Denis O'Donovan (Fianna Fail)
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I am glad to see that a Minister of State from Cork is present. She probably will understand the difficulties in managing west Cork as well as anyone. In the motion I tabled, I have set out how I have been contacted by a number of people expressing concern at the reduction in paediatric outpatient clinics in Bantry General Hospital. I believe that up to three years ago, there was a monthly paediatric clinic that rotated from being a general clinic to being a diabetes clinic. I also am informed that, currently, no diabetes clinic at all is held and that the general clinic only takes place three times per annum. At present, children with type 1 diabetes are only seen twice a year in Cork University Hospital. At a time when Members are particularly concerned about type 2 diabetes and obesity in young people, I fail to understand why the diabetes clinic has been discontinued. I perceive these changes to be a further diminution of service in Bantry General Hospital and a serious blow to remote rural communities. I will repeat a point I have made previously in respect of the children's hospital in Dublin, which is that for people in Dingle, Castletownbere or remote parts of County Donegal who will be obliged to travel for five or six hours, it does not matter a damn whether it is located on the north side, the south side or in Tallaght.

It is important to note that people in west Cork and south Kerry use the service in Bantry and to note that in the United Kingdom, children with diabetes are seen every three months. I have a general concern that when Bantry General Hospital lost its accident and emergency unit, there was a promise in the reconfiguration plan for the hospital that many clinics, be they orthopaedic, paediatric, for children or whatever, would take place and that consultants under contract in Tralee hospital, the Mercy University Hospital or Cork University Hospital would visit Bantry on a regular and ongoing basis. This was to prevent people from remote areas from being obliged to travel long distances to Cork, thereby creating long delays, overcrowding and so on. This is a specific item of deep concern and being a grandparent myself with a number of grandchildren, I can understand the problem and plight of young parents who have sick children. They believe the service with which they should be provided locally - this may mean an hour's drive for some of them - has now been reduced substantially and, in respect of diabetes, appears to have ceased. I acknowledge that the dedicated diabetes nurse who was based in Bantry has retired, but if that information is correct, she should have been replaced. Unfortunately, diabetes is a developing disease for all people. It is linked to obesity, and current thinking is to deal with children at a young age when they are two, three, four or five years old. That is the time to nip it in the bud, as when one gets older and becomes an adult, if one suffers from diabetes, it probably will entail the taking of medication for the rest of one's life. Consequently, this is an important issue. While one might argue it probably is parochial, it is of huge importance to the region I represent, and hopefully the Minister of State will have some positive news in this regard.

Kathleen Lynch (Cork North Central, Labour)
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Before I start to read the official reply, as someone who was involved in the campaign to have paediatric diabetes services brought to the south, I thank the Senator for raising this issue. A number of years ago, they were very poor and most families preferred to deal with Crumlin or Temple Street hospitals in Dublin in respect of their children.

They said that the best thing about the services there was the ready access to expertise through a specialist nurse who was at the end of a telephone line. That was the target we set for ourselves in the context of the service to be delivered in the south.

I thank the Senator for raising this important matter and for giving me the opportunity to inform the House of the significantly improved services which are now provided to paediatric diabetic patients in Cork. The unprecedented evolution of best practice and new models and standards of care for children with diabetes together with the reconfiguration of services in Cork and Kerry have led to significant enhancement in the delivery of services in recent years.

In line with the national paediatric and national diabetes clinical programmes, a subgroup was established in 2011 to examine the delivery of diabetes care in Ireland to all children under 16 years of age. In early 2012 a national clinical lead in paediatric diabetes, Dr. Stephen O'Riordan, based in Cork University Hospital, CUH, was appointed to implement improved access to diabetic care and to implement new models of care for diabetic services. The paediatric diabetes service resource is now concentrated in CUH and has been reconfigured to allow for the introduction of the insulin pump service in the region. While my welcome for this and that of Senator O'Donovan may be somewhat parochial, this development is, nevertheless, very important. The hospital provides all forms of diabetes care and insulin pump starts for children under five years which is a huge advance. This model of care offers greater access to a dedicated paediatric diabetes service delivered by a paediatric diabetes team. The service is led by two consultant paediatric endocrinologists and is supported by a dedicated diabetes specialist nurse and by a paediatric diabetes dietician. Having listened to the mothers of diabetic children, I know that all of these things are essential. I am very proud to say that Cork is spear-heading developments in paediatric diabetes and the development of the pump school service in the community has achieved national recognition by winning a health literacy award in 2014 and a health innovation award in 2013. The services in Cork are currently being assessed by Sweet.EU, a major EU initiative in the field of diabetes prevention, and are working towards being accredited as a recognised centre of excellence in Europe.

