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Seanad Éireann díospóireacht -
Wednesday, 22 Jun 2022

Vol. 286 No. 6

Neurology Nurses: Motion

I move:

“That Seanad Éireann: supports:

- the Patients Deserve Better campaign promoted by the Neurological Alliance of Ireland, an umbrella group of non-profit organisations which advocates for the rights of 800,000 citizens living with a neurological condition;

recognises that:

- neurological conditions which affect the brain and spine are the leading cause of disability throughout the world and include many common conditions such as stroke, migraine, epilepsy and acquired brain injury, in addition to certain rare and genetic conditions;

- almost 24,000 Irish people are on a waiting list for a neurology outpatient appointment;

- the number of people on the neurology outpatient waiting list is continuing to rise and the number waiting more than 18 months has increased by 30% in the last year;

- there is a shortfall of 100 neurology nurses in Ireland based on official national and international guidelines relative to population;

agrees that:

- people with long-term neurological conditions have limited access to the neurology nursing services that help them to manage their condition;

- this results in unnecessary hospital admissions and causes delays in necessary adjustments in medication;

- neurology nurses have a very significant impact on patients, increasing accessibility of healthcare and improving management of their condition;

and calls for:

- Government action to address the shortage of 100 neurology nurses which are vital to patient care and the reduction of neurology waiting lists which now stand at 24,000;

- the Minister for Health to publish his Department’s proposals to solve the shortfall in the provision of neurology nurse posts across Ireland’s ten hospital neurology centres; and

- the Minister for Health to prioritise adequate Budget 2023 funding to provide for 100 additional neurology nurses nationwide in line with the research and recommendations in the Patients Deserve Better campaign plan.”

I welcome the Minister of State to the House. This motion is about supporting the Patients Deserve Better campaign, promoted by the Neurological Alliance of Ireland, NAI, which is an umbrella group of the non-profit organisations that advocate for the rights of over 800,000 citizens living with neurological conditions. The motion seeks to recognise that this is an issue.

I wish to state at the outset that I have discussed the motion with my colleagues across the House in the last few days, and it has received a most favourable response. I do not think there is any division in this House about the absolute need to address the concerns in respect of the issue. Many organisations are tuning in to the debate today, including Aphasia Ireland, Ataxia Foundation Ireland, AFI, Enable Ireland, Epilepsy Ireland, PSPA Ireland, the Migraine Association of Ireland, MS Ireland, the Parkinson's Association of Ireland and Beaumont Hospital. There is a huge concern around the issue. We only want to give voice to what is a really successful campaign that has been run by the group. It has not been run by anybody else. I wish to acknowledge that the group has collaborated well with Senators and Deputies across the Houses. That is a measure of the success of the campaign.

The Patients Deserve Better campaign addresses Ireland's shortage of over 100 neurological nurses. There are currently 42 neurological nurses in Ireland. International recommendations state that Ireland should have 142 such nurses. The campaign decided to lobby on the issue, and it has lobbied very successfully. It is important to acknowledge the professionalism of the campaign. Looking at the campaign milestones, there have been six regional launches. As we are all aware, the campaign has sent 11,000 targeted emails to Oireachtas Members. The campaign has been involved in, and collaborated on, 140 parliamentary questions. It has engaged with 83 Deputies and Senators on the various issues around the campaign.

It is important to note the campaign's achievements to date. On 30 March 2022, the NAI received strong support for the campaign at a meeting of the Joint Committee on Health. That was a particularly important milestone. I wish to acknowledge the work of the committee on the issue. On 30 March 2022, the HSE confirmed that plans are in place to provide 16 additional nurse specialist in neurology services.

That is progress. It is slow and it is not what they want but it is going in the right direction. I want to acknowledge that too. How can we support the call to tackle the nursing shortages? It is important that we continue to lobby and use our contacts within the Houses of the Oireachtas for their campaign. As I said, it is very significant. Neurology covers many issues and these nurses treat illnesses such as multiple sclerosis, severe cluster headaches, epilepsy, Parkinson's disease and other rare diseases. It is critically important that we get this number of nurses up.

The recommendations of the neurological centre are based on the recommendation ratio. That is interesting. I will call out a few of the hospitals because I like to deal in facts. I thank the organisation for providing this information. Of course, we validate that information, which is critically important to bring some sort of integrity to our own debate in these Houses.

We know that in University Hospital Limerick, UHL, the recommendation is 11 nurses. Currently, there are three. There is a shortfall of eight of these specialist nurses. In Sligo University Hospital, very close to the Minister of State's constituency, the recommendation is seven nurses. The current number is three, which is a shortfall of four. In Cork University Hospital, CUH, the recommendation is 20 nurses; it only has four. There is a shocking shortfall of 16. We move on then to University Hospital Galway where the recommendation is 13 nurses; there are only four, leaving a shortage of nine nurses. Then, we come to what should be and is a hospital of excellence but clearly needs all the support it can get in this particular area, namely, Beaumont Hospital, which is very much a leading hospital in this area. The recommendation there is for 15 nurses. The current number is ten, which is a shortfall of five. The recommendation for St. Vincent's University Hospital in Dublin is 22 nurses. The current number is four, leaving a shortfall of 12. I will wrap up with St. James's Hospital where the recommendation is 14 nurses. The current number of nurses in this area is four, which is a shortfall of ten. The recommendation for the Mater Misericordiae University Hospital is 14 nurses; it has six in place with a shortfall of eight. Finally, the recommendation for Tallaght University Hospital is 20; it currently has in place 3.5 nurses, leaving a shortfall of 17.

