Kathleen Lynch (Cork North Central, Labour)

I congratulate the re-elected and newly-elected Senators. I also congratulate the Cathaoirleach on his election to his new position.

I thank Senator Terry Leyden for raising this matter on the Adjournment. In 2006 the then Department of Health and Children published a policy report on diabetes, Diabetes: Prevention and a Model for Patient Care. It set out a model of care based on shared care between primary care and acute services which would deliver quality diabetes care at the appropriate level. Many patients with a chronic condition such as diabetes do not require hospital admission but can be managed in primary and community care settings if the appropriate support is available and agreed protocols and pathways are followed. This also applies to self-management and support. It is important, in the current challenging economic climate, that patients receive the best treatment possible in the most cost-effective manner.

The HSE established an expert advisory group to take forward and implement the Department's policy recommendations on diabetes. Its report was launched in November 2008. The report made a series of recommendations relating to the changes required to raise the standards of diabetes care in Ireland to a level comparable to those currently attained in similar developed health care systems worldwide. These include specific recommendations on the provision of paediatric and adolescent diabetes care. A key element was the publication of integrated care guidelines which represented a new way of primary care and acute specialist services working together to reduce the burden of this condition.

The expert advisory group emphasised that real savings could be achieved in health care costs by preventing the complications of diabetes. These would be achieved through patient education and empowerment, primary care linked to specialist secondary care and special provisions for early detection and treatment of any complications that would develop. In this shared care model, roles and responsibilities are clearly understood and the model is supported by agreed protocols. This type of care has been shown to be particularly effective for the management of type 2 diabetes.

The HSE established a national clinical programme for diabetes within the clinical strategy and programmes directorate. A clinician was appointed to take the lead on the diabetes clinical programme and he has engaged with all stakeholders, including the Diabetes Federation of Ireland, clinicians and podiatrists to establish a multidisciplinary package for diabetic patients. A multidisciplinary working group, representing a number of nursing and allied health professionals, podiatrists and general practitioners as well as the Diabetes Federation of Ireland, are working through a number of key projects. The key deliverables for the 2011 programme are the implementation of projects such as diabetes retinopathy screening and a multidisciplinary foot care package for patients with diabetes.

It is planned that the diabetic retinopathy screening programme will be offered to all diabetics over the age of 12. The HSE has also established a national clinical programme for paediatrics, which will examine in detail the area of improved services for children and adolescents, and it will develop solutions to address the issues identified. Diabetes service implementation groups have been established throughout the country to progress the recommendations of the diabetes expert advisory group, including those which relate to paediatrics.

A diabetes service implementation group has been established for HSE west, and the group's regional work plan includes a focus on primary care, hospitals, children and adolescent support services, and linkages to the local diabetes implementation groups. The group is supported by three local diabetes services implementation groups, one covering the counties of the north west, another for those in the west and the third for the mid-west. With regard to access to treatments for children and adolescents with diabetes in HSE west, diabetes care is provided to this group at Letterkenny General Hospital, Sligo General Hospital, Mayo General Hospital, Roscommon hospital, Portiuncula Hospital, University Hospital Galway and mid-western regional hospitals. This care is provided by paediatricians with an interest in diabetes, as well as clinical nurse specialists.

In addition, the first paediatric endocrinologist in HSE west was appointed recently at the mid-western regional hospital in Limerick. There are transitional clinics in place across HSE west for children and adolescents who are transferring from paediatrics to adult services. Paediatric care is recognised as an important element of the diabetes programme required to maintain the health of the diabetic population. Regional diabetes services implementation groups are working to improve provision and access to services for paediatric patients with diabetes. I thank the Senator for raising the issue.