7. Deputy Niall Collins asked the Minister for Health the extra support that will be provided to University Hospital Limerick in 2018 to reduce waiting times for a first-time appointment to see a neurologist in view of the fact that 418 persons had been waiting more than 18 months for appointments at the end of 2017; and if he will make a statement on the matter. (Question 6421/18 asked on 08 Feb 2018)

Deputy Billy Kelleher: I ask the Minister for Health what extra support will be provided to University Hospital Limerick in 2018 to reduce waiting times for a first-time appointment to see a neurologist in view of the fact that 418 persons had been waiting more than 18 months for appointments at the end of 2017.

Deputy Simon Harris: I thank Deputies Billy Kelleher and Niall Collins for raising the important issue of the need to reduce waiting times for appointments to see neurologists at University Hospital Limerick. Reducing waiting times is one of the Government’s key priorities.

I am advised by the HSE that outpatient waiting lists, including neurology lists, are managed centrally at University Limerick hospitals group. All patients who are waiting are prioritised according to clinical need. University Limerick hospitals group will continue, as is right and proper, to focus on seeing and treating those who have been waiting longest.

The number of outpatients waiting for a neurology appointment at University Limerick hospitals group increased in 2017. At the end of January 2018, 408 patients were waiting. Among the reasons for the increase are growth in demand, an increase in the number of urgent referrals and a shortage of consultants.

This year, particular focus will be placed on the validation of outpatient waiting lists by University Limerick hospitals group to ensure all those who are waiting require appointments and resources can be targeted at those who need them. The scheduling of patients waiting longest will also be a focus. This will be subject to weekly review at hospital level and as part of this process, neurologists at University Hospital Limerick have commenced reviewing referrals of patients waiting longer than 36 months. Following consultation with patients’ general practitioners, University Limerick hospitals group will schedule appointments as required. Hence, there is a weekly procedure in place at the hospital to try to get on top of this issue.

Recent experience with waiting list initiatives, including outsourcing, suggests there are opportunities for further improvements and a number of steps are being taken to ensure that lists are accurate. These efforts will intensify in the coming months. My Department has also requested the HSE to develop an outpatient waiting list action plan for 2018. I will ask that neurology waiting lists in University Hospital Limerick forms part of this action plan.

Deputy Billy Kelleher: This issue is indicative of the serious problems in neurological services nationwide. They are overwhelmed as a result of changing demographics, the ageing profile, the increased incidence of dementia, stroke and other neurological illnesses such as Parkinson’s disease and multiple sclerosis. People cannot access the treatments they are entitled to and need. Early diagnosis is another issue that must be addressed. There are not enough beds, neurological consultants or capacity in the system to deal with the problem. Large numbers of vulnerable people are waiting for diagnosis, not to speak of treatment, and cannot access neurological services.

According to the Association of British Neurologists, there should be one consultant neurologist per 70,000 of population. In some areas of this country, the ratio is one consultant neurologist per 200,000 of population. We are, therefore, well off the mark even in terms of the basics, and this must be addressed urgently in view of the demographic changes that lie ahead.

Deputy Simon Harris: I largely agree with the Deputy on this matter. The HSE launched a model of care for neurology in 2016 and is moving towards the implementation of this model. The national clinical programme for neurology model of care document recommends an increase in the number of consultant neurologists and nurse specialists, including clinical nurse specialists, and other health care professionals. This would have a positive impact on addressing waiting time issues. The programme also proposed implementation of its recommendations over a five-year period. This would significantly improve access for all neurology patients. I welcome that the clinical community has come together to draw up this roadmap.

The national clinical programme for neurology reviewed demand and capacity for access to neurology consultants for adult services. Arising from this work, the number of consultant neurologists nationally is planned to increase by ten, which would be an increase in numbers of almost 50% and the single largest increase in the history of neurology services in Ireland. Seven of the ten additional consultants are already in place.

The point identified by Deputies Kelleher and Niall Collins is correct. The HSE will increase the number of neurologists and, in the meantime, weekly efforts will be made in University Hospital Limerick to drive the process forward.

Deputy Billy Kelleher: Multi-annual budgets are required for key areas such as neurology services to ensure the plan that has been drafted can also be implemented with sustained funding to allow the service to catch up with demand. Government, Parliament and citizens must debate the issue of demographics which will clearly present serious challenges in many areas, including dementia and other neurological diseases and conditions in the years ahead. We will not have the capacity or ability to address these challenges unless we commit ourselves to funding the necessary services. This will require the provision of additional resources from tax revenues. We must have this conversation because people will otherwise get lost in the system and we will have delayed diagnoses and poor outcomes and treatments.

Deputy Simon Harris: The Deputy raises a valid point. Capital projects will increase capacity in terms of the number of beds and dementia facilities. An issue also arises regarding the number of people on the outpatients list, particularly those with dementia, who could be treated in the community. This issue applies to the outpatients list in general. When so many people on such a large list miss appointments, it suggests there may be a mismatch between the number of people on the list and their requirement for a service. Many of those on the list may wish to have a service in the community and may want to be referred back to primary care.

Deputy Kelleher noted that 418 persons had been waiting more than 18 months for an appointment at the end of 2017. This figure has since fallen to 408 and I would like it to continue to reduce. The University Limerick hospitals group is prioritising this matter.