Ciarán Lynch (Cork South Central, Labour)

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.

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