On Friday, President Mary McAleese will launch Ireland's first neurological institute. Fiona Tyrrelltalks to the man behind the facility about neurology services in Ireland and new solutions to old healthcare problems
A TASTEFULLY renovated Georgian building in Dublin's Eccles Street is the unusual setting for a new concept in Irish healthcare - a €3.4 million neurological institute that is funded largely by donations from the public and will operate on a non-profit basis.
Established as an extension of the Mater Hospital's neurology department, the Dublin Neurological Institute will provide diagnosis, treatment management, support and counselling services to patients suffering from Parkinson's disease, stroke, multiple sclerosis and other neurological diseases.
It will double the number of neurology clinics at the hospital, according to Prof Tim Lynch, neurologist at the Mater Hospital. Given that one out of every five medical admissions to accident and emergency departments in Ireland is a result of neurological conditions, it will also help alleviate pressure on the hospital's emergency departments, he says.
The institute will also provide much-needed specialist service for neurology patients at a national level. Irish Parkinson's patients will, for the first time, have access to deep brain stimulation surgery - a life-changing operation that stops the tremors associated with Parkinson's disease. Tele-medicine facilities will also be on offer.
Necessity is the mother of invention, says Lynch, who has spearheaded the project for the past seven years. Neurology has been the Cinderella of the health service for too long, he says. Neurological disorders are a big cause of chronic disability but the discipline has not had its fair share of resources, according to Lynch.
"Neurology is a massive area of medicine with a huge morbidly, but it has not been addressed properly. Cancer has had a lot of the limelight. Yes, cancer is very important but it is not the big killer. Cardiovascular disease is," he says.
"The field of neurology is rapidly changing all the time. Neurologists used to be just diagnostic clinicians but now it is a therapeutic specialisation. This is the era of neurology and the brain is the Holy Grail."
Currently, neurological clinics at the Mater are conducted in a portacabin three afternoons a week. With five outpatient treatment rooms on offer at the institute, the number of clinics will be doubled in the short term with the potential for up to 12 clinics a week.
This will go a long way towards reducing waiting times to see specialists at the Mater, which can be up to 16 months.
The institute will also operate a drop-in centre for patients and their families. This nurse specialist-led service will offer information, advice and support to people with neurological conditions.
Neurological patients will also be able to avail of a day centre where they can receive treatment in a non-clinical setting such as rehabilitation and i/v infusions. Services at the institute will be available free to all.
Finally, the institute has formed research links with the Conway Institute at University College Dublin (UCD) and plans are under way to study neurological degenerative disease such as stroke and multiple sclerosis.
The building itself, 57 Eccles Street, was donated by the Sisters of Mercy and so far the Mater Foundation has raised €1.9 million towards the cost of the project. The Health Service Executive (HSE) gave a €1 million capital funding grant to the project last year.
While Lynch is keen to point out that the institute has been "developed in partnership with the HSE", he cannot hide his frustration at the state of neurological services in the Republic.
He served as a member of the HSE's neurological needs committee, which has made a raft of recommendations, including the need to immediately double the number of consultant neurologists in the country.
The report, which was produced over nine months ago, has yet to be published yet alone implemented, he says, "just like many other reports".
The ambitions to have up to 12 clinics a week running at the institute are of course staff-dependent. Currently, there are two, and a third consultant neurologist assigned to the Mater.
"Ideally we need five or six neurologists in the short term. There is no reason we could not increase our patient numbers from 3,500 a year to 6,000, with the proper staffing."
Lynch describes the so-called "employment ceiling" in the public health service as "a crude instrument" and says the institute is perusing other methods of funding such as public donations, philanthropic contributions and contracts with the HSE.
Lynch spent eight years in the US at the New York Neurological Institute and the Dublin institute is a smaller version of the operation over there.
He compares private medicine in Ireland, which is about making profit, to the great US models such as Harvard and Johns Hopkins, which operate on a not-for-profit basis: "The money they make is ploughed back in. This is what we are hoping to recreate in Dublin."
This model provides opportunities to "get around barriers in the health service", he says.
He hopes the model of the Dublin Neurological Institute will be copied around the State. "Why can we not have Limerick, Galway and Cork institutes of neurology?" he asks.
• National and international experts will gather at the Dublin Neurological Institute, Mater Miseracordaie Hospital, for a clinical neuroscience day on Friday including Prof Stanley Fahn and Prof Serge Predzborski of the New York Neurological Institute, Prof Peter Kelly, neurologist at the Mater, and Prof Dominic Walsh, neuroscientist at the Conway Institute, UCD.
NEUROLOGY FACTS
• Ireland has the lowest ratio of consultant neurologists per head of population in the western world. There is one consultant neurologist per 200,000 head of population in Ireland, compared with one per 18,000 in Finland and one per 108,000 in the UK.
• There are 700,000 people in Ireland with neurological conditions ranging from migraine, epilepsy and spinal injury to stroke, multiple sclerosis, Parkinson's disease and Alzheimer's disease.
• One in five medical admissions to AE in Ireland are a result of neurological conditions and one in eight visits to the GP are for neurological problems.
• There are 44,000 new patients with neurological conditions every year and 110,000 people in Ireland living with disabilities caused by neurological disorders.
• Of the 10,000 Irish people who have a stroke in Ireland each year, one-quarter of them will die, more than from bowel, breast and prostate cancer combined, according to recent figures from the Irish Heart Foundation.