I do not have to set it out much more plainly than that. The Minister of State knows the importance of this area as someone with responsibility in the Department of Health. What we are ultimately trying to achieve is support for the Patients Deserve Better organisation. It has done a great job as an advocacy group. Its representatives have connected with the practitioners. They have huge support from the consultants in these hospitals. It is important that we support them.

What is this motion calling for? That is what it is all about. We decided on a motion rather than some other piece of legislation because it is a particularly important issue. Most Deputies and Senators spoke about the large numbers of emails and the concerns of particular hospitals.

I wish to single out, in particular, Senator Maria Byrne from County Limerick and her party. She raised a number of issues and, indeed, she raised one yesterday in this House during Commencement matters, for which I was Acting Chairperson, on neurological support and nursing in her local university hospital. She spoke passionately about the need to address this but also about a load of shortcomings in that hospital, which is not part of our remit tonight. She made a very strong case, however, and a number of her own party Senators in this House and others across the floor did likewise.

Opposition is not just about opposing things. I think the Senator appreciates that, as do we all. We want to work constructively with the Government. We want to use our time tonight to highlight those shortcomings. As I said, we want to basically give voice to this enormous Patients Deserve Better campaign.

This motion calls for Government action to address the shortage of 100 neurological nurses, who are vital for patient care and the reduction of neurological waiting lists, which now stands at 24,000. It is a shockingly big number, which we need to address.

The motion also calls on the Minister for Health to publish the Department's proposals to solve the shortfall in the provision of neurological nursing posts across Ireland's ten hospitals of neurological specialty and centres of excellence. That is also a very focused ask. We also seek in this motion for the Minister for Health to provide adequate budget funding for 2023 to provide the 100 additional neurological nurses nationwide in line with the research and recommendations of the Patients Deserve Better campaign.

I will hand over to my colleague, Senator McDowell. However, I will wrap up by saying that this motion is motivated by collaboration. It is about support and a focus on the shortcomings. It is not about laying blame with anyone but about accepting and acknowledging that we are where we are today. We really want change. We are early enough out from the budget when, hopefully, Government and the lead Minister in the Department will be mindful of the ask. I am hopeful and very confident that we will have the support of all Members in this House tonight for this important motion.

It is an honour to second the motion that Senator Boyhan has brought before the House. I wish to say a few words to re-emphasise what he said. This is not point-scoring against the present Government . This is looking at a deficit that exists in the health system in Ireland. We are not moving this motion in a negative or carping spirit at all. We are endorsing the campaign for an increase in the resources that are going towards neurological nursing in Ireland and a recruitment and training campaign to make sure we have adequate numbers of neurologically-trained nurses.

As we all know, neurology is a developing science. We are now beginning to understand in ways we did not before just how much suffering is caused and damage done by neurological disease. Research must be there, of course, and there are some signs already. I listened to a BBC radio report today about some of the causes of Alzheimer's disease and the question of vascularisation of certain areas of the brain. Research is going on right across the board with regard to some of these scourges that affect our society. One of the people involved in that research said that if we can tackle that particular condition, for instance, we can improve the standard of life for people in their 70s and 80s - I am now 70 myself, actually 71 now that I think about it - in order that towards the end of a person's natural lifespan, he or she does not suffer from neurological or vascular problems or whatever if the proper research is done.

As Senator Boyhan said, it is hugely important not merely that we have the specialist posts filled but that we also have a cohort of nursing staff who can support them. There is a limit to what specialists can do in terms of treating patients if they do not have the valuable support of the nursing profession. It is a question of training and making resources available for those positions. It is also a question of retaining the people who are skilled in those areas and ensuring their skills remain in this country.

Sometimes, I think there are some fundamental problems with the health service in Ireland. I am not happy that between consultants and non-consultants, we have arrived at a happy system of providing in-hospital medical attention at the doctor level. I do not really believe there is a pathway to promotion or pathway to excellence for many of our non-consultant hospital doctors. There is to some extent a two-tier profession in existence. I am fully in favour of people going abroad to get valuable and absolutely necessary expertise but it does sometimes strike me as odd that we have people in Ireland who are trapped at a certain level. There is a glass ceiling above them. They are asked to work extremely hard to keep our hospital system going. I have no doubt the same would apply to the nursing profession. Nurses are in demand worldwide, particularly skilled Irish nurses.

We have to provide career paths that satisfy patient needs in Ireland.

In a constructive spirit, I endorse everything Senator Boyhan has done. I congratulate him on selecting this issue and asking our group to make available its Private Members' time to bring it to the fore. The Senator mentioned Senator Maria Byrne having raised the issue in the context of Limerick. Senator Buttimer has also said similar things in the House with regard to Cork. This is a real issue. It is not a party issue but a systemic issue in the health service. In that spirit, I regard it as an honour and a privilege to be in a position to second the motion tabled by the Seanad Independent Group and moved by Senator Boyhan.

Before I call our next speaker, I note that, although he has now left the Chamber, Deputy McAuliffe was here earlier with Councillors Racheal Batten and Keith Connolly from his area and members of the Fianna Fáil cumainn in Dublin 9 and 12. It is always good to see other political nerds in the Chamber.

