Thursday, 19 November 2020
Saincheisteanna Tráthúla - Topical Issue Debate
I bring to the attention of the House concerns over the staffing issues that will affect the diabetes clinic service in Midland Regional Hospital, Mullingar. Several constituents have contacted me this week over concerns that the service could cease at the end of the month. Patients were told when attending this week that there is uncertainty about the future of the service, and none of those who attended this week was issued with a future appointment. This problem has festered since the retirement of the dedicated diabetes nurse more than 18 months ago. I understand she even deferred a decision on her retirement in the hope that the post could have been backfilled before she retired.
Unfortunately, nothing happened, and since then the service has been dependent on other nurses standing in and assisting the consultant. As a consequence, dates for future appointments started to be pushed out. First it was three months and it then became four months. For those who attended this week, it was their first appointment in more than nine months, and now they face the prospect of no future appointments. This is very difficult for people and especially parents who are trying to manage medication and treatment. It simply cannot be allowed to continue. In the event that the service is not fully restored, the only option for the many service users will be to attend Our Lady's Children's Hospital in Crumlin, which is simply unimaginable.
This vacancy was first advertised in December 2019. This is not a new issue. The management of the hospital knew this retirement was coming down the line. In fairness to the nurse, she stayed on to support those families who are heavily reliant on the service and speak incredibly highly of the team in place there.
I want to put this into perspective. I spoke to the parent of a child with type 1 diabetes. The family is absolutely distraught. While speaking highly of the team, she said the nurse was the glue that held the team together for the family. She was on the phone when the family went abroad and the child's bloods went out of sync and when she entered puberty, which also knocked her bloods out of sync. The girl's most recent appointment was in January. She had another scheduled for June, which was cancelled, and this week she was told that from the end of November, no further service will be available to her.
This is devastating. The constituents I spoke to are not just from Longford-Westmeath. It is also children from Offaly and Laois. The son of another lady I spoke to ended up having to attend the accident and emergency department due to an insulin overdose. This is very serious stuff. The specialist service at the moment cannot be allowed to stop. It simply cannot be allowed to fail. It is also the case that children whose diabetes is consistently well maintained are being told they cannot have access to insulin pumps because the service will not be available there any more. There is no excuse for this happening. The position of diabetes nurse is one of the toughest to fill. This position should have been advertised much earlier than it was. There is talk of possibly interviewing for the post in early December, but the patients have been told there will be no more service from the end of November.
I thank the Deputies, on behalf of the Minister, Deputy Stephen Donnelly, for raising this issue and giving me the opportunity to provide an update to the House on concerns over the future of the diabetes service at the Midland Regional Hospital, Mullingar.
Diabetes, as we all know, is a complex condition that affects people from all walks of life, from the very young to the very old, and is considered an epidemic by the World Health Organization. People with diabetes run a greater risk of developing one or more severe health complications that can greatly impact on their independence and quality of life. According to the HSE, it is estimated that there are more than 200,000 people with diabetes in Ireland. It is estimated that approximately 33,000 of these have either type 1 diabetes or genetic or secondary causes of diabetes. The remaining patients have type 2 diabetes. A significant proportion of these patients remain undiagnosed. Worryingly, it is expected that the number of people with type 2 diabetes will increase by 60% over the next ten to 15 years.
Against the backdrop of an increasing prevalence of predominantly type 2 diabetes in the community, the HSE's national clinical programme for diabetes established a national diabetes working group, with the joint involvement of healthcare providers in primary, secondary and tertiary care sectors, to develop a national model of integrated care for type 2 diabetes. The national model of integrated care aims to reduce the proportion of diabetes-related mortality by 10%. It also aims to reduce diabetes-related morbidity such as blindness and lower amputations. In respect of paediatric diabetes services, the HSE developed a model of care for paediatrics and neonatology to underpin the delivery of healthcare for children both in the present and into the future.
