{"id":619525,"date":"2026-08-04T07:28:20","date_gmt":"2026-08-04T07:28:20","guid":{"rendered":"https:\/\/www.europesays.com\/ie\/619525\/"},"modified":"2026-08-04T07:28:20","modified_gmt":"2026-08-04T07:28:20","slug":"irelands-postcode-health-lottery-living-on-the-wrong-side-of-hse-area-boundary-the-irish-times","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/ie\/619525\/","title":{"rendered":"Ireland\u2019s postcode health lottery: Living on the \u2018wrong\u2019 side of HSE area boundary \u2013 The Irish Times"},"content":{"rendered":"

Aircraft maintenance engineer James Flanagan had a curious sensation in his legs while working inside a plane\u2019s fuel tank at Shannon<\/a> Airport.<\/p>\n

\u201cI thought my legs were wet,\u201d he says of that incident, which prompted him to go to the company doctor<\/a>. There had also been intermittent tingling in his left hand. But at age 26, the progressive, incurable disease of multiple sclerosis (MS) \u201cwas not on my radar at all\u201d.<\/p>\n

Until, after a series of tests, that was the diagnosis he received from a neurologist in Limerick in October 2014.<\/p>\n

Flanagan knew next to nothing about the autoimmune disorder, which affects the brain and spinal cord. Although he did remember watching a documentary about a young woman who went from completing marathons to being on the point of collapse due to MS.<\/p>\n

He is one of an estimated 860,000 people in the State \u2013 one in six of the population \u2013 living with a neurological condition, which is a broad term for brain, spinal cord, muscle and nerve issues. The most common of these is migraine, but epilepsy, stroke, dementia, acquired brain injury and Parkinson\u2019s disease, as well as MS, all come under the neurological umbrella.<\/p>\n

\u201cIt made me rethink everything,\u201d says Flanagan of his diagnosis. Less than two years later, he left his job in Shannon to work as an engineering supervisor with EasyJet. Wherever their planes went for maintenance, Flanagan would go to oversee the work.<\/p>\n

\u201cI just wanted to live my dream before things got worse. I had to be brave, take that jump.\u201d<\/p>\n

He travelled to places such as Malta, Cyprus, France, Italy and Spain with the job. He even returned to Shannon once, to supervise the work of his former colleagues. \u201cAll the while multiple sclerosis was burning away in the background. I could feel myself getting worse.\u201d<\/p>\n

\"JamesJames Flanagan: ‘I feel like MS is trying to slow me down \u2013 and every time it does, I kind of smile and push past it and say, nice try.\u2019 Photograph: John D Kelly <\/p>\n

During one visit home, a chance encounter with a former colleague at an M7 services station led to his permanent return to Ireland in 2019. The man had set up his own company and asked him to come and work for it.<\/p>\n

Flanagan felt it was good timing; he needed to be back home. However, it was difficult to leave the EasyJet job he loved. Work aside, in the UK he had been able to avail of a clinical trial in Addenbrooke\u2019s Hospital in Cambridge and would not have access to such a source of hope in Ireland.<\/p>\n

\u201cThey could find something amazing that could work for you.\u201d<\/p>\n

After deciding to come home, he recalls sitting crying on his bed in a five-star hotel in Cyprus, \u201cbut in the back of my mind [I knew] I had to leave\u201d.<\/p>\n

He has been working in aircraft leasing, back in Shannon, ever since. <\/p>\n

Within the first 12 months of his return, he had met his future wife, Laura, a nurse, who like him is from Cashel, Co Tipperary. \u201cEverything fell into place for us; we were just having a ball.\u201d<\/p>\n

They now live in the townland of Gaile, in between Thurles and Cashel, with their 15-month-old daughter NancyMay and newborn son Louis. They were not to know that being fractionally inside South Tipperary, rather than North Tipperary, would turn out to mitigate against access to neurological services.<\/p>\n

[\u00a0Living with multiple sclerosis: \u2018What I think matters has completely changed\u2019Opens in new window<\/a>\u00a0]<\/p>\n

Flanagan is a wheelchair user now. \u201cAlmost full-time,\u201d he says, stressing the word \u201calmost\u201d with characteristic determination to hold out against MS. He still works five days a week, commuting to Shannon, and appears to have huge mental strength in the face of adversity. <\/p>\n

\u201cI\u2019m just so used to it. It\u2019s strange in a way, I feel like MS is trying to slow me down \u2013 and every time it does, I kind of smile and push past it and say, \u2018nice try\u2019.\u201d <\/p>\n

