Diabetes care ‘in crisis’

THE Clare branch of Diabetes Ireland has highlighted the absence of a dedicated dietetic service for people with diabetes, despite the fact that funding became available in 2010.

Branch spokesperson, Grainne Flynn, expressed dissatisfaction that the long-awaited paediatric nursing and dietetic posts in Cork, Limerick and Galway have not even been advertised.

 

She claimed there are no education courses for people with type one diabetes or access to insulin pump therapy in the Diabetes Centre at the Mid-Western Regional Hospital, Limerick, despite many professionals stating they are needed for children with diabetes.

Her statement coincided with World Diabetes Day on Wednesday and the release of new HSE statistics showing there were 781 diabetes-related lower limb amputations in Ireland during 2010 and 2011 – a 20% increase on the previous two year period.

Diabetes is now the biggest single cause of amputation, stroke, blindness and kidney failure. Diabetes Action says the HSE is amplifying this “public health disaster” by failing to fill critical posts and make retinal screening available, despite funding being available since 2010.

“The greatest measure of failure in the treatment of diabetes is leg amputation. This tragedy occurs daily in our hospitals. One person with diabetes goes blind each week, caused by diabetic retinopathy. Moreover, promised advances in diabetes paediatric services to widen availability of insulin pumps for children under five years haven’t materialised,” said consultant endocrinologist Dr Kevin Moore, of the Irish Endocrine Society.

“On every front the HSE is failing on diabetes care, much work may have been done but we have yet to see patients benefit and there has been no impact on health outcomes. Footcare, eyecare and paediatric services have all been funded in successive HSE Service Plans since 2010 – of 16 footcare posts, nine remain unfilled. The promised retinopathy screening programme has stalled and paediatric nursing and dietetic posts in Cork, Limerick and Galway have not even been advertised,” he said.

Diabetes affects about 190,000 people in Ireland and consumes up to 10% of the entire health budget, most of which is spent treating costly but preventable health complications.

In 2010, the HSE’s National Clinical Programme for Diabetes was charged with developing diabetes services, which were widely acknowledged as the least developed services among the chronic illness group (diabetes, COPD, heart disease, cancer and asthma).

Diabetes Action says the programme now has three years worth of valuable work, which is on the point of delivery and is lobbying public representatives to push Health Minister James Reilly and the HSE on service development.

On HSE plans to move a large proportion of diabetes care from hospitals to GP level, Dr Moore noted, “It will be not safe or acceptable for the HSE to move diabetes care to primary care level until essential services, such as footcare and retinal screening, are in place. Most GPs are not trained in managing these complex aspects of diabetes care”.

Dr Anna Clarke of Diabetes Ireland described the HSE’s much publicised plans to recruit 17 diabetes nurse specialists to support integrated care (mainly to focus on primary care) as ‘double edged’.

“Most nurses applying for these posts will come from the hospital system and because of recruitment embargos, they won’t be replaced when they leave. The posts may strengthen certain pilot primary care initiatives but they will ultimately weaken already deficient services in hospitals where nursing posts will vanish.”

With diabetes complications at a record high and posts and programmes stalled, Diabetes Action says diabetes care is now “in crisis”. Failure to tackle diabetes, it says, will place intolerable pressure on health resources and threaten other service areas.

The Mid-West Health Service Executive hadn’t responded to the federation’s claims at the time of going to press.