Fidelma Healy Eames (Fine Gael)

I welcome Minister of State. The issue I wish to raise follows quite nicely from the previous debate because it is with regard to the provision of diabetic pumps and the appropriate backup staff for children with type 1 diabetes in County Galway.

Approximately 3,000 children and adolescents in Ireland have diabetes, and approximately 850 of them live in the HSE west area of which 200 to 250 live in Galway city and county. Almost all of these children and adolescents have type 1 diabetes, with the incidence of type 1 diabetes in childhood and adolescence having doubled in the past 20 years, which is quite an increase.

Generally, Ireland has very poor paediatric diabetes care, with over half of the patients having no access to a proper multidisciplinary team and many of the rest travelling long distances for care. Currently, children and adolescents with diabetes outside of Dublin are at a geographical disadvantage because of the lack of local services. On the other hand, children and adolescents with diabetes in Dublin, where there are services, are at a numerical disadvantage because so many children from outside Dublin are forced to travel there. Dublin services are inundated with referrals for children and adolescents with diabetes from throughout the country.

Children and adolescents with diabetes must attend hospital on average four to five times per year to monitor their diabetes. Monitoring children and adolescents with diabetes in hospital aims to limit the subtle but cumulative damage which diabetes can cause to the eyes, kidneys, nerves and smaller blood vessels. Up to 50% of children and adolescents with diabetes will have some form of long-term diabetes complication by the time they reach adulthood. This is worrying. Diabetes is a cumulative condition and if it is not properly approached and dealt with, complications can emerge quickly. In order to reduce the risk of a child developing any of these long-term complications, children and adolescents with diabetes learn to control their diabetes and to monitor their blood sugars and insulin levels.

Self-control of diabetes is challenging but this is what the parents want because they know that is what is best for their children. Technological advances now allow children and adolescents with diabetes to monitor their diabetes with intensive therapies, such as insulin pumps, much more effectively and accurately than with standard treatments.

Insulin pumps are the focus of my Adjournment matter. An insulin pump is a medical device used for the administration of insulin in the treatment of diabetes and of MDI, multiple daily injections of insulin. Both are an advance on the standard twice-daily injection with insulin. Insulin pumps are more correctly referred to as continuous subcutaneous insulin infusion. Insulin pump technology is not available at hospitals where the vast majority of children and adolescents with diabetes receive their diabetes care. Pumps are an effective method of insulin delivery and are the method of choice in many countries that practise intensive insulin management. An improved quality of life is associated with pump usage.

The use of insulin pump technology makes a lot of sense. The long-term cost to the health service of not approaching diabetes early is huge. Patients in Ireland should have an equal opportunity to access pump therapy and they and their parents are increasingly seeking insulin pumps. The funding issue regarding pumps is improving, but it is still inadequate as demand for pumps, for example in Galway University Hospital, vastly exceeds supply. Insulin pumps are, essentially, unavailable in Galway where only 12 pumps are allocated per year, despite the hospital having the correct clinical expertise on hand. Parents of children with diabetes in Galway are clear that they want this treatment and more pumps made available locally. Having children treated in Dublin means four to five trips per year, days off school and the transfer of the child's care to a Dublin hospital where there are no records for those children.

The provision of a comprehensive pump service requires essential personnel on the mutidisciplinary team, in particular a paediatric diabetes dietician and a pump nurse. A paediatric diabetes dietician is an essential member of the multidisciplinary team required to offer effective insulin management to parents and children. The paediatric diabetes service at Galway University Hospital, with a patient load of 110, has access to dietetic services for just 12 hours per month. This is below recommended levels and this service is currently not available as the person in question is on maternity leave and due to the embargo on recruitment has not been replaced. This issue must be re-examined.

The diabetes nurse specialist staffing levels are also below recommended levels. The hospital has only a whole time equivalent of 0.75 as opposed to the recommended level of 1.5 and there is no psychologist on the team. Despite the best effort of team members, this can impact on the quality of care provided. A ring-fenced paediatric dietetic service at Galway University Hospital and nationally is urgently required to ensure the provision of intensive insulin management and a satisfactory insulin pump service.

I am surprised to learn that insulin pumps are more available in some counties, such as Dublin and Clare. These counties have funding, but others do not. Will the Minister ensure that the multidisciplinary team for diabetes care is properly and adequately staffed? Investing now in paediatric diabetes care will reduce the cost to the State in the long run of dealing with complications in adults caused by poorly managed paediatric care. Will the Minister of State explain why there are adequate pumps available in Dublin and Clare, but not in Galway where there is a case load of 110 patients, but only 12 pumps available?