Launched in 2015 among much fanfare by the then Minister for Health, Leo Varadkar, the Model of Care for Children & Young People with Type 1 Diabetes is failing due to lack of commitment and urgency by the Department of Health and the HSE, according to Diabetes Ireland.
The Model of Care document essentially set out a blueprint for the development of a quality paediatric Type 1 diabetes service that was to put children and their family at the centre of their care plan i.e. patient centred as per HSE policy. The proposed model of care included the setting up of Integrated Practice Units, on a regional basis, with a Centre of Excellence supporting outreach centres and identified the staffing required to deliver high quality care and the current gap analysis.
Centres of Excellence were to be based in Cork, Waterford, Limerick, Galway, Sligo, Drogheda and Dublin providing support to a number of local outreach centres. To date, several of these centres, have unfilled consultant posts, even where funding is available and existing teams are very understaffed.
Professor Hilary Hoey, Consultant Paediatric Endocrinologist and Diabetes Ireland Chairperson said “It is very frustrating to see posts for which funding has been made available, still vacant 2 years on.
– In Waterford, the vacant Consultant post there was advertised last year and we have to wait over 6 months for interviews to be held and possibly up to a further year for the post to be filled.
– Following the transfer of a Consultant from Sligo Hospital to Limerick University Hospital, nothing is being done to date to recruit a replacement in Sligo.
– In Galway University Hospital, we are waiting for interviews to take place for the vacant Consultant post there which was recently re-advertised following the withdrawal of a successful candidate who was returning from abroad and who had accepted the post in 2015 and was due to start in 2017.
Meanwhile parents of children who attend these centres are concerned about the care of their children. More and more of these parents are trying to transfer their children to the Dublin Hospitals Temple Street, Tallaght and Crumlin all of which already have caseloads way in excess of what they can deal with”.
Professor Nuala Murphy, Consultant Paediatric Endocrinologist, Temple Street Hospital said “. With the increasing numbers of children and adolescents with Type 1 diabetes being treated in Dublin Hospitals, we are struggling to provide optimal care. We urgently require 3 new paediatric diabetes teams in Dublin to deliver the high quality care which we know is associated with much better long term outcomes for our patients.
Each of the Dublin Centres have long waiting lists for children to access insulin pump technologies. In fairness to the HSE, funding for insulin pump devices is available for all patients but in many instances, there are long delays in accessing pump technology. Insulin pump initiation requires intensive training prior to pump start and intense early support in the first 3 months of pump use. Staff deficits result in prolonged waiting time to access pumps.
For similar reasons, structured education programmes for all children with diabetes and their families, which have been developed, are not uniformly delivered nationwide. It is very difficult with current staffing to provide the high quality care we want to deliver and as a result it is difficult to attract and retain highly qualified consultants who are also being chased by health services from other countries who can offer a better work/life balance and better working conditions” added Professor Murphy.
When launched in 2015, the model of care document set out the national staffing level deficits for each of the Centres of Excellence and while some funding to fill these deficits was made available, the constant delays in recruiting and filling these posts and the failure to provide further funding in 2017 is simply undermining paediatric diabetes service development nationwide.
Professor Hilary Hoey continued “Right now, we want to see posts for which funding is available to be advertised with the necessary support to attract high quality candidates as a matter of urgency and looking forward, we need to see new funding being made available by the Government to enable implementation of the plan they endorsed in 2015.
The model of care still has the support of the diabetes community as it provides a strong platform on which to build a high quality service, with equity and local access and support for all children with Type 1 diabetes, regardless of where they live”.
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