IICN press statement regarding recent advertisement for Consultant Neurologist posts

PRESS STATEMENT  25/4/2007


1. Impact of unsupported Consultant Neurologist posts on clinical service to patients

The Irish Institute of Clinical Neurosciences (IICN) expresses great concern today, April 25th 2007, at the impact that the new consultant Neurologist posts, as advertised, will have on the quality of neurological services in Ireland. While welcoming the initiative of the HSE and the Department of Health and Children to address the severe shortage of neurological consultants in Ireland, the IICN envisages major practical difficulties with these recently advertised posts, which will leave patients without the necessary service and result in waiting lists persisting, despite the investment in additional specialists.

Sixty-eight consultant posts were advertised by the Health Service Executive (HSE) on April 19th 2007. These include 5 Consultant Neurologist and 3 Consultant Clinical Neurophysiologist posts.

“Best practice in neurological services requires the expertise of a multidisciplinary team such as occupational therapists, physiotherapists, specialist nurses, etc” says Dr Orla Hardiman, council member of the IICN. “The proposed new Consultant Neurologist posts are currently unsupported in these areas. From a patient treatment perspective, this means that the neurologists’ hands would be tied in the majority of cases. For example, a patient from rural Ireland with multiple sclerosis would, after diagnosis, have no access to the full range of services necessary in maintaining an acceptable quality of life for as long as possible.”

She adds that the posts as advertised represent a missed opportunity: “Unless these posts are backed up by access to adequate multidisciplinary support, it will be clinically impossible, despite best efforts, to provide an acceptable standard of specialist neurological care.”

2. Structure of proposed Consultant Neurologist posts

The IICN notes that the sessional breakdown and location of at least 3 of the proposed Consultant Neurologist posts have been unexpectedly restructured without prior consultation with existing service providers in Neurology and without consultation with the HSE Needs Assessment Group in Neurology which is under the chairmanship of the Population Health Department of the HSE.

The IICN cautions in the strongest possible terms that this restructuring will adversely affect the development of multidisciplinary, consultant-provided neurological services, because of the reliance on single-handed consultant neurologists who will be geographically dispersed and unsupported by clinical teams.

The IICN calls for an immediate reversion to the agreed plans with respect to the structuring of new Consultant Neurologist posts.

3. Service support requirements

The IICN is concerned that the posts are being advertised “cost neutral”. The financial allocation provides for a consultant salary only, without any funding for infrastructure or staff for service development.

• The provision of high quality evidence-based neurological care requires the appointment of multidisciplinary teams, of which the neurologist is a key member. Traditionally it had been accepted that newly appointed consultants would lead the development of new services by advocacy. However, the advertisements specify that funding for the proposed new posts have been provided “on the clear understanding that no claims will be entertained at a later date for increased costs associated with this post or for overspends against the financial allocation of the hospital”.
The ability of new consultants to advocate both within the hospitals, and in public, for improved services for patients will be severely curtailed.

4. Full professional context

The IICN notes that the posts as structured provide no allocated time for audit, clinical research, teaching or professional development.

• The failure to provide ring-fenced time for these activities is of serious concern. The full exercise of professional competence entails not only time spent in clinical work, but also a full array of other best-practice activities such as clinical audits, peer-review audit, and continuous professional development, in addition to the normal professional activities of engaging in clinical research and third- and fourth-level teaching. Failure to specify these aspects of the posts appropriately will ultimately lead to a decline in clinical and academic standards.
• Failure to provide for audit is contrary to the principles & recommendations of the Lourdes Inquiry by Judge Harding-Clark.

5. Type of contract

The IICN notes that all posts will be offered as “Type B” contracts, and that a “public only” contract is not available to prospective candidates.

The IICN urges the Minister, the Department of Health and the HSE to implement the planned development of Neurological Services in accordance with the agreed recommendations and in line with and the forthcoming report of the Neurology Needs Assessment Group.
The IICN expresses grave concerns that the proposed appointment of single-handed clinicians with no supporting neurological services or infrastructure will not be able to deliver for patients.

ENDS

For further details contact Colette Fitzpatrick, IICN Administrator: email info@iicn.ie; tel: (061) 203040, (087) 274 6684

Note for Editors:

The Irish Institute of Clinical Neuroscience (IICN) supports development of the clinical neurosciences in Ireland, with the aim that international standards of care can be achieved. It is also actively involved in educational initiatives and in raising funds for research projects.

Many members of the IICN have been prominent advocates for a significant improvement in the funding of the clinical neurosciences in the public health system for several years, and have repeatedly argued that significant increases in consultant appointments are necessary.

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