I was very glad to see our local party members from Dublin 9 and 11 in the Chamber to witness part of this debate because they live within the vicinity of, and would be connected with, Beaumont Hospital. Senator Boyhan mentioned that there is a shortage of 15 neurological nurses in that particular hospital along with the many other shortages he outlined. I thank the Senator and Senator McDowell for their presentation. They were very instructive. I also thank the Patients Deserve Better campaign for the wonderful work they have done over recent weeks and months to highlight this very important issue.

It is shocking that we have such a shortfall of these highly specialised nurses right across the country. It is an issue that many Senators have raised in the House. It is not good enough that patients feel this shortage in their lives. Additional neurological nurses could be transformational for those people who acutely need them. I ask the Minister of State and the other Ministers in his Department to consider the contributions made to this debate and seriously consider funding these extra nurses.

It is not good enough that there is this shortfall. As Senator Boyhan has outlined, we have the opportunity to rectify that between now and budget day. I know a lot of work will be done over the summer. I hope the record funding of the health system will take this issue into account because, while it is a very specialised area, it impacts people right across the country and extra resources in the area would be of fantastic benefit to local communities and people who are really suffering. I look forward to hearing what the Minister of State has to say and to the rest of the contributions to the debate.

I am sharing time with Senator Buttimer. We will take three minutes each. I thank my Independent colleagues for tabling this motion. I remind Senator Boyhan that I have, on a number of occasions, highlighted the lack of neurological nurses in the mid-west and nationally on the Order of Business and through Commencement matters. I very much support the Patients Deserve Better campaign. I acknowledge Alison Cotter of MS Ireland who is in the Chamber and who worked for me previously. I know the great work MS Ireland does and how its work could be greatly enhanced if there were more neurological nurses.

Some of us were at the briefing last Wednesday. It was a very powerful briefing in which a young lady from Galway in her early 20s very powerfully presented on the difference availability of and access to neurological nurses would make to the lives of people of her age. There was also an older, although not elderly, gentleman with Parkinson's disease who had a very similar story to tell. What was very powerful were the parallels between these two people's experience. Despite their different ages and coming from different generations, their stories were the same. They spoke about living independently and being able to lead full, equal, accessible and fulfilled lives. That is what step-down neurological nurses in the community who visit people in their homes, engage with them and take phone calls mean for people. That is the difference. We talk about primary care in the community, supporting people to live in their homes and how much more cost-effective that is than having them in nursing homes, care facilities and so on. That is what we need to achieve. The vast majority of people can live in their homes if the proper supports are in place.

I ran a campaign in this House for a number of years to have eye clinic liaison officers appointed to the hospital groups so that, when people are diagnosed with sight loss, there would be a person available to them who had all of the knowledge and contacts with step-down facilities, including everything from peer counselling to guide dogs and mobility training. They would know the NGOs and who was good at what. This was run on a pilot basis in Temple Street hospital. Referrals went up 66% and the net result was that people felt they were able to adjust to their new circumstances more quickly and that they could contribute more to society. In some cases, people who did not have access to this programme never felt they could contribute and fell into the cracks. As a result of this campaign, largely run by me in this House and through the Joint Committee on Health, there will now be eye clinic liaison officers in every hospital group in the country. This means that, as our population becomes elderly and their vision naturally starts to become impaired, there will be somebody who knows how to navigate and help them. I see this campaign for neurological nurses as being something similar, although probably in a more advanced clinical setting. It would give people with Parkinson's disease, epilepsy or multiple sclerosis somebody to talk to and a link or contact, somebody with knowledge and experience who can be a support. In some cases, just knowing that such a person is there is liberating.

From my personal experience of the Minister of State, who has been my colleague for nearly 15 years, I know how committed he is to equality. I know that, when he goes into the Department of Health and takes part in the process of negotiating the budget, preparing the Estimates and considering the various demands that are on the table at budget time, he will fight tooth and nail for an increase. Nobody expects 100 extra nurses to be provided in budget 2023 but there should be a legitimate expectation that 30 or 35 nurses would be provided, or at least that this number of positions would be funded. The challenge is then hiring neurological nurses because it is a very distinct and specialised sphere. It will not be easy. If the Department could even give an indication that this is going to happen, the wheels could be put in motion to start the recruitment process, which will be difficult in itself.

I commend my colleagues. They are using Seanad time in a very clear and compassionate way that will achieve a result. Well done. I am very happy to support the motion.

Senator Conway has not left very much time for Senator Buttimer to contribute.

I am sorry. I thought I spoke for under the three minutes.

The Senator did not even take a breath but it does not matter; Senator Buttimer can speak later.

I will share time with Senator Buttimer if he would like.

I thank Senator Boyhan and the Seanad Independent Group for bringing forward this Private Members' motion. Sinn Féin is very happy to support it. It is relevant to every county and to most hospitals.

I commend Senator Boyhan on using this Private Members' business to move this motion. I will use my contribution to call on the Minister for Health, the Minister of State, Deputy Feighan, whom we worked well with during our shared time in the Seanad, the Department and the HSE to ensure the recruitment of these 100 neurology specialist nurses as recommended by the HSE's own model of care. We need the Minister and the Department to ensure that there are no obstacles to the HSE drawing down money to recruit and train these nurses. By the HSE's reckoning, we have approximately 30% of the specialist neurology nurses that we need, which is making their job difficult. We need 100 more.

