Kathleen Lynch (Cork North Central, Labour)
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Question 83: To ask the Minister for Health and Children if her attention has been drawn to the fact that the number of children with diabetes being treated by the paediatric diabetes unit at Cork University Hospital has risen from 120 patients in 2002 to 207 in 2006; the extra resources which will be given to the unit to cope with this extra demand; her views on whether there is an urgent need to have a dedicated medical person appointed to the unit to give advice to parents on all aspects of their children's health; and if she will make a statement on the matter. [35690/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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My Department has been informed by the HSE about this matter and I have been advised that discussions are ongoing between the hospital, the parents' support group for children with diabetes and the network manager about the services provided for children with diabetes.

A post of clinical nurse specialist filled on an acting basis has been advertised for permanent appointment. A further clinical nurse specialist has also been appointed and will take up duty on 12 November. This increase in support will improve response time to phone calls for advice and insulin dose changes, improve access to education sessions and provide greater continuity of service for children by avoiding long periods without cover.

I am confident the HSE will continue to monitor the delivery of paediatric diabetes services at Cork University Hospital to ensure that the needs of service users are prioritised.

Kathleen Lynch (Cork North Central, Labour)
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The Minister's answer epitomises what has happened on this issue since 2002. In 2002, 120 children with type 1 diabetes were treated at Cork University Hospital. This year, it is estimated that number will rise to between 207 and 215. As the Minister correctly stated, discussions between the parents' support group and the HSE are ongoing and have been taking place for 18 months. Local representatives are also involved in discussions. We hear different versions of the answer given by the Minister every time we attend a meeting.

The Minister's answer in written form, which I assume is correct because she has responsibility for this matter, states two full-time permanent clinical nurses will be in place from 12 November. Two weeks ago, the Deputies for the area were told two full-time nurses would be in place from 10 November but that one of them would be paid for by the private sector with a grant of €40,000 for one year and the other position would be filled by two part-time nurses.

It is easy to understand how the parents involved have become frustrated. No one knows what is the exact position or what it will be. The HSE states progress is being made and it has an estimate in for what the parents seek, including a full-time consultant — who will now be shared with other paediatric services — and three full-time specialist diabetic paediatric nurses. At present, 1.5 such nurses are in place, one of them for only one year. The parents also need a space dedicated to their needs instead of sharing with everyone else as they do now.

What the parents need to know is what the position will be. The requests made by the HSE are for a full-time consultant, a full-time dietician with expertise in this area and three specialist paediatric nurses with clinical expertise. I am sure the Minister has examined the Estimates for this year, particularly for this area. Is the answer given by the Minister today the same as that which the parents will receive next week?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am informed a full-time clinical nurse specialist will start on 12 November. At present, a clinical nurse specialist is acting on a temporary basis and that post has been advertised for permanent appointment. That will mean a total of two nurse specialists.

With my support, the HSE recently advertised for 100 new consultants to be appointed to hospitals during the coming months. These appointments will be based on innovation. When I refer to innovation, I mean the hospitals which are performing well will get more consultants because it is clear we will get more from consultants who are applied to an innovative environment than if we appoint them in a traditional way. I do not know if Cork University Hospital will apply for consultants under that initiative but there is much interest from other hospitals.

On a more general point, adult and child diabetes should be managed in the community and treatment should not be hospital based, which is not best practice in other parts of the world. We are moving to ensure we manage illnesses such as diabetes on a community basis and the staff involved should work in a community setting. One of the major discussions we are having in the context of renegotiating the contract of employment with general practitioners is how what are essentially nurse-led clinics will manage type 1 and type 2 diabetes, which have very serious consequences for patients and the health care system.

Type 1 diabetes can take 20 years off one's life if it is not managed and type 2 diabetes can take ten years off one's life. I met a lady at a recent event who has had her diabetes managed for 67 years. She was perfectly healthy because it was well managed and she had not had many of the complications which, unfortunately, are suffered by other patients.

Diabetes is a major priority and challenge for the health service. I am conscious of the deficiencies that exist in Cork but I hope the appointment of the new nurse specialist will greatly alleviate some of the pressures parents are experiencing. In particular I hope parents can have their child assessed on a frequent basis rather than as an emergency case, which is what happens when there is not an appropriate service.

Kathleen Lynch (Cork North Central, Labour)
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We all agree diabetes should be community managed. The difficulty in Cork is that diabetes is not managed at all, either in the community or the hospital. If we were to apply best practice in this area, we would have three nurse specialists, a committed consultant, a specialist dietician and a special area to which patients could come to have prolonged consultation on a frequent basis.

There were approximately 40 mothers with children from as young as 18 months up to 15 years of age outside Cork University Hospital this morning. In ideal circumstances, these people would probably tut-tut at anyone making a protest. However, the mothers have been driven to the point where they had to bring their children, who were being monitored, to the protest to highlight this issue. This is despite the fact the issue had already been highlighted in 2002 in a report on diabetes nationally in which Cork was earmarked as a blackspot with regard to the provision of treatment for type 1 diabetes, which affects children.

When a child is diagnosed in Cork, the parent is given a syringe and an orange and told to go home, to practise and that eventually they will get it right. The issue is more serious when children are involved, as the Minister knows, and there it is necessary to ensure a regular and constant balance with regard to diet, insulin injections and the energy children expend.

When things begin to go wrong for such children and their mothers telephone the nurse at Cork University Hospital, whether it is late in the evening or during the day, they will probably get an answering machine because the nurse works just two and a half days per week. They are lucky to get a call back the following week. There are parents in Cork who take their children out of the system there and bring them to Temple Street Hospital in Dublin, where there is a 24 hour call service and nurses bring their telephones with them to give the advice that is necessary.

Everyone agrees it should be a nurse-led service but hoping and wishing the system will be better is no longer good enough. The Minister knows the position and what needs to be put in place. The notion that she has instructed that 100 consultants be appointed is of no benefit to mothers in Cork given they are not certain one of the consultants will be available to deal with their children. Wishing and hoping for it is not good enough. What will the Minister do about it?

Mary Harney (Dublin Mid West, Progressive Democrats)
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While the Estimates have not yet been published, it is no secret that this year the HSE will get at least an extra €1 billion to provide services around the country on a priority basis over the next year. We are fortunate that over the past nine or ten years we have been able to triple health funding because of the great success of the economy. Health Ministers from Europe and elsewhere tell me their challenge is to maintain services with increases of 2% or 3%, which in some cases does not even meet inflation.

As we increase funding, we must ensure we make appointments that make sense and on terms that make sense. That is why the 100 consultants the HSE has identified to appoint this year are not by speciality but by priority areas, particularly in hospitals where innovation is being embraced. I am not certain whether Cork University Hospital will qualify or has applied. I hope it has done so. Priority areas will receive consultant posts until we reach the stage where we can appoint the consultants we need for the health service over the next number of years.

I share Deputy Lynch's concern. Diabetes, if not managed early, has catastrophic effects on patients, their families and the health system and budgets. That is why this is a priority and I have had a number of meetings with HSE experts on how we can begin to have a community-wide initiative in 2007 to manage diabetes involving GPs and nurse-led clinics. If we can move into that space, it will be successful.