Election 2024: Disability — 'It’s all empty promises. Why must we rely on charities?' 

A family spending thousands of euro on private therapists for their two-year daughter and a doctor who is one of 68 GPs for a population of 100,000 in Clare outline their experiences of the health service as part of the Irish Examiner’s focus on services for people living with disabilities
Election 2024: Disability — 'It’s all empty promises. Why must we rely on charities?' 

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Emily Healy’s daughter Brooke is a gentle, sweet toddler, living with a rare disease that has turned the family’s days into an all-consuming search for help.

A hairdresser in Limerick, Emily even chats to clients about her daughter’s care, and they swap tips on private therapists. Despite efforts from some HSE staff, almost all of Brooke’s care in her two years of life has been private.

Emily's joy in Brooke is clear as she says: “She is so happy, just gentle and sweet and so social. Everyone who meets her dotes over her.” 

The little girl has Cornelia de Lange Syndrome, a developmental disorder that affects many parts of the body.

“The more we do for her now, the better the outcome will be when she is older,” Emily explains.

“At the moment she is still not walking, she has never crawled. She does get around on her bum but she’s been on her bum since before she was one. It’s getting to the stage where she’s getting swelling in her joints.” 

Emily points out they were “really lucky” to get a diagnosis early, thanks to an “unbelievably helpful” cardiologist at University Hospital Limerick. She referred them to CHI at Crumlin for genetic testing.

“It is heart-breaking, you don’t know what is ahead really,” she says.

“Especially when it’s rare there are not a lot of people around you can turn to. I think a lot of people have that shock with autism but it is a lot more common as well.” 

Their GP referred them to a HSE physiotherapist in Nenagh who Ms Healy also praises for trying to help them.

Realising Brooke needed specialist care, this physio referred them to a children’s disability network team. The wheels stopped turning then.

“The children’s service don’t even have an occupational therapist on their team at the moment,” Emily explains in frustration.

While waiting, she and her husband Martin have turned to private therapists.

Physiotherapy can cost from €75 for 30 minutes up to €120 depending on the therapist, even though they do not see differences in the care.

They found a speech & language therapist at €60 for 30 minutes, although she adds: “She usually does an hour, she’s lovely.” A paediatrician appointment set them back around €200, only to be told Brooke has reflux.

Emily Healy (right) and Martin (left) with their daughter Brooke in Annacotty, Limerick. Picture: Brian Arthur
Emily Healy (right) and Martin (left) with their daughter Brooke in Annacotty, Limerick. Picture: Brian Arthur

After months of worry about feeding problems, they went to a private clinic called the National Tongue-Tie Centre near Clonmel.

“They told us she had a tongue-tie, a lip-tie and two cheek-ties. If we had caught those early, we could have been charged maybe €600 for them, but because we caught them so late and over an age limit, she had to be sedated. It cost us over €3,000,” she said.

Although her husband has health insurance through work, this was not covered. The family are supported by Rare Ireland and Enable Ireland.

Ms Healy has already taken this up with canvassers, asking why she is relying on charities instead of the State.

She wants to know why colleges are not funded to train more therapists and why the HSE cannot hire to fill the gaps in the teams. She says: 

It’s all empty promises, you never really hear from them.

“It’s very frustrating. I don’t feel it is a priority for anyone really unless you have kids with disabilities yourself.” 

Laura Egan, co-founder of Rare Ireland said: “We have children in membership who have never received the therapies they require to reach their potential.

“As a charity, every year we have more parents coming to us seeking support in paying for these therapies privately as they are not available in the public system”.

Case Study: GP shortage in Clare highlights service issues

Dr Micheal Kelleher has gone from working with his GP father to working alone, to being part of a three-practice merger in the face of doctor shortages in north Clare.

The GPs in Lahinch and Corafin saw patient numbers rising but struggled to attract new doctors to smaller practices. So they took a chance on something new.

This beautiful rural area has seen a population-bump post-pandemic as remote workers re-located. That is in addition to thousands of tourists.

More people means more patients, but Clare now only has 68 GPs per 100,000 of population. This puts it in the crisis zone referred to by the Irish College of General Practitioners as it pointed to the target of 100.

Dr Kelleher, a GP for 40 years, said: “What we did here in north Clare was we merged three neighbouring practices, and that worked and is working quite well. We are in our fourth year of that merger.”

They use three buildings but work as one entity, he explained, meaning resources are shared.

“Over time, we also hope to merge into two rather than three centres of practice,” he said.

“Two of those practices are next door to each other, so that doesn’t discommode the patients.”

Just before the merger he was working alone, saying: “I previously was a partner with my late father, that’s several years ago.”

Another practice was single-handed and the third had two doctors.

Dr Michael Kelleher. Picture: Brian Arthur
Dr Michael Kelleher. Picture: Brian Arthur

Dr Kelleher said: “The merger made a lot of sense when we teased out the mechanics of it, we had some help with that and so far it’s been working well and hopefully will continue to work well.”

The team now includes four GP partners, two associates, and two registrars in higher training.

“Over time, we have consolidated the practice services and there is a degree of synchronicity that wouldn’t have been there before,” he explained.

He expects to see more mergers, saying: “I think it will be increasingly difficult to fill rural practices that are single-handed.

“We’re not unique but there aren’t that many have done it.

“I think we are probably pioneering in that aspect.”

GPs are not HSE staff but most have contracts treating medical card patients for the State.

Some 42% of the population now have either a full medical card or a GP visit card.

The difficulty with single-handed practices is that the contract is a 24-hour contract,” he said. "Very few doctors would work those hours now but that is the contractual obligation.

A key challenge is the struggle to find locum cover for holidays, sick leave, or even maternity leave, Dr Kelleher explained.

Working in a team removes many of those barriers.

“Our practice areas would have always over-lapped and we have younger doctors who are embedded in the community,” he said. “They live in the community and are likely to continue in practice here. For me, as the elder doctor in the group, it allows me to continue in service because I have more manageable hours now.”

Dr Kelleher also said the shortage of GPs is not unique to Ireland with a similar crisis brewing across Europe.

He cautiously welcomed the recent increase in training places here. This will see 350 new GPs trained every year after completing their initial training.

“It takes a long time to shift these things, medical education takes between 10 and 15 years,” he added.

“So the 350 coming in now, the earliest we will be seeing them come into practice is in four to five years.”

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