2026-06-24

Go raibh míle maith agat. I welcome the opportunity to raise the issue of the lack of a dedicated neurological service at the Regional Hospital Mullingar. It is not that we have an under-resourced service or a service that needs expansion; we simply do not have any dedicated neurology service at all. Instead, there is a limited outreach arrangement with another hospital in another county. For perspective, it will take one of my constituents from Moyne 90 minutes, each way, to travel to Tullamore. It is 105 km. The national model of care for neurology services, published in 2016, clearly states that all model 3 hospitals should have a dedicated neurology service. A decade later, the people of Longford-Westmeath are still waiting for their service. The consultant neurologist in Tullamore Hospital is not on a full-time basis. The service delivers three 90-minute telephone clinics per week and one in-person clinic every second Thursday. For a catchment population of over 200,000 people across Longford, Westmeath, Offaly and surrounding counties, are we really expected to believe that this constitutes an acceptable neurology service? Does the Minister of State believe that this is safe? Does he believe it is sustainable? Does he believe it is a clinically appropriate level of care given the demand? Neurological conditions are now the leading cause of disabilities worldwide. In Ireland, one in six people is now living with a neurological condition. People are living with Parkinson’s disease, multiple sclerosis, epilepsy, acquired brain injury, motor neurone disease and numerous other conditions that require specialist assessment, diagnosis, treatment and long-term management. The consequences of failing to provide local services are felt every day by my constituents and their families in Longford-Westmeath. People are being forced to travel to Dublin for appointments that should be available closer to home. They are being forced to travel to Tullamore for appointments that should be available closer to home. We know there are thousands of outpatient appointments in St. James's Hospital every year for people in my area, based solely on the addresses they provide to that hospital. For many patients, particularly those with progressive neurological conditions, these journeys are not a minor inconvenience. They need time off work, suffer a loss of income, incur transport and parking costs, must arrange carers and family support and endure lengthy travel times, while dealing with what can be debilitating symptoms. There have been reports and press releases about healthcare being delivered closer to home. Neurological patients have every right to ask where that care is for them in Longford-Westmeath. The Neurological Alliance of Ireland, NAI, has highlighted significant regional inequalities in access to neurological care. A recent report found that people living in regional and rural areas face longer waits, greater travel burdens and poorer access to specialist services than those living in major urban centres. One woman I met, a patient, summed up the problem perfectly when she said that Ireland is policy rich but implementation poor. That phrase stuck with me because, in this instance, we have policies, reports and models of care but what we do not have is delivery. The national model of care clearly states that every model 3 hospital should have a dedicated neurology service. The programme for Government commits to improving neurological care. Yet in the midlands, people are being left behind. Added to that concern is the fact that Ireland still does not have a national brain health strategy. This is a time when neurological conditions are increasing, our population is ageing and demand is rising. The absence of that coherent national strategy is becoming increasingly difficult for the Government to justify. It is not simply about staffing numbers and waiting lists. This should and must be about equity. A person's access to neurological care should not depend on their address and their ability to travel to Dublin. People across Longford and Westmeath deserve the same access to specialist neurological services as people living elsewhere in the State. I ask the Minister of State to first acknowledge the reality that there is no dedicated neurological service in the Regional Hospital Mullingar and to commit to delivering one because ten years after the report, my constituents deserve it.