The HSE has advised that the Midland Regional Hospital, Mullingar has a comprehensive diabetes and endocrinology service which is an integral part of the services provided by the hospital. This service is supported by a multidisciplinary team of doctors, nurse specialists, dieticians and administrative staff. The service includes a rapid access diabetes service, general diabetes clinics, a young adult clinic, a diabetes in pregnancy clinic, a diabetes foot clinic and a community e-consultation service. On the face of it, therefore, one might say that everything is perfect, but I take on board both of the Deputies' points about the diabetes nurse manager.
My understanding, from a supplementary note I have just received, is that Deputy Clarke was correct in saying the position was first advertised on 20 December 2019 but that place was not filled at that time, and then Covid-19 happened. The position was opened to applicants on 21 September 2020, with a closing date of 5 October 2020. The interview board has been convened and interviews will take place in the coming weeks.
That is the most up-to-date information I have.
I appreciate the seriousness of this issue. For the past four years, always on World Diabetes Day, I was to the fore in raising it in the Dáil. I am proud to say that, working with the Ceann Comhairle in the previous Dáil, we managed to turn the lights on the right side of Leinster House blue to mark that occasion. This is an issue that is very close to my own heart and I know how serious it is. My understanding is that there should not be any cause for worry in regard to the service in Mullingar. There is a comprehensive diabetes and endocrinology service in place and the recruitment of the person who will be the glue that holds everything together, as Deputy Clarke described it, is currently in process.
I thank the Minister of State for her reply. I welcome the commitment that the position is being advertised and will be filled. I hope the delay in filling it will not affect the service in the interim. We are all well aware that diabetes is a very costly issue for the health service. The easiest and most effective way to deal with it is through personal management of the illness rather than expensive interventions. In Longford alone, over a four-year period, there have been 24 cases of lower limb amputation as a direct result of diabetes. In the same period, there were 124 cases of diabetes patients dealing with severe foot ulcers. I am concerned that there has been a delay in filling the post but I accept the Minister of State's commitment that the service will not be affected.
I welcome the commitment the Minister of State has given. Retaining the service at Mullingar makes sense not only from a moral point of view but also from a fiscal perspective. Children learn very early to manage their diabetes and it is a habit that follows them into adulthood. When they become adults, that habit reduces the cost to the HSE in terms of the number of hospitalisations and interventions needed. However, an issue that has cropped up during this period is that there has been a distinct lack of information and no clarity given to parents and patients. That creates a vacuum where misinformation can take hold and rumour can take over, which causes further stress and pressure for people. We need a commitment that the service will not be impacted while the recruitment process is ongoing. Heaven forbid that a nurse is not recruited.
I agree with the Minister of State that we are facing an epidemic of diabetes. I suffered from gestational diabetes. In a response to a parliamentary question from my colleague, Deputy Cullinane, we were told that there are 26.5 full-time equivalent diabetes nurse positions. How do we manage an epidemic with that number?
I reiterate that the Government is absolutely committed to further strengthening and developing diabetes services throughout the country for children and adults. I draw the Deputies' attention to the FreeStyle Libre device that is proving very successful in helping children and young adults to manage type 1 diabetes. It is not an option to manage diabetes. Given the prospective increase in the number of people who will be affected by this chronic health condition in the years ahead, it is a necessity. The HSE has advised that the Midland Regional Hospital Mullingar will build on the success of the very reputable diabetes service it currently provides. Parents are concerned about the future of the service because it is a good service. The HSE has assured me that a number of qualified applicants have been shortlisted for the position of paediatric diabetic nurse manager and the recruitment process for the post will be expedited to the greatest possible extent.
Deputies may be interested to know that I received an email today confirming the setting up next week of an all-party committee on diabetes under the chairmanship of Deputy Devlin. I was formerly chairman of the all-party committee on dementia which had a hugely successful engagement on the issues relevant to its remit. The Acting Chairman often attended its meetings. The most important point about all-party committees is that politics are left at the door. Everybody involved wants to work together to devise the best possible way of affecting change. I hope Deputies will support the inaugural meeting of the new committee next Tuesday.