Over the past two years, budgets have promised thousands of staff, but they have not materialised. It is vital that these 100 nursing posts are allocated and filled. Specialist nursing staff are needed to manage long-term neurological conditions, monitor patients, adjust medication amounts and prevent unnecessary hospital admissions. Having nursing capacity in the system to support consultants would reduce the need for outpatient consultants and free up staff time to get through waiting lists. There are more than 23,000 patients on neurology waiting lists, yet only some of these nursing posts have been sought to be filled this year. That is not good enough. The Minister and the HSE need to ensure that there are no obstacles to drawing down the full funding required for recruiting and training nurses for these posts.

I commend the motion and am proud to give it Sinn Féin’s support. I thank Senator Boyhan for tabling it and the Minister of State, Deputy Feighan, for attending.

I welcome the Minister of State. This motion is reasonable and one that I wish to support.

Sometimes, I feel sorry for a Minister coming to the House to take a motion like this, given that the problems that we are discussing have been endemic in the health system as far back as I remember. On Sunday, I listened to Ms Phil Ní Sheaghdha, the general secretary of the Irish Nurses and Midwives Organisation, INMO. She was speaking about the shortage of nurses in accident and emergency departments, and as I listened to her, I thought back. The first time I became aware of a problem with staffing – I am referring to the medics at the coalface – in the health system was when I was ten years old and stuck in a bed in the middle of the long ward on the second floor of what was then Galway Regional Hospital because the hospital was overcrowded. It is a long time since I was ten years old, but nothing has changed, so the Minister of State is not responsible. However, he has the opportunity to make changes, which is what we are discussing. I also thought back to my cousin, Ms Kathleen Craughwell, a president of what was the Irish Nurses Organisation, INO, some years ago. I remembered speaking to her about shortages in nursing and nursing care. My wife is a nurse. She worked in the accident and emergency department in Galway, where the staff were always run off their feet.

The nursing profession has never managed to retain in the Irish system the excellent people we have trained and educated. As Senator McDowell stated, we train them to the highest level and make them attractive to health services all over the world. It is great for people to go away, build up the requisite level of experience and bring that back to this country. The problem is that the system is under such strain that none of these excellent people wants to return. They want to stay in health services where they are not constantly under pressure and doing the job of more than one person.

If there is the correct staffing, with qualified nurses supporting consultants in neurology, outpatient time can be reduced by 40%. Medication changes are required in neurology. A member of my family suffers epilepsy and a change of medication is a serious matter, given some of the side effects and changes involved in the transition periods between one drug and another. From that point of view, we need experts – nurses – on whom we can call.

I once spent four months in Tallaght University Hospital. I saw my consultant twice per week – he was an excellent and wonderful man – but I saw my nurses several times every day. They were the people who were the consultant's eyes and ears and could tell him what was happening. We undervalue nurses.

There is a recommendation of 20 nurses in this specialism in Cork University Hospital but a shortfall of 16. There is a shortage of 17 at St. Vincent’s University Hospital in Dublin and 17 at Tallaght. These organisations are under severe pressure. I invite the Minister of State to visit the neurological outpatient clinic at Tallaght hospital to see how under pressure its nurses are. There are so few of them. The Minister of State knows how an outpatient clinic works – the consultant comes in and everything has to be ready to move because the consultant’s time is limited. From this point of view, having the necessary staff is important.

Other Senators will call on the Minister of State for additional resources for accident and emergency services, urology and so on, but we must step back and ask ourselves how we have not brought matters to a better conclusion in the 50 plus years I have referenced.

People have been speaking to me about various issues that I have raised in the House, search and rescue services being one. The Minister of State and I debated that issue as a Commencement matter a couple of days ago. Another is the Commission on the Defence Forces, with people telling me that we cannot spend money on defence because we need it for hospitals and education. Finland, an economy much the size of ours, has an excellent education system, an excellent military and an excellent health system. Something is wrong somewhere and we are going to have to step back and see what it is. The people who represent voluntary organisations are doing a fantastic job, but they need support. We need to step back and see how we can fix matters for them, because the current situation is terrible.

I commend my colleagues, Senators Boyhan and McDowell, on the leadership they have given on this matter. I thank the party spokespersons who have contributed for their commitment to an Independent Group motion. I believe that the Minister of State will do the best he can.

I welcome the Minister of State. I congratulate and thank Senators Boyhan and McDowell for this important motion. I hope that there is unanimous support for it and that the House will not divide because this is an important debate on the continuum of care. I thank the Neurological Alliance of Ireland for its wonderful campaign. I thank Deputy Colm Burke, who was instrumental last week in arranging an important briefing in the AV room. Last week, Senator O’Donovan and I raised hospital services in a timely Commencement matter.

The Patients Deserve Better campaign is not just about highlighting the need for extra nurse specialists to be put in place; it is about the model of care that we want in neurological services. I am a simple and ordinary person and, to me, neurological care is about looking after people with different conditions, but the term “neurological care” does not cover what we are discussing now. This motion is about quality of care, access to therapy and services and the additional nurse specialists that are required. It is also about ensuring that we examine the issue of waiting lists and neurological services as a whole.

