I welcome the Minister of State at the Department of Health, Deputy Kathleen Lynch, to the House.
Commencement Matters
Garda Misconduct Allegations
I, too, welcome the Minister of State.
This matter deals with the tragic case of a brilliant, attractive, talented young man who met his death some years ago, to the immense and continuing distress of his entire family. He took his bicycle out for a run and was knocked down by a Lithuanian heroin addict who had between 40 and 50 convictions for drugs offences and larceny on both sides of the Border. The addict was on the Interpol register as a criminal and on the PULSE system. One hour before the brilliant young man was killed, the car driven by the Lithuanian drug addict was stopped at a Garda checkpoint. Since there was no insurance on the car and a series of other complicating factors, including the fact that the driver was on PULSE and the Interpol register, he should have been stopped and arrested. He simply should not have been allowed to continue to drive the car. Had appropriate Garda action been taken, the young man, who had so much to give to his family and this country, would be alive today.
There was a series of other complicating factors. We are addressing the repercussions of the incident today. There was a catalogue of Garda malpractice. I wrote to the former Minister, Deputy Shatter, about it and received an emollient reply. He expressed sympathy for the family and his letter was understanding, but he distanced himself from the matter and said that, because of the separation of powers, there was no way in which he, as Minister, could interfere. Thus, he denied responsibility. That negated any opportunity I had of doing what I had intended to do - that is, to raise the matter on the Adjournment. If the Minister has no responsibility in this matter, it cannot be raised in the House. The current Minister has acceded to the establishment an independent review panel to consider the activity of the Garda in Cavan-Monaghan, which I very much welcome, but the chairman of this panel is the senior counsel who represented the Lithuanian drug addict, Mr. Gridziuska. Both senior and junior counsel were supplied free of charge by the State to the drug addict, whereas no such provision was made for the family of the bereaved. There is an extraordinary lack of co-ordination.
I wish to draw the attention of the Minister of State to a parallel case that we all know about - namely, that of Ms Savita Halappanavar, who died tragically in hospital. An inquiry was established that involved one of the hospital consultants who had treated Ms Halappanavar. Ms Halappanavar's husband, Praveen, objected to this and, as a result, the consultant, without any impugnment of his reputation, was removed from the inquiry because of a perception of a conflict of interest. This is exactly what we are dealing with in the case I am raising. The family of the deceased is outraged that the man who, as senior counsel, represented the Lithuanian drug addict is now the chairman of what is supposed to be an independent review panel. I do not in any sense impugn the reputation or conduct of the barrister. In law, people represent those they are appointed to represent, and do so to the best of their ability. The barrister in question did a very good job - a tragically good job - for the Lithuanian, the man he was representing, but that is what his function was. However, there is a clear perception of a conflict of interest. How can somebody who professionally represented a criminal responsible for the death of a young man be seen as a proper person to conduct the inquiry? He should be removed and distanced from this section of the inquiry. At least, the Minister should undertake that the barrister will have no role to play in the conduct of the inquiry.
Transparency International, two Dáil Deputies and solicitors representing the family have written to the Minister objecting to this gentleman's appointment to this position.
I had a useful reply from the Minister in the past few days but she draws attention to a European Union directive that she is transposing and hopes to have in by November. She states that it requires every member state to give all victims of crime information, support and protection and that the directive provides that the victim should receive appropriate information about their case, have access to victim support services and so on. A further provision states that the victim may be accompanied by a person of their choice for interviews with police. That is not a satisfactory reply. It is the mildest possible provision that one can be accompanied to a police station and get information. We have that already. I ask that this gentleman, with no slur cast on his reputation, should be distanced or removed from this inquiry.
Regardless of the action taken, it will bring no comfort to anyone who has lost someone in these tragic circumstances. It will not bring the person back, and I can understand their distress.
