefore, established a health strategy group, which carried out a survey - it is the rather large document with which members were presented earlier - of rheumatology services in Ireland. I will briefly summarise the main points contained in the survey. We met officials from the Department of Health and Children and the Minister, Deputy Martin, in April and presented the strategy to both.
The number of rheumatologists per 100,000 of population in Ireland is the lowest by far in the European Union. Frighteningly, it is considerably lower than non-EU countries such as Croatia and Russia. There is a graph on pages 8 and 9 of the document if members are interested. We only have 38% of the optimal level of rheumatologists according to a paper by Debbie Symmons who reviewed the status of rheumatology. One of the most frightening statistics is that there are regions of this country that do not have rheumatology services. I refer here to the North-Eastern and Midland health board areas. Since we established the strategy, the Mid-Western Health Board has advertised for its first rheumatologist. There are regions that are particularly under-served which are represented here today, namely, the western seaboard, the Southern Health Board area and also the area of the EHRA that encompasses Tallaght. These limitations lead to very lengthy out-patient waiting lists. In Galway, the waiting list is up to four years.
There are also no paediatric rheumatologists in Ireland. There are paediatricians who have a special interest in trying to fill the gap and who are doing a good job, but they are not fully trained rheumatologists. In Ireland, 94% of rheumatologists also have a general medical take commitment. Only 19% of their counterparts in the UK have such a commitment. This eats considerably into the time available for rheumatology. Beaumont Hospital, for example, has two rheumatologists but if one takes our sessional commitment to rheumatology between both of us, excluding general medicine, there is only 0.8 of a rheumatologist. Rheumatologists do not work alone. We need the backup of physiotherapists and occupational therapists to keep people functional. Early splinting and exercise keep people mobile along with medical help but many areas do not even have such backup support.
I would like to thank the committee for listening to the presentation. We made some recommendations to the Minister, which can be found at the back of the health strategy. Any health board, where there is no consultant rheumatologist, and any region where their ratio is 0.4:100,000 or less, are in an emergency state and they need emergency provision of rheumatologists. At least one paediatric rheumatologist is needed as well as backup, including clinical nurse practitioners, occupational therapists and physiotherapists. We have more short-term recommendations, once the emergency package is filled. They are listed on page 24 of the health strategy. There should be no single-handed rheumatologist. Accountability should be allowed for general medicine to increase the rheumatology commitment. We need to be able to treat patients quickly and arrange for follow ups with their general practitioners.