The HSE has become good at saying “the pandemic has delayed” or “the pandemic has paused”.

We accept that it has, but we cannot hide behind the pandemic for everything. I thank everybody present tonight who is working with people on the ground. We are talking about people here. The key points from tonight's debate relate to there being four nurse specialists when there should be 20, and the shortage of 16 people to provide essential care to those with neurological conditions, such as multiple sclerosis.

If I may digress for a second, one of our ushers, Mr. Darren Fitzgerald, is in the House tonight. Last year, he created a significant amount of publicity around his 65 Holes for 65 Roses campaign to support Cystic Fibrosis Ireland and working for his daughter, Caoimhe. What Darren did was unbelievable. He took the person and made the story about the delivery of services. To be fair to Senator Boyhan, that is what this motion is about. He is right that it is not political but is about the people. It is the story of Darren and Caoimhe we should focus on. Equally, it is Mr. Declan Greogor in Cork and Mr. Tony Wilkinson of Cork Parkinson's Association we should be talking about in the context of the advocacy and work they have been doing. I referenced their remarks and contributions in the House last week, as did Senator O'Donovan. For example, hiring just one nurse who specialises in the condition of Parkinson's would save the HSE €300,000 a year. That is just one part of it. Mr. Declan Groeger said: "I'm not looking for someone 24/7 ... What the nurse would mean to me is that I could contact them when I have a particular issue." That is the second part; it is about quality of life.

I had the unfortunate privilege to be in Cork University Hospital for a period earlier this year with my late father. The continuum of care was unbelievable. The accident and emergency department was full but the care given was brilliant. The level of care and communication in the ward my father was in was phenomenal. We are talking about people who want to live life with multiple sclerosis, Parkinson's disease, epilepsy, cystic fibrosis or whatever. To be fair to the Minister of State, he challenges officials every day in his Department. This particular issue is probably not within his exact remit but there is a gap and lacuna in the provision of services for those with neurological conditions. Yesterday, Senator Blaney, in his contribution on the Electoral Reform Bill, spoke about the need for Oireachtas representatives, who in many cases have previously been members of local authorities where we had to access to information and officials. With the greatest will in the world, the quarterly briefing with HSE people is not enough in itself. Tonight, in a unified Upper House, we are sending a message not just to the Government but to the HSE that the lacuna in the care of people with neurological conditions is unacceptable and we want to see it addressed.

I again thank the Independent Group for its motion. I certainly hope we will not oppose it because we should not. It is an important one that is about people. My final remarks are for those in the advocacy groups who are working so hard. I thank them. Their voice was most definitely heard on this particular matter because they made it personal. I thank them all for that tonight. It is an important matter and I thank the Acting Chairperson for her indulgence.

I pay tribute to the Independent Group for tabling this motion. I am standing in for Senator Hoey. Members of our group attended the briefing that was held recently. The campaigners showed an excellent grasp of the issues, and excellent advocacy on behalf of their members and people who have been affected by neurological conditions. They have sent more than 11,000 emails to Members to date and submitted 100 parliamentary questions. I pay tribute to the campaigners and those affected by neurological conditions. They should know that their hard work and dedication have not gone unnoticed, especially by the Independent Group that tabled the motion.

As has been said by previous speakers, neurological nurses deal with conditions such as multiple sclerosis, Parkinson's disease, epilepsy, migraine and brain injuries. The list goes on. The work these nurses do in helping to support neurology patients is crucial. Their expertise even allows them to intervene to avoid hospital admissions. One study showed that where people had access to specialised nurses, less pressure was put on emergency services, meaning there were less hospital admissions and it cost less money. At a time when our emergency departments are almost crippled due to the immense pressure of Covid and other issues, such as bed shortages and lengthy waiting times, more neurology nurses have the potential to benefit not only patients but the HSE as a whole.

We are far below internationally recommended ratios for specialist neurology nurses. There are currently only 42 in the Irish health system and, according to national and international recommendations, we need at least 142. That is a shortfall of 100 nurses. St. James's Hospital is the main neurology centre in my constituency. It urgently needs at least ten extra neurology nurse specialists. I have received emails from constituents who are very concerned as patients are unnecessarily waiting longer for diagnosis and treatment. Based on the catchment area, national and international guidelines recommend there should be 14 neurology nurse specialists but there are only four. These patients deserve better.

Many of the neurology departments are based in Dublin. If we move outside Dublin, with the cost of hotel rooms skyrocketing and the price of fuel going up, patients who need urgent care can barely afford to access it. We need to focus on these facilities being located throughout the country so they are more accessible. The Minister of State is currently in budget negotiations for his Department. I ask that over the summer he has a look to see if he can get an additional budget for 20 extra nurses to be added to neurology facilities throughout the country in order to at least begin to ease the burden on our health system and bring us up to international standards.

I welcome the Minister of State and congratulate the Independent Group on tabling this very important motion. It addresses a very worthy topic and a series of facts and conditions that can affect any family at any time. Neurological conditions can strike very suddenly. Strokes and acquired brain injuries can happen all of a sudden. Any of us present could get a phone call at any time to tell us very difficult and tragic news about a family member, friend or neighbour. It is a real problem and a life-changing issue, and a series of life-changing events resonate from it within one's family.

