As I am not quite used to this format, I was furiously scribbling down the questions. I thought I might talk through the model of care that we propose because it touches on many of the issues. If I have missed anything, perhaps members can bring me back to it. Let me start by outlining what I mean by the model of care. It starts with prevention and then moves into what we deliver at the primary care level, at the tertiary hospital level and for the most complex diseases. I will consider these four areas.
On the preventive side, an interesting point was made about how it is surprising and somewhat depressing to be talking about 50% increases in dementia and stroke over time. People in the Western industrial world must realise that living properly into old age in an industrialised nation now means managing with a chronic disease. The average 65 year old has one or two chronic diseases with which they are managing within the community. Consequently, our challenge is not to obliterate chronic disease but to have a good quality of life while managing to live with a chronic condition. This can be anything from osteoarthritis through diabetes to more serious illnesses such as epilepsy and stroke. It is ironic that over the last 25 years we have got to grips with heart disease to the point whereby acute coronary syndromes are being managed and people are being kept alive, with the result that they live 20 years longer only to then acquire a chronic illness. Perhaps they get stroke, diabetes or Alzheimer's disease and this is where such increases are originating. It is nihilistic to look to the future from the perspective of thinking that such illnesses are being eradicated. What we are going to do is to live better with them.
I really want to be in the prevention space because this has not been the case up to now. We have been so overwhelmed by the acute issues, to which I will refer, that we have been unable to give voice to our concerns regarding preventive issues. For instance, in my area of epilepsy, 50% of hospital admissions are due to alcohol abuse. I see patients who have been admitted to hospital with epilepsy and am expected to manage the epilepsy condition, provide treatment, care and information and then discharge these people to be managed in the community, when really what is going on is that they have an addiction to alcohol. Consequently, the notion of prevention is absolutely crucial and as these programmes develop over the next five years, I fully expect that members will see forceful campaigns and representations from consultants and the teams that will deliver such services on public policy in respect of prevention. The four biggest issues in respect of epilepsy are stroke, perinatal care, alcohol abuse and road accidents. Members should watch this space because we are going to be in this space very shortly. However, I agree that we have not been in it sufficiently heretofore.
If I can move from prevention to the area of primary care, it is a huge challenge and relates to some of the points made by members. On a personal level I feel terrible about the unevenness of the delivery of care in this country. Most people in this room have private health care or, if not, they may know a doctor. Members now know me and could call me if they had a neurological problem. Many people of privilege in this community can negotiate the health system but if one does not, one simply cannot negotiate it. I am referring to the estimates for the number of people who have epilepsy but who never have been seen by a doctor. Delays of eight months were mentioned but some people live their entire lives with epilepsy yet have never received a specialist opinion. While the ethos of what we are trying to achieve here can be easily underestimated, it is absolutely fundamental that we get everyone who has a stake in the delivery of care across these programmes to agree on what a basic standard of care should be. Let me repeat a point I made earlier to Ms Rogers. Even if, for the sake of argument, the whole place implodes, the IMF is brought in, there is no money at all, we are unable to reconfigure any services and nothing happens regarding the delivery of these programmes, I still think we will have made huge progress by simply getting all the clinicians to agree that one has as much of a responsibility to a person living on the Dingle Peninsula as to a person living in Dublin 4. That responsibility and ethos are crucial to the programmes.
Again, it is very important for members to understand that we are absolutely committed to national delivery. Deputy Lynch referred to the south. We have come up with a plan which evens up the number of neurologists per head of population in the country. Last Thursday was a seminal day in the history of neurology because we got approval on 13 new posts in neurology across both paediatrics and adult neurology. That is a massive investment that will never be seen again. It has not happened up to this point and it will never happen again. We have got agreement from the consultants appointments committee that, in principle, it agrees that these should be appointed now.
Given the current fiscal crisis how those jobs will be implement is down to individual hospitals. One of the members mentioned administrative support. We do have to come up with solutions. We cannot appoint people if they do not have space in which to see patients and nobody to transduce their opinions into communications to GPs. There are solutions. This should not derail us. For example, in my own practice we make use of electronic communication and voice recognition software. There are ways around it. There is no getting away from the fact that administrative staff are important for managing cases but we want them doing case management and not typing. Typing can be done. We have the technology to fix that. What we need is case management. We need people shuttled through the health system, up to the specialist opinion and then to be shuttled from specialist opinion back out into the community. There are many steps where their care can fall and we need that help. On the issue of retraining, I would get rid of typing and retrain these people in managing cases and get the people the services they need.
I will finish off with the community side. General practice is absolutely crucial and we need to support it. If GPs are not getting the communication and are not given the resources to manage the cases the whole system falls on its face. We will be providing an intelligence support network through web-based technologies for GPs to give them the initial advice and let them manage cases and crucially that pathway through the care system right up to the people who can make decisions.
Deputy Ó Caoláin mentioned the four-week waiting period before seeing a consultant neurologist. We have a principle around seeing patients. My view is that if a patient needs to see somebody urgently, four weeks is too long. That person needs to be seen now, today or tomorrow. However, a person with a long-term chronic condition who is transferring care from one place to the next does not need to be seen tomorrow. That person needs special case management, a GP who knows how to deal with the system, and a telephone number of somebody he or she can call to manage the condition. That is the primary care area.
In regard to acute care, the ethos is that everybody in the country deserves access to the service that is available to the most privileged in society. That is our goal. In the south, two neurologists have been appointed to Cork University Hospital, which will expand the service significantly. Dr. Peter Kelly, professor of neurology at the Mater Hospital, is designing a stroke programme along with Dr. Joe Harbison of the geriatrics group. They are focusing down on thrombolytic delivery, that is, very acute care. We are moving very quickly through the care system. We are committed to the idea that everybody in the country has availability within a reasonable period.
Deputy Naughten asked about the rarest conditions and the most complex care and what we are doing about it. The key is that when we get the delivery of care correct for the range of the most common conditions it will free up time for individuals who have special interests. It is important to say that the neurological body of consultants are extremely well trained. Most of them have been abroad and worked in large institutions there and most have come back with a special interest. For example, in my area, while my bread and butter day-to-day work is epilepsy, I have a strong interest in early onset dementia in the young which the committee would have addressed earlier. There are not a large number of people with that condition but it needs specialist care. I need to ensure I can delegate the care of epilepsy to people that I trust to have the expertise to deal with it and that frees up my time to deal with these rare conditions. We do have the expertise to deal with it. That is the solution.
I have no illusions about the difficulty in implementing this extensive programme. I cannot say the gate is down on the first hurdle. In the first hurdle we have engaged with all concerned, including the NAI, and asked if we do things this way, can live with it and is this a standard of care we are happy with. We are nearly there. That is a very valuable position to be in. I have no illusions that the next part is extremely difficult and we need the help of the committee to get us over that next part.