Achieving milestones, such as completing a master\u2019s in engineering practice at the University of Limerick in 2023, and then, of course, starting a family, helps him psychologically. The arrival of their children was \u201camazing for everyone,\u201d he says, pointing out that everybody in his family, his wife and his parents, are affected by his MS. \u201cThey all have to watch me struggle with this.\u201d<\/p>\n

In a stark example of what the Neurological Alliance of Ireland (NAI) calls a \u201cpostcode lottery\u201d, Flanagan does not have access to a community neurorehabilitation team. The southeast is the only geographical part of the State still waiting on funding for one. Instead, he pays for physical therapy privately. His house is just inside Dublin and South East HSE region, which has one team \u2013 more than 150km away in Bray, Co Wicklow. If his home was just a few kilometres up the road in Thurles, he would be in the HSE Midwest region, which has a specialised, multi-disciplinary team based in Dooradoyle, Limerick.<\/p>\n

\"JamesJames Flanagan with his wife Laura, their son Louis, daughter NancyMay and his parents Jim and Marie at the family farm in Co Tipperary. Photograph: John D Kelly <\/p>\n

Nine such teams were promised in 2019, one for each of the then nine HSE administrative areas, which have since been consolidated into six regions. Eight of the teams have been funded, with six up and running. They include physiotherapists, occupational therapists, neuropsychologists and dietitians, all specialised in neurorehabilitation.<\/p>\n

\u201cThese are fantastic,\u201d acting as a \u201cbridge between hospital and community\u201d, says NAI\u2019s chief executive officer, Magdalen Rogers. There is a big difference for, say, a road accident victim or stroke survivor between being ready to be discharged from hospital and being well enough to resume independent living or go back to work. That\u2019s where the team steps in. They also help to prevent others needing to go to hospital.<\/p>\n

\"NAI’sNAI\u2019s chief executive officer Magdalen Rogers. Photograph: Damien Eagers <\/p>\n

Flanagan discovered the \u201camazing\u201d benefit of neurorehabilitation in early 2022, when his neurologist in Tallaght University Hospital referred him to Peamount Healthcare, Co Dublin, for a week. In the previous months he had been able to avail of revolutionary stem cell treatment at one of UCLH\u2019s (University College London Hospitals) centres, under the HSE\u2019s treatment abroad scheme. He was much weaker by the time he returned home but full of hope that his MS would have been \u201cswitched off\u201d and he would not deteriorate further.<\/p>\n

\u201cI just needed to build the strength back. I couldn\u2019t repair damage that was done but I could just make myself stronger.\u201d<\/p>\n

He worked with specialised neuro-physical therapists every day at Peamount. \u201cThey were well aware of what my body could do and what it couldn\u2019t do and what I should do. Day by day, I got stronger and stronger. It was just amazing what happened.\u201d He also saw OTs who showed him ways to improve daily life and had sessions with a psychologist.<\/p>\n

\u201cWhen I left, I was walking; I was doing 1,800 steps per day. Whereas when I went in, I wasn\u2019t covering anything near that.\u201d<\/p>\n

The physical therapy had been of such benefit that he wanted to continue it all year round, but there was nothing like it available in his community. He had some access to a physio and OT at a primary care centre but they are not trained specifically in neurological conditions.<\/p>\n

\u201cIt\u2019s really disappointing, especially when you\u2019ve got a taste of what neurorehabilitation can do. People don\u2019t know what they are missing out on because they have never been able to avail of it.\u201d<\/p>\n

He pays about \u20ac5,000 a year for private physical therapy, \u201ctrying to recreate that care I got in 2022 \u2013 at huge personal expense, but my body\u2019s on the line\u201d.<\/p>\n

The southeast is an \u201coutlier\u201d in being the only area not funded for community neurorehabilitation, says Rogers. The alliance\u2019s recent pre-budget 2027 submission seeks an investment of \u20ac2.2 million to address both this anomaly and other regional inequities within neurological services.<\/p>\n

\u201cIt\u2019s not just the care for people who get a diagnosis; it\u2019s the people who are being missed presenting in their regional hospitals.\u201d<\/p>\n

There is this \u201crandom situation\u201d, she explains, where some of the State\u2019s 17 model 3 hospitals (ie those providing 24\/7 acute care but not at the level of model 4 hospitals) have a neurology service, as per the 2016 model of care. \u201cOthers either don\u2019t, or have a very under-resourced neurology [service].\u201d<\/p>\n

