Martin Kenny (Sligo-Leitrim, Sinn Fein)
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I wish to raise an issue that has become very serious in Sligo University Hospital and for the entire north west. I will paint a picture of the situation for the Minister of State. If an adult or a child in Sligo, Leitrim, south Donegal or west Cavan is diagnosed with type 1 diabetes, he or she is sent for an appointment and an assessment to a unit located in a two-room portakabin in a yard at the back of Sligo University Hospital. They walk through what is literally a building site as a new mental health services unit is being built in the area. The people who work in that small portakabin have to keep the windows closed because of the dust. The Minister of State can see the picture. A family arrives at that portakabin with a child who has been diagnosed with diabetes, and two other people may be waiting to be seen in that small room half the size of the area of the floor of this House. They get an assessment done on the level of insulin or whatever the child needs, they make further appointments, and each time they come back to that unit. The staff in the second room in the portakabin have their computers and their phones there. They monitor people with type 1 diabetes from across the entire north west in respect of whom they receive reports. It is a cramped and unsuitable unit. The HSE has an application in for funding the building of a new unit for the past four to five years but nothing has happened.

There is also the serious matter of people who are diagnosed with type 1 diabetes who need an insulin pump, which is a marvellous advance in treatment. I spoke to a man a number of months ago who was waiting to be fitted with an insulin pump. He knew it had been ordered. In fact, it had been purchased and was sitting on a shelf in that unit but he could not get it fitted because he needed to be trained on how to use it. The specialist nurse who provides the training had been seconded to another part of the hospital and was not available to give him the training. An 18 year old woman who is in college contacted me in recent weeks who is in the same situation. She wants to be fitted with an insulin pump and has been told there is nobody available to train her on how to use what is a simple enough piece of equipment.

There are two issues involved. One is the facility, the cramped and unsuitable unit, and the staffing of it. Quite apart from the unavailability of a specialist nurse to provide training on the use of an insulin pump, the staff who work in this small portakabin are totally stressed out, are under pressure and cannot deal with the demand for this service that they are trying to provide and are providing, in fairness, under very difficult circumstances.

I want the Minister of State to provide an assurance that any person in the north west who needs to be fitted with an insulin pump and wants to have that done will be able to get it done with all the haste that is required and that the training they need will be available as soon as they apply for it and need it. Will the Minister of State advise also regarding progress on the building of a new diabetes unit at Sligo University Hospital?

Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister, Deputy Harris, I thank the Deputy for raising this matter. As he will be aware, diabetes is one of the most challenging health problems in the 21st century. Just like the rest of the world, Ireland is experiencing sustained increases in the number of people with diabetes. Currently, there are more than 200,000 people with diabetes in Ireland. People with type 1 diabetes make up 10% of all people with diabetes. If not well managed, diabetes can lead to debilitating complications, including visual impairment and blindness, lower limb amputations, kidney failure and heart disease. As a result, the increasing prevalence of diabetes poses a major challenge to our health service, with increasing costs driven primarily by hospitalisation and treating associated complications. This is also evident in the increase in demand for diabetic care in our acute hospitals and our community healthcare organisations, including in the Deputy's area.

The diabetes service team at Sligo University Hospital is led by consultant endocrinologists and serves the populations of Sligo, Leitrim, south Donegal, north Roscommon and west Cavan. This adult diabetes service also includes an insulin pump service. Referrals are also received from Letterkenny University Hospital in this regard. In addition, there is a pregnancy diabetes service, inpatient ward-based consultation service, and an inpatient and outpatient podiatry service. There is a well-established integrated multidisciplinary team approach between both the hospital and the community, supported by specialist diabetic nurses and an advanced nurse practitioner as well as a full range of support staff. In addition to this, there is a paediatric diabetes specialist service that provides a regional insulin pump service for children across the north west. Both the adult and paediatric pump services have experienced considerable growth in referrals both from new patients commencing treatment as well as repatriation of patients from national tertiary centres. In addition, a full endocrinology service is provided, which includes dynamic endocrine function testing.

The HSE has advised that tender documents for the diabetic day unit at Sligo University Hospital have been finalised and are ready to issue to contractors. It is intended to proceed to construction in 2019, with the unit expected to be operational in 2020. The funding of all projects is subject to the availability of capital funding and the progress of other priorities. The Government is committed to the further development of services for people with diabetes and other chronic conditions.

Earlier this month, the Sláintecare Action Plan 2019 was published which will be a fundamental enabler in the delivery of the Sláintecare vision. As part of this action plan, a series of service design and delivery workshops will be held. These workshops will he focused on chronic disease management, including the management of diabetes.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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I thank the Minister of State for her response. I acknowledge the inclusion in it to the effect that "tender documents for the diabetic day unit at Sligo University Hospital have been finalised and are ready to issue to contractors" and that it is due "to proceed to construction in 2019". While that is very welcome news, the next sentence states: "The funding all projects is subject to the availability of capital funding and the progress of other priorities." There is always a little fear in that respect, particularly in the context of what has happened with the national children's hospital, but I will not go down that road. The building of this unit would involve a fairly low cost for the major benefit it can create for people with diabetes. I welcome that it will proceed with all due haste and as quickly as possible.

The other issue I raised is that people are unable to be fitted with an insulin pump because of the absence of specialist nurse to train them on how to use it as that nurse has been seconded to another part of the hospital.

That is a serious problem. One lady I spoke to told me of a situation where she was there along with her child, and another child in the hospital had been diagnosed with diabetes and arrived over in their pyjamas to this unit for an assessment, having walked across what was practically a building site. There are no toilet facilities in the place. At the end of the assessment, another man came in to inquire what was happening as he had been waiting for the insulin pump for several months and had not got it. This is a real issue that needs to be dealt with. While I welcome the proposal that there will be capital funds in place to build this, it needs to happen as quickly as possible.

There is also the issue of ensuring adequate staffing. The Minister of State mentioned that the multidisciplinary team is in place but to my knowledge it is not complete and there are holes in that service that need to be filled. That should be done as quickly as possible.

Catherine Byrne (Dublin South Central, Fine Gael)
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I have noted the Deputy's concerns. I recognise the reply states there is an intention to proceed with construction in 2019 and it is expected to be operational in 2020, and the reply also states this will be subject to availability of capital funding. All other projects throughout the country are in the same position. It is down to funding, and let us be honest about it.

I am not sure about the status of the multidisciplinary team, which the Deputy said is not complete. I will have to go back to the Minister on that. With regard to training for the pumps, how difficult can it be to train somebody to use a diabetic pump? I know somebody who uses one daily. I am committed to going back to the Minister to ask that a comprehensive answer be given to the Deputy and that the Minister would contact the hospital to find out why training is not happening when the pumps are already there and waiting to be used. We all know a diabetic pump can mean so much to people's everyday lives. I know someone who uses one daily.

I am sorry I do not have more information for the Deputy. As always, I will refer back to the Minister, Deputy Harris. I will do my best to hammer home the concerns that have been raised.