The Minister for Justice and Equality, Deputy Frances Fitzgerald, wishes to thank the Senator for raising the matter and regrets that she is unable to be present to take it herself. Senator Norris is referring to the mechanism established for the independent review of certain allegations of Garda misconduct, or inadequacies in the investigation of certain allegations, which have been made to the Minister for Justice and Equality, or the Taoiseach, with a view to determining to what extent and in what manner further action may be required in each case. In order to carry out this review, a panel consisting of two senior and five junior counsel, all selected on the basis of their experience of the criminal justice system, was established. The independent review is well under way at this stage, and is in the process of considering 313 cases. This is a significant number of cases, and somewhat higher than originally estimated, but the Minister thought it was important to refer to the panel all of the allegations on hand, with only a minimal filtering process, so as to ensure that every appropriate case got the benefit of an independent review. Its role is effectively to triage those cases with a view to determining to what extent and in what manner further action may be required in each case.
The review of each allegation consists of an examination of the papers by a counsel from the panel, and does not involve interviews or interaction with complainants or any other form of investigation. I should point out though that counsel may recommend that the Minister seek further information to assist in coming to an appropriate recommendation in any particular case. The Minister has asked counsel to recommend to her what action, if any, might be appropriate in each case. Each recommendation made by the panel will be very carefully considered. Clearly, having engaged counsel for this review, it would be entirely appropriate for the Minister to be guided by their advice. Obviously, it would not be appropriate to comment upon the potential outcome of any individual complaint being reviewed by this mechanism before the Minister has received and considered counsel's recommendation.
As I have already explained, the panel members were all selected on the basis of their experience. In this regard, and having regard to the scope of the review, and the number of complaints involved, there is always the possibility that a conflict of interest could potentially arise. The Minister has asked me to assure the House, however, that appropriate steps have been taken to ensure the integrity of the review mechanism, including the avoidance of issues of conflict of interest. Arrangements have been put in place to ensure that if there is any conflict, or potential conflict, the particular counsel not only will not be involved in the particular case, but also will not be aware of which counsel is reviewing it. This is normal professional conduct, and there are sufficient counsel on the panel to ensure the practicality of that.
The Minister is aware that concerns have been raised regarding the particular case referred to by the Senator. The Minister is deeply conscious of the profound distress experienced by the family. However, they have been advised of the arrangements that apply, as has their legal representative and the various public representatives who have raised the concern on the family's behalf by way of parliamentary questions and representations. Whatever steps are necessary will be taken to ensure there is no conflict of interest.
I would like to assure the House that every case, including the case referred to by the Senator, will be reviewed by independent and impartial counsel who will make an objective recommendation. I hope that goes some way to allay the Senator's concerns.
I thank the Minister of State. I have just seen this and there is some movement. I would make three points. I recognise that the Minister of State cannot answer because she is not directly concerned with them but I ask her to convey these points to the Minister directly and ask her to contact me.
The first point is the statement that the panel members were selected on the basis of their experience. The experience of this gentleman is of defending the criminal, and that surely is a conflict of interest.
The Minister of State then said that if there was any conflict or potential conflict the particular counsel would not only not be involved in the particular case, but would also not be aware of which counsel was reviewing it. She failed to say that this particular case met those considerations. She does not actually say that in this case there is a conflict of interest that will be addressed.
The final point concerns the Minister of State's statement that whatever steps are necessary will be taken to ensure there is no conflict of interest. I welcome that but again there is no statement that in this case these steps will be taken. I ask the Minister of State to get the Minister, Deputy Fitzgerald, to contact me to assure me that such steps will be taken in this case.
I will ensure that the Minister is made aware of the Senator's further concerns but I assume, and in some instances we can only assume, that the spotlight this particular case has been given, both in this House and the Lower House, will ensure that no conflict will arise. However, I will convey the Senator's further concerns to the Minister.
I thank the Minister of State.
Accident and Emergency Departments
I welcome the Minister to the House and thank her for dealing with this matter. I welcome the decision by the Minister and the Minister of State in dealing with the emergency that has arisen in recent weeks with regard to the overcrowding in accident and emergency departments, with the large numbers increasing. As I said to someone recently, if we take the figures for last year we see that, on average, 20,000 people attend accident and emergency departments every week. If there is a 20% increase, that is an extra 4,000 people and, therefore, a huge change can occur at very short notice.