For example, there is no neurologist in Tipperary hospital, she says, while cover is scant in Tullamore and Mullingar hospitals. So little consultants\u2019 time is allocated to these two hospitals that local patients have to travel to Dublin to see those same neurologists.<\/p>\n

As for people admitted to a regional hospital, if there isn\u2019t a full-time neurologist, either patients have to be kept in until they are seen, \u201cor there\u2019s a risk that they\u2019re not seen by a neurologist\u201d, she says. It\u2019s \u201cluck of the draw\u201d for patients: some hospitals provide specialised care and some hospitals don\u2019t.<\/p>\n

The NAI, an umbrella organisation for neurological patient groups, is one of many lobbying for more money from Budget 2027 for their area of interest.<\/p>\n

What does Rogers think makes their case compelling?<\/p>\n

\u201cOver 50,000 people are being diagnosed with a neurological condition each year and that always takes people by surprise,\u201d she says. Growing demand for services has outpaced increased investment in recent years, with neurology waiting lists having doubled over the past decade to more than 24,000, partly due to an ageing population.<\/p>\n

The State still has the worst ratio of neurologists to patients in Europe, although the gap is not as big as it was, she says. However, \u201cit is no good, if they\u2019re all based in the major population centres\u201d. The Department of Children, Disability and Equality says its \u20ac3.9 billion allocation to the HSE this year for specialist disability services is 20 per cent more than 2025. The HSE, it points out, is leading the national neurorehabilitation strategy that aims to deliver services as close to patients\u2019 home as possible. It adds that until the 2027 budgetary process, through which the HSE can submit proposals to both maintain and expand services, it would not be appropriate to comment further.<\/p>\n

\"NancyNancy and James. <\/p>\n

HSE Dublin and South East, the region in which Flanagan lives, says submissions will be made to Budget 2027 to fund community neuro-rehabilitation teams in remaining areas that do not have funding for such a team, including in Dublin and South East, and to enhance existing teams.<\/p>\n

\u201cThe HSE continues to engage with the Department of Children, Disability and Equality through the annual budgetary process to secure the necessary funding to establish this essential service in such a way that there is equity of access for those who need it, regardless of where they live.\u201d<\/p>\n

Meanwhile, the Department of Health says that, in 2025, \u20ac4.3 million was allocated to support the implementation of the neurology model of care. \u201cThis funding is enabling the recruitment of five consultant neurologists and an additional 25 nurse specialist and health and social care professional posts.\u201d<\/p>\n

[\u00a0Spending above \u20ac10,000 in health service now requires top-level approvalOpens in new window<\/a>\u00a0]<\/p>\n

To progress the model of care recommendations, the national clinical programme for neurology is working on a \u201chub and spoke\u201d model, under which there will be one model 4 hospital per region catering for the most complex care, while supporting model 3 hospitals to provide services to people with less complex needs, and access to the \u201chub\u201d as required. New services, it adds, will be developed at: Letterkenny University Hospital, Wexford General Hospital, Mayo University Hospital, Midlands Hospital, Portlaoise, and Kerry General Hospital.<\/p>\n

While Flanagan is now a wheelchair user, the MS has not affected his cognitive abilities. He had research work published in the Journal of Air Transport three months ago. The disease affects people in different ways and he has met people with MS who can walk perfectly but find it difficult to think and speak.<\/p>\n

\u201cIt has only held me back with my legs,\u201d he says, adding that the stem cell therapy could have saved him from deterioration of other functions. \u201cSo, I\u2019m lucky in a way.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Aircraft maintenance engineer James Flanagan had a curious sensation in his legs while working inside a plane\u2019s fuel…\n","protected":false},"author":2,"featured_media":619526,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","_share_on_mastodon":"0"},"categories":[40],"tags":[9,10,143035,18,13,14,6,60,19,17,11,12,15,16,167,71824,5,40299,2121,7,8],"class_list":["post-619525","post","type-post","status-publish","format-standard","has-post-thumbnail","category-ireland","tag-breaking-news","tag-breakingnews","tag-cashel","tag-eire","tag-featured-news","tag-featurednews","tag-headlines","tag-hse","tag-ie","tag-ireland","tag-latest-news","tag-latestnews","tag-main-news","tag-mainnews","tag-mental-health","tag-multiple-sclerosis-ireland","tag-news","tag-shannon","tag-tipperary","tag-top-stories","tag-topstories"],"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@ie\/117036064790013407","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/619525","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/comments?post=619525"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/619525\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media\/619526"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media?parent=619525"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/categories?post=619525"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/tags?post=619525"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}