Ruairi Quinn (Dublin South East, Labour)

I thank Deputy O'Mahony for raising this matter on the Adjournment which I am taking on behalf of my colleague, the Minister for Health, Deputy James Reilly.

It is estimated that there are currently between 3,000 to 4,000 children and young adults under 16 years of age with diabetes in this country. Over 90% of patients have type 1 diabetes but, unfortunately, there are 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. Given 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 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.

A clinician was appointed to take the lead on the diabetes clinical programme. He has engaged with all stakeholders, including the Diabetic Federation of Ireland, clinicians and podiatrists, to establish a multidisciplinary package for diabetic patients. A multidisciplinary working group is currently working through a number of key projects.

There are two proposed models of care to improve the situation for paediatric diabetes care. The first is based on eight to ten regional networks, with the three existing Dublin centres acting as a tertiary hub of excellence and continuing to see one third of the national paediatric/adolescent diabetes population. This model has been proposed by the Diabetes Federation of Ireland.

The second model came from the HSE's expert advisory group. This proposes that care be centralised for each region in a dedicated paediatric/adolescent diabetes centre looking after at least 150 children or adolescents. Ideally, the centre should be in a regional hospital that has an adult diabetes centre to facilitate transition to adulthood.

The national clinical leads for diabetes and paediatrics are to meet in the next couple of weeks to assess current services across the country, to agree a model of care, and to standardise these across the country. They will also develop criteria for use of CSII therapy - that is, insulin infusion - in children and adolescents with type 1 diabetes, and work on policy to prevent and aid the 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.

Diabetes service implementation groups have been established countrywide, including in HSE West. The group's regional work plan includes a focus on primary care, hospitals, children and adolescents, support services and linkages to the local diabetes implementation groups. The group is supported by three local diabetes services implementation groups

Services are provided for children and adolescents with diabetes in all the major hospitals across HSE west. These services are provided by paediatricians with a special interest in diabetes in Galway University Hospital, Portiuncula Hospital and Mayo General Hospital. The consultants are supported by clinical nurse specialists in diabetes and the diabetes teams have access to dieticians, psychologists and social workers. In addition, transitional clinics are provided across HSE West for adolescents who are transferring from the paediatric service to the adult service.

Nationally, the diabetes working group has undertaken to roll out a diabetic retinopathy screening service for all diabetics over the age of 12 years in 2012 to ensure early detection and treatment of diabetic eye disease, thus helping to prevent blindness due to the complications of diabetes. The group is also working closely with the chronic disease watch programme to increase GP awareness of diabetes.

Paediatric care is recognised as an important element of the diabetes programme required to maintain the health of the diabetic population. Taken together it is envisaged that the services planned, once operational, will enhance overall diabetes care for children and adolescents.

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