Terry Leyden (Fianna Fail)
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I welcome and the Minister of State and thank the Cathaoirleach for allowing this matter to be raised on the Adjournment. Senators have been contacted by members of the public and particularly the group Diabetes Action. I requested that the Minister for Health, Deputy James Reilly, outline the access to treatment for children and adolescents with diabetes and the plans to reorganise diabetic paediatric services in the HSE west area and throughout the country.

Diabetes Action launched an advocacy campaign entitled, Half the Services, Half the Care, in September 2010. Other Members, namely, Senators Marc MacSharry and Brian Ó Domhnaill, asked to be associated with this request, as they have also been contacted by the organisation. The central message of the campaign is that people with diabetes have not been helped sufficiently by general health policy. Rather, various issues need to be addressed in a national diabetes strategy. If the Government implements strategic policies, we may improve dramatically the health of people with diabetes, while saving millions of euro through preventing health complications for such persons in the next decade.

In 2008 the report of the diabetes expert advisory group identified that service provision in this area was inadequate and proposed a comprehensive regional plan to improve the service provided. In the interests of balancing the available resources, it recommended that the majority of patients with type 1 diabetes requiring care, including all paediatric and adolescent diabetes cases, should be treated in hospital diabetes centres. Approximately 70 children and adolescents with type 1 diabetes are living in Roscommon-Leitrim South. While many are cared for locally, many others must travel to Dublin to access intensive treatment because the local paediatric diabetes team is under-resourced. Paediatric diabetes services in Dublin have been inundated with referrals, while local services remain underdeveloped and underutilised. Children with diabetes should be seen four or five times a year in hospital to help to limit the damage high blood sugar levels can cause to the eyes, kidneys, nerves and smaller blood vessels in adulthood, but they are not seen as often as they should be.

Diabetes Action proposes a reorganisation of diabetes paediatric services with eight networks, one of which would serve 350 to 400 children with diabetes in counties Galway, Mayo and Roscommon in order that intensive therapies could be accessed locally. It also proposes a network to serve 200 children with diabetes in counties Sligo, Donegal and Leitrim. The campaign is well organised and the Minister of State is aware of it. I note the response sent to me by Mr. J. J. O'Rourke, PRO for the Leitrim branch of the Diabetes Federation of Ireland. He requested that I raise the matter in Seanad Éireann to highlight an important aspect, the incidence of which is increasing. We can take action to provide a service in the region in the most economic way possible.

I again thank the Minister of State for attending and the Cathaoirleach for allowing me to raise this matter.

Kathleen Lynch (Cork North Central, Labour)
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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.

Terry Leyden (Fianna Fail)
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I thank the Minister of State for her very comprehensive reply. Although I was at one stage Deputy Terry Leyden I am now a Senator. It is a while since I was there. I will convey the Minister of State's reply to the organisation and we will follow up any queries. I thank the Minister of State and her officials for putting so much work into the reply.

Paddy Burke (Fine Gael)
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The Senator is glad to be here.

Terry Leyden (Fianna Fail)
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I certainly am, and the Cathaoirleach is glad to be where he is. I am thankful for the opportunity to address the issue on the Adjournment, which is a very useful vehicle for getting responses from Departments.

Imelda Henry (Fine Gael)
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I thank the Cathaoirleach for providing the opportunity to speak to this issue on the Adjournment and the Minister of State for coming to the House. The removal of breast cancer surgery services from Sligo General Hospital almost two years ago was very disappointing for the women of the north west. It was an excellent service that worked very well and it is greatly missed. I know the Minister for Health is in discussions with the National Cancer Control Programme manager on the issue and I await the decision on the matter. I hope the Minister will be in a position to return the service for the women of the north west.

Mammography services ceased in Sligo General Hospital in October 2009 and with the transfer of the breast cancer treatment services, the plan was to ensure a surveillance mammography service would be in place in Sligo General Hospital for patients with a previous diagnosis of breast cancer. Given the above, it would be necessary to ensure a service would be provided from University Hospital Galway as the cancer centre, and radiographers would travel from the hospital in Galway on an agreed basis.

To complete investigations for patients falling within the Sligo catchment area, the National Cancer Control Programme funded two radiographer positions. The successful candidates for the positions were subsequently promoted internally and these posts were then subject to the national moratorium, and as such they have remained unfilled to date. Patients have therefore been forced to continue to travel to Galway for post-cancer mammography until resolution of the issue. I ask the Minister to ensure radiographers are put in place as soon as possible.

