I thank the joint committee for inviting us today to talk about Irish rheumatology services. Most of us in this room will develop arthritis, not necessarily when we are old. Many people develop symptoms when they are very young and their only hope of a normal life is to receive early rheumatological assessment and treatment.
The term "rheumatology" means all forms of arthritis, in addition to rare and potentially life-threatening conditions such as vasculitis, lupus and scleroderma. These diseases affect the internal organs and cause damage to the heart, lungs, liver, kidneys and brain. Patients with chronic inflammatory arthritis such as rheumatoid arthritis have a poor prognosis. While most people realise that people with arthritis suffer chronic pain, disability, depression, social isolation and work loss, few realise that arthritis patients actually die younger than they should, from heart disease, cancer and serious infections.
From an economic viewpoint it is cost effective to treat these conditions early and minimise the complications. On the other hand it is extremely expensive to allow these secondary consequences of disease to develop. The Irish taxpayer unwittingly bears the financial burden of poor rheumatology services. The lack of resources means inequality of access to rheumatology services, thus discriminating against patients who live in certain parts of Dublin or certain parts of Ireland. This is unacceptable when we know that early and effective treatment can revolutionise the outcome of these diseases and allow patients to live normal lives.
I particularly emphasise early arthritis, which refers to joint inflammation that has been present for just a few weeks. An example is rheumatoid arthritis and Ms Mary Healy will speak shortly about what it is like to live with the disease. There is now considerable evidence that the only opportunity for sustained disease remission in patients with rheumatoid arthritis occurs in the first few weeks after symptom onset. Once that time period has passed the opportunity has gone and it never returns. The disease then becomes established and eventually resistant to treatment. The patient becomes susceptible to a range of other diseases and longevity is reduced.
Given the overwhelming evidence of the benefits of early intervention in rheumatoid arthritis it is no longer medically or ethically acceptable to be unable to provide access for sufferers to rheumatology services. In the past ten years enormous advances have been made in the world of rheumatology in terms of revolutionary new treatments that can dramatically alter the outcome of these diseases, alongside improvements in technology that allow us to diagnose problems at a much earlier stage. These advances are of no consequence if we cannot provide the basics and get access for these patients to specialised rheumatology services in a timely manner.
Irish rheumatology services compare poorly with international standards of best practice. In the UK, the British Society for Rheumatology and the Royal College of Physicians have made recommendations for the care of rheumatology patients. For example, in a rheumatology clinic they recommend that a maximum of 25 patients, both new and returned, be seen, to take into account the complexity of rheumatic diseases and to facilitate safe and optimal patient care.
In Ireland, however, many rheumatology clinics have up to 60 patients, because of the pressure of waiting lists and the urgent nature of patient symptoms. In addition, it is recommended that patients with early arthritis wait a maximum of six weeks. This, however, is impossible in many services in Ireland because there are no resources for urgent referrals. As members will be aware, many patients on Irish rheumatology waiting lists wait more than a year for an appointment and in some parts of Ireland, particularly in the west, they wait up to four years. This is in contrast to the recommended six weeks.
There are 3.5 rheumatologists per 100,000 population in certain parts of Europe, which contrasts starkly with the Irish ratio of 0.25 per 100,000. The Government-commissioned Hanly report in 2003 recommended that there be 47 rheumatologists in the Republic. Currently there are 20.5 with three posts due to be filled shortly. All of the consultant rheumatologists in Ireland participate in the general medical emergency rota which takes up approximately 50% of our workload. Therefore, in real terms, the actual number of consultant rheumatologists working in the Republic is closer to ten whole-time equivalents. As many consultant rheumatologists in Ireland do not participate in any voluntary private practice, they can devote their time and resources to developing the public services.
Ireland is grossly underresourced in allied health professionals such as nurse specialists, physiotherapists, podiatrists and occupational therapists. The lack of such personnel greatly contributes to the long waiting lists, the overburdened clinics and the poor patient outcomes. The recent Comhairle na nOspidéal report on rheumatology services highlights many of these issues.
Each hospital unit that has a rheumatology service requires adequate infrastructure for patients with disabilities. Surprisingly, this is not the case in every rheumatology centre and this deficiency clearly requires capital investment. Community services in rheumatology are well developed in the UK, the US and many parts of mainland Europe. This makes sense because musculoskeletal problems account for approximately 25% of GP consultations. GPs should have greater access to physiotherapy, occupational therapy and podiatry services. They should also have access to osteoporosis screening and radiological investigation. It is surprising that this is not the case and it adds to the burden of rheumatology waiting lists.
Community services for rheumatology are very underdeveloped in Ireland and we are not making use of an obvious way of reducing the long waiting lists for patients with acute and chronic musculoskeletal conditions, the majority of whom have treatable problems, particularly with early intervention. The geographic gaps in rheumatology services in Ireland need to be filled as a matter of urgency. For example, there are no rheumatology services in Letterkenny, Sligo, Mayo, Tralee or the midlands.
Our priorities for action must, therefore, be to ensure equality of access and resources in all parts of Dublin and the remainder of the country by increasing consultant numbers, with those relating to all other members of multidisciplinary teams. We must achieve parity with other EU countries in respect of service delivery and international standards of patient care. National standards for services and treatment must also be developed, with the setting of appropriate targets and outcomes. Community services must be established by strengthening links between hospitals and GPs. It is important to increase both public and political awareness of arthritis as a treatable and not necessarily inevitable disease.
Historically, rheumatology services in Ireland have been ignored and poorly funded, possibly because it was thought that the diseases to which they relate were chronic and untreatable. Hope has accompanied the recent dramatic changes in treatment, and rheumatology services in Ireland urgently need to reflect this reality. History will judge all of us poorly if we do not fix this problem before thousands more patients with arthritis become unnecessarily disabled, before countless more family lives are unnecessarily ruined, before thousands more good employees are unnecessarily lost from service and before thousands more arthritis patients die at an unnecessarily young age of diseases which, with early intervention, are preventable.
That is all I wish to say as an introduction, but other members of the delegation are keen to contribute.