HOSPITAL PRESSURE: Intense pressure on the accident and emergency unit of Dublin's Beaumont Hospital over the past year has resulted in neurology patients from across the State finding it increasingly difficult to be admitted to have conditions such as MS and Parkinson's disease investigated.
The problem has shown up in preliminary figures from a new audit, details of which will be published later in the year. It shows that admissions to the neurology department were down by about 18 per cent in 2003 and that waiting lists for beds in the department grew by a similar percentage over the same period.
Furthermore, the figures show that patients from outside Dublin are disproportionately represented on the unit's waiting list.
Dr Orla Hardiman, consultant neurologist at the hospital, said this was because patients were often called at short notice when a bed becomes available and this more often than not does not suit patients who have to travel long distances.
"Patients are suffering because of much longer delays in getting into hospital. They are not being diagnosed in time. There are some conditions like MS where, if you diagnose early, you can start treatment which will improve outcome.
"In epilepsy, if you bring people in early you can improve the rate at which they have seizures and can significantly improve their employment prospects and quality of life. And if a feeding tube and an external breathing apparatus are put in early in a person with motor neurone disease, you can extend life expectancy by about 25 per cent. Such opportunities are now being curtailed," she said.
Beaumont is one of the national centres for neurology. "About 50 per cent of our patients come from the Eastern Regional Health Authority [ERHA\] area and about 50 per cent come from outside the ERHA area but when you look at the waiting list, there are a much higher percentage of people from outside Dublin on the list. So you wait longer if you come from outside Dublin," Dr Hardiman said.
The average waiting period for patients from outside Dublin, who do not arrive through casualty or inter-hospital transfer, is nine months. Many of these will have been waiting up to a year and a half for an outpatient appointment before even being put on the waiting list.
"For people living in the ERHA area, the waiting period is significantly shorter," she said.
Up to 70 per cent of the waiting list is made up of patients from outside the ERHA. "I've been very conscious of the discrimination against people from the regions and that I'm not providing as good a service for them as I should be because of the difficulty getting them into beds," she said.
Dr Hardiman noted that despite the length these patients had to wait, they were not eligible for treatment under the National Treatment Purchase Fund (NTPF), set up to buy treatment in private hospitals in Ireland or Britain for those waiting more than six months on hospital waiting lists. Hospitals can now also refer patients waiting longer than three months.
"The NTPF works best on people who need a procedure. It does not work for somebody who needs ongoing management of a condition," she said.
She had hoped that deficiencies in the service would be tackled when Comhairle na nOspideal published a report over a year ago recommending the number of consultant neurologists in the State be increased from 14 to 34.
"A year on there has been no change and our service has actually declined because of the pressure on A&E and, as a result of which, we can't plan admissions. It's no way to run a service.
"For some people a waiting period of six to nine months equals their life expectancy," she said.
Apart from at Beaumont, neurology services are available in Cork, Galway and Limerick and the Comhairle report recommended services be also established in Sligo and Waterford. "That should go ahead as a matter of urgency," Dr Hardiman stated.
There are some 6,000 people in the State with MS and a similar number with Parkinson's disease, according to Dr Hardiman. A high proportion of people with MS have "rarely or never" seen a neurologist due to the shortage. There are no neurologists in seven of the 11 health boards. A Department of Health spokesman said the implementation of the Comhairle report would be progressed having regard to "the evolving policy framework in this area, competing funding priorities and the report of the National Task Force on Medical Staffing [Hanly report\]".