In September 2008, the Friends of Sligo General Hospital received a national lottery grant of €170,000 in recognition of the need to purchase a bus and formalise a daily service between Sligo General Hospital and University Hospital Galway. At the time of the initial allocation when the Friends of Sligo General Hospital committee sought to purchase a bus service, the quotations received were in the region of €300,000, and it was impossible therefore to proceed with the purchase at that time.

To this end and in the context of the current economic climate, where the cost of the bus has decreased, the Friends of Sligo General Hospital committee purchased a bus in early 2011, with additional funding from Cancer Care West and the Sligo General Hospital oncology unit trust. This bus has been commissioned to the highest possible specification in consultation with patients and local groups and it is expected that the bus will be on the road within weeks. The facility will provide transport for patients from Sligo for breast clinic services, radiotherapy and oncology appointments where necessary, and it is a positive development for patients in the region. The revenue cost of this new bus service is estimated at between €90,000 and €100,000 per year. The HSE is reviewing its policy on eligibility for non-ambulance based transport services. I urge the Minister to expedite this review and make provision to fund the revenue costs for this very valuable and much needed service.

Kathleen Lynch (Cork North Central, Labour)
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I am taking this on behalf of the Minister for Health, Deputy James Reilly, and I thank the Senator for bringing it to our attention. I welcome this opportunity to address the House on the issue of cancer services at Sligo and across the system. The burden of cancer continues to increase. This year, approximately 24,000 people will be diagnosed with invasive cancer and over the coming years, the numbers diagnosed will continue to rise owing to the ageing profile of our population. This provides a major challenge for cancer control.

The National Cancer Control Strategy addresses this challenge. It envisions a cancer control system that will reduce Ireland's cancer incidence, morbidity and mortality relative to other EU countries. Prevention, early detection and treatment are all core elements of such a system, and continued progress in these areas remains a high priority for the Minister. With regard to prevention and early detection, the programme for Government includes a commitment to extend BreastCheck to include women who are aged 65 to 69 years of age. At present BreastCheck is available nationwide to women aged 50 to 64. The HSE's National Cancer Control Programme is examining how it can extend the programme to those aged 65 to 69.

With regard to treatment, considerable work was done by the National Cancer Forum, which developed the cancer strategy, on how treatment services should be organised, especially in acute hospitals. The strategy set out the rationale for the restructuring of cancer services in our hospitals and recommended that cancer centres which each serve a minimum population of 500,000 should be designated by the HSE and that Ireland required approximately eight such centres. Accordingly, in 2007 the HSE designated eight hospitals as cancer centres and established the National Cancer Control Programme to implement changes in how treatment services were organised and delivered.

A key element of this is the centralisation of diagnosis and treatment for cancer in the eight centres.

This is in line with international evidence which shows that the best outcomes for patients are achieved by specialist teams in specialist settings with access to ongoing education, training, research and peer review. Sligo General Hospital is one of a number of hospitals from which breast cancer diagnosis and surgery was transferred in line with the HSE's cancer strategy. The transfer took place in August 2009 and women in the Sligo area are now provided with breast cancer diagnosis and surgery at Galway. It is important to note that 96% of women who attend the Galway unit do not have cancer and only one visit is normally necessary. For the small number diagnosed with breast cancer, 85% will require radiotherapy as well as surgery, which would involve treatment in Galway in any event.

Chemotherapy services continue to be provided in Sligo and are linked with the necessary multidisciplinary team in Galway. The Minister is pleased to confirm that recruitment of a second medical oncologist for Sligo is in train. There is also a specialist breast nurse in Sligo and detailed clinical pathways have been worked out for Sligo patients presenting with post-operative infection or other conditions so as to minimise the need to travel to Galway. Sligo also provides a significant range of other cancer services, including surgery for non-melanoma skin cancer and colorectal cancer. It has also been selected as one of the 15 candidate colonoscopy centres for the colorectal cancer screening programme to be launched next year.

The Minister intends to keep the current arrangements for cancer treatment at Sligo under review, particularly in relation to follow-up mammography services for women. These services are currently provided from Galway. The Minister shares the Senator's concerns and will keep the matter under review.