All hubs and no spokes? Equity of access for dermatology patients

Research needed to reveal impact of “distance-decay” on health utilisation

The Irish Skin Foundation (ISF) has called for research into the effects that a household’s distance from specialist dermatology services is having on patients living with chronic inflammatory skin disorders such as psoriasis, atopic eczema and hidradenitis suppurativa.

“We know anecdotally from the ISF Helpline that disadvantaged, less-abled, and marginalised patients, who don’t live near urban centres with public transport, don’t or can’t travel to access specialist services clustered in Ireland’s major hospitals”, says CEO David McMahon.

“This means that the most vulnerable and less well-off patients have difficulty accessing services where they are needed, leading to more suffering, poorer health outcomes and greater severity of disease”.

The ISF says that access and utilisation of health services is multi-faceted but often influenced by cultural, behavioural and financial factors. One critical variable is thought to be the distance of the patient’s household from a specialist clinic. The phenomenon of decreasing health care utilisation with increasing distance lived from a facility is often called the “distance-decay effect”.

“It appears that the current model for delivering services may be weighted too far in favour of hubs based in major cities. If this is the case, service provision may be failing to deliver equity of access for thousands of children and adults living with skin conditions in many parts of Ireland – notably in the Midlands, North West and South East.  However, it must also be acknowledged that there is a ongoing recruitment and retention crisis in all specialties, including dermatology, which has contributed to unprecedented pressure on existing services”.

“We don’t understand the full impact of the distance-decay phenomenon on people living with chronic skin disorders.  Policy research is urgently needed to feed into an evidence-based service planning process so that care is delivered in a manner that guarantees better access for all people living with a chronic skin disease”.



According to the Dermatology Clinical Programme, outreach clinics in peripheral hospitals – as part of a hub-and-spoke model – currently deliver services in for following centres:


  • Tralee, Bantry, Clonmel and Mallow for Ireland South
  • Nenagh, Ennis for the University of Limerick network
  • Ballinasloe, Castlebar, Roscommon, Letterkenny for the Saolta network
  • Cavan and Connolly for Dublin North East
  • Naas for the Dublin Mid-Leinster network


“Outreach clinics each operate from a hub hospital, seeing up to 20 new patients or 30 returning patients each day.  Some services operate one or two clinics each week, others less frequently; nationwide such clinics can potentially care for between 250-450 patients each week depending on a number of variables.  Research into service planning is needed to determine whether or not patients’ long-term health outcomes can be optimised by delivering more services along this model”.

The ISF advocates for more equitable and convenient specialist access for patients to services. Outreach clinics in peripheral hospitals support local networks of GPs, providing care closer to home for patients, and onsite dermatology consultations for inpatients.  Certain peripheral hospitals already provide phototherapy services but more can be done to make this widely available.

Hospital-based dermatology typically delivers a wide range of specialist services which can include phototherapy, patch testing, minor surgery, photodynamic therapy, nurse-led treatment clinics and clinical research.

The ISF operates a specialist nurse-led helpline to support people living with or caring for someone with a chronic skin condition or disorder.

Find out more about our advocacy work.  

If you need guidance or support about managing a skin disorder, contact the ISF Helpline for free assistance and information.