The concentration of diabetes services in CUH is in line with the Government's policy on the reorganisation of hospital services. The framework for smaller hospitals articulates the Government's commitment to securing and further developing the role of smaller hospitals in the delivery of significant volumes of less complex care. The framework outlines the need for smaller hospitals and larger hospitals to operate together as a single hospital group. In this instance, the South/South West Hospitals Group has ensured that the care of complex paediatric diabetic patients is centralised in CUH. Children who need this specialist treatment are provided with a safe and high-quality service in the most appropriate setting. While the diabetes clinics have transferred from Bantry General Hospital to CUH, I have been assured that the more straightforward paediatric clinics will continue to operate in Bantry as before. Indeed, I understand that hospital management is actively engaged in developing this service.

To conclude, I would like to assure the House that the movement of paediatric diabetes services to CUH should not be seen as a threat to Bantry General Hospital but as an opportunity to provide the children of Cork with the best service possible in the right setting. The role of Bantry General Hospital will not diminish but will be developed as appropriate in the context of the wider needs of the South/South West Hospitals Group. I hope this is of some comfort to Senator O'Donovan. The paediatric clinics will continue in Bantry General Hospital and are the ideal vehicle for picking up children who have or who develop type 1 diabetes. The service such children are receiving at CUH is second to none. It is better than the service that was being delivered by the Dublin-based hospitals.

Denis O'Donovan (Fianna Fail)
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I thank the Minister of State for her reply. While I am somewhat reassured by what she has said, a commitment was given by the HSE to provide certain services at Bantry General Hospital in the reconfiguration programme. Those services were withdrawn, unilaterally, without consultation with the general practitioners and parents concerned.

Thankfully, the number of children with diabetes who have been affected by this is limited but that said, for those children who are living in remote areas on the peninsulas or near Bantry, CUH is a one and a half or two-hour drive away. It would not have been too much of a burden on the HSE to advertise through the GPs in the area that this service is no longer available at Bantry General Hospital and the reasons for that. That was the problem.

Parents of children with diabetes were attending Bantry General Hospital for three years or more but suddenly they were told they had to travel to CUH. It is difficult for parents to deal with that. While the service in CUH may be more efficient or centralised, the way this change has been implemented in the context of services at Bantry General Hospital is a source of worry to me. This is not the only clinic to have been moved. Clinics are introduced with great fanfare and lauded as being great for the area. Then, all of a sudden, they disappear. The services are revamped and re-emerge in the central set up at CUH. That might be the ideal location from a health point of view but for those living in remote parts of rural Ireland, there are concerns. I understand what the Minister is saying but my fears are not totally allayed. I may have to revisit this issue at another time but I appreciate the information the Minister of State has provided today.

Kathleen Lynch (Cork North Central, Labour)
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I understand fully the Senator's concerns. Children with diabetes can have a poor episode very quickly and parents need to be reassured. The main point made to me by parents was that having a specialist nurse at the end of a phone line to give reassurance is crucial. The introduction of the insulin pump is also vitally important, particularly for very young children because it allows for greater control of insulin levels. Parents become expert at adjusting insulin levels as required. When children with diabetes are out playing soccer, hurling or football, for example, parents quickly learn how much food and insulin they need in those circumstances. All of that has improved significantly. That said, I do not dismiss the worries of people who are living in more remote areas in terms of quick access to services but having a specialist nurse at the end of a phone line is enormously helpful.