Dáil Éireann Debate, Wednesday - 7 April 2004
10 Mr. Murphy asked the Minister for Health and Children the efforts he is making to reduce waiting lists and the lengths of periods for patients on waiting lists to see consultant endocrinologists; and if he will make a statement on the matter. [10866/04]
Amharc ar fhreagra34 Mr. Connaughton asked the Minister for Health and Children the paediatric care services available in the health system for children with diabetes; and if he will make a statement on the matter. [10850/04]
Amharc ar fhreagra70 Mr. Costello asked the Minister for Health and Children if his attention has been drawn to comments made by a consultant (details supplied) which described the state of services for children with diabetes as a scandal and medically indefensible; the steps he is taking to ensure that adequate services are available to children with diabetes; and if he will make a statement on the matter. [10803/04]
Amharc ar fhreagraI propose to take Questions Nos. 10, 34 and 70 together.
There are two main types of diabetes mellitus. Type 1, or insulin dependent diabetes mellitus, accounts for approximately 10% of patients and affects mainly young people. Type 2, or non-insulin dependent diabetes mellitus, accounts for 90% of all cases and affects mainly middle-aged or elderly people.
Patients with diabetes mellitus are diagnosed and treated in a number of different settings within the health services. The majority of patients, particularly those with type 2 diabetes, receive their treatment at primary care level. Other patients, particularly those with type 1 diabetes, receive their care primarily in the hospital setting, usually from a physician with a special interest in diabetes or, in rarer situations, from an endocrinologist who specialises in the treatment of diabetes.
Children diagnosed with diabetes usually require hospital admission for the medical management of their acute condition and the commencement of their diabetes education. Acute centres that provide diabetes care for infants, children and adolescents are outlined in the following table:
|
Health Board/Authority |
Hospital |
|
Eastern Regional Health Authority |
Beaumont Hospital; Mater Hospital; St. Columcille’s Hospital, Loughlinstown; St. James’s Hospital; St. Vincent’s University Hospital; Adelaide and Meath Hospital, incorporating the National Childrens Hospital at Tallaght; Children’s University Hospital, Temple Street. |
|
Midland Health Board |
Midland Regional Hospital at Portlaoise; Midland Regional Hospital at Mullingar. |
|
North Eastern Health Board |
Our Lady of Lourdes Hospital, Drogheda; Cavan General Hospital. |
|
North Western Health Board |
Letterkenny General Hospital; Sligo General Hospital. |
|
South Eastern Health Board |
St. Joseph’s Hospital, Clonmel; St. Luke’s Hospital, Kilkenny; Waterford Regional Hospital; Wexford Regional Hospital. |
|
Southern Health Board |
Bon Secours Hospital, Cork; Cork University Hospital; South Infirmary Hospital, Cork; Tralee General Hospital. |
|
Western Health Board |
University College Hospital, Galway; Mayo General Hospital. |
|
Mid-Western Health Board |
Limerick Regional Hospital. |
I recognise there is a need to expand and improve service provision to meet increasing demand. After detailed consideration and having had a series of meetings with the Diabetes Federation of Ireland to consider its strategy document, Diabetes Care: Securing the Future, I have asked the chief medical officer of my Department to chair a working group on diabetes. This group is charged with formulating a national framework for the future development and delivery of services for the increasing number of diabetics, including children, who require treatment. The group has been asked to examine the current and predicted epidemiology of diabetes, health promotion and preventative initiatives, including screening, current service provision, including the need to achieve better integration of care using current resources and facilities and the expansion of shared care programmes and future needs in terms of service provision and staffing.
Future planning in the care of diabetic patients will be informed by the recommendations of the working group which has been asked to report this year.
Given that the working group has not met since the end of January, the Minister might advise us why this is the case. Will he accept that people diagnosed with diabetes must wait up to 15 months for a hospital appointment to see a diabetes specialist and that there is a danger of developing complications over that period? The Diabetes Federation of Ireland, which recently attended the Oireachtas Joint Committee on Health and Children, pointed out that complications can arise during that period. It was also pointed out to the committee that the recommendation is for one consultant endocrinologist per 50,000 of the population. Currently there is one consultant endocrinologist per 150,000 of the population. Will the Minister agree that one consultant endocrinologist per 150,000 of the population cannot give the required service?
One paediatric endocrinologist per 200,000 of the population is recommended. There are currently just four part-time paediatric endocrinologists for a population of 1.4 million under the age of 18. We require one per 200,000 and we have one per 285,000. Will the Minister agree that an adequate service cannot be delivered with that level of expertise?
I agree that we need further concentration and expansion of services in the diabetes area. It did not come under the cardiovascular strategy. While many of the issues covered by the cardiovascular health strategy overlap with the diabetes issue in the preventative area, diabetes lost out as a by-product of that, even though not intentionally.
