Madam, - Mary Keane of Mooncoin, Co Kilkenny pointed out, in a letter published two months ago, that Irish citizens, with potentially painful disabling conditions such as multiple sclerosis, frequently have to travel up to 200 miles to see a consultant neurologist.
There are 16 consultant neurologists employed in the public service in Ireland. This represents the worst ratio of consultant neurologists per head of population in the Western world and is utterly unacceptable in a wealthy society.
Dr Gerard Burke (January 24th) pointed out that most patients with acute or chronic medical conditions can be managed by a consultant generalist in the local hospital. Unfortunately, his letter, which was cut for publication, unintentionally implied that local consultant neurologists are not needed.
An audit of the inpatient referrals to the neurology service in the Mater Misericordiae University Hospital found that over 40 per cent of referrals were to establish a specific diagnosis, 11 per cent of patients had a new diagnosis made and approximately 50 per cent of referrals were seeking advice regarding therapeutic management (Costello et al, Irish Medical Journal 2005: 134-137). Many of these patients were critically ill with stroke, seizures or coma and were not in a position to travel for neurological care.
The audit clearly demonstrates that the presence of a local consultant neurologist is of major benefit to the patient. Disappointingly, patients from Carlow, Cavan, Clare, Donegal, Kerry, Kildare, Kilkenny, Laois, Leitrim, Limerick, Longford, Louth, Mayo, Meath, Monaghan, Offaly, Roscommon, Sligo, Tipperary, Waterford, Westmeath, Wexford and Wicklow are unable to avail of this basic clinical service locally. For example, it is extraordinary that there is no consultant neurologist in the public service in Limerick, the third biggest city in the Republic and home to Minister of State at the Department of Health and Children, Tim O'Malley.
One in seven patients attending a GP and one in five A&E admissions have a neurological problem. Many of these patients have treatable and sometimes disabling conditions such as multiple sclerosis, Parkinson's disease, epilepsy, motor neurone disease, migraine, stroke or Alzheimer's disease.
The neurological service to these patients is utterly unsatisfactory, similar to the over-run, under-resourced neurosurgical service as described by Prof Ciaran Bolger, consultant neurosurgeon at Beaumont Hospital (January 21st).
It is time to establish a national brain strategy, similar to the national cardiovascular and cancer strategies, to improve the clinical neurology and neurosurgery services in Ireland. This strategy should incorporate a national Stroke Strategy as called for by Dr Peter Kelly (February 14th).
Neurological and neurosurgical services have been ignored for too long and require substantial investment over the next five to 10 years to improve the care of patients nationally. This investment should include increased infrastructure (operating theatres, outpatient facilities and extra inpatient beds) as well as increased consultant numbers and multidisciplinary teams. - Yours, etc,
Dr TIMOTHY LYNCH, Consultant Neurologist,Chair, Irish Consultant Neurologists' Association, Mater Misericordiae Hospital, Dublin 7.