Dáil debates
Tuesday, 21 May 2019
Saincheisteanna Tráthúla - Topical Issue Debate
Hospital Services
6:50 pm
Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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Diabetes is a condition that affects a large proportion of the population, numbering some 190,000. It is a condition that involves a great deal of management and it can involve a great deal of hardship. It involves invasive finger-prick tests and so on. I attended a protest at Cork University Hospital, CUH, yesterday morning, led by the parents and families of children and teenagers who have type 1 diabetes. Their frustration has been building up over some time at the lack of services and the difficulty they have in seeing a consultant at CUH. They were full of praise for the support they got from nurses in the hospital and for the consultant, Dr. Stephen O'Riordan, who is alone responsible for some 400 children and teenagers with type 1 diabetes, as well as for all sorts of other endocrinology disciplines such as Addison's disease, thyroid disease and coeliac conditions. More than 200 children are currently waiting to be seen in CUH, of whom almost 30 have been waiting for more than a year, with many more waiting between six and eight months. International best practice recommends that children and teenagers with type 1 diabetes be seen every three to four months but the HSE is falling far short of that in respect of these children in Cork and the surrounding areas.
One of the parents told The Evening Echoin Cork that her son, who suffers from type 1 diabetes, had not seen a consultant endocrinologist for almost two years, since one of the consultants retired. That is not good enough. These parents feel let down and they are worried. There is evidence that suggests the better care one receives when young, the less likely one's condition will deteriorate or that there will be further complications later in life so it is vitally important that these children and teenagers get a quality service when they are young. They are not getting that at the moment and this is causing a great deal of anxiety and worry for their parents, as well as discomfort for the children and teenagers themselves.
The issue of psychological support was also raised. This condition can be traumatic and can cause stress for children but it has been difficult for them to get support in this area too. There is clearly a need to fill additional consultant positions in CUH. Children are not being seen often enough and not getting the support they deserve. What will Minister do to ensure the waiting lists are reduced and a better service is provided?
Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputy for raising this issue and for the opportunity to provide an update to the House on services for children and teenagers with type 1 diabetes in the Cork area. Regarding paediatric diabetic services generally, the Deputy may be aware that the HSE developed a model of care for paediatrics and neonatology in Ireland to underpin the delivery of healthcare for children, both in the present and into the future. Key steps in its development were wide consultation with all healthcare professionals, involvement with parents and parent groups, a detailed analysis of the current clinical activity of all paediatric medical and surgical subspecialties, including paediatric endocrinology and diabetes, and a study of how paediatric clinical care is distributed with reference to international best standards. The HSE model of care for paediatrics includes the proposed model of care for paediatric diabetes services.
6 o’clock
High-quality diabetes care is complex and requires intensive consultant-delivered care. It is recognised that diabetes care provided by a multidisciplinary team, including clinical nurse specialists, dietetics, social work and clinical psychology, results in fewer days in hospital, a higher level of participation in diabetes self-care practices, decreased readmission rates and delayed development of complications. Diabetes technology also provides an opportunity to improve control and quality of life in selected patients and is expanding rapidly, with continuous subcutaneous insulin infusion, or pump therapy, increasingly used in the paediatric population.
The model for service provision proposes that all hospitals providing acute paediatric care will have staff trained in the acute care of newly diagnosed diabetes. Children whose diabetes is diagnosed in level 1 hospitals that do not have access to a paediatrician with endocrinology training will be referred to their nearest diabetes multidisciplinary team once they have been stabilised in accordance with local agreed guidelines. In addition, the HSE has advised that seven clinical guidelines have been published and disseminated to the delivery system to guide and support service delivery to this patient cohort.
Regarding services in the Cork area specifically, CUH is a centre for paediatric diabetes and provides care for patients in the south west. More than 400 paediatric patients attend the diabetes service in CUH, with one to two new cases of insulin-dependent diabetes mellitus, IDDM, diagnoses per week. The paediatric diabetes service in the hospital has provision for two consultants, 2.8 diabetes nurse specialists and one dietician. The second consultant post is currently being recruited for and the candidate is expected to take up the position in January 2020. CUH is working actively to expedite this start date and, in the interim, is seeking to secure a locum consultant endocrinologist. In addition, it has recruited a locum consultant paediatrician to support the paediatric endocrinology service commencing in June.
Approval for recruiting additional posts for paediatric services in Cork was given in this year's national service plan. The posts include a psychologist, social worker and dietician. These posts will support the delivery of the model of care for paediatrics in CUH.
7:00 pm
Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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I thank the Minister of State for his response, but more is needed. From speaking to the parents at the protests, they were concerned, frustrated and angry at a situation that had been developing for some time. Many of them pointed to the fact that the number of children and teens presenting with diabetes was increasing rapidly. Is the Minister of State confident that what has been agreed to, but still has not been delivered, will be adequate to clear what is a substantial backlog of 400 children and young adults? They are not just from Cork, but the wider south west. Will the appointment of an additional consultant on a locum basis and the appointment of a consultant on a permanent basis at the start of next year, which is still a ways off, be enough? This issue needs to be examined carefully to ensure that the children in the substantial backlog are seen every four months as required.
I will take this opportunity to draw the Minister of State's attention to another matter that has occurred to me during our discussion on diabetes. He will be aware that Sinn Féin has published legislation on reforming the long-term illness scheme so that it is reviewed more frequently than is currently the case. Some products and medicines would benefit people, including children, with diabetes. FreeStyle Libre has been made available to children under the scheme but, as far as I am aware, it is not available to all patients with diabetes. Our legislation would allow the long-term illness scheme to be reviewed regularly and to be of benefit to many of the patients in question.
There is a substantial backlog of patients. I appreciate that an appointment next January has been approved and that a locum will be in place. I hope that the latter will be dedicated to this service full time. To put it bluntly, if the additional consultant is provided, is the Minister of State confident that children will be seen every four months?
Finian McGrath (Dublin Bay North, Independent)
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Regarding the Deputy's question on whether it is enough, it will never be enough where some services are concerned. I have just come from the Rehab talks, which are moving along nicely.
The Government is committed to developing and strengthening all paediatric services, including diabetic services. I accept the Deputy's points, particularly those concerning teens and children. No one is arguing otherwise. The national paediatric model of care aims to deliver services that are timely, effective, safe, child and family-centred, efficient and equitable. No one disagrees that all children should be able to access high-quality services in an appropriate location within the appropriate timeframe irrespective of their geographical locations and social backgrounds. That is the plan under Sláintecare, which sets out a vision of high-quality, integrated and accessible healthcare services for children from birth to adulthood. The model is based on the principle of good quality care with an emphasis on early detection and prompt treatment.
Regarding the services in Cork, a second permanent post is being recruited for and is due to commence. We are trying to move that process forward and get that person in place. In the interim, CUH is hoping to secure a locum in addition to the locum general paediatrician. The HSE's national service plan also makes provision for the recruitment of additional posts for paediatric services in the Cork area. These include a psychologist, social worker and dietician and are intended to support the delivery of the model of care for paediatrics in CUH. The issues that the Deputy raised are important and I will highlight them to the Minister, Deputy Harris.