Long wait for neurology care


IMAGINE HAVING to wait 18 months to see a specialist after you went to your GP with chest pain. Or having symptoms suggestive of cancer and waiting at least a year to see a consultant. Either scenario, were it to occur on a regular basis, would trigger a public outcry. For the three-quarters of a million people with a neurological condition, however, waiting 18 months to see a consultant and 10 months to have an MRI scan in order to secure a diagnosis is now the norm.

The situation reflects the relative neglect of neurology services in the Republic compared with the prioritisation achieved through national strategies for heart disease and cancer. While most neurological conditions are disabling and significantly life-altering, generally they are not immediately life-threatening. This may explain – although it does not excuse – the neglect of neurology by the Department of Health and the Health Service Executive (HSE).

An unpublished report, commissioned by the HSE and drawn up by a broad church of professionals and patient representatives, languished for nine months in the office of the HSE chief executive. Despite the involvement of its own senior managers in the review process and three reminders form senior clinicians, the comprehensive report remained unacknowledged by the HSE from December 2007 until September 2008. And when a meeting was finally arranged between the National Hospitals Office and representatives of the strategic review group, it was decided the report should be sent abroad for external review.

The report concluded that “long waiting lists for access to neurological services are common”. Access to occupational therapists and psychologists is essential for people with conditions such as multiple sclerosis, Parkinson’s disease and dementia. Yet hospital inpatients with these conditions had to wait up to two weeks to see a therapist, thereby prolonging their length of hospital stay. There is even less access for outpatients, with six months waiting for some and a complete absence of rehabilitation services in other areas.

The lack of joined-up thinking by the HSE is illustrated by these excessive waiting times. While actively pursuing a strategy to free up beds, it allows patients remain unnecessarily in hospital while waiting for routine paramedical assessment.

Some progress has been made following the publication of a 2003 Comhairle na nOspidéal report into neurological services. Ten additional consultant neurologist posts have been provided by the HSE after it received €3 million in dedicated funding in 2006 and a further €4 million in 2007. However, with 22 posts filled, we are well short of the 42 needed for the recommended ratio of one consultant per 100,000 people.

Perhaps the most worrying aspect of this saga is the attitude displayed by senior HSE management when it decided to deal with what is essentially a national neurology strategy by referring it for “stress-testing” by two foreign specialists with no experience of the Irish health system.