I lost an uncle this year who had two strokes last year. He was 89 years old and would have been 90 in June. He had lived his life but there are people who suffer health impacts in their 30s and 40s who would have had a whole life in front of them. Certainly, those people's lives and those of their loved ones are more impacted by these issues. My father died in 2018 of a neurological issue for which we never really got a diagnosis. It is something that impacts so much on life. It is very debilitating and requires help and assistance when it gets to the stage of the affected person returning home, if he or she can return home. In some cases, that is obviously not practical and people end up in permanent care. That differs depending on one's family circumstances.

I fully support the campaign. I have spoken to that at the Joint Committee on Health.

I welcome the progress this year. There is a campaign for extra nurses in Galway, where there should be 13 neurological nurse specialists but there are only four. The Department and the Minister should be working towards an incremental approach to increase the numbers over a period to reach an acceptable level. I certainly hope we will see additional progress this year. In the western region, three extra nursing positions are due to be filled this year at University Hospital Galway, UHG, and that is welcome. I hope that can be replicated next year and the year after to get to the acceptable level.

As the motion states, there is a shortfall of up to 100 neurological nurses in Ireland based on national and international guidelines relative to population. People with long-term neurological conditions have limited access to the neurology nursing services that help them to manage their condition. This is something that is very important to the patients who are affected, their families, their loved ones and those around them. As I said, I feel for younger people, in particular, who may have small children and who may leave a partner having to deal with all the pressures and stresses of life in addition to dealing with somebody who suffers a debilitating condition in this regard. I hope and expect the Government, subject to the availability of specialists to be recruited and adequate training programmes, to ensure we have an adequate cohort of people who can be put in place across the system. I certainly hope we can put a plan in place in the shortest term possible to reach a stage where an adequate number of neurology nurses can be acquired. I support the call for the Minister to prioritise funding for additional nurses in budget 2023. Ideally, it would be 100 in one go if they were available, although that might not be practical, but certainly he should go some way to ensuring that we can reach that milestone in as short a period of time as possible.

I again commend the Independent Senators on tabling this important motion.

I commend the Independent Senators on putting this motion forward. There is no question that there is an incredible shortage of neurology nurses throughout the State. However, I wish to mention something that I am sure Members have mentioned, although I apologise that I have not been able to follow the debate. It is essential that in places such as St. James's Hospital we have an additional ten neurology nurses at the very minimum. Such a leading centre in the country having a shortfall has a devastating effect on families and most particularly on patients. It is absolutely essential for the support of individuals and we must be creative in how we ensure we have enough people qualified and enough people coming into the country. We have to look at this from the flow of where we are drawing our neurology nurses from and whether we are supporting that as a choice for specialist training. We need to examine that and I urge that we do so. Most particularly, we must put the funding and support in place to ensure we have an adequate complement of neurology nurses throughout the country.

I thank Senators Boyhan and McDowell for tabling this motion. I am responding on behalf of the Minister for Health, Deputy Stephen Donnelly, and the Government. Senators O'Donovan and Buttimer had a Commencement matter on this issue last week. It also has been raised by many other Senators and Deputies in the Houses.

The motion highlights the Patients Deserve Better campaign, promoted by the Neurological Alliance of Ireland and its partners, which is calling for an additional 100 neurology nurses in our hospitals. The Government is not opposing the motion, as it aims to support neurology services. However, it is incumbent on me to point out that, as with all health workforce expansion requests, bids for additional nursing and midwifery personnel will be considered and addressed in the context of the Department of Health’s ongoing workforce planning considerations as well as the annual Estimates and budgetary processes. These considerations aim to address, in an appropriate fashion, the many competing needs of the health and social care system. Many of the Senators have asked me, in my capacity as Minister of State in the Department of Health, to support this and I have no problem doing that within the Department.

I thank Senators Boyhan and McDowell and other Senators for the way they conducted this debate. There was no point scoring and it was very constructive and informative. That is a good way of addressing a very complex and important issue. The motion provides me with the opportunity to discuss the important work under way in neurology services. Indeed, many of the Senators have already highlighted that. Senator Clifford-Lee spoke about the great work that is being done in Beaumont Hospital in her area. She also appropriately referred to the many people who were here tonight who have a huge interest in health. Senator Craughwell spoke about being a ten-year-old many years ago. He said it was 50 years ago; I would have thought it was perhaps a little longer, but the Senator may answer that himself. He highlighted the great work that his family had done in the IMO and in many other areas.

Deputy Colm Burke held a meeting here over a week ago and it highlighted a very pertinent issue for Members of the Oireachtas. It is a very good way of informing Deputies, Senators and Ministers. Unfortunately, I was unable to attend it, but I followed the social media on it and I raised my support.

Senator Moynihan spoke about the briefings. A lot of the time there are people who can lobby. Over the years we have had the Irish Farmers' Association, the Irish Pharmacy Union and many others. This has been a very effective - I will not call it a lobby group - information campaign which has caught the imagination of Deputies and Senators. It should take a bow. It is a very good way to lobby. It was not confrontational; it was informative. If one wants something done, one should bring people along. That is very effective. Senator Kyne talked about the campaign, his family, issues in Galway and the personal experience. That was an interesting and emotive way of addressing this debate.

