The situation in Limerick Hospital Group was highlighted at a Diabetes Ireland public meeting in Limerick. Diabetes Ireland sought clarification through official channels on the current diabetes staffing levels and if any action was undertaken to address those staffing deficits identified in the June 2018 Acute Hospital Survey.

Following this, a press release and media/public representative campaign was undertaken by the Diabetes Ireland advocacy team in conjunction with local patients.

Background

People with Type 1 diabetes must attend specialist hospital services for the medical management of their condition and to support their daily best self-management practices.   Type 1 diabetes is a condition whereby the insulin producing cells in the body are killed off by the body’s own defence system and is currently not preventable but treatment with insulin is life preserving and hourly monitoring is needed to prevent loss of limb, eyesight, mortality and hospitalisations.

Insulin is needed to properly use sugars. Lack of insulin causes too much glucose (sugars) to accumulate in the blood and cause damage. Therefore, there is constant balance needed of insulin in (must be injection/pump) and glucose intake and usage. This is complicated by many factors such as exercise, food intake, stress, illness etc.

Type 1 diabetes management is medically prescribed insulin through injection or pump balanced against daily self-management/monitoring. The specialist hospital team support the individual to maximise their diabetes control.

Problem

The diabetes team in Limerick Regional University Hospital identify people with Type 1 diabetes whose health would be better managed by using continuous insulin administration (PUMP) to maximise their diabetes control.   There is no dietitian to assist in training these  people to use a PUMP and hence are not getting the care medically prescribed for them resulting in their increased risk of hospitalisation, loss of eyesight/limb, morbidity and mortality.

The hospital were aware of the issue as it was highlighted in the 2018 National Survey of Diabetes Care Delivery which also highlighted the 88% deficit in diabetes resources across all specialists in Limerick University Hospital Group.

Why has problem developed?

One year post the publication of the National Survey and despite local requests for action, the Hospital Management has not addressed the issue.

Current situation

Limerick University Hospital is failing to deliver the care the diabetes medical team has deemed most appropriate for their services users.  They are failing to deliver on National Type 1 Diabetes Guidelines.  They are failing their patients.  This is not just a delay in accessing care but a complete lack of care to those people who require pump therapy despite the best efforts of the current diabetes team.

Action

1. Diabetes Ireland formally asked the Business Manager, Medicine Directorate of Limerick University Hospital to clarify the current situation. The response acknowledged a current wait of up to 4 years for routine Type 2 GP referrals to be seen, and the absence of a dietitic and pump initiation service.

1. A press release was issued by Diabetes Ireland asking for local public representatives and media to highlight the issue   See https://www.diabetes.ie/limerick-university-hospital-group-unable-to-provide-specialist-type-1-diabetes-care/

1. 1. Interviews about the issue were aired on Limerick Today on 16/07/19 and West Limerick 102 on 23/07/19

1. 1. The Limerick leader carried both hard and soft copy raising the issue as a public concern. (https://www.limerickleader.ie/news/home/431968/significant-gap-as-limerick-and-mid-west-lacks-specialist-dietitian-for-adult-diabetics.html
   3. At a national level, the Irish Times carried it a page 3 article on Saturday 19^th July.

1. Public representatives were asked to highlight this issue with their party and seek the local hospital Group to have this issued addressed as matter of urgency.
2. The matter will be raised as an advocacy item at National Level with health authorities and brought to the attention of the HSE National diabetes Working Group.

Result

There are some indications that the Limerick hospital Group have agreed to have the additional posts required to rectify this situation in the 2020 estimates.   We will continue to advocate on this issue and monitor the situation.

(August 2019)