Brian Ó Domhnaill (Fianna Fail)
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I raise the issue of diabetes facilities in Letterkenny General Hospital. In Ireland, there are approximately 4,000 children and young adults under the age of 16 with diabetes. Approximately 90% of patients under the age of 16 have type 1 diabetes but, unfortunately, an increasing number of young patients are developing type 2 diabetes. The incidence of type 1 diabetes is also increasing, by between 2% and 3% per year, and experts anticipate that the number will double by 2020.

Type 1 diabetes is a complex condition in children and young adults and it is recommended that care be delivered in multidisciplinary settings, with access to a consultant paediatric endocrinologist, a paediatric diabetes specialist nurse, a paediatric specialist dietician, a psychologist and a social worker. Because of the complexity of the condition and the significant dangers of hypoglycaemia, there can be a clinical advantage in having continuous insulin infusion therapy for children and young adults with type 1 diabetes.

I recently attended a meeting with the parents' support group in Donegal. They have major concerns regarding the future of services at Letterkenny General Hospital. In 2010, the Health Service Executive established a national clinical programme for diabetes with the aim of defining the way diabetes clinical services should be delivered, resourced and measured.

I understand there are two proposed models of care to improve the situation for paediatric diabetes care. The first model comes from the report of the HSE expert advisory group, chaired by Dr. Colm Costigan. This model proposes that care be centralised for each region in a dedicated paediatric adolescent diabetes centre looking after at least 150 children and adolescents. The second model comes from the Diabetes Federation of Ireland. It recommends the establishment of between eight and ten regional networks with three existing Dublin centres acting as territory reference centres and with one third of the national diabetes population being served in Dublin.

The parents of the 160 children with type 1 diabetes who attend Letterkenny General Hospital want to ensure that the services currently available at Letterkenny General Hospital are maintained and enhanced. I understand that discussions are currently taking place at a national level on the diabetic clinical care programme but no decision has yet been made.

A number of things are significant in the case of County Donegal. The county is geographically isolated. If services were to be withdrawn from Letterkenny General Hospital parents and children would have to make a return journey of at least six hours to get the care that is currently being provided in Letterkenny.

Currently, 21 hospitals in the country provide this level of care. It is essential that a consultant endocrinologist be appointed at Letterkenny General Hospital. I understand such an appointment is being considered for January 2012. I raise this issue because I seek some level of clarification as to whether or not that is the case and whether or not the HSE will give the go-ahead to employ a consultant endocrinologist.

Will the HSE approve the appointment of a clinical nurse specialist? Currently, two clinical nurse specialists are employed at Letterkenny General Hospital, working with adults and paediatric patients. What is required is a dedicated nurse who would deal solely with children and adolescents with diabetes. This appointment would be vitally important.

Can the Minister give an indication that the service will be retained at Letterkenny General Hospital? The hospital has the excellence and the ability to provide this care. It deals with 160 children, more than the 150 recommended by the HSE expert advisory group. Given that national statistics predict that the number of children with type 1 diabetes will double between now and 2020, there will be more than 300 children with diabetes in the Donegal region by that date.

I hope progress can be made and that the Minister can give a commitment to the provision, retention and enhancement of the services currently available in Letterkenny General Hospital. I hope there will be a commitment to the provision, retention and enhancement of the services currently available at Letterkenny General Hospital

Róisín Shortall (Dublin North West, Labour)
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I thank Senator Ó Domhnaill for raising what is both a local and a national issue. There are no plans to remove or downgrade the existing paediatric diabetic service at Letterkenny General Hospital. There are two clinical nurse specialists at the hospital. These specialist nurses work with the adult and paediatric diabetic service and a consultant endocrinologist is scheduled to take up appointment in January 2012. Funding is not currently provided for a dedicated paediatric clinical nurse specialist.

The future development of diabetic services in the State and at each hospital site, including Letterkenny General Hospital, will be determined by the HSE national clinical programme for diabetes. This programme includes the care of children and adolescents with diabetes and was established within the clinical strategy and programmes directorate. The purpose of the national diabetes programme is to define the way diabetic clinical services should be delivered, resourced and measured. A clinician has been appointed to lead 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 of children and young adults with diabetes are required and, with this in mind, a number of models have been proposed. One such model is suggested by the recent Diabetes Federation of Ireland "Diabetes Action" campaign, chaired by Professor Hilary Hoey, retired professor of paediatric endocrinology in the National Children's Hospital in Tallaght. The second model is from the report of the expert advisory group, chaired by Dr. Colm Costigan, paediatric endocrinologist in Crumlin hospital.

In the context of the national clinical programme, the national clinical leads for diabetes and paediatrics have met to discuss the issues involved in the care of children and adolescents with diabetes. They have set up a working group to assess current services across the country, to agree a model of care and to standardise services across the country. This work will also include work on the provision of insulin pumps and work on policy for prevention and early detection of diabetes in young children and adolescents. The group's work is continuing and will determine the final shape of any model for service delivery.

Brian Ó Domhnaill (Fianna Fail)
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I welcome what the Minister of State has said, particularly with regard to the endocrinologist who will be appointed in January and the fact there are no plans to remove or downgrade the existing services. She has stated that the work of the expert group is continuing and will determine the final shape of any model for service delivery. I hope that whatever decision or recommendation is made by that group, it will not involve any downgrading or removal of services at Lettterkenny General Hospital. I ask her to bear that in mind when decisions are being formulated, because the level of service delivery is vitally important to the families and children who use the service at the hospital. It is a hospital which is endeavouring to deal with the difficult financial constraints it is under but which provides an excellent level of care, which can only be enhanced by the decision to appoint an endocrinologist and specialist nurse. We appeal to the Minister of State to try and ensure that money is ring-fenced to provide the nurse specialist treatment that is required by the patients.

Róisín Shortall (Dublin North West, Labour)
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There are no plans to downgrade the excellent work being done in Letterkenny General Hospital. I am very hopeful that we will be able to roll out the clinical care programme for diabetes. As the Senator has said, the explosion in the number of cases in diabetes is probably the biggest threat facing the health service. It is a huge challenge to address that, to concentrate on prevention and to provide for management of chronic diseases, particularly diabetes, at primary care level. That is the way we want to go and I hope that if funding is provided, we can start on that important programme next year. We cannot afford not to, given the threat posed by the disease. Clearly, Letterkenny General Hospital will play a critical role in the roll-out of the programme.