On consultant numbers, we are back to the fundamental issue facing the Irish health care service. We depend far too much on doctors in training. We need consultants to provide a service, plus a new consultants' contract. I accept there are not sufficient senior consultants in a range of specialties, yet we tend to become fixated about other aspects of the health care debate. In essence, this is the key issue. If we can resolve the consultant contract issue this year — this envisages a significant industrial relations process — and get agreement on the ratio between consultants and junior doctors, it will open up a significant potential dividend for the Irish health care system and the public in terms of wider access to a range of other specialties where we are historically below the levels that obtain in other European countries.
What effort is the Minister making to reduce hospital waiting lists? Is he aware that 2,026 patients had their procedures deferred at University College Hospital last year and 865 had their procedures deferred more than once for various reasons, including lack of beds and so on? Is he aware there is a four-year waiting list in the Western Health Board area for rheumatology? What is he doing about the serious issue of reducing waiting lists? Obviously the waiting lists are getting longer. In reply to my parliamentary question yesterday, he said it is a matter for the Western Health Board whether it appoints a second rheumatologist. It had €15 million left over in the last two years but it has not appointed a rheumatologist. Is the Minister or the health boards responsible for the substantial increase in waiting times? For example, in University College Hospital, Galway, 985 patients had their admissions deferred last year because there was no bed available. Some 406 admissions were deferred by the consultant, 275 were deferred by the hospital and so on. I do not think the Minister is aware of these figures. When I tabled a question on the matter, it was referred to the Western Health Board for answer. What is the Minister doing about reducing hospital waiting lists, which is the essence of this question? It appears he is doing very little because hospital waiting lists are increasing. Can we get some information on the appointment of a second rheumatologist in the Western Health Board area?
When this issue arose in the context of the Hanly debate, we made the point that the model we want to bring forward ultimately offers the best guarantee in terms of regional self-sufficiency in specialties such as endocrinology, rheumatology and so on.
The facts do not support it.
This is the ultimate gain to be derived from the blueprint we are trying to put forward, without undermining the basic hospital infrastructure in a particular region. There are some macro issues that must be resolved.
On the individual cases referred to by the Deputy, it is the responsibility of the health boards within their own resource constraints to prioritise what specialties they will concentrate on and so on.
Can the Minister not correct the health boards?
This is why we are reforming the health structures. I made the point at the launch of the health service reform programme that there has been patchy development of specialties in different health boards throughout the country, depending on which got priority in the hospital or which priority in the region, following which the health boards make submissions further up the line. This underlines the case for a national hospitals agency that would examine the need for specialties and would have the power not just to analyse and advise, but to execute and reduce the plethora of waiting lists.
What has the Minister done to reduce the waiting lists? He has been in office for a long time.
We have done a great deal about them.
The Minister refused a second rheumatology post in Galway.
I do not refuse posts.
In my constituency there is a young girl who cannot find a place in a rehabilitation centre in Dublin. Can such a person be treated outside the State under the treatment purchase scheme? It is an emergency.
I do not know the specific case the Deputy has mentioned but the treatment purchase scheme has done a great deal to reduce the numbers who have been on waiting lists for a long time. It is getting through the lists quickly and nearly all hospitals are co-operating with it. The Deputy or the person's GP is free to contact the treatment purchase fund to see if the person can be treated abroad or elsewhere in the State through the fund. If we can make significant progress on waiting lists, the fund can be broadened to include lengthy out-patient lists.
Diabetes services in the Mid-Western Health Board are in dire straits. Children presenting with type one diabetes do not receive specialist medical care and are being looked after by a physician or they are recommended to attend diabetes centres in Dublin. This is serious and these children will run into problems later in life because they are not being dealt with now, creating burdens for the system in future. Does the Minister have plans to deal with the crisis in services in the mid-west?
Work is under way to develop a national approach to diabetes service provision and prevention. The early identification and diagnosis of children with type one diabetes is essential and much can be done with early intervention to ensure the quality of life of young people in that situation.
On the future of the shared care scheme for diabetics in the north Dublin area, does the Minister accept the importance of undertaking diabetes care, as far as possible, at primary care level? This makes for more effective use of resources and staff. The future of the shared care scheme is now in jeopardy.
I will see if anything can be done about the scheme but I cannot give any commitments. It was a private scheme funded from private sources but I will investigate it. The Deputy is right, the multi-disciplinary approach, with primary care and effective specialist nursing for children and young people, has been effective. If we can develop multi-disciplinary teams on a shared care basis with primary and secondary care providers, we can improve the situation for those with diabetes.
The Minister pointed out that the appointment of a second rheumatologist is a matter for the Western Health Board. Will the Minister ask the board to spend the €15 million surplus it has on the appointment of another rheumatologist to reduce the waiting time from four years to a reasonable period so that people are not suffering while appointments are cancelled?
The Western Health Board will prioritise its appointments within the resources it is given. We sanction posts and they then go to Comhairle na nOspidéal for approval.
Who is responsible for the appointments? The Minister should not fudge the matter.
Does the Minister have any control over the matter?
Written Answers follow Adjournment Debate.
