Waiting lists for consultant rheumatology services in many areas are unacceptable, according to a new report which has recommended a doubling of the number of specialists working in this area.
The report from Comhairle na nOspidéal, the body which oversees the approval of hospital consultant posts, points out that the midlands has no consultant rheumatologist at all. It should get two immediately, it says.
"Rheumatology has clearly not been viewed as a priority by local managers in the midlands, where there is no locally based public rheumatology service," the report says.
There are now 25 consultant rheumatology posts, 12 of them in the Dublin region.
The report recommends that an additional 26 posts be created, so that there is one rheumatologist for every 80,000 of the population. At the moment there is one for every 167,000 of the population.
The most immediate priority, it says, is for a rheumatology service to be established in the midlands. "It is recommended that two posts be put in place in the region as a priority."
After that the next priority should be to address the fact that consultant rheumatologists are working single-handedly in the northeast, midwest and northwest. An additional two priority posts are recommended for the northeast, one for the northwest based in Letterkenny and two additional priority posts are recommended for the midwest, based in Limerick.
An extra consultant rheumatologist should also be appointed as a priority to Galway, to Mayo General Hospital, to the southeast (the base there to be decided locally) and to Tallaght hospital.
It is already known that it can take up to four years to see a consultant rheumatologist for a routine appointment in the west but the report notes that "early intervention in rheumatic conditions can significantly enhance patient outcomes".
The report also says there are about 700 children in the State with rheumatic conditions, but there is only one consultant paediatrician with a special interest in rheumatology. That consultant is based in Dublin. Similar posts should be created in Cork and Galway, it says.
Meanwhile, the report refers to the fact that there are two "isolated units"- St Joseph's unit in Harold's Cross, Dublin, and Manorhamilton - providing rheumatology services.
It says: "Large clusters of isolated rheumatology inpatient beds are no longer appropriate for optimum care. Comhairle envisages that services and facilities currently provided at isolated units will gradually transfer to acute hospitals in their regions."
Rheumatology is not an acute frontline speciality and as a result has been "somewhat overlooked" in terms of development, the report says. "However, those with rheumatological conditions represent large numbers of patients who suffer significant effects to their quality of life," it adds.