Catherine Murphy (Kildare North, Independent)
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Question 5: To ask the Minister for Health if his attention has been drawn to the fact that paediatric services in Dublin have become inundated with referrals; his views that children with diabetes should be seen four or more times each year in order to properly manage their condition and minimise problems in adulthood; if he has considered the re-organisation proposal from Diabetes Action who are seeking a re-organisation of the service into eight networks in order that there is an equality of distribution/access to services; and if he will make a statement on the matter. [18078/11]

James Reilly (Dublin North, Fine Gael)
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The HSE's national clinical programme for diabetes, which includes the care of children and adolescents with diabetes, has estimated that there are between 3,000 and 4,000 children and young adults with diabetes in this country. It was established by the HSE 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.

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 and other diabetes health care specialists and psychological support. For young people this diagnosis presents great difficulties and life changes, particularly in the teen years.

One proposed national model of diabetes care 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 and adolescent diabetic population. This model has been proposed by the Diabetes Federation of Ireland. The second model came from the expert advisory group, chaired by Dr. Colm Costigan, paediatric endocrinologist in Crumlin Hospital. This proposes that care be centralised for each region in a dedicated paediatric and adolescent diabetes centre, looking after at least 150 children and adolescents. Ideally the centre should be in a regional hospital that has an adult diabetes centre to facilitate transition to care in 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 - 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 the executive is working to this end. In parallel, my Department 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, the Deputy may wish to note 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, probably during 2012. This programme is significant because diabetic retinopathy is the leading cause of blindness and serious visual impairment in Ireland. Some 90% of people with diabetes will develop retinopathy, while 10% will be sight threatened if undetected and untreated. I met community ophthalmologists on this issue and discussed their plans for rolling this out. I will also meet optometrists who may also have a role. A national footcare model has also 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.

Catherine Murphy (Kildare North, Independent)
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I rely on people who contact me to tell me about the level of care they feel they and their children, in particular, receive. I am sure most of us, including those on the other side of the House, have had significant communication on the issue of the structure of the diabetic services. I hear that the Dublin hospitals are inundated with people looking for services. People are making contact because they are concerned by the queues and the fact that children are not seen as often as desirable to minimise damage that might occur later. I take it from the Minister's response that he will agree some changes to the system. Does he have a timeframe for when he expects these changes to be fully rolled out? The change is about doing things smarter and will not necessarily cost more. However, if the system is done differently, it may well save unnecessary damage and bring about better outcomes in the long term.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy for raising this issue and I hear her concerns loud and clear. Many people have the same concern. In my response I indicated that in the next couple of weeks a meeting will be held between the clinical leads for diabetes and paediatrics to assess the current services across the country and, most importantly, to agree a standard model of care. Without going into too much detail, I imagine we are talking about a matter of months and that something concrete will arise from that meeting. I will certainly push them to come to an early conclusion. Much work has been done in the area and while I know there are varying views on how best to achieve the end, I have no doubt that all parties concerned are interested in and committed to the well-being of children with diabetes and that they will expedite a plan that we can implement.