An emergency task force was set up to deal with this problem. Nursing Homes Ireland, which represents the private nursing homes, accommodates over 22,000 people in private nursing homes. I understand that in setting up the emergency task force to deal with the accident and emergency problem in the sense of trying to get people out of hospital and make beds available for people who need to be admitted, there was no representative from the private nursing homes. The private nursing homes are a key ingredient in dealing with this issue as well as the doctors, nurses, hospital administration staff and all the backup support needed, whether it is home care packages for people being discharged from hospital or whatever. My understanding is that the nursing homes are not represented on the emergency task force and it would be appropriate that they would have a representative to ensure that all the issues can be dealt with, that a service that is made available continues to improve, and that we have a response as soon as possible.
I thank Senator Burke for raising this issue. Emergency department, ED, overcrowding is a priority issue for me and for the Government and I acknowledge the difficulties the current surge in ED activity is causing for patients, their families and the staff who are doing their utmost to provide safe, quality care in very challenging circumstances. The Minister for Health convened the emergency department task force in December 2014 to develop long-term solutions to overcrowding by providing additional focus and momentum in dealing with the challenges presented by the current trolley waits. The task force comprises senior doctors, lead hospital consultants, Health Service Executive national directors, union representatives and senior officials from the HSE acute hospitals directorate and the Department of Health. The task force will provide additional focus and momentum in dealing with the challenges, complementing the ongoing work of the special delivery unit and taking a service-wide approach including social care, primary care and acute care. The aim is to develop effective measures that will achieve sustainable, integrated and effective improvements across all services related to the ED trolley waits.
At their meeting last Monday, the task force discussed a draft action to specifically address ED issues with a view to a significant reduction in trolley waits over the course of 2015.
The Minister for Health and I are determined that the action plan be completed as soon as possible, taking the views of the task force into account, and then operationalised without delay. The task force is due to meet again on 9 March. In the interim, all hospitals have escalation plans to manage not only patient flow but also patient safety in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care. These plans include opening the establishment of additional overflow areas, the reopening of closed beds, the provision of additional diagnostic scans and additional ward rounds by consultants to improve the appropriate flow of patients through the hospital system. The Government has provided additional funding of €3 million in 2014 and €25 million in 2015 to address delayed discharges. The actions being taken include the provision of additional home care packages, additional transition beds in nursing homes, 300 additional fair deal places and an extension of community intervention teams.
With regard to the issue of appointing representatives from the private nursing home sector, both the HSE and the Department of Health have given the matter serious consideration. It is acknowledged that private nursing homes have a valuable contribution to make in respect of specific issues such as delayed discharges and patient flow from acute or transitional care into long-term care. The position of private nursing homes does mean that, given their business interests, they have a very specific interest in how services are provided. It is considered that the existing membership of the task force is well placed to best cover the broad nursing home requirements. That said, the HSE will engage positively with private nursing homes and invite input and submissions from them on the work of the ED task force and other relevant issues under HSE's remit.
On a personal basis - this is something I will discuss with the officials - I do not have a difficulty with representatives of the private nursing home sector being on the group. They are key to how it is managed. Also, it would be remiss of us if we did not ensure GPs were part of this as well. The only way to stop the type of crisis we have seen this year and in the past from happening in the future is by ensuring that people are well maintained within their own community, and GPs are key to all of that.
I thank the Minister of State for her comprehensive response. The nursing homes represent the private sector. As the Minister of State has said, unions are represented on the task force, which is extremely important. Around 22,000 beds are provided by the private sector and, therefore, it plays a major part in dealing with the issues involved.
It would be interesting to discuss the transfer of people from nursing homes to accident and emergency departments. Would they have been better off staying in the nursing homes? If they had, they would probably have got equally good care and treatment. This issue arose at a meeting of the Oireachtas Joint Committee on Health and Children held last Thursday week, when Senator Jillian van Turnhout mentioned what happened when her father fell ill. His regular GP was unavailable so the family called the doctor-on-call service. That doctor immediately responded by suggesting that the Senator's father should be transferred to an accident and emergency unit. Such admissions, particularly when they happen at weekends, create problems in EDs. If nursing homes were represented on the task force they could play a key part in working to reduce the number of people who are transferred from nursing homes to accident and emergency units.
