Following frustration with local diabetes services, Chairperson of Diabetes Ireland’s Sligo branch, Ms Suzanne Donnelly publicly highlighted the lack of support provided to the diabetes team working tirelessly in Sligo University Hospital by hospital management. Below is an update of the various issues and the HSE response.
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 Sligo University Hospital have identified 30 individuals who require access to continuous insulin administration (PUMP therapy) to maximise their diabetes control. These 30 individuals cannot get training to use a PUMP in Sligo University Hospital 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.
Why has problem developed?
Sligo University Hospital have not replaced specialist dietitians currently on maternity leave and have no dedicated PUMP nurse. The effect on the diabetes service is no access to dietetic education for many people with diabetes but for the 30 people waiting to commence PUMP usage, no PUMP. Ms Suzanne Donnelly was prescribed PUMP therapy but can not avail of it as the necessary training could not be delivered due to no dietetic cover and limited nursing.
Action
Ms Donnelly raised the issue with Sligo University Healthcare Group formally in writing and the response she received outlined many of the diabetes issues that the hospital currently are dealing with but made no reference to the specific request as to how management were addressed the current lack of dietetic services. The hospital response as outlined below focused on:
- Current staffing shortages in general
- Development of the new Diabetes Day Centre building
- Recruitment of Dr Neylon’s replacement i.e. Consultant Paediatric Post.
Staffing Shortages
Sligo University Hospital as part of the Saolta University Healthcare Group provide care to people in Sligo/Leitrim, South Donegal, North Roscommon and West Cavan. They stated that in line with other HSE areas, there are staffing challenges and the aim is always to ensure that the resources available are used in the most effective manner possible, in line with prioritised needs. They stated they were implementing the Slaintecare Integrated Care Programme which will support self-management of diabetes through enhanced capacity in GP and community nursing. However, implementing the Integrated Care Programme will not assist people with Type 1 diabetes as their medical management is not possible in community/primary care settings given that it requires specialised multidisciplinary input and whereas some might argue its implementation will reduce demand on hospital services, the reality is given the increase in numbers diagnosed and younger age of onset, the demand continues to increase.
Diabetes Day Centre
The response provided good news in that the Sligo Hospital Diabetes Day unit build is expected to start in Q3 of 2019. Q3 started on July 1st and as the building contracts do not appear to have been awarded yet, this needs close monitoring to ensure limited slippage on dates.
Paediatric Diabetes Care
The response reported that 4 candidates were interviewed on July 3rd so hopefully the successful candidate has paediatric diabetes experience and the vetting process is swift.
The bottom line seems to be that there will be investment in buildings and community service capacity but the hospital staffing levels for optimum diabetes care is not a priority at present.