Seán Kyne (Galway West, Fine Gael)
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I am grateful to the Ceann Comhairle for selecting this topical issue. I welcome the Minister of State.

The HSE national service plan for 2012 includes a commitment to roll out a new kind of treatment for diabetes in children, including the use of insulin pumps. Five centres were identified - three in Dublin, one in Cork and a shared service between Limerick and Galway. The target completion date was the end of the third quarter, that is, the end of September. There are two issues - one is the restriction of this new insulin pump treatment to children under five years of age and the other is the discrepancies in the treatment of children in different regions.

One often hears complaints of a Dublin-centric attitude. Galway children must travel to Temple Street children's hospital in Dublin to see a consultant six or seven times a year in order to use the insulin pump. As a Galway Deputy, I will speak about regional deficiencies. I warmly welcome the announcement at the start of this year of an additional 1.2 diabetes nurse specialist posts in Limerick and Galway, with a diabetes dietician also shared between the Mid-Western Regional Hospital and University College Hospital Galway. These posts were to be filled and operational by June 2012 but this did not happen. Following representations and a delay of several weeks, I received news this afternoon - by strange coincidence - that the posts will be advertised in the coming weeks and will be in place by the start of 2013. Despite the delay, I can see the benefit in this.

Advocacy groups suggest Galway is the poor relation when it comes to urban areas and diabetic treatment. However, the good news I have mentioned does not solve another issue, namely, the apparent differentiation between age groups. The new insulin pump treatment will only be introduced for children under five years of age. I am concerned about those over that age. A constituent approached me on behalf of his 11 year old daughter. The girl requires four or five injections of insulin a day for type 1 diabetes. This caused an amount of trauma to the body to the extent that the abdomen suffered bruising. The injections were administered subsequently to her arms and currently to the back of her legs. This is of major concern to the girl and her parents who want to know when they will have access to an insulin pump. She is an 11 year old in Galway and I ask whether this treatment will continue to be available only in Dublin. It is a major regional issue.

No one likes to talk about the cost of health care but we must be practical. We must use the funding we allocate to health care to its optimal use. By not extending insulin pump treatment to all children, we will be penny rich and pound foolish.

Kathleen Lynch (Cork North Central, Labour)
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I am responding on behalf of the Minister for Health, Deputy James Reilly. The HSE national clinical programme for diabetes, which includes the care of children and adolescents with diabetes, was established to define the way diabetic clinical services should be delivered, resourced and measured. The programme is lead by a clinician and its central aim is to save lives, eyes and limbs of patients with diabetes. The national clinical leads for diabetes and paediatrics met to discuss the issues involved in the care of children and adolescents with diabetes. A working group was established to discuss services throughout the country, to agree a model of care and to standardise these throughout the country. Their work involves the development of criteria for the use of insulin pump therapy in children and adolescents with type 1 diabetes, as the benefits of this form of therapy are well established, especially in children younger than five years of age. They also work on policy to aid the early detection and prevention of diabetes in young children and adolescents. The group's work is ongoing.

I am delighted to say that this year the HSE paediatric and diabetes clinical programme initiated a project to provide insulin pump therapy to children with type 1 diabetes under five years of age in five centres nationally. This is a wonderful advancement in the treatment of children with diabetes. The centres include the Adelaide and Meath Hospital, incorporating the National Children's Hospital, Crumlin, Temple Street, Cork and Limerick-Galway. All children under five years will be assessed for suitability for insulin pump therapy in one of these centres. If suitable, the children and parents or carers will undergo a structured education process prior to commencing insulin pump therapy. If not found suitable, children will be treated using multiple daily injections. The diabetes team will work with the parents and children to address the deficits if desired.

All insulin pump therapy commenced in children under five years will be maintained in the over five years age group. In order to provide this treatment, additional nursing resources are required and work is progressing on the recruitment of these nursing resources. I am fully aware of the challenges facing young diabetic patients and of the need to support patients and their families. I am committed to providing the best possible health service for our children and their families and will continue to work with the HSE and, specifically, the clinical programmes to ensure the best possible outcomes for these patients. I thank the Deputy for raising the matter.

Seán Kyne (Galway West, Fine Gael)
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I welcome the announcement made today regarding the service to be operated jointly between Limerick and Galway, the fact that the posts should be in place by 2013, that the recruitment programme is commencing in Manorhamilton and that all insulin pump therapy commenced in those under five years will be continued after that age. It is good news for those who receive the treatment. Where does the 11 year old child stand? Where can she go? Her body is marked with injection sites. Her family sees the major benefit of an insulin pump in terms of lessening the number of injection sites. I am not sure how many children are in a similar position but I am dealing with a specific case. Where does that child stand? A child of four and half years will receive the benefit but not a child of 11 years of age.

Kathleen Lynch (Cork North Central, Labour)
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One can understand the parents' concern at the delicate age of 11 years. Even without diabetes, that age brings a degree of worry. We must begin somewhere and the treatment of children under five, who will receive insulin pumps, will be maintained into later years and adolescence. While I have every sympathy, I cannot comment on a particular individual with diabetes. I understand the concerns but we must begin somewhere. As is the case with various vaccination programmes, it is our aim to do a follow-up and a catch-up programme. I will speak to the Minister for Health on this important matter. I know the value of a treatment process, especially in the case of diabetes where treatment is a daily event. I know the benefits of an insulin pump. It relieves the constant worry about the amount of insulin and when it is given. Children do not normally have that kind of routine. I am not certain that we will be to deliver a catch-up programme but we should seriously consider it.