I thank Deputy Clarke for the opportunity to address the House today on an issue that I know is of real importance to her constituents and to the midlands. I am taking this Topical Issue debate on behalf of the Minister for Health, Deputy Jennifer Carroll MacNeill. The HSE recognises the vital importance of timely access to neurological services for patients across the midlands and acknowledges the significant impact that delays in accessing specialist care can have on patients and their families. The HSE has advised that, currently, neurological services for patients in the midlands are provided through a combination of local services at Midland Regional Hospital Mullingar and specialist regional neurological services. While there is currently no onsite specialist neurological services at Midland Regional Hospital Mullingar, it is important to be clear that access to specialist neurological options for patients in the midlands is available through the established referral pathway to specialist services at the Mater Misericordiae University Hospital. The HSE continues to monitor demand for neurological services in Mullingar and across the midlands and is working with clinical teams to maximise available capacity, improve patient pathways and ensure that patients are prioritised according to clinical need. Patients requiring urgent assessment continue to be seen as a priority through available referral pathways while every effort is being made to reduce waiting times for routine appointments. Indeed, the challenges facing neurological services are not unique to the midlands. The national clinical programme for neurology has acknowledged that demand for neurological services has grown significantly in recent years. To address this, the Minister for Health allocated significant investment in 2025 to expand regional neurological services. This included €4 million in funding for the recruitment of five additional consultant neurologists and six clinical nurse specialists specifically to support services in model 3 hospitals, including Mullingar. A further 16 neurological nurse specialist posts and three health and social care professional posts were funded across a range of specialist neurological services. The HSE anticipates that these positions will be filled during 2026, helping to address some of the service gaps identified and improve access to care for patients. This service development is supporting progress on the implementation of the HSE's model of care for neurology. The focus of the neurology initiative is aimed at improving access to appropriate neurological services; improving safety and quality in the delivery of patient-centred neurological care; and improving value for both patient and health services across neurological services. More broadly, the national clinical programme for neurology is actively working on a hub and spoke model to guide equitable neurology services across the country. This aligns with the health regions and aims to tackle the gaps in neurology services nationally. The model will include one model 4 hospital hub per health region, catering for the most complex neurological care. These sites will support model 3 spoke sites, including Mullingar, which will provide services for people with less complex needs. Many hospitals already have well-developed neurological services, but funding received in 2025 is enabling the delivery of phase 1 of the hub and spoke model. It is expected that this proposed hub and spoke model will enable a reduction in waiting lists and timely access to diagnosis and treatment and thus improve quality of life and prognosis for people with neurological symptoms. This will cater for people with all neurological conditions and will deliver on the Sláintecare principle of delivering care closer to the patient's home. Improving access to specialist care remains a priority for this Government and the HSE is continuing to work with the national clinical programme for neurology to strengthen neurological services.

I want to return to the evidence, because the facts contained in the Neurological Alliance report are stark. Mullingar hospital is a model 3 hospital. The national model of care says that it should have a dedicated service. The first fact is that one in six people in Ireland are living with a neurological condition and it is now the leading cause of disability worldwide. Yet, despite the growing demand, Mullingar hospital still does not have a dedicated service. The second fact is that the Neurological Alliance report specifically highlights concerns that Mullingar remains dependent on an outreach service and does not have a dedicated service as outlined in that model of care. The third fact is that demand has outstripped capacity. The Neurological Alliance briefing note says that more than 160 people are currently on a waiting list for neurology services in Mullingar alone. The fourth fact, which we know from various other areas outside health, is that regional inequality is a national problem. People living in regions and rural areas face greater travel burdens, longer waits, and poorer access to specialist expertise than those living in centres. That is a system where access to care is being determined by geography rather than need. The Neurological Alliance found that consultant neurology staffing remains below recommended levels nationally. Specialist nursing numbers remain significantly below recommended levels. Major gaps exist in multi-disciplinary supports and neurorehabilitation services. These are not my figures or Opposition speaking points. These are the findings of a report from a national umbrella body representing almost 40 neurological organisations and more than 860,000 people living with neurological conditions. The evidence exists, the need is highlighted and the recommendations are outlined. When will the people of Longford-Westmeath get a dedicated neurology service in Mullingar Regional Hospital, which they were promised a decade ago?

Again, I thank Deputy Clarke for raising this important issue. I fully acknowledge that too many patients are still waiting far too long for appointments and treatment. I recognise the real strain that is placing on individuals and families. As outlined, neurological services in the midlands are delivered through a combination of local supports in Mullingar and specialist regional services. Urgent patients continue to be prioritised and every effort is being made to reduce waiting lists for routine appointments. It is important to recognise that significant investment has been made to expand neurological services, which will help to address the service gaps and improve access to care for patients right across the regions. As I mentioned in my opening remarks, the implementation of the model of care for neurological services, including the hub and spoke system, is a key part of this, because this will focus on reducing waiting lists, ensure early diagnostics and also deliver timely treatment for patients. It will also improve the quality of life and outcomes for those living with neurological conditions. Regarding Mullingar itself, strengthening services, reducing delays and delivering care close to home is a key priority that the Government wants to achieve. The Minister remains fully committed to improving neurological services right across the country, including for patients in Mullingar and across the midlands, with regard to reducing waiting times, expanding capacity and ensuring patients can access neurological care closer to home when they need to.