Senator Seery Kearney spoke about the importance of St. James's Hospital. Everybody is looking for extra nurses in their areas, and that is to be commended. Sligo was mentioned as well. We all want to get more nurses than we have, and the more placements we can have, the more areas will benefit. I thank Senator Warfield. We worked closely together in the Seanad and I thank him for raising these issues. Some Members talked about qualifications, people coming into the country and the choice of training. That is a pertinent issue. Mr. Darren Fitzgerald was mentioned as well, and the great work he did with his daughter, Caoimhe. Again, it certainly raised a lot of information on the issue.

It is the right way to do it.

There is no doubt that neurology nurse specialists play a significant role in the triaging, assessment, treatment and delivery of care for ongoing support of neurology patients. Neurology is a very important branch of medicine dealing with disorders of the nervous system, including the brain, brain stem, spinal cord, root, plexus, peripheral nerves and muscles.

Importantly, the HSE's national clinical programme for neurology engages regularly with patient organisations, including the Neurological Alliance of Ireland, to identify service requirements and patient demand for neurology nurse specialists. In this regard, the executive's clinical programme is focusing its current workstreams and initiatives on nurse-led clinics, nurse liaison services and outreach programmes. Examples of this work include the headache programme and the epilepsy outreach programme, both funded under the Sláintecare innovation fund. These programmes reconfigure the management of the conditions, enabling clinical nurse specialists and advanced nurse practitioners to lead and co-ordinate the care related to the conditions in the community. This reduces demand on consultant neurologists and tertiary services appropriately and safely, which allows more timely access to services and improves the overall quality of care for patients.

With regard to workforce planning, ensuring an appropriate pipeline of suitably qualified healthcare professionals in Ireland is a top priority. However, it is important to recognise that this is set against a global shortage of healthcare professionals, including nursing and midwifery. The Department of Health is engaging with the Department of Further and Higher Education, Research, Innovation and Science and other relevant stakeholders regarding a strategic approach to workforce planning and future skills needs. Progress is being made on increased numbers of undergraduate places across many health care professions, including nursing. Senator Maria Byrne raised the issues in her area in Limerick last week. I thank her for doing so again.

The HSE is developing a strategic programme of work to enable the health services to attract, develop and retain the workforce needed to meet the demand both now and into the future. There is work under way on the recruitment of nursing staff, including specialist nurse campaigns launched nationally and internationally for clinical nurse specialists and advance nurse practitioners. This is supported by the policy on graduate, specialist and advanced nursing and midwifery practice, which provides a clear framework for the development of specialist and advanced roles.

The Department of Health has also commenced a project, Health and Social Care Workforce Planning in Ireland, to address the long-term workforce planning needs of the health sector generally. This work is being undertaken with the support of the European Commission Directorate-General for Structural Reform Support and is being undertaken to develop a health and social care workforce planning strategy and action plan and a planning projection model for Ireland.

The Minister of Health also published the Report of the Expert Review Body on Nursing and Midwifery 2022, which sets out a pathway for developing and strengthening the role of the nurse and midwife. The House may be aware that the Minister has accepted all 47 recommendations in the report. This will support nurses and midwives to continue to learn and develop in professional roles, enabling significant reform aligned with population health needs and ensuring that critical Sláintecare priorities are realised.

In terms of funding an increase in the healthcare workforce, I am pleased to inform the House that budget 2022 provides funding for a large expansion of the workforce, of up to an additional 11,369 whole-time equivalents, reflecting the ambition and desire of Government to invest in Ireland's health services and ensure services are fully and safely staffed. A total of 12,506 whole-time equivalents were hired in 2020 and 2021. The year 2020 saw the largest increase in staffing since the foundation of the HSE, and 2021 saw the second largest. The largest area of growth in 2020 and 2021 was in nursing and midwifery, with an additional 3,372 whole-time equivalent posts, or a 9% total growth in numbers.

The motion refers to the waiting list for neurology outpatient appointments. It is important to say that the 2022 waiting list action plan for the health services was published on 25 February last and is now being implemented. Through this plan, the Government has provided €350 million in 2022 to reduce waiting lists and waiting times for scheduled care. The plan includes several proposals from the HSE to address the outpatient neurology waiting list. This additionality is in the form of both once-off activity to address the backlog and proposals for recurring activity to meet ongoing demand for neurology services. It is significant that, in total, 3,230 additional neurology outpatient appointments will be delivered by the end of 2022 through once-off funding. An additional 9,140 appointments could be provided each year upon approval and the roll-out of improved patient pathways, in addition to linked recurring activity associated with the acute hospital waiting list plan. It is important to point out that these additional activity levels do not include HSE proposals for active clinical prioritisation, which will also help to improve waiting times for patients on neurology waiting lists.

With regard to the provision of neuro-rehabilitation services in the community, the HSE's implementation framework for the neuro-rehabilitation strategy was launched in February 2019. The aim of the implementation framework is the development of neuro-rehabilitation services that will improve patient outcomes by providing safe, high-quality, person-centred neuror-ehabilitation at the lowest appropriate level of complexity. The framework also describes a managed clinical rehabilitation network demonstrator project, which is currently progressing through the development of post-acute and community neuro-rehabilitation services, with full-year funding of €2.29 million available from 2021. This funding will mean that approximately 40 patients per annum will have their rehabilitation needs met in an appropriate setting outside acute hospitals.

