Alex White (Dublin South, Labour) | Oireachtas source

I thank Deputy Colreavy for raising the issue of the appropriate provision of specialised therapies for patients with type 1 diabetes. Type 1 diabetes mellitus is a complex condition that has a profound impact on the quality of life of people living with the condition and on the health services as a whole. Those with chronic, non-communicable diseases, such as diabetes, are heavy users of the health services. It is estimated that three-quarters of Irish health care expenditure relates to such diseases. In practical terms, this translates to 80% of general practitioner consultations and 60% of hospital bed days. Non-communicable diseases also account for two-thirds of emergency medical admissions to hospitals.

The pressures placed on the Irish health care system by this burden cannot be sustained from a cost or hospital capacity perspective under current structures. The national clinical programmes, with their models of structured integrated care, are gradually shifting our health systems away from an "illness" model of health care and encouraging patients to actively participate in the management of their condition, by seeking to provide treatment at the lowest level of complexity that is safe, timely, effective and as close to home as possible. In this way, we can deliver better health outcomes, enhanced clinical decision making and more effective use of resources.

The implementation of the national integrated care diabetes programme on a phased basis is a key development in the management of diabetes care. I am sure the Deputy is very aware of the recent appointments of an integrated diabetes clinical nurse specialist, operating from Letterkenny General Hospital, and the recruitment of a paediatric diabetes nurse specialist at this site also, as well as the recent appointment of a consultant paediatrician with a special interest in endocrinology at Sligo Regional Hospital. However, not all patient care can be managed locally. The national clinical programme for diabetes states that people with type 1 diabetes or complex genetic or secondary causes of diabetes will have their diabetes-related care provided under the governance of the consultant-led diabetes multidisciplinary team in a secondary or tertiary care centre.

With specific reference to insulin pump therapy, I acknowledge that such therapy is the "gold standard" as it is less invasive, less painful and more accurate, particularly in the management of type 1 diabetes in children. I acknowledge also that the current requirement on children and their families to travel to Dublin from the north-west for device monitoring and adjustment is onerous. However, the extension of this specialist therapy to other hospitals must be considered in the context of the recommendations of the clinical programme for diabetes, the expert advisory group report on diabetes, and the additional staffing and supporting resources which the establishment of additional insulin pump therapy centres would demand.

I am sure the Deputy will be pleased to note that these matters are under consideration by the Department of Health and the HSE in the context of considering the most appropriate service developments for the children of the north west and west, and that these ongoing considerations will also take into account potential appropriate cross-Border collaboration.

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