Kathleen Lynch (Cork North Central, Labour)

I thank Senator Healy Eames for raising this issue.

It is estimated that there are currently between 3,000 and 4,000 children and young adults under 16 years of age with diabetes in Ireland. Over 90% have type 1 diabetes but there are an increasing number of young patients developing type 2 diabetes. The incidence of type 1 diabetes is also increasing by about 2 to 3% per year and experts anticipate that over the next ten to 15 years, the incidence of type 1 diabetes will double. Type 1 diabetes is a particularly complex condition in children and young adults and so it is recommended that their care be delivered in a multidisciplinary setting with access to a consultant paediatric endocrinologist and other diabetes health care specialists. In view of the complexity of the condition and the significant dangers of hypoglycaemia to the developing brain, continuous subcutaneous insulin infusion, commonly referred to as insulin pump therapy, is often a preferred treatment option. An insulin pump is a method of administering insulin on a continuous infusion basis and is portable and easy to use. It is an alternative to injections and is an appropriate therapy for younger children.

The suitability of certain children or adolescents for insulin pumps is also a factor that must be taken into account. The HSE national clinical programme for diabetes - which includes the care of children and adolescents with diabetes - was established within the clinical strategy and programmes directorate. The purpose of the programme is to define the way diabetic clinical services should be delivered, resourced and measured. A clinician has been appointed to lead on the development of the programme, which has as its central aim to save lives, eyes and limbs of patients with diabetes.

Improvements in the care for children and young adults with diabetes are required and with this in mind a number of proposed models have been suggested. One model, based on eight to ten regional networks with the three existing Dublin centres acting as a tertiary hub of excellence and continuing to see one third of the national paediatric and adolescent diabetes population, comes from the recent Diabetes Federation of Ireland diabetes action campaign. The second model is from the expert advisory group report. This model proposes that care be centralised for each region in a dedicated paediatric and adolescent diabetes centre, looking after at least 150 children or adolescents. Ideally the centre should be in a regional hospital that has an adult diabetes centre to facilitate transition to adult care. However, the final shape of any model will be determined by the working group and may be a variation of either of the two earlier models described.

While services are provided for children and adolescents with diabetes in all the major hospitals across HSE west, there is currently no pump service available and children must attend either Crumlin or Temple Street to avail of this service. I wish to inform the House that the national clinical leads for diabetes and paediatrics met recently to discuss the issues involved in the care of children and adolescents with diabetes. They set up a working group to assess current services across the country, to agree a model of care and to standardise these across the country. This work will also include work on the provision of insulin pumps. The group will also work on a policy to prevent and aid the early detection of diabetes in young children and adolescents. The group was only recently established and its work is continuing.

In HSE west, services are provided by paediatricians with a special interest in diabetes in Galway University Hospital, Portiuncula Hospital and Mayo General Hospital. The consultants are supported by clinical nurse specialists in diabetes and the diabetes teams have access to dieticians, psychologists and social workers. The consultants are supported by clinical nurse specialists in diabetes and the diabetes teams have access to dieticians, psychologists and social workers. In addition, transitional clinics are provided across HSE west for adolescents who are transferring from the paediatric service to the adult service. It is widely recognised that secondary or acute care alone cannot cope with the current and increasing burden of disease. Re-organising systems into more integrated models presents opportunities for a more efficient and effective approach to the management of diabetes care. Diabetes service implementation groups have been established countrywide, including in HSE west. At national level, a priority of the working group is to progress the integrated care model of care. Work is continuing in this regard in order to improve services available for this chronic disease across the health system.

Regarding maternity leave and speaking as the Minister of State with responsibility for equality, they should be exempt from the embargo.