Martin Conway (Fine Gael)
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I thank the Cathaoirleach for accepting this very important Commencement matter. As the Minister is no doubt aware, last Sunday, 14 November was World Diabetes Day.It is a day when people who suffer from diabetes campaign, advocate and reflect on what needs to be done to improve the quality of their lives. Sadly, an increasing number of people in our country are being diagnosed with diabetes. It is a significant and serious health challenge, particularly if it is not treated properly and if the services, supports and structures are not in place to ensure the people who are diagnosed with diabetes can access them. That is the problem in the mid-west, in counties Clare, Limerick and Tipperary, which are serviced by the University Limerick Hospitals Group. The diabetic services and supports available at Limerick hospital are not, unfortunately, up to standard. A good friend of mine suffers from type I diabetes and, as such, I am fully aware of the timeline and what has and has not been delivered in Limerick hospital.

In 2006, the dose adjustment for normal eating, DAFNE, programme, which is now seen as the principal programme that people with type I diabetes should be part of, was rolled out. It is a structure and programme based on providing education around insulin so that people can eat and function normally. In 2006, the programme was rolled out in six areas but, of course, Limerick was not included. As time passed, the DAFNE programme was seen as the key element in terms of education and intervention for people with type I diabetes. In more recent times, the number of DAFNE-supported clinics providing this service throughout the country has increased to 15. It is now considered standard by the HSE and all of the experts who work in the area of diabetes that this should happen. Limerick is still lacking a DAFNE-supported structure even though there are some hospital groups that have more than one. Clearly, there is a problem.

I accept that there is problem around the retention of dieticians, diabetic nurses and endocrinologists. That challenge is faced nationally. The single biggest problem in the mid-west is that while posts are being advertised and, to be fair, the funding is in place, staff have not been recruited. There is still no dietician associated with the diabetic clinic in the University Limerick Hospitals Group. The number of diabetic nurses is far short of what it should be. Although the funding is in place to recruit diabetic nurses, they have not been recruited. As a result of the expertise and specialist professional medical people not being in place in Limerick hospital, the hospital is not in a position to roll out the DAFNE programme.

I want to know what the HSE is doing to resolve this problem in the mid-west. It is not fair that in the people in the region who are suffering from diabetes have to travel to Galway city to have their insulin pumps dealt with and to access the appropriate interventions needed. That is not good enough. It is great for the people for Galway that they have such a fantastic facility. I am delighted for them. The position is similar in Cork and other parts of the country. However, provision is not universal because the people of Limerick do not have a service. This issue has been highlighted annually for the past 20 years, in particular in the years since a very articulate group of people came together in the mid-west to fight the good fight. They were outside the hospital in Limerick protesting on World Diabetes Day to highlight this issue. I am hoping the Minister of State, Deputy Rabbitte, will have some good news for me in terms of dealing with this problem such that, once and for all, people in the mid-west who are suffering from diabetes receive the same service as those suffering in other parts of the country.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank Senator Conway for the opportunity to address the House on this important matter, which I am taking on behalf of the Minister for Health, Deputy Stephen Donnelly.I assure the Senator that the Government remains fully committed to improving patient-centred care and services across the country. That commitment is seen in the unprecedented level of funding that is being targeted across the health service in budget 2022. This investment will ensure that hospitals can continue to develop the services they provide, including diabetic services in the mid-west.

The University Limerick Hospitals Group, ULHG, has advised the Department of Health that it recognises the need for additional resources within adult diabetic services and is focused on and committed to improving those services. Developing services around insulin pump therapy and structured education requires that further specialist posts be filled, including nurse and dietician posts. While there is a specialist dietician working with paediatric diabetes patients, there is no specialist dietician in post for adults with type 1 diabetes, a matter the Senator referenced. Patients are seen by a ward dietician as inpatients, but there is no specialist dietetic care for outpatient adult appointments.

ULHG sought to address these issues. In December 2020, it received confirmation of funding from the national clinical programme for diabetes to recruit three additional dietetic posts. The recruitment process for two senior dieticians and one staff grade dietician is at an advanced stage. It is prudent for me to point out how long it takes the HSE to recruit staff. It could take up to 50 weeks to recruit for a post, but the ongoing work in this regard is welcome.

A second consultant endocrinologist took up a post on 1 October 2020. Two further consultant endocrinology posts have been approved and are being progressed. There are also three diabetic staff nurse positions within the diabetes unit at University Hospital Limerick, of which two are filled. A recruitment process is ongoing to fill the final post.

In addition to the recruitment for these posts, the adult diabetic service is supported by a dedicated team of clinical nurse specialists and staff nurses. Four diabetic nurse specialist posts have been approved for University Hospital Limerick, of which two will commence over the coming months. A recruitment campaign is ongoing for the remaining two posts.

ULHG has confirmed that the insulin pump programme will be extended when all clinical nurse specialists are in place and fully trained to provide the service. There are two dietetic staff nurse positions within the diabetes unit at University Hospital Limerick, both of which have been filled. The DAFNE course for adults with type 1 diabetes will be dependent on the appointment of these specialist dieticians and the recruitment of the additional clinical nurse specialist.

ULHG advises that the adult service is currently unable to commence patients on insulin pumps due to service demands. The service in Limerick does, however, accept patients established on pumps from elsewhere. These patients are managed under the care of a consultant endocrinologist. The largest group of these patients has been transferred from the paediatric diabetes service at University Hospital Limerick. All insulin pump patients are seen in University Hospital Limerick.

I am assured that ULHG remains committed to the progressive development of diabetic services and that this is a core focus of the group, given its importance to the patients of the mid-west. While recognising that there is still plenty to be done, the recent investment will help ensure that ULHG achieves this goal. I welcome how the HSE has outlined the recruitment process and the funding being put behind the service. I hope that we will see progress in the coming months.

Martin Conway (Fine Gael)
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I thank the Minister of State for updating the House. The DAFNE programme is a critical part of the management of diabetes. Professionals not being in place means that it cannot be provided, and if it is not provided sooner rather than later, the Government will have to consider an alternative approach, that is, making professionals in other diabetic clinics available to Limerick.

There is an inequity. People in Ennis and Limerick who are suffering type 1 diabetes having to go to Galway, Cork or elsewhere is not fair when people in Galway and Cork do not have to travel because their local clinics are able to provide them with supports and services.While I welcome this, I ask the Minister of State to seek from the University Limerick Hospitals Group an update on whether it has hired the extra professionals required and, if not, what stage the recruitment process has reached and when we can expect the staff to be appointed. If the Minister of State's office makes that response available to me, I will make it available to people in the mid-west who are suffering from type 1 diabetes.

Anne Rabbitte (Galway East, Fianna Fail)
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I again assure the Senator that the Government and Department of Health remain fully committed to improving services and having patient-centred care in Limerick and throughout the country. This includes diabetic services. It is clear that significant efforts are being made to ensure such services are being progressively developed at the University Limerick Hospitals Group. The group is fully aware of the need for additional resources within its diabetic services. For this reason, it is proactively working to increase specialists and clinical personnel, including three dieticians, two additional endocrinologists and additional diabetic staff nurses.

I will revert to the Senator on his specific question seeking a timeline for filling the posts. I will go further and seek to find out how many staff are in the interview process and how many have been short-listed for the various posts I outlined in my initial response.