I will be very brief. The pilot study of two nursing homes in Cork was on long-stay care and not transitional or short-term care. Following training at the nursing homes, admissions to accident and emergency departments were reduced. In saying that, the nursing homes where the training was carried out did not have a high incidence of admissions because they were very good at what they did. Clearly, there are GPs who would not be familiar with the person concerned on an ongoing basis. There are also some nurses who are worried about how to deal with people in later life who have become acutely unwell. We have to understand those factors too. It is about the type of training we can introduce to ensure that people do not end up in accident and emergency departments unnecessarily. Nursing homes must be part of the argument, but centrally, GPs have to be part of it as well.
Disease Incidence
Gabhaim mo bhuíochas leis an gCathaoirleach as ucht an deis an t-ábhar tábhachtach seo a ardú. Bhí sé ar an sceideal an Déardaoin seo caite ach ní raibh mé anseo in am. Bhí mé ceithre nóiméad déanach an lá sin.
I rise this morning to raise an important issue that has caused considerable concern in the area of Duleek, County Meath, particularly in a small part of the village, and, according to media reports, in Mornington, which is about seven miles away. I refer to a number of cases of a disease called Guillain-Barré syndrome, which I will call GBS for short. The best description I can give of GBS is from a victim of the condition who wrote a little booklet on his experiences before he knew other people suffered from it in his area. He said:
That immune system of the body attacks the nerves going to and controlling the muscles. Instead of the signal from the brain telling the muscle to move, it goes to the outer skin where it feels like pins and needles, or severe nettle stings, all the while happening. The illness starts at the toes and feet, moves up the lower legs and sometimes reaches the neck area. Even the face and eyelids can be affected. All bodily functions are knocked out as it comes up the body. Bowel, bladder and lungs can also be affected.
Clearly, it is a serious disease, but fortunately it is a rare one. I understand that one can expect one or two cases per 100,000 people, not per annum but in total. There have been four confirmed cases of Guillain-Barré syndrome in the village of Duleek. I have met two of the people confirmed to have it, who are recovering. They are neighbours, and the other two confirmed cases live close by. There are two other cases in which GBS may be implicated, and the people affected live very close to the people who have been confirmed as sufferers. I am unfamiliar with the case in Mornington which was cited in media reports. Mornington is seven miles from Duleek.
The literature available on Guillain-Barré syndrome states that it is very rare, but there is also literature available that suggests that it can appear in clusters. There have been references in the literature to clusters occurring in China and Arizona. Environmental causes have sometimes been linked to outbreaks or clusters, but other issues are also involved. There is a medical trigger for GBS, which is usually an infection. I want to know why so many cases have occurred in one small area.
The clusters that have become apparent in other areas were over a period of many years and number only slightly more than the number of cases discovered in the small village of Duleek. This apparent cluster in Duleek, County Meath, and the general east Meath area appears to be quite significant. These people have been badly affected by GBS in the past year or two.
There are environmental concerns in the region. I will not outline them today, because it is not my role to blame anyone, if blame can be apportioned. Having talked to people who suffer from the disease, and in one case a person two years after he or she first acquired the disease, I know they are keen to discover the reason for the number of cases in the area. They are also keen that nobody else should suffer, because they have suffered hugely.
It is a deeply worrying time for everyone. I live within three miles of the two victims confirmed to have the illness - the two people I have met. The matter is deeply worrying for people in the area. We would like the HSE to conduct an investigation, which I understand has been agreed to. An investigation should include the EPA and Irish Water, because water has been blamed in some cases. I am not saying any one thing has caused it or has anything to do with the incidence of GBS. I am saying we should investigate all possible causes and do as much as possible. Another case of GBS has been discovered in the general Cavan-Meath vicinity. The case has been mentioned to me but I will not say where it is because I do not have the information first hand.
The incidence of GBS is of concern. Some of the clusters that have been reported in the literature over the years encompassed large areas, perhaps the same size as County Meath.
However, this is a very small area and if there are other cases in County Meath, it paints an even more worrying picture. I seek answers and for this investigation to proceed as quickly as possible within a short timeframe. It should bring in all the statutory agencies that may be relevant to it and try to get answers for these people.
