Concerns raised after suspension of diabetes clinic

A group representing diabetes patients in the Midlands has expressed serious concern at the temporary closure of a specialist clinic based at Regional Hospital Mullingar.

The HSE wrote to type 1 diabetes patients at the end of September informing them that, due to staffing shortages, the adult day diabetes centre was being "temporarily suspended".

Norman Dolan, a type 1 diabetic from Delvin, Co Westmeath was one of a number of people who campaigned for this specialist clinic for many years.

Over 20 years ago, the then-Health Minister Mary O'Rourke committed to establishing a specialised service in Mullingar.

Mr Dolan is disappointed by what has happened two decades later and said he is concerned about the future.

"We simply have no staff to run the clinic anymore and Mullingar deals with patients from counties Westmeath, Leitrim, Offaly, Longford, Meath, Kildare and Roscommon," he said

The HSE has confirmed that the service has experienced "multidisciplinary staff challenges".

It said the closure "was temporary" and that "every effort is being made to restore the service to full capacity as soon as possible".

The HSE said that the clinic is currently experiencing staffing shortages due to vacant Clinical Nurse Specialist positions and one vacant Clinical Specialist Dietitian position.

It said these roles are an "important part of delivering comprehensive diabetes care and supporting patients in the management of their condition".

The group estimates that there are around 600 type 1 diabetes patients using the service and around 200 patients are waiting for a pump.

"I genuinely feel so sorry for those people," said Mr Dolan. "They're injecting and they're finger pricking and, with the new technology that's out there, they shouldn’t have to be doing that.

"But because there is no service in place, there is no one to provide these patients with training," he explained.

"If my pump sees a high blood sugar, it will automatically give me insulin to correct that. That's a game changer."

Mr Dolan said type 1 diabetes patients rely on specialist teams to keep them well and out of hospital, and this temporary closure impacts patient safety.

"We had our blood pressure checked; our urine samples were tested. We could get also heart checks and at one stage our eyes were checked.

"Then we would meet the consultant who would go through all our blood sugars and see were there any irregularities in our blood sugars in the 24-hour period.

"We're being told now to contact our GP but we know the GP cannot have our information because it's all on in the computers in the hospital.

"Our sensors on the pump send all that information to the hospital," he added.

The HSE said that it has worked to recruit for the vacant positions and "appointments are being considered for approval to proceed".

It said it hopes to make appointments "as soon as possible".

However, patients are not convinced and say the dietician post has been vacant for over two years now.

"We contacted the hospital in June last year and the dietician was gone from the hospital from the previous March, and they have still not has been replaced," said Mr Dolan

"The three nurses that were looking after us have since retired and have not been replaced.

"We're constantly being told they’re interviewing but interviewing does not replace a person in the hospital," he added.

Orla Petticrew is a diabetic for over forty years and she said the specialised service is vital for type 1 diabetes patients, as the condition can have complications from head to toe.

"I had my dietitian advice constantly with the clinical nurse specialist," she said.

"We have foot care to think of, wound management, and then there’s constant infections coming into the winter, all of that was looked after by the specialist team."

She said with the team now gone; patients and their GPs have been left to cope.

"So much work that has gone into this service.

"We first developed the Westmeath Diabetes Group 30 years ago and initially, it was brought on board to start the fight for an endocrinologist in Mullingar, which eventually we did get," said Ms Petticrew.

"Since then, we managed to secure a centre of excellence which provided education not only to diabetics but also to students and nursing students coming as well.

"Now we have nothing at all," she said.

The HSE has said that patients of the diabetes service will continue to be managed through Consultant Diabetes Outpatient Clinics.

It added that "some patients prioritised for earlier and more frequent follow up in Consultant led clinics".

The HSE confirmed that the consultant-led diabetes outpatient service at Regional Hospital Mullingar will be unable to accept new referrals during this period.

Existing pathways to the Community Diabetes Service will continue to accept referrals, it said.

The HSE has acknowledged the impact the "current temporary service reduction creates for patients and GPs" and said it and sincerely regret any inconvenience caused.

Duration of closure

Patients are concerned about the duration of the closure and are calling for a timeline on its re-opening.

Mary Moriarty, who has been attending the clinic for over 20 years, said she is worried for the future.

She said patients with type 1 diabetes, including insulin-dependent patients need ongoing input from specialist nurses, dieticians and endocrinologists.

"If I've a problem or a question, I don’t even have a phoneline to contact someone now.

"It’s a worry if something goes wrong now.

"I believe it's coming down to finance, and they’re making cutbacks, but this is a very important service.

"They're saying temporary but if they have to interview for posts, all that takes time and they’ve interviewed for posts before and they haven’t filled them."

Diabates Ireland, which helps and support diabetics across the country said this "is an isolated case at present and no other diabetes day services are currently suspended".

However, it said there have been previous instances where elements of diabetes services have been temporarily suspended or disrupted because of staffing shortages.

It said paediatric diabetes and insulin pump services have been affected in some hospitals, for example.

Diabetes Ireland said what is clear is that "significant staffing gaps within multidisciplinary diabetes teams are an ongoing concern across the country" affecting both adult and paediatric services.

It said this was highlighted in the "Diabetes Policy and Services Review: The Strategy for Better Care", launched by the Minister for Health Jennifer Carroll MacNeill in May this year.

It said staffing gaps, particularly among diabetes nurses and dietitians, can affect continuity of care and potentially compromise patient safety.

"People living with diabetes need timely and consistent access to the specialist services and support they require," the statement concluded.