In spite of the many challenges facing the health services today, the workforce and budgetary planning under way in the Department aims to address, in an appropriate fashion, the many competing needs of the health and social care systems.

I thank the Senators again for tabling the motion. It was very constructive, as was the debate. We learned all about the issues in the mid-west. We heard from Senators Conway and Maria Byrne, who referred to Limerick, and we also heard about Galway, Beaumont and St. James's hospitals. I thank Senators Boyhan and McDowell for tabling the motion. I understand Ms Alison Cotter was mentioned earlier. I thank her for the work she has done with her colleagues. The campaign has been very interesting and informative. Work is under way in the neurology service, including on recruitment. There are many challenges. I thank the Senators for the opportunity to contribute and, most important, for their very constructive and challenging contributions. It is great to be back here in the Seanad. I have always found it a very sensible place where collegiality has always resulted in an effort to get the best result.

We will keep the seat warm for the Minister of State.

The Minister of State should have been here.

I will be brief because we had a Commencement debate yesterday on issues concerning UHL. I compliment the Senators who tabled the motion. It is something I firmly believe in. I have had a number of Commencement debates on this subject over the past few years, especially on the shortage in UHL. While I acknowledge that two nurses were taken on in the past two years, there is still a shortage of 11.

I was involved in MS Ireland for a number of years as a volunteer and still have an association with it. From speaking to people there and to people with debilitating health issues, I know having enough neurological nurses would help to curb the amount of time some of them need to spend in hospital. Phoning a neurological nurse can solve their issues or give them the advice needed. I welcome what the Department is doing on waiting lists, which is an enormous issue. The provision of these nurses needs to become a priority for the Department, not just in University Hospital Limerick and the mid-west, but nationally. We face a crisis in many hospitals with people on trolleys, people on waiting lists and people having to go in because their issue cannot be dealt with elsewhere. Having more neurological nurses would certainly help to reduce the waiting lists and also the amount of time people spend in hospital.

I firmly support the motion and welcome the debate we have had this evening. I thank the Minister of State for coming. I ask him to emphasise to the Minister, Deputy Stephen Donnelly, and the Department that these 100 nurses need to be provided sooner rather than later.

I thank the Minister of State and echo what Senator Maria Byrne said. In her absence I told the House that I chaired yesterday's Commencement Matter debate and she had raised issues relating to Limerick. I acknowledged that and I thanked her earlier in the debate. I also acknowledge the considerable work Senator Conway has done on it. The motion has cross-party support. This is about being united. Senator Buttimer summed it up very nicely when he talked about unity across the House on this important issue and I agree with that.

All the discussions I have had leading up to this motion have been about keeping focus on the issue. I again thank the Minister of State and acknowledge the great work of those involved in Patients Deserve Better. What a campaign they ran. If I were looking for someone to run a campaign for me, I would certainly take advice from them. Their infographics were excellent and their messages were clear. They were really well endorsed. They targeted Deputies and Senators very effectively. It is great that we have that public engagement and close contact with people outside the bubble of Leinster House.

We have 42 nurses at the moment and there is a shortfall of 100, based on the internationally recognised norm. As a pragmatist, I acknowledge that we will not get there overnight. Hopefully we will come close to it.

I wish to thank Deputy Colm Burke of Fine Gael who set up the event in the audiovisual room.

It was a great job.

It was an excellent job. There was an energy there. I had no doubt even then that this would go somewhere. Members across all parties in this House are not unified too often. We are politicians with different perspectives. However, we are united as one on this message and tonight's debate has demonstrated that well. I also thank Robert Dunne, the research and communications officer in our team. He did considerable work and engaged with many Members. I know that many organisations are linked into tonight's meeting. They engage very much with their membership which is important.

As we hopefully agree tonight's motion, we are calling for the Government to take action to address the shortage of 100 neurological nurses, who are vital for patient care and for the reduction of neurological waiting lists. That is one of the calls we are signing up to if we support the motion tonight. I thank the Minister of State, Deputy Feighan, for stepping in for the Minister for Health. I know this matter goes beyond his portfolio. We are also making a commitment for the Minister for Health to publish the Department's proposals to solve the shortfall in the provision of neurological nursing posts across Ireland's ten hospitals which specialise in neurological services. We are also calling on the Minister for Health to prioritise adequate budget 2023 funding to target achieving that figure of 100 additional neurology nurses nationwide in line with the research and international best practice and recommendations.

Members of this House are in politics and we have connections with political movements and parties within the House. We have given voice today to an amazing campaign by Patients Deserve Better. I am confident we will pass the motion tonight and we can use that to keep the pressure on. This gives us further leverage to keep the pressure on the Government to deliver or seek to deliver as close to these targets as we possibly can. I thank the Acting Chairperson, the House and the Joint Committee on Health which did a considerable amount of work on this. I am not a member of the that committee, but I know from talking to members of the committee and looking at reports that they did considerable work.

United we stand; divided we fall. We are together in unity on this issue. Let us continue to work and keep in contact with Patients Deserve Better, which ran an excellent campaign and has been the motivating force behind tonight's motion.

Question put and agreed to.
Cuireadh an Seanad ar athló ar 7.56 p.m. go dtí 9.30 a.m., Déardaoin, an 23 Meitheamh 2022.
The Seanad adjourned at 7.56 p.m. until 9.30 a.m. on Thursday, 23 June 2022.
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