Tuesday, 27 January 2004

Questions (13)

Olivia Mitchell


135 Ms O. Mitchell asked the Minister for Health and Children the plans that are in place and the amount of money allocated in 2004 to ensure access by all who need it to a comprehensive neurology service. [1536/04]

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Oral answers (5 contributions) (Question to Minister for Health and Children)

Following a number of meetings with various interest groups, I requested Comhairle na nOspidéal to conduct a review of neurological services and related issues. Comhairle na nOspidéal established a committee to examine,inter alia, existing arrangements for the provision of consultant level neurology and neurophysiology services nationally and to make recommendations on the future organisation and development of those services. Comhairle na nOspidéal has now published its report and, having considered it, I am happy to endorse its recommendations.

The report recommends significant enhancement of neurology and neurophysiology services, including increases in consultant manpower. It also recognises that there are aspects of a number of other specialties and services, such as rehabilitation medicine, geriatric medicine and old age psychiatry, which are related to and overlap with neurology services. Comhairle na nOspidéal has recommended that a national multidisciplinary review of rehabilitation services be undertaken to further inform the policy framework on the development of neurology services.

Consistent with this recommendation and in line with commitments in the national health strategy, a national action plan for rehabilitation services is being prepared by my Department. The action plan will set out a programme to meet existing shortfalls in services and to integrate specialised facilities with locally based follow-up services. The rehabilitation action plan, together with the Comhairle na nOspidéal report and the work undertaken by the Neurological Alliance of Ireland through its publications, will offer a comprehensive policy framework for the future development of neurology and neurophysiology services in this country. My Department will continue to work closely with the alliance and the Irish Consultant Neurologists Association on the future development of services. The implementation of the recommendations will be progressed having regard to the evolving policy framework in this area and in the context of competing funding priorities.

Specialty costing data in respect of hospitals which provide neurology services indicate that in-patient costs for this specialty for 2002 were over €19 million. This figure excludes costs in respect of neurology services provided in out-patient and accident and emergency departments and specialist day case activity, which are not routinely collected by my Department.

It is incorrect to claim that the report has just been published — it was published last spring. I am concerned about what has happened since then. It appears the Minister has simply commissioned yet another report, the review of rehabilitation services. While that is welcome, it does not indicate that there has been any significant progress in appointing neurologists. The review showed that Ireland is yet again at the bottom of the league, as it were, with the smallest ratio of neurologists to population. We have less than one third of the required number of neurologists. What has been done to provide additional neurologists since the report was published? How many neurologists have been approved or appointed?

We have to consider how many additional consultants can be appointed in the context of the funding envelope that is available for this year and forthcoming years. There is a significant lead-in time from the date of sanctioning a consultant post to the post coming on stream. Generally, our consultant numbers across a range of specialties are below what pertains in other countries. That was the reason for the Hanly programme, the need for change in the consultants' contracts and the aim of doubling the number of consultants. There is caution, therefore, about making further dramatic increases in consultant numbers in certain specialties in advance of dealing with those critical issues.

There has been a dramatic increase in recent years in the number of consultants in the critical areas of cancer, cardiovascular and accident and emergency medicine. Unprecedented numbers of consultants were appointed. I will have to examine the financial envelope this year to see what can be done to advance the cause of neurology. I acknowledge the need for additional consultants in this area. The Comhairle na nOspidéal report was published too late for last year's financial envelope.

I am aware there is a long lead-in time from the time of sanction. That is the reason I asked if any appointments had been sanctioned. The Minister must be aware that neurological diseases can be treated and managed and the progress of the diseases can be postponed. The patient's quality of life can be immeasurably improved if the patient gets access to a neurologist and the neurologist's support team. The Minister said he opposes a dramatic increase in the numbers. I accept that this must be done in a planned and phased way, but has there been any increase? Is there any sense of urgency?

This is yet another specialty in which there is under-provision. The Minister spoke about the Hanly report and doubling the number of consultants, but this report has confirmed gross under-provision in neurology without an input from Hanly. However, there are no new consultants after more than eight months and there is no sign of any posts being sanctioned. Every day people are diagnosed with serious neurological illnesses and their outcomes are diminished by the fact that they cannot see a neurologist.

I do not dispute the need for additional consultants in neurology. However, I will have to examine how many additional posts can be sanctioned within the financial envelope available to me this year.