Dáil debates

Thursday, 25 November 2021

Saincheisteanna Tráthúla - Topical Issue Debate

Hospital Services

7:20 pm

Photo of Brian StanleyBrian Stanley (Laois-Offaly, Sinn Fein)
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I wish to raise a very important matter relating to the diabetes clinic at Portlaoise hospital, which services a very large area not just in County Laois but also Offaly, north Tipperary and south Kildare. Currently it is blocked from providing full services and it cannot provide insulin pump services because there is no adult dietician in place for the adult clinic, which is required for it to function fully.

I have spoken to staff and some of the families affected by this. There is a wonderful children's diabetes clinic at the site but unfortunately diabetes has become very prevalent. We must deal with that and prevention is better than cure but we must also deal with the here and now. A high number of people suffer from diabetes in this country and although we must get better at prevention, this is where we are. There are hundreds of adults and children attending the Portlaoise clinic. I hear nothing but praise about the children's clinic but, unfortunately, the adult facilities do not provide full services. There are also many teenagers caught in a position where they should be transferring to adult services but cannot do so; they have come of age but the service is not there so they cannot move on.

People are currently travelling to Dublin for insulin pump services and many are paying for a private service. Some of the people are on low incomes from work or a mixture of work and social welfare. It is putting huge financial pressure on families. The Minister of State understands community care as well as the Minister for Health because of her interest in these matters. I know we cannot have a service at every crossroads but we must regionalise services and ensure we have a strong range of services because where people can access them, they are more inclined to use them.

This is really important and my understanding is the hospital management has made the case on no fewer than three occasions in the recent past to try to get an appointment to the post. I hear the Minister of State is responsible for good news and she had some earlier for Deputy Murnane O'Connor. This is one post and it is important that diabetes is treated properly.

The families had a protest outside the hospital last Sunday week, that is how strongly they feel about this. They have conveyed to me in no uncertain terms that this must be sorted out. The hospital staff and management are on board with this request. Portlaoise hospital is making good strides and there is new investment going in, which is all to be welcomed. I always complain when something does not happen but I will always acknowledge when something does, and that is important. We must recognise what is happening and the new respiratory assessment unit will be great when it is built with the other facilities. This piece is missing from the adult services for diabetes.

As I said, there was a protest last Sunday week, on 14 November. If we can get this over the line it would be really good for the area, not just in Laois but the surrounding counties as well.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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Again, I am taking this matter on behalf of the Minister, Deputy Donnelly. Diabetes is a complex condition that can have a profound impact on the quality of life of people living with the condition. If not well managed, it can lead to debilitating complications. The increasing prevalence of diabetes poses a major challenge to our health service, with increasing costs driven primarily by hospitalisation and treating associated complications. Management of the condition is required across the entire spectrum of healthcare delivery, including self-management support, as well as care delivered through general practice, community specialist care and hospital inpatient specialist care. Diabetes services at Portlaoise hospital provide care for patients with paediatric, adult and gestational diabetes. The services provide treatment for.patients as part of a multidisciplinary team comprised of consultant endocrinologists, dieticians, clinical nurse specialists in diabetes for adults and children, an advanced nurse practitioner and a podiatrist.

Portlaoise hospital services have been providing insulin pump therapy service to patients since 2017. Insulin pump therapy supports patients to improve their glucose control and improves their quality of life. Currently, 86 children with type 1 diabetes are attending the hospital, with 49 patients receiving insulin pump therapy. At present, approximately nine new patients require access to this therapy each year, which is guided by the paediatric model of care for children and young people with type 1 diabetes.

As patients reach 16 years, diabetes services hold a transitional clinic where paediatric patients are supported to transition to the adult diabetes service. The Deputy was speaking about that transitional care piece. In the past two years, eight patients have transferred to the adult service, five of whom continued to receive insulin pump therapy. It is estimated that approximately 11 patients will transfer to the adult service in 2022 and a further 14 will transfer in 2023.

Portlaoise hospital recognises the importance of this service for diabetic patients and their families. The hospital is working to support the dietetic service in meeting the increasing demand for insulin pump therapy as patients are transferred from the paediatric to the adult service. Currently, six adult patients receiving care are on insulin pump therapy and four adult patients are on the waiting list. Portlaoise hospital has employed an advanced nurse practitioner in diabetes to support the diabetes service and has recently approved an additional 0.5 whole-time equivalent to meet immediate needs in the dietetic service. I do not know how recently that was.

The HSE is committed to working with Portlaoise hospital to maintain and improve diabetes services, including through further development of the adult insulin pump service. This response indicates there is active management involvement in ensuring we can recruit the staff to meet the needs of the growing population transferring from paediatrics into adult care. The first response has been the recruitment of the 0.5 whole-time equivalent.

7:30 pm

Photo of Brian StanleyBrian Stanley (Laois-Offaly, Sinn Fein)
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I thank the Minister of State for her response. I wish to clarify this. Having spoken to staff and families, they are clear that at this point, unless the situation has changed in the last day or two, a dietician is required for the adult services to operate fully. A senior dietician is needed to provide instant pump services. That is the issue I want clarified. The HSE can often explain matters in medical terms; we are lay people. That is the missing piece here.

The importance of providing that proper treatment to people with diabetes cannot be overstated. It is for their health. All medical practitioners, nurses and GPs, will say it is really important that it is maintained and monitored properly and that they have the proper care. Failure to look after it properly leads to a whole range of other health problems down the line. We have all seen that in the community with people who are diabetic and do not get proper treatment. While cost should not be the biggest consideration, it can lead to extra cost on the health system because if prevention is not addressed, one will end up with greater health problems, higher costs and sicker patients, which is the real issue here.

We are talking about this one position. We are not talking about millions of euro. A relatively small amount of money is needed to facilitate the full service. I appeal to the Minister of State to put that in place. There are huge demands on the health system currently and we all understand that. However, while that is happening, I am sure the Minister of State would admit that there are many gaps in our health services at the front line. HSE management might talk around it and the Minister of State could be as confused as ever when finished talking to them. I do not mean that in a derogatory way. The public needs access to good local services. Will the Minister of State clarify exactly what she said in relation to the dietician for that clinic?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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Let us be clear on the response. Portlaoise Hospital has employed an advanced nurse practitioner in diabetes to support the diabetes service and has recently approved an additional 0.5 whole-time equivalent to meet the needs in the dietetic service. In reference to the dietetic service, a 0.5 of a whole-time equivalent has been approved and that was shared in my initial response. I will seek further clarification to give the Deputy a comprehensive answer from the Minister, Deputy Stephen Donnelly. This Government is completely committed to improving services for all those living with chronic disease, including diabetes. If this has not been answered wholesomely enough, we will get confirmation from the HSE and I will forward an answer to the Deputy though the Chair by tomorrow.