Charlie McConalogue (Donegal, Fianna Fail)
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47. To ask the Minister for Health his plans to create a centre of excellence in diabetes care in the north west in view of the fact that there is no centre of excellence in diabetes care north of the Dublin to Limerick line; his further plans to increase the level of staffing in the diabetes team in Letterkenny University Hospital; and if he will make a statement on the matter. [27785/17]

Charlie McConalogue (Donegal, Fianna Fail)
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It is welcome that the Minister is due to meet the Donegal Diabetes Association next week and has met its representatives previously. Commitments were made to try to ensure services would be improved. My question focuses on what the Minister and the Government are doing to support diabetes services in County Donegal. In particular, what is the position on the Minister's commitment to explore establishing a centre of excellence in paediatric diabetes care in County Donegal and improve diabetic services and supports for adult diabetic patients in the county?

Simon Harris (Wicklow, Fine Gael)
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I look forward to the meeting next week. The Deputy is welcome to come along and engage with Oireachtas Members, the group and me on the issues we discussed when I visited Letterkenny previously.

Letterkenny and Sligo university hospitals provide essential high quality hospital care for patients in the north west. I can assure the Deputy of the continued commitment to develop services in both hospitals, including those for patients with diabetes.

Adult diabetes services at Letterkenny are provided by a consultant endocrinologist, supported by a locum consultant general physician with a diabetic interest. In order to address waiting lists, additional clinics are provided on a monthly basis. Furthermore, the Saolta University Healthcare Group has advised that it is making applications for the approval of a second consultant post and an advanced nurse practitioner post in insulin pump therapy to serve both adult and paediatric patients. I can assure the Deputy that when the applications are made, they will be assessed with a degree of priority because of the importance of the matter.

With regard to the provision of paediatric diabetes services, an insulin pump therapy service commenced at Sligo University Hospital in 2015, with outreach clinics delivered at Letterkenny. However, in mid-April the consultant paediatrician with a special interest in paediatric diabetes post in Sligo became vacant and the Saolta University Healthcare Group has advised that it is actively engaged in recruiting a replacement. That process is ongoing. Pending completion of the recruitment process, consultant paediatricians at Sligo and Letterkenny hospitals have undertaken additional training and development to maintain the provision of the paediatric insulin pump therapy service at both hospitals. Further additional support for these services has been arranged with another consultant, currently practising within the Saolta hospitals.

Provision of a diabetes centre at Sligo hospital is included in the capital plan for this year. HSE Estates advises that planning permission for the centre has been granted; construction is scheduled to commence by the end of the year and be completed in quarter three of next year. Filling the permanent diabetes consultant post at Sligo will enable the group overall, including in County Donegal, to further advance its plan for the diabetes care centre.

I will meet the Donegal branch of Diabetes Ireland, the HSE and the Saolta University Healthcare Group this month to discuss the current challenges and future development of diabetes services in the north west.

Charlie McConalogue (Donegal, Fianna Fail)
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For children with diabetes, there is no centre of excellence in paediatric diabetes care north of the Limerick to Dublin line. Services are quite limited and in no way sufficient to meet the number of children in the county or the north west who need them. It is often considered at official level that if a service is provided in Galway, patients in County Donegal are covered. I know that the Minister has been to Letterkenny a few times and will know that it is closer to Dublin than to Galway. We need services in the north west.

On the provision of a centre of excellence in paediatric diabetes care which would include a consultant endocrinologist and support staff such as a dietician and a psychologist, will the Minister give a firm commitment that such a centre will be developed in the north west to serve children from Donegal and neighbouring counties? On the adult diabetes service, there is a need for an additional consultant in Letterkenny and a team to support him or her to deal with the number of patients in the county with diabetes. A total of 7,000 people in County Donegal have been diagnosed as having diabetes, of whom 700 have type 1 diabetes. The waiting time for a follow-up appointment is more than 20 months for patients with type 1 diabetes at a time when the recommended period is four months. It is simply not acceptable. The necessary resources and staff need to be provided to serve patients with diabetes in County Donegal.

Simon Harris (Wicklow, Fine Gael)
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The Deputy makes a very fair point. The health service cannot presume that Letterkenny is just up the road from Galway. It is a significant journey to travel. We have talked previously about certain specialties, inlcuding cancer care, and the need at times for patients to travel to Galway, but, in general, as many clinics as possible should be held in Letterkenny to help patients in the north west. As I said to the Deputy, active recruitment is under way to try to fill the vacant consultant paediatrician post. Filling it would make a significant difference. I have asked the HSE to come back to me with further information in advance of our meeting with the Donegal branch of Diabetes Ireland. Obtaining a replacement to fill the post would be of significant assistance. In the meantime it is worth saying, as I mentioned, that paediatricians in Sligo and Letterkenny hospitals have undertaken additional training in order that they can keep the paediatric insulin pump therapy service running at both hospitals. There will be the development of a diabetes centre in the north west. Funded is provided in the capital plan for this year. I want to see paediatric services provided in the north west. I will be happy to discuss the matter further with the Deputy and the group when we meet next week.

Charlie McConalogue (Donegal, Fianna Fail)
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I thank the Minister and look forward to discussing the matter further with him with the Donegal Diabetes Association next Wednesday. I highlight the impact on children with diabetes in County Donegal of not having a paediatric consultant endocrinologist in Sligo. It means that insulin pump therapy is not available to newly presenting children under the age of five years with type 2 diabetes. The service is struggling to provide a support service for the children who are receiving this therapy. It is crucial that the post be filled soon to ensure a service will be available to all children with diabetes. It is also crucial that Letterkenny University Hospital see an increase in staff numbers. An additional consultant should be provided, with the necessary support staff, to serve adults with diabetes. Teenagers who enter the adult diabetes service on reaching the age of 18 years are moving from having repeat appointments every three to four months to having to wait over 20 months for them. That is simply not acceptable and is very distressing for them. The problem can only be solved by having an additional consultant in Letterkenny University Hospital to ensure the service can be provided. Having regard to the fact that there are 7,000 people in the county with either type 1 or type 2 diabetes, it is crucial a service be available. As we know, prevention is better than cure. Therefore, the provision of support is critical for patients with diabetes.

Simon Harris (Wicklow, Fine Gael)
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I will make four brief points. I can confirm to the Deputy that the process in regard to the consultant paediatrician post which is vacant will be expedited through what is known as the CAAC, the consultant applications advisory committee, and the Public Appointments Service. Saolta has confirmed that to me. Saolta has also advised that a plan is being put in place to ensure that all existing paediatric patients on pump therapy will continue to be managed locally in Sligo and Letterkenny with existing paediatric consultant staff and continuation of existing clinics. The locum paediatrician in place in Sligo and the existing consultant paediatrician in Letterkenny have undertaken additional training in order to continue provision of that service. Further development of clinical staff will be scheduled in coming months in order to continue the delivery of this therapy. All options both internal and external to the group are being explored to make sure that patients under the age of five years will have access to pump therapy. The Saolta group advises that it is currently engaging with a consultant in another hospital in the group with a view to putting governance arrangements in place for the oversight and review of patients and the management of new patients. This consultant has experience in the delivery of paediatric diabetic pump services. Sligo is further developing its centre for diabetes care. It is included in the capital plan for this year and this will ensure the facilitation of paediatric insulin pump services for people in the north west.