Juvenile arthritis services slashed by 50%

VITAL specialised services for children with a potentially crippling and painful condition have been halved because of staff shortages.

Dr Orla Killeen, a consultant paediatric rheumatologist at Our Lady’s Hospital for Sick Children in Crumlin, said they cannot offer children with juvenile arthritis the full range of services necessary to treat their condition because of failure to fund key specialist posts.

“We have only half the staff we should have on our multidisciplinary team. We have no social worker, no dedicated psychologist, no podiatrist. Our nurse specialist is sponsored by a drug company and that funding runs out in April and we have no clarity on what will happen after that.

“We have a half post for an occupational therapist, but that person is on sick leave and a replacement has not been appointed.

“It is of great concern to us that we are trying to function as a multidisciplinary team with only half the staff and as a result we have had to reduce our inpatient rehabilitation programme by 50%,” Dr Killeen said.

There are currently approximately 350 children with juvenile rheumatoid arthritis on a 13-month waiting list for treatment at Crumlin, which is the sole specialised provider of paediatric rheumatology services in the Republic.

In addition, approximately 30 children considered urgent cases are waiting three to four months for a first appointment.

Dr Killeen said forcing children to wait for specialised treatment and then only offering half a service was not good for long-term outcomes. If treatment is aggressive from the onset of symptoms, the prognosis is good; if left untreated children face permanent muscle wastage, joint damage and deformity and intense pain, she added.

The hospital’s psychology department was in “dire circumstances”, she said.

“This is a crucial service for the children I treat. Theirs is a condition that puts a huge emotional strain on the child and the family.

“They need to see a psychologist for cognitive therapy and for advice on pain management and for teens, it is particularly crucial in helping them realise the necessity of compliance with their medication,” added Dr Killeen, the country’s only paediatric rheumatologist.

Arthritis Ireland, which last year presented a petition to the Government requesting the appointment of a second paediatric rheumatologist, said it intends to continue its lobbying campaign in 2010.

A spokesperson for Crumlin said it had applied to the Health Service Executive (HSE) for an additional consultant paediatrician with a special interest in rheumatology, and “with a full-time commitment (37 hours per week) including support and healthcare professional staff” in late 2009.

The HSE said two rheumatology consultant applications were scheduled for consideration at the next meeting of the consultant appointments unit. But a spokesperson said they were for general rheumatology posts and not paediatric.

Ireland has the second- lowest ratio of paediatric rheumatologists per head of population in Europe. Only Poland is lower.