Michael Colreavy (Sligo-North Leitrim, Sinn Fein)
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On most occasions that I speak in the House, I am addressing a problem but, today, I am addressing an opportunity. The Minister for Health, Deputy James Reilly, has stated on a number of occasions that he supports changing the way health care services are configured to improve delivery to patients who need the services. I believe there is a big opportunity presenting in regard to the provision of insulin pump therapy to those who need it in the north west. Type 1 diabetes mellitus is an autoimmune condition characterised by the destruction of beta cells in the pancreas, leading to an inability to produce insulin, resulting in raised blood glucose levels in children. Conventional treatment involves giving insulin injections anything from two to five times per day using an insulin pen device. Alternatively, it can be delivered using an insulin pump.

It is accepted worldwide that the pump therapy is the best treatment option for many children with type 1 diabetes. Insulin pump therapy can provide a child with a much improved quality of life, reduces the number of injections to be endured daily and can reduce the incidence of long-term complications arising, such as blindness, kidney failure and nerve damage. These long-term complications of current diabetic treatments are extremely difficult and expensive to deal with. International studies have shown that improved control of diabetes in children and adults can reduce the incidence of severe and costly complications arising by as much as 76%. There is also an immediate cost saving to our health services in that, if a child with type 1 diabetes has an illness, it tends to be more manageable at home if a child is using an insulin pump.

In summary, from a health and well-being perspective as well as from a short-term and long-term economic perspective, it is clear that insulin pump therapy is the way to go. This was recognised in the HSE expert advisory group report on diabetes. What is happening at present, however? At present, children in the north west who were referred for insulin pump treatment must go on a waiting list and eventually travel to Dublin for the treatment. This causes absenteeism from school, financial cost to their parents and disruption to the lives of the children and their parents, and they are the lucky ones. Because of the numbers seeking such treatment, many are never taken from the waiting list. This is not equity of access; this is discrimination based on location.

We do, however, have a big opportunity in the north west because Sligo Regional Hospital has a consultant paediatrician with a special interest and training in endocrinology who is willing to support insulin pump therapy, and there is a part-time paediatric diabetes nurse qualified to support pump therapy. The elements are all in place. All it needs is the political will of the Minister and the Government and a modest resource allocation, which would in time be saved many times over, to make it happen. Will this be done and, if not, why not?

Alex White (Dublin South, Labour)
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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.

Michael Colreavy (Sligo-North Leitrim, Sinn Fein)
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I thank the Minister of State but I am disappointed. I thought we would be able to say that, yes, this is something good and that we will work to achieve it. I am disappointed because, like many people in the west and the north west, when I hear words like "the matters are under consideration", it tends to scare me. This is because previous considerations of services to Sligo Regional Hospital resulted in reductions in the number of beds, failure to employ a mammographer, the removal of the mammography equipment, with no word about its replacement, reductions in front-line staff, reductions in and withdrawal of day services and non-replacement of critical front-line staff when they are on holidays, maternity leave or are sick. The most recent and frightening aspect is the leaked report that consideration is being given to the very future of maternity services at Sligo Regional Hospital.

I am not pleased to note that these matters are under consideration because if the outcome of these considerations had the same impact on Sligo Regional Hospital as previous HSE and Department of Health considerations of services at the hospital did, we will lose again.

I have made a strong case that this service should be provided and based in Sligo Regional Hospital and I am disappointed that the Minister of State has not said that it can and will be done.

Alex White (Dublin South, Labour)
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I know the frustration Deputies often feel, which I often share, when they hear about something being under consideration but it is not always a cover for inactivity. In fact, it is something we are considering very carefully because the approach our health services take, particularly to chronic illnesses such as diabetes, will shape how we configure our health services more generally in the future because we simply will not be able to manage 21st-century illnesses like diabetes under the structures we have had to date.

It is more complex than the issue of what we do in our hospitals although I acknowledge that, as the Deputy said, well-equipped and properly configured hospitals are critical. However, they are not the full story. We must emphasise the importance of primary care, care in the community and very often self care, particularly in respect of chronic illnesses. The Government and I have been doing so. Based on his contribution, I know the Deputy would agree with that. I understand what he says about Sligo General Hospital and I hope to be there next week and also at Letterkenny General Hospital.

Michael Colreavy (Sligo-North Leitrim, Sinn Fein)
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Sligo Regional Hospital.

Alex White (Dublin South, Labour)
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I am very aware of the importance of our hospitals, including our regional and teaching hospitals, but I also urge the Deputy and House to agree that our hospital-centred model of care, particularly in respect of chronic illnesses, must change. We will not be able to manage and sustain our health service unless it changes. I have listened carefully to what the Deputy said and he makes some good points. The issue is not whether insulin pump therapy is a good thing or idea because it clearly is. The issue is how we configure those services and facilities around our hospital services across the country and, most important, how we ensure we manage these major threats to our health and, ultimately, the funding possibilities for the health service in the community and primary care. They are all issues we must address.