ORLA HARDIMAN,
Madam, - I refer to the letter from Liam Woods, Deputy CEO of the Eastern Regional Health Authority (December 27th) outlining the achievements of the ERHA during its two-and-a-half years in operation. Mr Woods says the quality of health services has improved because the authority has adopted the principles of evidence-based medicine. Regrettably, this has not been the experience in the delivery of services in neurology over the past two years.
We have ample evidence that our services are seriously under-funded. As Mr Woods points out, we provide services to a large and growing population, yet the ratio of neurologists to the general Irish population has remained static at 1:350,000.
The waiting period for review by a neurologist as an out-patient is now between 18 months and two years. All of our clinics are over-subscribed, and most patients who attend public clinics must wait for up to two hours, due to lack of funding for appropriately trained medical staff. The waiting list for admission to the in-patient neurology service at our institution, which provides for patients from throughout the country, is now about 12 months. There has been no improvement in these statistics over the past two years.
Until recently, our institution had the benefit of two MRI scanners, but under the recent "health adjustments" the second one was considered to be an excessive expense for the hospital. This has increased waiting times for both in-patients and out-patients, by up to five days and up to six months respectively.
One of the roles articulated by the ERHA at its inception was to integrate community based-and hospital-based care. This integration has not taken place in the provision of services for patients with chronic neurological disease. Patients with conditions such as Parkinson's disease and motor neurone disease who attend our specialist service must wait for at least six months for review by a hospital-based physiotherapist due to funding restrictions. Patients with non-life-threatening neurological conditions are unlikely to ever undergo a review by a specialised occupational therapist. Some districts within the ERHA area cannot provide even a basic level of physiotherapy and occupational therapy assessment and care.
Services in areas cognate with neurology are also severely under-funded. Patients with dementia, and those with behavioural problems attending our services must wait up to two years for review by a neuropsychologist. The service in vocational rehabilitation is supported at present by a single individual who is close to retirement, and for whom a replacement has not been planned. Our service has been without a full-time neurophysiologist for almost two years, despite numerous representations to the Eastern Regional Health Authority.
We are privileged at our institution to work with extremely motivated and hard-working specialist nurses who provide services for patients with multiple sclerosis, motor neurone disease, epilepsy and migraine.
With the exception of the nurses who specialise in epilepsy, all of these positions were supported until recently by the private sector, with assistance from relevant voluntary organisations. The posts clearly fulfil the mandate set out by the authority for efficient delivery of services. All of these nurses maintain data-bases that reflect their clinical work, which extends to patients throughout the ERHA area and beyond. These data-bases are open to monitoring and evaluation by the ERHA. Regrettably, attempts to interest the relevant sections of the authority have not met with any degree of success, and ongoing funding for the development of these services has not been forthcoming.
Mr Woods's assertion that the work of the ERHA can be directly translated into other health board regions cannot apply to specialist services such as neurology. A national approach with the strategic location of properly funded specialist centres is required, with adequate community-based supports for patients with chronic disease.
A reduction in the number of health boards, the strategic development of specialist centres, and the recognition of the value of integrated care between the hospitals and the community would significantly improve our health services.
The quality of service that I and my colleagues in neurology can deliver has regrettably declined rather than improved over the past two years. We hope that the coming year will witness a true evidence-based improvement. - Yours, etc.,
ORLA HARDIMAN,
BSc, MD, FRCPI,
Consultant Neurologist,
Beaumont Hospital,
Dublin 9.