John O'Mahony (Mayo, Fine Gael)
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I thank the Ceann Comhairle for selecting this matter for discussion. It is by no means an exaggeration to use the word "plight" when describing the way in which people with type 1 diabetes deal with their condition. It is a difficult task for them. In County Mayo alone, there are approximately 100 children and adolescents living with the condition. That figure increases to 400 when the counties of Galway and Roscommon are factored in. In County Mayo, an average of one person per month is diagnosed with diabetes.

Many people living with type 1 diabetes receive their care locally but others travel to Dublin to access intensive treatment as the local diabetic care teams are under-resourced and underdeveloped. Nonetheless, I cannot speak highly enough of the under-resourced staff in Mayo General Hospital, which includes one paediatrician with an interest in diabetes and two specialist nurses to cater for those 100 people.

However, while the access to the treatment in Dublin is of benefit to patients, because of how it is resourced and the amount of technology available, it is far from an ideal solution. Children with diabetes, who should be seen four or five times a year in hospital to help limit the damage which high blood sugars can cause to the eyes, kidneys, nerves and smaller blood vessels in adulthood, are not seen as often as recommended.

As we all know, if diabetes is not well managed, it will cost a huge amount in future health care. In an attempt to address this issue, Diabetes Action has proposed a reorganisation of diabetic paediatric services in eight networks. It is envisaged that one of those networks would serve the 400 affected children in Mayo, Roscommon and Galway, so that they could avail of intensive therapies locally.

To ensure the equal availability of life-changing intensive treatments for those living with the condition, seven of the networks outside Dublin would require additional staff. I am aware that money is not available at the moment, but there are huge amounts of money in the health service. If reconfiguration took place there would be a lot of money saved down the line. The financial cost is estimated to be approximately €750,000 per annum but research has proven that by making the appointments, the potential is there to reduce the development of complications in adulthood by as much as 76%. That is a hugely significant figure, given that the treatment of diabetes complications normally account for 60% of the diabetes care budget, while the budget for diabetes care itself can account of as much as 15% of Ireland's health budget.

The central message of Diabetes Action is that people with diabetes have not been helped or served well by the generalist health policy. Instead, it proposes that the various issues need to be addressed by a national diabetes strategy. If the Government were to implement such strategic policies, the health of those living with diabetes would be greatly improved while simultaneously saving the State hundreds of millions of euro each year caring for people who will develop health complications in their diabetes care over the next decade.

I was speaking this evening with the parent of a ten-year-old child with diabetes. The parent went through the care the child needs, including five injections per day. The mother has to administer one injection in school at lunchtime. Technology is available in some areas, including, for example, an insulin pump that is available in Cork and Dublin, but not in Mayo General Hospital. The pump used to cost €5,000 but now costs only €2,500. The cost of some such technology and the appointment of an endocrinologist would make more sense. It would amount, in other words, to a centre of excellence. I acknowledge that one cannot have it in every hospital, but it could be in some hospitals to serve the regions so that people with diabetes would not have to travel to Dublin where facilities are totally overrun.

Ruairi Quinn (Dublin South East, Labour)
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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.