Joe Flaherty (Longford-Westmeath, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I am extremely worried about developments at the paediatric diabetes clinic at Mullingar hospital, where services and appointments have ceased as a result of a farcical recruitment issue. There are 130 children attending this service, with 41 on insulin pumps.

Based on those numbers and international standards, there should be two clinical nurse specialists, CNS, attached to this service. A former CNS was due to retire in May 2019 but remained working on a part-time basis until November 2019 to ensure the service could continue. Unfortunately, it is now almost 20 months since the service has had specialist diabetic nursing support for clinics and for the necessary follow-up support services. Parents are deeply perplexed. Great credit is due to Professor Michael O'Grady who heads up the service and in recent days took the time to issue parents with a four-page document setting out the comprehensive background that has led to the suspension of services.

The case for a replacement CNS was first rejected at national director level in 2019 but, thankfully, following the intervention of Professor O'Grady, that decision was subsequently reversed. As we all know, there is a shortage of nurses qualified to work in the role of CNS in paediatric services. Professor O'Grady again intervened and asked that a background in paediatric nursing be removed from the job specification to broaden the pool of potential applications. Unfortunately, that request and advice was ignored. Not surprisingly, when the post was advertised in December 2019 there were no applicants. So began a new recruitment process which, within the HSE, typically takes six months. Once again, the prohibitive requirement that applicants have a background in paediatric nursing was retained despite the HSE knowing it would restrict the level of applications. Around this time, and in conjunction with the recruitment campaign, Professor O'Grady presented a business case for a second CNS for the service in line with the aforementioned international staffing requirements. That case was duly approved by local management but was subsequently rejected up the line.

Last September, the service was forced to scale back the number of services offered in Mullingar and to close access for new patients, who are now being sent to Dublin for treatment. The service was also forced to suspend the initiation of insulin pump therapy for new users following the departure of one of Professor O'Grady's consultant colleagues. As things stand, a replacement CNS has been approved but, unfortunately, for personal reasons, this person is not in a position to take up this position until 2022 and the service in Mullingar is paused. Children are being referred to Dublin where the service is already at capacity in the three hospitals. Those hospitals will be overwhelmed with an additional 130 patients.

Professor O'Grady has fought valiantly for more than a year to save this service. It is regrettable that the future of such an important service for our region is the subject of a debate here this evening.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for raising this issue and for setting out clearly the history in this situation, which gives me the opportunity to provide an update to the House in regard to the concerns relating to the paediatric diabetes service at the Midland Regional Hospital, Mullingar.

The HSE has advised that the Midland Regional Hospital, Mullingar, has a comprehensive diabetes and endocrinology service. This is an integral part of the overall services provided by the hospital and is supported by a multi-disciplinary team of doctors, nurse specialists, dieticians and administrative staff. The services include a rapid access diabetes service, a general diabetes clinic, a young adult clinic, a diabetes in pregnancy clinic, a diabetes foot clinic and a community e-consultation service.

We know that diabetes affects people from all walks of life, from the very old to the very young and that the number of people with all types of diabetes is predicted to increase rapidly in the coming years. Internationally, type I diabetes is increasing in all age groups. In Ireland, this is especially true in the 10 to 15 year old age group. In regard to paediatric diabetes services generally, the HSE has developed a model of care for paediatrics and neonatology in Ireland, which includes a chapter on the provision of diabetes services. This model of care highlights that high-quality diabetes care is complex and requires intensive consultant-delivered care. It also recognises that diabetes care should be provided by a multi-disciplinary team that includes clinical nurse specialists, dietetics, social work and clinical psychology.

The HSE has advised that, as highlighted by the Deputy, 130 children and adolescents attend the paediatric diabetes service at the Midland Regional Hospital, Mullingar, which consists of a clinical nurse specialist and specialist dieticians. The Deputy might wish to note that the hospital has also recently secured approval for 19-hours per week senior dietetic support. The HSE has further advised that the paediatric diabetes service was suspended temporarily last week pending the successful recruitment of a paediatric diabetes nurse, that prescriptions are still being offered through the service and that if a patient is sick, he or she can be seen through the hospital's emergency department.

The Deputy outlined that the paediatric diabetes nurse position was first advertised in December 2019. However, for a number of reasons the position was not filled on foot of this process. The position was again advertised in autumn 2020. I am advised that interviews for that position were completed recently and that an offer has been made to a successful candidate. It is, therefore, expected that the new paediatric diabetes nurse will take up employment shortly.

Joe Flaherty (Longford-Westmeath, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome the response, but I take issue with parts of it, specifically that the current service consists of a clinical nurse specialist. That is not true. I appreciate that a position has been offered but the reality is the person cannot take up that position until 2022. In effect, there is no clinical nurse specialist attached to this service.

I refer to Professor O'Grady's recommendation and business case for a second clinical nurse specialist for this service in line with international norms. I acknowledge that parents and children can access services through the emergency department, if necessary, but in the context of Covid-19 we are trying to discourage that. It is critical that we get this service back up and running. It is a vital service for the region. To be honest, the response issued from the HSE through the Minister of State is not good enough for the parents and young children.

I would be remiss if I did not acknowledge Professor O'Grady who, along with his family, moved here from Australia eight years ago, settling in Mullingar town, and pioneered and developed this state-of-the-art leading paediatric diabetes service in this country, of which the hospital in Mullingar is incredibly proud. He has spoken passionately about this service. He is exasperated and the parents are crestfallen. They have spoken about the demise of the service and have communicated this in emails. To be honest, they are angry and distraught. It would seem that the only bodies that can save this service are the HSE and the office of the Department of Health. I plead with the Minister of State to take back to the HSE the message that the people of four counties, including Longford, Westmeath, Offaly and Meath, are dependent on this service and that its response via the Minister of State this evening is not good enough for the parents and children concerned.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for the constructive manner in which he has approached this matter. I take on board his acknowledgement of Professor O'Grady and all of the work he has done over the past eight years to develop this service, which is very important.

The Government is committed to further developing and strengthening diabetes services throughout the country, for both children and adults, given the prospective increases in the number of people that will be affected by this chronic health condition in the years ahead. I reiterate that it is expected that the new paediatric diabetes nurse will take up employment shortly. The HSE has not mentioned this will happen in 2022 but, coming from the particular area, I am sure the Deputy has a lot more knowledge on this issue than I do.

I understand the widespread concern that the current suspension of the paediatric diabetes service in Regional Hospital Mullingar has caused. As I said, the HSE has advised that an offer has been made to a successful candidate and the recruitment process for this post will be finalised as quickly as is possible. I am confident that the paediatric diabetes service will recommence operation when this post is filled. I will bring the Deputy's concerns to the attention of the HSE.