Gino Kenny on Ireland's Neurology Shortfall and Medical Cannabis
Gino Kenny questioned health experts about Ireland's neurology services, highlighting a shortfall in consultants and nurses and stark regional inequities. He pressed for stronger regional hubs and asked whether medical cannabis has a role in drug-resistant epilepsy and MS; experts said evidence exists but access is delayed by reimbursement processes.
Consultant numbers and approvals
Experts outlined current neurology staffing figures, reporting roughly 44 clinicians in varying posts and about 34 full substantive approved consultant posts under the CARLA consultant approval process. The speakers noted part-time posts, locum cover and National Treatment Purchase Fund appointments, and judged current consultant capacity to be about half of what is needed for population demand.
Regional disparities and hubs
Kenny highlighted geographic inequities, praising Limerick as a growing neurology hub that expanded from two to four neurologists in a year. He contrasted that with poorly served areas - for example, Donegal is managed from Sligo where there are two neurologists and a third recently advertised - and said waiting lists, especially north of Letterkenny, remain significantly worse than most of Western Europe.
Nursing shortfall and timeline
The discussion noted a shortfall in specialist neurological nurses, with current figures cited at about 42 nurses in the state and a recommendation to at least triple that number over a five-year period to meet service needs.
Medical cannabis evidence and clinical role
Professor Hardiman confirmed that there is an undoubted role for medical cannabinoid products for particular forms of drug-resistant epilepsy and for managing spasticity in MS, citing a strong evidence base from paediatric and adult epilepsy research. The licensing for MS spasticity was noted, and speakers accepted that some other spasticity indications may also benefit.
Access barriers and reimbursement process
Experts explained that slow patient access to the medical cannabis access programme since its November launch is linked to reimbursement negotiations and health technology assessment work - specifically pharmacoeconomic negotiations handled through Michael Barry's unit - rather than clinician reluctance to prescribe or systemic refusal to permit treatment. Delays in securing an acceptable price for the most efficacious products were identified as the main barrier.
We publish thousands of recordings to make Irish politics transparent and resistant to manipulation. Spotted an error? Report it — together we are building a reliable archive of Irish politics.
Thanks Cairlock. A lot of the questions that I had have been already answered, so I am probably going to ask some questions that are slightly supplementary to the issue. Just a question, I am not sure it has been answered, but in relation to neurological consultants in Ireland, in relation to the rest of Europe, how does it match? Is it on the European levels? In Irish terms, where does that lie? We are still much lower than mainland Europe. We are even lower than the UK, which is much lower than mainland Europe. So we often compare ourselves to the UK, but actually the UK doesn't do very well in terms of delivery of neurological services, in terms of the ratio between consultants and patients. So we are much lower than we should be. But again, there is an inequity in Ireland, in that there are parts of the country that are really poorly served with respect to neurology, and I elucidated those areas earlier. And we really need to build the regional support services. There are good stories here as well. For example, in Limerick, which is a hub in development, there are now four neurologists in Limerick. Last year there were only two. And Limerick is a case in point of a really good development of a hub for neurological care. But there are other parts of the country that remain very poorly served. We also have to think about not only the ratio, but also the geographic terrain. So the north east or the north west is an example of that, where the whole of Donegal is managed by by my colleagues in Sligo, where there are two neurologists, a third neurologist has just been has been advertised, I think, recently interviewed. But really, if we look at the the need of that part of the country and the waiting list, particularly in the north of Letterkenny, that's that's still much worse than anywhere else across the whole of Western Europe, I think, and very, very significant waiting list. Professor Harriman, in relation to neurological consultants, how many would there be in Ireland at this moment in time? So it's a slightly, it's a slightly difficult question to answer because we have a number of people in local posts, a number of people funded to the National Treatment Purchase Fund. I think the the total number is 44, as far as I know, is that is that correct, Max, or in that order? The approved post is about 34? Yes, but there are some people who are in part time posts and we have some people who are locuming and some people who are in National Treatment Purchase Fund. In terms of CARLA or the consultant approval process, 34 full substantive posts, but some more in the offing, I think, coming forward, but still not enough. About half of what it should be? Yes. Yeah. Given the population. Okay. And obviously, there's obviously there's a shortfall in relation to neurological nurses in the state. I think at the moment there's what, 50, 42 in the state, and obviously that needs to be pushed up to at least triple that. Obviously, that's over a five-year kind of period. So that's, yeah, okay. Just in relation to my final question to Professor Hardiman, it's probably not related to exactly this subject matter, but I will ask it anyway, and it's in relation to the medical cannabis access programme. And obviously, two of the three conditions that have been stipulated under the programme are neurological conditions, namely drug for this and epilepsy and MS. Now, obviously, the programme has been up and running since November. There's only a small amount of people that have got access to medical cannabis. It's extremely frustrating for those that are trying to get access to medical cannabis via the programme. In your professional opinion, do you think there's a role for medical cannabis in relation to, particularly around drug-resistant epilepsy and MS and certain other neurological conditions where there has been really good evidence and efficacy in relation to medical cannabis intervention in relation to them conditions? Professor Hardiman There's an undoubted role for it. And my colleagues who look after epilepsy, both paediatric and adult, have researched the evidence base for this. And there is clearly a very strong evidence base in support of the medical cannabinoid products in the management of particular forms of epilepsy, some types of epilepsy. There's definitely a role for managing spasticity and the licensing is for MS, but there may be a role for other types of spasticity as well for some of the cannabinoid products. The difficulty in accessing my understanding is that it's related to the actual companies that make the products that are most efficacious and the process of reimbursement through the the health technology assessment services through Michael Barry's unit in the pharmacoeconomics sector, and that the negotiations around the reimbursement, that there have been some delays in that. So this is not an issue, my understanding, it's not an issue about a reluctance of colleagues to prescribe, nor is it an issue of a reluctance within the HSE to permit, it's an issue of ensuring that the best price is available to the Irish Exchequer and that the process of establishing that is currently in the way. That's my understanding. Thank you.
Thank you for downloading 🙏
If you publish this material on social media, we would be very grateful if you tagged VideoParliament. It helps us reach more people and keep building a transparent archive of Irish politics.