Those who have been in the acute hospital services as a result of this have nothing but praise for the staff. It is important to mention this because this is an extremely rare disorder and the staff in Our Lady of Lourdes Hospital, Drogheda, have received high compliments from the two men I have met who are victims of this syndrome. I wished to put that on the record because the staff often get forgotten. However, the big issue in this regard is to ascertain whether there is a reason for this and, if so, to put an end to it.
I thank the Senator for raising this issue, because although the condition is rare, it is highly traumatic and upsetting for those who acquire it. Guillain-Barré syndrome is an autoimmune disorder in which the body's immune system attacks part of the peripheral nervous system. It usually occurs a few days or weeks after a person has had symptoms of a respiratory or gastrointestinal viral infection. The syndrome is slightly more common in men than women and can affect people of any age, including children. The syndrome is rare, afflicting only approximately one person in 100,000. It is estimated that 50 to 100 people are affected in Ireland annually. However, as Guillain-Barré syndrome is not a notifiable disease, there is no requirement for doctors to report cases. Guillain-Barré is called a syndrome rather than a disease because, as the Senator pointed out, there could be a lot of reasons and it is not clear that a specific disease-causing agent is involved. A syndrome is a medical condition characterised by a collection of symptoms, that is, what the patient feels, as well as signs, that is, what a doctor can observe or measure. As the signs and symptoms of the syndrome can be quite varied, doctors may, on rare occasions, find it difficult to diagnose it. Two thirds of people with Guillain-Barré syndrome are known to have experienced an infection before the onset of the condition. Most commonly, these are episodes of gastroenteritis or a respiratory tract infection. Approximately 30% of cases are provoked by Campylobacter jejuni, with a further 10% of cases attributable to cytomegalovirus. Despite this, only very few people with Campylobacter or cytomegalovirus infections develop the syndrome. Links to other infections are less certain. Most people make a full recovery within a few weeks or months and do not have any further problems. However, some people may take longer to recover and there is a possibility of permanent nerve damage. There are therapies that lessen the severity of the illness and accelerate the recovery in most patients.
I have been informed that officials from the Health Service Executive met members of local environmental groups from the Louth-Meath area on 28 January in Navan. These groups voiced concerns that a number of the cases were related to environmental issues in the Duleek area. However, it was clarified that the majority of confirmed cases of Guillain-Barré syndrome are linked to a previous episode of infection, a vaccination or a surgical intervention, rather than to environmental factors. The department of public health in the north east has agreed to follow up on these cases to try to identify possible causes for this apparent cluster of cases. This will include meeting with the individual patients in the near future to further that investigation. I hope that when these meetings take place, the concerns regarding whether this is water borne or whether there are other environmental issues will come up and, if there is need for further investigation, that this will be taken on board.
I take this opportunity to encourage anyone who may be a victim of this syndrome and who has not come forward to go directly to the HSE. They need not approach me, another politician or any local group. Such people can go directly to the HSE and ask that they be interviewed in this regard. The Minister of State has mentioned gastroenteritis, which I believe is associated with Campylobacter jejuni, as well as respiratory tract infections, and I suppose that some of the environmental concerns come from that. While nobody knows what is causing it at present, it is important that nothing is ruled out. We all are beginning to find out information on this subject about which none of us really had any knowledge until this matter came to light a few weeks ago. However, to be of help to the Minister of State, my understanding, based on some of the literature I have read, is that the vaccination issue arose back in the 1970s and it may no longer be relevant today. However, much research remains to be done. Certainly, however, I wish to ascertain what, if anything, can be done about this. I am not putting pressure on the HSE as such. It already has agreed to carry out an investigation, which is important, but it should be done as quickly and as comprehensively as possible.
It strikes me that the Senator is correct that it will be increasingly common, especially with the advent of Facebook and so on, that people will be able to communicate better with one another. I assume that people who developed this syndrome in the past would have felt quite isolated and would not have known there were other people with the same difficulty.
In this case, two neighbours did not know that they suffered from it.
Exactly. In the context of not knowing that other people suffer from a condition, Facebook and similar types of interactions most definitely are a help. On the other hand, like the Senator, I would not rule anything in or out because we are learning all the time. Equally, however, this makes the case for ensuring our water system is clean and safe.
Hospital Services
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.
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 spearheading 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.
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.
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.
Sitting suspended at 11.20 a.m. and resumed at noon.