Dáil debates

Wednesday, 22 June 2022

Saincheisteanna Tráthúla - Topical Issue Debate

Health Services

9:22 am

Photo of Pádraig O'SullivanPádraig O'Sullivan (Cork North Central, Fianna Fail)
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I wish to raise the issue of paediatric patients in Cork University Hospital, CUH. An issue in respect of type 1 diabetes and the lack of provision of insulin pumps in particular is causing concern for parents. Many parents to whom I have spoken have been calling for additional staffing and resources for several years. This has been an issue for quite some time. Many of the issues relate to employment and the inability to appoint a consultant and nurses in that space. That has proven difficult in recent years. Many children whose parents I have spoken to have received initial appointments. The parents praise the CUH staff and the level of service they have received up to now but, unfortunately, after the initial consultation there is an issue in respect of insulin pumps in particular. Many parents to whom I have spoken have been waiting more than a year for those new pumps to be approved and for people to be trained in their use. The delays are occurring both in CUH and in training the parents and families.

Obviously, the great benefit of the pump therapy is that it reduces people's reliance on having to give themselves injections, as they may have to do repeatedly throughout the day. It is a much better process than the older and outdated one. I am aware of a four-year-old boy who is due to start school in September. His school and his special needs assistant, SNA, in particular have been great. They were ready to be trained to help him with his injections or to do the injections for him while he is at school but, unfortunately, at the last minute CUH withdrew the potential for training those school staff members to make sure that young child can self-medicate. Obviously, that is a specific circumstance, but it is indicative of the wider problem in respect of staffing and training.

I understand there is a severe shortage of consultants in the field. CUH currently has one whole-time equivalent and two diabetes nurses, with a further two to be hired. We are still waiting for them to start. Much of the correspondence I have received states that commencement will happen shortly but many of these families have been waiting two or three years and the commencement cannot come quickly enough. The consultant who is in place in CUH currently has between 400 and 500 patients under his care. He has issued guidance notes stating that, in theory, a consultant should only have 150 paediatric patients under his or her care. Services at CUH are under severe pressure. Several children on pump therapy are awaiting new pumps. Many of the older pumps, or the warranties thereof, have expired. There are delays in issuing new pumps and getting people the relevant training for the new pumps so that they can carry over. They have had to revert to the injection model, which is not ideal.

Looking at it from the outside in, the problems in respect of vacancies and employment in the HSE seem to be catching up with us in this field. Does the Minister of State have any update in respect of the commencement of those much-needed staff?

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising this issue and giving me the opportunity to provide an update to the House on the paediatric diabetes clinic services at Cork University Hospital. I take on board the situation he raised in respect of a four-year-old with type 1 diabetes who is starting school for the first time and trying to cope with all the intricacies of that. As the Deputy is aware, type 1 diabetes is an intensive condition to manage.

Commencing a child on an insulin pump requires intensive education for not only the child but the entire family, as well as the school and the special needs assistant, SNA, involved. It involves close monitoring of glucose levels and insulin doses, particularly in the early stages of insulin pump use.

To support the child and the family, an intensive programme is put in place by the multidisciplinary team. This helps to optimise the child's health and prevent hospitalisation. Specialist nurse teams work closely with the family to allow for close monitoring, insulin pump dose adjustment and to ensure the child and family have guidance and support during intercurrent illness and outpatient appointments.

The HSE has advised that with respect to services in the Cork area, Cork University Hospital, CUH, is a centre for paediatric diabetes providing care for patients in the south-west region. There are currently more than 525 paediatric patients attending the diabetes service in CUH. In CUH the multidisciplinary team members have met and reviewed all patients, who will be prioritised in line with the individual patient's clinical need, based on best practice and international guidelines in the recommencement of the insulin pump service. The HSE has advised me that the new pumps are due to be available in CUH by the start of July.

A small selection of children will be started on the new pumps and it is planned to increase the numbers as more supplies become available in CUH. Children will be supported and guided in their use on a case by case basis. The HSE has assured me that engagement is ongoing with the Cork diabetes parent group, T1 Diabetes Parents' Alliance, which is being kept updated on service developments.

The HSE has confirmed that the CUH paediatric diabetic team comprises one whole-time equivalent consultant dedicated to the paediatric diabetes and endocrinology service. This is provided by two paediatric consultants with a special interest in diabetes and endocrinology at 0.5 whole-time equivalents each. There is also one full-time dietician in post and two whole-time equivalent diabetes nurse specialists in post. The HSE has further advised that additional staffing resources were secured by way of a business case submitted by CUH to the South/Southwest Hospital Group, where an advanced nurse practitioner and two additional diabetics nurse specialists were secured for the paediatric diabetes service. These posts are being progressed through recruitment with a nurse specialist panel being available to allow for the direct progression of the positions. I take on board what the Deputy has said in that it cannot happen soon enough, especially with 525 young children attending the service.

The Government, along with the Department of Health and the South/Southwest Hospital Group are fully committed to the progressive development of the paediatric diabetes clinic service within the group and to improving this service for patients of the south and south-west region.

9:32 am

Photo of Pádraig O'SullivanPádraig O'Sullivan (Cork North Central, Fianna Fail)
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I thank the Minister of State and appreciate her response, although it is similar to some of the responses I would have gotten over the past number of weeks. I am in a fortunate position because I have three children and I am unaware of any medical needs they might have. They are very young and I hope they will be fine when it comes to issues like type 1 diabetes, which as the Minister of State said is a severe illness that will affect people for the rest of their lives. When engaging with the HSE and health services in the country, however, these are the types of things that infuriate people. There is the language, including words like "shortly" but there are no definitive or indicative timelines. Communication is ordinarily scant, and that frustrates parents and causes most concern.

I acknowledge that CUH has recently engaged with that new parents' group, which is welcome. A number of parents I spoke to have acknowledged that. Realistically, we must get on with hiring these staff urgently. This has gone on for a number of years. I can remember watching video clips on Facebook going back to 2017 and 2018 on this matter of a lack of pumps. This is what we are talking about today and it is three or four years on from those initial protests but very little has been done.

I understand funding and the posts have been signed off. I ask the Minister of State to follow up with CUH to see what "shortly" means in this context. Is it next week, next month or in six months? Any type of an indicative timeline would be great for those people. As I said, a number of the children are starting school, which is stressful enough in itself, even without having to be tasked with self-injecting on numerous occasions throughout the day. I thank the Minister of State for her time.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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The Minister of State has time for a reply.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I see the Acting Chairman is multitasking today.

I take on board everything the Deputy said. As we mentioned, diabetes is a very serious illness and commencing a child on an insulin pump requires intensive education for the child and entire family, with close monitoring of glucose levels and insulin doses required, particularly in the early stages of insulin pump use. Type 1 diabetes is an intensive condition to manage and in order to provide safe care for the entire paediatric diabetes patient cohort, the service must prioritise the essential components of diabetes care for all children under the care of the service.

It is welcome that with the diabetes service in Cork, new insulin pumps will be available at the beginning of July and plans are well advanced to train staff, patients and their families in the use of these pumps. The hospital has secured additional staffing resources that are in the process of being recruited. Unfortunately, as I know all too well in my role, sometimes recruitment of staff can take between 40 and 50 weeks. We will check it out for the Deputy and see if we can get a more indicative timeline in that regard.

I assure the Deputy the South/Southwest Hospital Group remains committed to the progressive development of paediatric diabetes services within the group and to improving the service for patients of the south and south-west region. I know how worrying it is for families and especially the young children trying to deal with this on a daily basis. We will revert to the Deputy on this.