Ciarán Lynch (Cork South Central, Labour)
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I thank the Minister of State for coming into the Chamber to debate paediatric diabetes services, which is an issue with which she has great familiarity. I am sure other Members present also have been contacted lately by constituents and parents on this matter. There are almost 4,000 children with type 1 diabetes in Ireland, which is an auto-immune condition that cannot be prevented or reversed and the incidence of which has doubled in the past 20 years. These children attend hospital an average of four to five times a year to monitor their diabetes. Monitoring children and adolescents with diabetes in hospital aims to limit damage that diabetes can cause to the eyes, kidneys, nerves and smaller blood vessels as a child grows older.

The long-term complications of type 1 diabetes like retinopathy, kidney disease, nerve and microvascular damage cost the health service millions of euro each year. The short-term complications among children with diabetes usually arise from low blood sugars and very high blood sugars and result in hundreds of children being admitted to hospital accident and emergency units nationwide each year. The fact is that 50% of children and adolescents with diabetes will have some form of serious and costly long-term diabetes complication by the time they reach 30 years of age. However, for many children with diabetes intensive treatment such as, for example, insulin pumps, can hugely reduce the development of long and short-term complications.

At present, 21 hospitals provide diabetes care to children but only three hospitals in Dublin are adequately resourced to provide intensive treatment to children who could benefit from improved control of their diabetes. The 2008 diabetes expert advisory group report admitted that "Ireland has [a] very poor paediatric diabetes care [service], with over half the patients having no access to a proper multidisciplinary team and many of the rest travelling long distances for care", such as the cases to which I refer this evening. Children with diabetes outside Dublin are at a geographical disadvantage because of a lack of local services. Those in Dublin, where there are services, are at a numerical disadvantage because so many children from outside Dublin are forced to travel here. Dublin services are being stretched at both levels, the care for those in the Dublin area and the care of children from outside the Dublin region. Dublin services are literally inundated with referrals of children and adolescents with diabetes from the rest of Ireland.

The proposal by Diabetes Action has the full support of all the paediatricians and nurses working with children and adolescents. I am aware also that the Department, the HSE and the new national clinical lead in diabetes, plan to discuss a model of care for children with diabetes in the coming weeks. This is a welcome development.

I ask the Minister of State what measures the Department and the HSE plan to take to balance this system and to make treatments equitably available to all children with diabetes. The Minister of State will be aware that Diabetes Action is proposing the establishment of regional teams or networks of clinicians who would offer intensive treatment at the 21 hospitals where diabetes care is currently given. The reorganisation being sought seems to involve only a modest increase in staffing resources and it should be given full and proper consideration.

In my constituency of Cork South-Central, Cork University Hospital, which serves over 300 children and adolescents with diabetes, will have a new consultant who will be well placed to deliver intensive treatments for type 1 diabetes to County Cork and County Kerry but he will need more nursing and dietetic support. While the arrival of the consultant is welcome, a support team will be required. In the delay of those additional appointments being made, in Cork an unknown number estimated to be between 40 and 60 children have been referred to Dublin hospitals in an attempt to access intensive treatment for diabetes, such as insulin pump treatment, which is not available in CUH. Referrals from across the country have congested the Dublin diabetes services and have robbed CUH of the opportunity to develop the expertise to offer these services to the whole HSE south region.

The reality of the current arrangements leads to Cork children and their parents facing four to five trips to Dublin hospitals each year. This affects school attendance for children and annual leave for parents. The most unsatisfactory and potentially dangerous effect of this situation is that CUH does not have access to the child's Dublin file in the event of an emergency admission to CUH because of their diabetes or indeed any medical condition.

I ask the Minister of State what steps will be taken by her Department with regard to diabetes services in the Cork region and the southern region of Cork and Kerry.

Kathleen Lynch (Cork North Central, Labour)
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Currently it is estimated there are between 3,000 to 4,000 children and young adults under 16 years of age with diabetes in this country. The majority of patients have type 1 diabetes, more than 90%, but unfortunately there is an increasing number of young patients developing type 2 diabetes. The incidence of type 1 diabetes is also increasing by about 2% to 3% per year and experts anticipate that over the next ten to 15 years the incidence of type 1 diabetes will double.

Type 1 diabetes is a particularly complex condition in children and young adults and so it is recommended that their care be delivered in a multidisciplinary setting with access to a consultant paediatric endocrinologist, paediatric diabetes specialist nurse, paediatric specialist dietician, psychologist and social worker. Because of the complexity of the condition and the significant dangers of hypoglycaemia there can be a clinical advantage in having continuous subcutaneous insulin infusion therapy for children and young adults with type 1 diabetes.

The HSE has established a national clinical programme for diabetes in 2010 with the express aim of defining the way diabetic clinical services should be delivered, resourced and measured. One of the key priorities is to facilitate future organised care and screening for diabetes-related complications. There are two proposed models of care to improve the situation for paediatric diabetes care.

The first model is from the HSE expert advisory group report, chaired by Dr. Colm Costigan, paediatric endocrinologist in Our Lady's Hospital for Sick Children in Crumlin. This model proposes that care be centralised for each region in a dedicated paediatric-adolescent diabetes centre looking after at least 150 children-adolescents and ideally, the centre should be in a regional hospital that has an adult diabetes centre to facilitate transition to adulthood. The centre should be led by a paediatrician with a special interest and training in diabetes. The report also recommended amalgamation of the Dublin centres into a national tertiary centre that would act as a resource to assist the regional centralisation.

The second model comes from the recent Diabetes Federation of Ireland Diabetes Action report. This report recommends the establishment of eight to ten regional networks with the three existing Dublin centres acting as tertiary reference centres and continuing to see one third of the national paediatric-adolescent diabetes population. Within each hospital in the region from existing resources, a paediatric nurse would be identified to care for children with diabetes in that hospital. The network team would deliver care at existing centres around the country and travel to outreach clinics as required. To move this plan forward, the national clinical leads for diabetes and paediatrics are to meet in the next couple of weeks to propose the following: the establishment of a joint subgroup with representatives from the paediatric and diabetes working groups to address paediatric diabetes care; to perform a gap analysis to determine the current existing diabetes service across the country for paediatrics and young adolescents; to agree on a model of care for children and adolescents with diabetes; to standardise paediatric diabetes emergency care across the country; to standardise hospital diabetes care across the country; to develop criteria for use of continuous subcutaneous insulin infusion therapy in children and adolescents with type 1 diabetes; and to work on prevention and public health policy to prevent and to aid early detection of diabetes in young children and adolescents.

Ultimately, the function of the HSE national programme for diabetes, among others, is to consider which model is most appropriate and it is working to this end. In parallel, the Department of Health and the HSE will be meeting the Diabetes Federation of Ireland with a view to progressing the issues around the appropriate model of care for children and adolescents with diabetes.

Finally, there have been the following important developments in this area. The national diabetes programme is continuing the development of a national diabetic retinopathy screening programme. While retinopathy screening is continuing in the north-west region, the intention is that services be rolled-out nationally in 2012. This programme is significant because diabetic retinopathy is the leading cause of blindness and serious visual impairment in Ireland. A total of 90% of people with diabetes will develop retinopathy while 10% will be sight threatened if undetected and not treated. A national foot-care model has been agreed. The aim for 2011 is to establish 16 specialist multidisciplinary foot care teams across the country in line with indicative national hospital reconfiguration which will have different levels of care for patients depending on their risk of diabetic foot disease. Taken together, it is envisaged that these planned services, once operational, will enhance overall diabetes care provided for children and adolescents in Ireland.

I thank the Deputy and I hope we can at long last provide a service to these people.